Organizational Culture in Nursing: A Systematic Review [PDF]

Organizational Culture in Nursing: A Systematic Review Setiawan Lecturer at Program Studi Ilmu Keperawatan, Fakultas Kedokteran, Universitas Sumatera Utara Doctoral Student, Faculty of Nursing, Prince of Songkla University, Thailand

literature by summarizing large bodies of evidence. By conducting systematic reviews, we can learn how to apply scientific strategies, in ways that limit bias, to the assembly, critical appraisal, and synthesis of all relevant studies that address a specific question. This systematic review is found to be useful in understanding a concept by careful reviews of several studies and assist to get the confident of the findings. This study reviewed 11 papers related to organizational culture. The results were grouped into 3 categories: domains of organizational culture, factors influencing organizational culture, and effects of organizational culture. Issues of organizational culture in health care setting, especially in nursing, are needed to be understood because it has effects on job satisfaction, job commitment, team functioning, and team action. Keywords: systematic review, organizational culture, nursing Abstrak: Penelusuran sistematik sangat bermanfaat untuk mendapatkan kelengkapan literatur dengan membuat ringkasan dari serangkaian hasil penelitian. Dengan melakukan penelusuran sistematik, kita dapat belajar bagaimana menerapkan strategi ilmiah, dengan cara mengurangi bias, merangkai, melakukan penilaian secara kritis, dan melakukan sintesis terhadap semua penelitian yang relevan yang berupaya menjawab sebuah pertanyaan yang spesifik. Penelusuran sistematik sangat berguna dalam memahami sebuah konsep dengan cara penelusuran yang cermat dari beberapa penelitian dan membantu meningkatkan rasa percaya terhadap hasilnya. Penelitian ini menelusuri 11 makalah yang terkait dengan budaya organisasi. Hasilnya dikelompokkan ke dalam 3 kategori: ranah budaya organisasi, faktor-faktor yang mempengaruhi budaya organisasi, dan efek budaya organisasi. Isu-isu tentang budaya organisasi dalam bidang kesehatan, terutama dalam keperawatan, perlu dipahami karena budaya organisasi berpengaruh pada kepuasan kerja, komitmen terhadap pekerjaan, berfungsinya suatu tim, dan aksi suatu tim. Kata kunci: penelusuran sistematik, budaya organisasi, keperawatan

INTRODUCTION Within organization, people interact with each other in a variety ways. Patterns of interaction then are formed, and share of cultural knowledge occurs. This shared knowledge is used by organizational members to make sense of past experience and provide framework for interpreting situations and deciding present and future actions. Culture is defined as the totality of socially transmitted behavior patterns, arts, beliefs, institutions, and all other products of human 1 work and thought. While organization is defined as a group of persons organized for a particular 1 purpose. McNamara basically defined an

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organization as a group of people intentionally organized to accomplish an overall, common 2 goal or set of goals. An organizational culture is the ways of thinking, behaving, and believing that members 3 have in common. Organizational culture refers to a pattern of shared basic assumptions that the group learned as it solved its problems of external adaptation and internal integration, that has worked well enough to be considered valid and, therefore, to be taught to new members as the correct way you perceive, think, and feel 4 in relation to those problems. Every organization has its distinct characters. People make organizations work,

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and the culture of the organization ties people together, giving them meaning and a set of principles and standards to live and work. Basically, organizational culture is the personality of the organization. Culture is comprised of the assumptions, presuppositions, values, norms and tangible signs (artifacts) of 5 organization members and their behaviors. Culture is one of those terms that's difficult to express distinctly, but everyone knows it when they sense it. The culture or personality of an organization, by its nature, places certain restrictions and boundaries around behavior. Significance of the Organizational Culture Several case studies demonstrated how health care organization can successfully foster organizational culture resulting in improved quality, efficiency, safety, and patients and staff satisfaction. Elements of culture should be reflected in human resources policies in form of hiring practices and performance expectations related to professional values. Health care organizations have a promising opportunity to foster organizational culture given the values taught and socialized in nursing, the prevalence of nurses in the health care work-force, and the central role that 6 nurses play in care delivery. Within a health organization, culture are likely to found practices, beliefs, values and assumptions that tend by their very nature to strongly resist attempts to change them. In common with the human relations movement, organizational culture emphasizes the socially dynamic aspect of organizations. An infusion of the organization by values, and an associated resistance to change, are both important aspects of the study of organizational culture. The organizational culture that is conceived as comprising shared key values and 7 beliefs fulfils several important functions. 1. It conveys a sense of identity for organization members. 2. It facilitates commitment to something larger than the self. 3. It enhances social systems stability. 4. It provides a sense-making device to guide behaviors. Organizational culture also has impacts on individual such as on employee morale, commitment, productivity, physical health,

