Page 393 - Encyclopedia of Nursing Research

360 n ORGANIzATIONAL CULTURe

about their agreement with carefully framed or organization’s culture that can facilitate
statements; Martin, 2002). desired change, rather than trying to change
O Frost, Moore, Louis, Lundberg, and culture directly.
Martin (1991) and later Martin (2002) have Over the past decade, health care orga-
described three approaches to the study of nizations have been challenged to con-
culture: (1) the integration perspective, which tend with pressures to increase efficiencies
characterizes culture as an institution-wide through interdisciplinary collaboration,
consensus about values and approaches to comply with national and international
to work; (2) the differentiation perspec- practice guidelines, and to become account-
tive, which emphasizes subcultures within able for both quality and progress in quality
organizations that somehow form coherent improvement activities. Because conserva-
wholes in organizational life (e.g., the cul- tism, adherence to tradition, a local rather
tures across different departments, clinical than national outlook, and strong profession-
areas, and professional/occupational groups specific identities among workers have been
within an institution); and (3) the fragmen- key forces in the evolution of many health
tation perspective, which emphasizes ten- care facilities, such changes often represent
sions, paradoxes, and ambiguities among the a major shift.
different subcultures within an organization Not surprisingly, managers and execu-
as a fundamental feature of organizational tives and ultimately scholars have turned
life. The integration perspective is an espe- to the culture concept to drive this work
cially popular way of thinking about culture forward. Over the past decade, perhaps the
among practicing managers, including those most widespread use of the concept has
in health care. However, critics argue that it been in the sense of “safety culture” (Agency
fails to accurately capture the complexity of for Healthcare Research and Quality, 2010;
organizational life and at its worst, can be Nieva & Sorra, 2003). This term refers to
used to overemphasize the importance of aspects of organizational culture that guide
charismatic leadership, and serves as a justifi- decision making around institutional prior-
cation for the silencing of differences of opin- ities related to safety, openness to adoption
ion in organizations that merit exploration of best practices, and promotion of feedback
and discussion. Arguably, many of the ideas loops where errors or near misses are used
in more recent discourse in organizational to guide team learning and change. Many
behavior theory have not had a particularly leaders and researchers are especially inter-
strong influence on the practice-oriented ested in the potential effects of safety cul-
literature or the education of managers. ture on health care workers’ priority setting,
Integration perspectives have been largely willingness to speak up, and steadfastness
absorbed by practitioners, perhaps because in situations where compromises should not
the concrete implications for leadership from be made, as well as “correct” ways to han-
differentiation or fragmentation perspectives dle situations where safety breaches occur. It
are much less clear-cut. is notable that a number of these skills and
Schein (1985) has written that because behavior patterns that are now being fos-
culture reflects the ways that an organiza- tered run contrary to some deeply ingrained
tion has adapted to its environment, there is traditions (cultural elements) in health care.
no such thing as good or bad culture, simply In recent years, organizational culture
cultures that are more or less suited to the has also emerged in the field of nursing
challenges and imperatives dictated by cer- research utilization (for a recent example,
tain environments. Seen this way, the impli- see Cummings, Hutchinson, Scott, Norton,
cation for leaders is that it may be preferable & estabrooks, 2010). Many would argue
to identify and draw upon aspects of a unit’s that quantitative approaches, driven by