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How to change organisational culture: Action research in a South African public sector primary care facility

View Article: PubMed Central - PubMed

ABSTRACT

Background: Organisational culture is a key factor in both patient and staff experience of the healthcare services. Patient satisfaction, staff engagement and performance are related to this experience. The department of health in the Western Cape espouses a values-based culture characterised by caring, competence, accountability, integrity, responsiveness and respect. However, transformation of the existing culture is required to achieve this vision.

Aim: To explore how to transform the organisational culture in line with the desired values.

Setting: Retreat Community Health Centre, Cape Town, South Africa.

Methods: Participatory action research with the leadership engaged with action and reflection over a period of 18 months. Change in the organisational culture was measured at baseline and after 18 months by means of a cultural values assessment (CVA) survey. The three key leaders at the health centre also completed a 360-degree leadership values assessment (LVA) and had 6 months of coaching.

Results: Cultural entropy was reduced from 33 to 13% indicating significant transformation of organisational culture. The key driver of this transformation was change in the leadership style and functioning. Retreat health centre shifted from a culture that emphasised hierarchy, authority, command and control to one that established a greater sense of cohesion, shared vision, open communication, appreciation, respect, fairness and accountability.

Conclusion: Transformation of organisational culture was possible through a participatory process that focused on the leadership style, communication and building relationships by means of CVA and feedback, 360-degree LVA, feedback and coaching and action learning in a co-operative inquiry group.

No MeSH data available.


Baseline cultural values assessment.
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Figure 0001: Baseline cultural values assessment.

Mentions: Twenty-five staff members completed the baseline survey, including 5 nurses, 5 allied health professionals, 11 support staff and 4 unknown. The top 10 personal, current and desired organisational values are shown in Figure 1 and plotted against the seven levels of organisational consciousness. Five of the values in the current organisational culture were limiting values (control, cost reduction, long hours, confusion, not sharing information), which were likely to be reducing staff engagement and organisational performance. Overall levels of cultural entropy were high (33% of all values selected were limiting values), which according to the Barrett’s Centre report implied serious problems requiring cultural and structural transformation, leadership development and coaching. Caring was a value shared across all three domains, while commitment was the only other personal value found in the current culture. Personal values of respect, fairness and accountability were asked for in the desired culture. Patient satisfaction and open communication were present in both the current and desired culture. The desired culture asked for a shift of focus to levels 2 and 5 indicating a need to pay more attention to relationships, building a sense of community and shared purpose. The values at level 1 and 3 were hindering organisational performance, and staff asked for a focus on excellence instead of these values.


How to change organisational culture: Action research in a South African public sector primary care facility
Baseline cultural values assessment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016718&req=5

Figure 0001: Baseline cultural values assessment.
Mentions: Twenty-five staff members completed the baseline survey, including 5 nurses, 5 allied health professionals, 11 support staff and 4 unknown. The top 10 personal, current and desired organisational values are shown in Figure 1 and plotted against the seven levels of organisational consciousness. Five of the values in the current organisational culture were limiting values (control, cost reduction, long hours, confusion, not sharing information), which were likely to be reducing staff engagement and organisational performance. Overall levels of cultural entropy were high (33% of all values selected were limiting values), which according to the Barrett’s Centre report implied serious problems requiring cultural and structural transformation, leadership development and coaching. Caring was a value shared across all three domains, while commitment was the only other personal value found in the current culture. Personal values of respect, fairness and accountability were asked for in the desired culture. Patient satisfaction and open communication were present in both the current and desired culture. The desired culture asked for a shift of focus to levels 2 and 5 indicating a need to pay more attention to relationships, building a sense of community and shared purpose. The values at level 1 and 3 were hindering organisational performance, and staff asked for a focus on excellence instead of these values.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Organisational culture is a key factor in both patient and staff experience of the healthcare services. Patient satisfaction, staff engagement and performance are related to this experience. The department of health in the Western Cape espouses a values-based culture characterised by caring, competence, accountability, integrity, responsiveness and respect. However, transformation of the existing culture is required to achieve this vision.

Aim: To explore how to transform the organisational culture in line with the desired values.

Setting: Retreat Community Health Centre, Cape Town, South Africa.

Methods: Participatory action research with the leadership engaged with action and reflection over a period of 18 months. Change in the organisational culture was measured at baseline and after 18 months by means of a cultural values assessment (CVA) survey. The three key leaders at the health centre also completed a 360-degree leadership values assessment (LVA) and had 6 months of coaching.

Results: Cultural entropy was reduced from 33 to 13% indicating significant transformation of organisational culture. The key driver of this transformation was change in the leadership style and functioning. Retreat health centre shifted from a culture that emphasised hierarchy, authority, command and control to one that established a greater sense of cohesion, shared vision, open communication, appreciation, respect, fairness and accountability.

Conclusion: Transformation of organisational culture was possible through a participatory process that focused on the leadership style, communication and building relationships by means of CVA and feedback, 360-degree LVA, feedback and coaching and action learning in a co-operative inquiry group.

No MeSH data available.