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and emotional well being. The culture of a work organization drives the behavior of its employees. Organizational culture can serves as cognitive map for members so they can understand what is valued in their organization and how to direct their behaviors accordingly. The concept of culture is particularly important when attempting to manage organization-extensively change. Practitioners are coming to realize that, despite the bestlaid plans, organizational change must include not only changing structures and processes, but also changing the organizational culture as well. Understanding the organizational culture is helpful in understand why change does not take place in an organization, or why a project fails. It will also be helpful to determine where to strive to make changes to the culture. Objectives of the Study Objectives of this study are to present the available information about the organizational culture for development of an instrument to measure the culture of nursing organizations and for effectiveness of interventions designed to improve quality of nursing service. The study also provide a narrative summary of the domains of organizational culture, factors influencing organizational culture, and impact of organizational culture. Method of the Study Search sought to identify published studies and utilized a range of electronic databases using accepted search techniques, and included CINAHL, MEDLINE, Findarticles.com website, and Sciencedirect.com website range from 1980-2005. These are databases of literature emanating from a variety of disciplines including nursing, medicine, and general disciplines for the websites of findarticles and sciencedirect. The key words used were: organizational and culture. To filter the articles being reviewed, selection criteria was used. The criteria to select material for inclusion in the review were as follows: studies of organizational culture; English language; publication in journal from 1980 up to 2005; and any qualitative or quantitative methods. Dissertation and published abstracts were excluded.

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Each paper selected for review was evaluated by the author by using constructed a matrix to record the following data for each reviewed paper: type of study, purpose of enquiry, method and participants, summary of findings, and summary for implication for practice. Results of the Study This study reviewed 11 papers which appeared to meet the inclusion criteria. Papers that were exclusively theoretical or methodological or not specific to organizational culture were excluded. The research methods used by the studies cited in this review were: 9 quantitative studies (survey, evaluation approach, correlational study, and exploratory study), qualitative studies (ethnography study), and using both methods quantitative and qualitative. The results of this study are presented in the following categories: 1. Domains of organizational culture. 2. Factors influencing organizational culture. 3. Effects of organizational culture.

Domain of Organizational Culture Domain of organizational culture has been described as forms of central category of core values and beliefs. Understanding values and beliefs is an important part of understanding a workplace culture. This review revealed that a study of the workplace culture of a special care nursery proposed 4 key categories of domain of organizational culture: teamwork, learning in practice, inevitability of change and family9 centered care. In teamwork, there are values and beliefs of cooperation and harmony. In learning in practice category there are values and beliefs of partnership, questioning, and team focused. Enablers and new ideas are the values and beliefs under category of inevitability of change. Finally for family-centered care category, the values and beliefs are empowerment of families, continuity, and enabling environment. Delobbe, Haccoun and Vandenberghe identify five fundamental core dimension of organizational culture: recognition-support, commitment-solidarity, innovation-productivity, control, and 10 continuous learning.

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Factors Influencing Organizational Culture Culture of an organization is influenced by many factors. These factors could be from 11 external and internal environment. Economic and political system, external regulation, and public attitudes are the external factors that can influence organizational culture. Whilst, the organizational arrangements of job design, reporting hierarchy, rewards system, and teams are internal environmental factors that can influence organizational culture.

