cultures for health reviews
Deeper still, and thus much less overt and accessible, are the largely unspoken and often unconscious expectations and presuppositions that underpin both dialogue and clinical practice (the shared assumptions; box 2). Clearly, the relations between culture and quality, safety, or efficiency are unlikely to be straightforward. wrote the first draft of this paper and all authors contributed to subsequent drafts. This begs other questions, such as what is organizational culture? The management of organizational culture is increasingly viewed as a necessary part of health system reform. . The second level is the shared ways of thinking that are used to justify the visible manifestations (box 2). Cultural diversity. Some of the deeper values and assumptions are taught in early professional education (the so-called hidden curriculum), reinforced through ongoing professional interactions, and then made visible as accepted practices. In addition to, or instead of, driving beneficial outcomes, culture change policies may induce a range of unintended and dysfunctional consequences . The management literature on organizational culture has tended to assert a relationship between ‘strong’, unified cultures and commercial success. Two main styles of leadership are widely recognized: ‘transactional’ leadership, based around securing organizational compliance and control by using material motivational factors like reward systems; and ‘transformational’ leadership processes, which inspire cognitive change by redefining the meaning of information to which organizational members are exposed (but not necessarily sensitized). There are two distinctive views of culture. Only after an effective diagnosis or cultural audit has revealed how the current order is sustained can effective change management strategies be deployed. Indeed the whole emphasis shifts from what organizations accomplish to a cultural anthropological understanding of how organizations are socially accomplished and reproduced. The ideas people have about health, the languages they use, the health literacy skills they have, and the contexts in which they communicate about health reflect their cultures. We review key theoretical debates on the nature of organizational culture(s) and consider what practical strategies are open to health care organizations to implement culture change. Integrating these two styles is a necessary and challenging project.
It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Organisational culture represents the shared ways of thinking, feeling, and behaving in healthcare organisations. They also form an important target for purposeful cultural reform, which might sometimes seek to strengthen current trends or at other times to inhibit them.
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