Culture’s Place in Quality of Care in a Resource-Constrained Health System: Comparison Between Three Malawi Districts

Public health scholars describe “culture of quality” in terms of desired values, attitudes, and practices, but this literature rarely includes explicitly stated theories of culture formation. In this article, we apply Fredrik Barth’s transactional model to demonstrate how taking a theory-centered approach can help to identify what would be necessary to foster “cultures of quality” outlined in the public health literature. We draw on data from a study of the Republic of Malawi’s Performance and Quality Improvement for Reproductive Health initiative. These data were generated in 2017–2018 through a 6-month organizational ethnography in three facilities selected to represent a range of districts with differing social and economic contexts. Our analysis revealed facility-level organizational cultures in which staff valued providing care, but responded to structural constraints by normalizing divergence from quality-of-care protocols. These findings indicate that sustaining a quality-oriented organizational culture requires addressing underlying conditions that generate routine experiences and practices.

Responding to organizational identity change: ethnographic insights from multinational hotel subsidiaries

Purpose This paper aims to use an organizational ethnography perspective to explore how subsidiary hotel properties of a multinational hotel corporation experience planned organizational identity (OI) change instituted by headquarters. Design/methodology/approach This study uses a multi-site approach to collect ethnographic data on organizational change from six hotel subsidiaries in California, USA. Over three years, multiple sources of data were collected including: 31 interviews with hotel subsidiary leaders; more than 100 participant observation hours including job shadows, conferences and meetings; and photographs and internal communication materials. Findings Multinational hospitality companies face struggles between corporate standardization and subsidiary localization. This paper reveals that when headquarters plan changes focused on employees at their subsidiaries, the ways the latter initially accept and resist change are significantly impacted by the organizational memory and history of subsidiary leaders. However, as time progressed, properties with strong financial performance continued to operationalize new identity initiatives while properties with poorer profit margins played a balancing act between headquarters’ visionary identity and subsidiary ownership’s revenue expectations. Additionally, the situational realities caused by the COVID-19 pandemic put a halt to all properties which amplified practical and emotional challenges of organizational ethnography in hospitality research. Originality/value This paper contributes to hospitality literature by introducing an under-researched concept, OI change and advances understanding of the struggles in managing multinational company change. More importantly, this paper is a stepping stone for future hospitality management to embark on organizational ethnography.