Patients-people-place: developing a framework for researching organizational culture during health service redesign and change. 2014

Nicola K Gale, and Jonathan Shapiro, and Hugh S T McLeod, and Sabi Redwood, and Alistair Hewison

BACKGROUND Organizational culture is considered by policy-makers, clinicians, health service managers and researchers to be a crucial mediator in the success of implementing health service redesign. It is a challenge to find a method to capture cultural issues that is both theoretically robust and meaningful to those working in the organizations concerned. As part of a comparative study of service redesign in three acute hospital organizations in England, UK, a framework for collecting data reflective of culture was developed that was informed by previous work in the field and social and cultural theory. METHODS As part of a larger mixed method comparative case study of hospital service redesign, informed by realist evaluation, the authors developed a framework for researching organisational culture during health service redesign and change. This article documents the development of the model, which involved an iterative process of data analysis, critical interdisciplinary discussion in the research team, and feedback from staff in the partner organisations. Data from semi-structured interviews with 77 key informants are used to illustrate the model. RESULTS In workshops with NHS partners to share and debate the early findings of the study, organizational culture was identified as a key concept to explore because it was perceived to underpin the whole redesign process. The Patients-People-Place framework for studying culture focuses on three thematic areas ('domains') and three levels of culture in which the data could be organised. The framework can be used to help explain the relationship between observable behaviours and cultural artefacts, the values and habits of social actors and the basic assumptions underpinning an organization's culture in each domain. CONCLUSIONS This paper makes a methodological contribution to the study of culture in health care organizations. It offers guidance and a practical approach to investigating the inherently complex phenomenon of culture in hospital organizations. The Patients-People-Place framework could be applied in other settings as a means of ensuring the three domains and three levels that are important to an organization's culture are addressed in future health service research.

UI MeSH Term Description Entries
D009936 Organizational Innovation Introduction of changes which are new to the organization and are created by management. Organizational Change,Change, Organizational,Innovation, Organizational,Changes, Organizational,Innovations, Organizational,Organizational Changes,Organizational Innovations
D011787 Quality of Health Care The levels of excellence which characterize the health service or health care provided based on accepted standards of quality. Pharmacy Audit,Quality of Care,Quality of Healthcare,Audit, Pharmacy,Care Quality,Health Care Quality,Healthcare Quality,Pharmacy Audits
D004739 England A part of Great Britain within the United Kingdom.
D006739 Hospital Administration Management of the internal organization of the hospital. Hospital Organization and Administration,Organization and Administration, Hospital,Administration, Hospital
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D013222 State Medicine A system of medical care regulated, controlled and financed by the government, in which the government assumes responsibility for the health needs of the population. National Health Service, British,Socialized Medicine,British Health Service, National,British National Health Service,Medicine, Socialized,Medicine, State,Service, British National Health
D015279 Organizational Culture Beliefs and values shared by all members of the organization. These shared values, which are subject to change, are reflected in the day to day management of the organization. Corporate Culture,Corporate Cultures,Culture, Corporate,Culture, Organizational,Cultures, Corporate,Cultures, Organizational,Organizational Cultures

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