Health Service Culture

Culture is “the pattern of basic assumptions that a given group has invented, discovered or developed in learning to cope with its problems of external adaptation and internal integration and that have worked well enough to be considered valid and, therefore, to be taught to new members as the correct way to perceive, think and feel in relation to those problems”.Edgar Schein

A health service or research collaborative functions due to an inter-relationship between people and organisations, each of which affects the other

A simple model of an organisation is that it consists of a structure, systems, and a culture.

Of these, the structure is easiest to change, and for this reason, structural change is common, although the least important of the three components of an organisation; healthcare is so complex that there is no correct structure. Systems are more difficult to change but can be developed and modified. The culture of the organisation, of at least equal importance to its systems, is, for many people who manage healthcare, the most difficult part of an organisation to influence.

Meanings of Culture in the Management Literature
“An organization’s culture defines what goes on in its workplace. Loosely defined, culture is the soft, imprecise, fuzzy stuff of everyday life. Within any company, it is what people think and believe and what drives daily priorities. Leadership and a company’s culture are inextricably intertwined.” Source: Morgan, J.M. and Liker, J.K.   (2006)   The Toyota Product Development System. Integrating people, process, and technology. Productivity Press, New York, pp. 217, 218.

“Culture is the shared tacit assumptions of a group that is has learned in coping with external tasks and dealing with internal relationships.” Source: Schein, E.H.   (1999)   The Corporate Culture Survival Guide. John Wiley & Sons (p.186).

“Although the notion of organisational culture is now frequently invoked in the organisations and management literature, it remains an elusive concept, fraught with competing interpretations and eluding a consensual definition. …. Despite such diverse views, two broad schools of thought can be distinguished. Firstly, there is the family of approaches that regard culture as something that an organisation is …. In contrast, there is the group of approaches that conceive of culture as something that an organisation has: aspects or variables of the organisation that can be isolated, described, and manipulated.” Source: Davies, H.T.O., Nutley, S., Mannion, R.   (2000)   Organisational culture and quality of health. Quality in Health Care, 9: 111-9 (p. 111-2).

“These assumptions, values and patterns of behaviour within an organization are often terms its ‘organizational culture’”. Source: Mannion, R., Davies, H.T.O., Marshall, M.N.   (2005)   Cultures for Performance in Health Care. Open University Press. (p.1).

“Culture is a property of a group.” Source: Schein, E.H.   (1999)   The Corporate Culture Survival Guide. Sense and Nonsense about Cultural Change. Jossey-Bass (John Wiley & Sons). (p.13)

“A better way to think about culture is to realize that it exists at several ‘levels’ ….. The easiest level to observe when you go into an organization is that of artifacts: what you see, hear, and feel as you hang around.” Source: Schein, E.H.   (1999)   The Corporate Culture Survival Guide. Sense and Nonsense about Cultural Change. Jossey-Bass (John Wiley & Sons). (p.15)

“Culture is the shared tacit assumptions of a group that it has learned in coping with external tasks and dealing with internal relationships.” Source: Schein, E.H.   (1999)   The Corporate Culture Survival Guide. Sense and Nonsense about Cultural Change. Jossey-Bass (John Wiley & Sons). (p.186)

“Culture is the set of important understandings (often unstated) that members of a community share in common”. (Sathe, 1985, p.6).” Source: Martin, J.   (2002)   Organizational Culture. Mapping the terrain. Sage Publications, Inc. (p.57).

“Culture refers to what stands behind and guides behaviour rather than the behaviour as such.” Source: Alvesson, M. and Sveningsson, S.   (2008)   Changing Organizational Culture. Cultural change work in progress. Routledge. (p.36).

“The culture of a profession is manifested in its members by a sense of community and by the bonds of a common identity.” Source: Helmreich, R.L. and Merritt, A.C.   (1998)   Culture at Work in Aviation and Medicine. National, organizational and professional influences. Ashgate. (p.30).

“Adler (1997) provides a useful starting point for a basis for the exploration of culture in the context of health risk communication. … has synthesized many definitions of culture and says that culture is:

Something that is shared by all or almost all members of (a) social group. Something that the older members of the group try to pass on to the younger members. Something (as in the case of morals, laws and customs) that shapes behaviour, or … structures one’s perception of the world.”

Reference:   Adler, N.J.    (1997)   International dimensions of organizational behaviour, 3rd ed. Cincinnati, Ohio, Shour-Western College Publishing. Source: Hillier, D.   (2006)   Communicating Health  Risks to the Public. A Global Perspective. Gower Publishing Ltd. (p.23).

“Ways of thinking about the organization, whether it be a social construction or a structured entity, are enshrined in the concept of organizational culture, which is some composite of the discourses and the activities within an organization which turns it into an abstraction and represents it as a whole.” Source: Campbell, D.   (2000)   The Socially Constructed Organization. London & New York, Karnac Books. (p.31)

“What is culture? Where does it originate? How does it sustain itself?

All cultured organizations are essentially religious – they may not revolve around God, but they hold a core set of spiritual values that inform their actions.” Source: Herzlinger, R.   Who Killed Health Care?

“Of the many recent descriptions that attempt to capture key properties of cultures, Edgar Schein’s is perhaps the best known. In Schein’s view, culture is defined by six formal properties: (1) shared basic assumptions that are (2) invented, discovered, or developed by a given group as it (3) learns to cope with its problem of external adaptation and internal integration in ways that (4) have worked well enough to be considered valid, and therefore, (5) can be taught to new members of the group as the (6) correct way to perceive, think, and feel in relation to those problems.” Source: Weick, K.E. and Sutcliffe, K.M.   Managing the Unexpected. (p.114)

“… culture is the way in which a group of people solves problems and reconciles dilemmas.” Source: Trompenaars, F. and Hampden-Turner, C.   (1997)   Riding the Waves of Culture. 2nd edition. Nicholas Brealey Publishing, London. (p.6)

“…. culture is the means by which people ‘communicate, perpetuate, and develop their knowledge about attitudes towards life. Culture is the fabric of meaning in terms of which human beings interpret their experience and guide their actions (1)”. Reference: Geertz, C.  (1973)  The Interpretation of Cultures. Basic Books, New York. Source: Trompenaars, F. and Hampden-Turner, C.   (1997)   Riding the Waves of Culture. 2nd edition. Nicholas Brealey Publishing, London. (p.24)

Culture and Leadership
There are even more uses of the term leadership than of the term culture but there is agreement that the shaping of culture is one of the tasks that distinguishes the leader from the manager; in the words of Schein

''“When we examine culture and leadership closely, we see that they are two sides of the same coin; neither can really be understood by itself. If one wishes to distinguish leadership from management or administration, one can argue that leadership creates and changes cultures, while management and administration act within a culture.”'' Source: Schein, E.H.   (2004)   Organizational Culture and Leadership. John Wiley & Sons Inc. (pp.10-11).