Effects of Organizational Culture Several studies addressed the effect of organizational culture on the organization. Strength of organizational culture predicted 12 job satisfaction well and positively. The concepts of organizational core task and organizational culture could be useful as management tools to anticipate the consequences 13 of organizational change. It is confirmed that organizational culture plays a mediation role between HR system and firm’s innovation 14 outcome. There is a relationship between the degree to which individual believes in the values of the company and the individual’s amount of job 15 satisfaction and job commitment. In medical setting, a study found that organizational culture model can show opportunities for better information exchange and open dialogue 16 between groups in the organization. Organizational culture is also predictor of 17 commitment of employee to the organization. In the study of influence of hospital culture, it is found that the culture is associated positively with the team functioning in term of team relation (interprofessional relations, physician support, organization, task orientation, and innovation) and team action (teamness, communication, effectiveness, and 18 collaboration). CONCLUSION A systematic review is a summary of the healthcare literature that uses explicit methods to perform a thorough literature search and critical appraisal of individual studies to identify the valid and applicable evidence, and then uses appropriate techniques to combine these valid studies. Systematic review on organizational culture was

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conducted in this study, which its purposes was to present the available information about the organization culture and to provide a narrative summary of the domain, factors influencing, and effects of organizational culture. This systematic review of organizational culture revealed, from 11 research papers, the domain of organizational culture, factors influencing organizational culture, and the effects of organizational culture. Teamwork, learning in practice, inevitability of change, and family centered care, recognition-support, commitmentsolidarity, innovation-productivity, control, and continuous learning are the identified domain of organizational culture found this study. There are two main factors influencing organizational culture that are external factor (such as economic and political system, external regulation and public attitudes) and internal factors (such as arrangement of job design, reporting hierarchy, reward system, and teams). This systematic review also found the effects of organizational on various aspects of organization such as on job satisfaction, job commitment, team functioning, and team action. REFERENCES 1. The American Heritage® Dictionary of the English Language. (2000). Fourth Edition. Houghton Mifflin Company. Retrieved from /reference/dictionary/entry/culture. 2. McNamara, C, (1999). Basic Definition of Organization. Retrieved from . 3. Thomas, C., Ward, M., Chorba, C., & Kumiega, A. (1990). "Measuring and Interpreting Organizational Culture." Journal of Nursing Administration,17-24. 4. Schein, E.H. (1992). Organizational culture and leadership. Retrieved from . 5. McShane, S.L. & Von Glinow, M.A. (2003). Organizational behavior: emerging realities for the workplace revolution. New York: McGraw-Hill.

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7. Smircich, L. (1983). Concepts of culture and organizational analysis. Administrative Science Quarterly, 28, 339-358. 8. Cameron, K.S. & Quinn, R.E. (1999).

Diagnosing and changing organizational culture. Addison-Wesley, Reading, MA. 9. Wilson, V.J., McCormack, B.G., & Ives, G. (2004). Understanding the workplace culture of a special care nursery. Journal of Advanced Nursing, 50,1, 27-38. 10. Delobbe, N., Haccoun, R.R., & Vanderberghe, C. (2005). Measuring core

dimensions of organizational culture: a review of research and development of a Download from new instrument. www.iag.ocl.ac.be/papers/wp53.pdf. 11. Yamaguchi, S. (2004). Nursing culture of an operating theatre in Italy. Nursing and Health Sciences, 6, 261-269. 12. Tzeng,H.M., Ketefian, S., & Redman, R.W. (2000). Relationship of nurses’ assessment of organizational culture, job satisfaction, and patient satisfaction with nursing care. International Journal of Nursing Studies, 39, 79-84. 13. Reiman, T., Oedeald, P, & Rollenhagen, C. (2005). Characteristics of organizational culture at the maintenance units of two Nordic nuclear power plants. Reliability Engineering and System Safety, 89, 331-345. 14. Lau, C.M. & Ngo, H.Y. (2004). The HR system, organizational culture, and product innovation. International Business Review, 13, 685-703. 15. Richie, M. (2000). Organizational culture: an examination of its effect on the internalization process and member performance. Southern Bussiness Review. Retrived from www.findarticles.com . 16. Smith, C.S., Francovich,C., & Gieselman, J. (2000). Pilot test of an organizational culture model in a medical setting. Health Care Manager, 19, 2, 68-77.

6. Wooten, L. & Crane, P. Nurses as Implementers of Organizational Culture (2003). Nursing Economics Journal, 21: 275-279.

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17. Ingersoll, G.L., Kirsch, J.C., Merk, S.E, & Lightfood, J. (2000). Journal of Nursing Administration, 30, 1, 11-20.

18. Strasser, D.C., et al. (2002). The influence of hospital culture on rehabilitation team functioning in VA hospitals. Journal of

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