Objective. To review the quantitative instruments available to health service researchers who want to measure culture and cultural change. Data Sources. A literature search was conducted using Medline, Cinahl, Helmis, Psychlit, Dhdata, and the database of the King's Fund in London for articles published up to June 2001, using the phrase ''organizational culture.'' In addition, all citations and the gray literature were reviewed and advice was sought from experts in the field to identify instruments not found on the electronic databases. The search focused on instruments used to quantify culture with a track record, or potential for use, in health care settings. Data Extraction. For each instrument we examined the cultural dimensions addressed, the number of items for each questionnaire, the measurement scale adopted, examples of studies that had used the tool, the scientific properties of the instrument, and its strengths and limitations. Principal Findings. Thirteen instruments were found that satisfied our inclusion criteria, of which nine have a track record in studies involving health care organizations. The instruments varied considerably in terms of their grounding in theory, format, length, scope, and scientific properties. Conclusions. A range of instruments with differing characteristics are available to researchers interested in organizational culture, all of which have limitations in terms of their scope, ease of use, or scientific properties. The choice of instrument should be determined by how organizational culture is conceptualized by the research team, the purpose of the investigation, intended use of the results, and availability of resources.

Tim Scott is a senior lecturer in organization at the University of St. Andrews School of Management. His publications include articles on a range of topics, including improving communication with people with cancer and heart disease, organizational culture, health information technology, and ethnography. He has published books on health care performance and organizational culture, and on implementing new information technology in Kaiser Permanente. His current book, advocating a poststructural revision of organization studies, is forthcoming.Davies is a professor of health care policy and management at the University of St. Andrews School of Management. His research interests include public service delivery encompassing evidence-based policy and practice, performance measurement and management, accountability, governance and trust. He also has a particular interest in the role of organizational culture and organizational learning in the delivery of high quality services, and in developing greater understanding of the working relationships between service professionals and service managers. Diane Whalley is a research fellow in the National Primary Care Research and DevelopmentCentre at the University of Manchester. Her main areas of interest include the psychological aspects of recruitment and retention in the primary care workforce, and the design and psychometric evaluation of measurement tools in health care.

There is some evidence to suggest that organisational culture may be a relevant factor in health care performance, yet articulating the nature of that relationship proves difficult. Simple relationships such as 'strong culture leads to good performance' are not supported by this review. Instead, the evidence suggests a more contingent relationship, in that those aspects of performance valued within different cultures may be enhanced within organisations that exhibit those cultural traits. A striking finding is the difficulty in defining and operationalising both 'culture' and 'performance' as variables that are conceptually and practically distinct. Considerably greater methodological ingenuity will be required to unravel the relationship(s) between organisational culture(s) and performance(s). Current policy prescriptions, which seek service improvements through cultural transformation, are in need of a more secure evidential base.

Russell Mannion and Huw Davies explore how notions of culture relate to service performance, quality, safety, and improvement

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