Culture in Health Care Organizations

Modern health care policy frequently invokes notions of cultural change as a key means of achieving performance improvement and good quality health care. This chapter aims to sharpen thinking around the theory and feasibility of culture change in health care contexts by setting out some of the key conceptual and practical challenges that need to be addressed by policy makers, health care managers, researchers, and by others seeking to understand, assess and change cultures in health care organizations. It begins by introducing some of the sources of ideas, conceptual underpinnings and key concerns with using organizational culture, before considering the evidence on the linkages between culture and health care performance and the wide range of models that have been used to understand culture change and the management of cultural diversity in health care organizations. The chapter closes by arguing that the diverse and contested nature of understanding about culture will necessarily mean that there will be diverse and contested ways of seeking to harness the power of culture to deliver the desired improvements in health care quality and performance. What is clear is attempting to enact culture change to improve health care performance is a difficult, uncertain and risky enterprise and may not always generate the anticipated outcomes. As in many other areas of management we are in need of a more secure evidence base that is underpinned by a more sophisticated understanding of these complex and dynamic organizational phenomena.