Page 394 - Encyclopedia of Nursing Research

ORGANIzATIONAL DeSIGN n 361

questionnaires and/or standardized, val- is probably understandable given both the
idated observational grids, can be useful complexity of culture as a concept and the
in benchmarking organizations against complex pathways that likely link culture to O
each other over time. Benchmarking data individual and group clinician behaviors and
can help determine the types of leadership in turn to clinical outcomes. In the end, orga-
approaches that will tend to work best in par- nizational culture and cultural factors may
ticular institutions or clinical areas to enable be better conceptualized in both quantitative
an organization or its subunits to adapt to and qualitative work as a mediating vari-
its environment. In the case of stimulating able between organizational interventions
lasting change in clinical practice driven by and their effects (e.g., as a factor affecting the
empirical findings, considerable investments uptake and impacts of safety or quality ini-
of human resources in identifying relevant tiatives or organizational redesign on actual
evidence, applying evidence to local realities, clinical practice) rather than as an indepen-
and executing the required planned changes dent predictor of organizational outcomes.
are needed. A culture of evidence-based Organizational culture organizes many
practice in a service organization is often observations and impressions of life in and
shaped by university/college affiliations, across institutions. The challenge ahead is
which produce regular contact with research to strengthen its usefulness as a variable to
and researchers and increase the likelihood explain, to predict, and to control organi-
that managers and clinicians will be social- zational outcomes, whether in terms of its
ized into evidence-based practice as well as direct effects or its possible role as a mediator
by the presence of organizational programs of other factors. This will require a more con-
and mechanisms such as training programs, sistent exploration of its deeper rather than
mentoring, research rounds, and integration more superficial features, in combination
of quality improvement activities within with research on organizational leadership
shared governance structures. A critical mass and leaders’ impacts on attitudes, values,
of grassroots interest in making the change beliefs, and customs, and ultimately on indi-
is essential, along with a shared expectation vidual and team behaviors in the workplace.
for cooperation in the change process among
health care team members. Not surprisingly, Sean P. Clarke
culture has been raised as a potential expla- Raquel M. Meyer
nation for the differences in investments and
the speed of diffusion of ideas across institu-
tions and regions.
For some time, a popular understand- OrganizatiOnal Design
ing of “culture” within nursing has been as
a variable with great potential to predict or
quantitatively explain differences across Organizational design is concerned with the
units and institutions in terms of practices configuration and coordination of structures
and clinical outcomes, along the lines of the and work roles that influence organizational
staffing-outcomes literature. Similar research performance. Health care organizations
in educational, retail, and banking settings employ nurses to deliver care, and the extent
has attempted to predict organizational per- to which an organization can accomplish its
formance using elements of organizational goals depends, in part, on how well nurses’
culture (or climate) along with a variety of roles are supported by organizational struc-
other characteristics. Results of quantita- tures. Although a growing proportion of
tive research on culture as a predictor of nurses in North America were used by hos-
outcomes have been disappointing, which pitals after the Great Depression of the 1930s,