Faith in the 'cultural fix': limits to a planned cultural change program in a rural health service

Abstract

This paper, by way of a narrative on the author's participation, explains the limits to a planned cultural changeprogram in a large rural health service. Cultural change was identified by the CEO as crucial to the success of a majorrestructuring of the service, and the attitudes and beliefs of the 'old guard' were considered to be constraining progress.Advocates of cultural integration contend that shared core values across an organisation can overcome such obstacles.This is a matter of faith. An application of Habermasian theory suggests that organisational leaders are drawing ontraditional/religious beliefs and practices to bolster their visions and missions at a time of motivational crisis.Though a need for cultural change in some sectors of the health services is acknowledged, the particular challenges inattempting to manipulate the traditionally embedded culture and sub-cultures of the health services is highlighted.An analysis of some of the ideas and beliefs surrounding authority, deference and discipline is undertaken. It is arguedthat the ritualistic reinforcement of these beliefs and the reproduction of sub-cultures along material and ideal interestsmilitate against the implementation of objectives delineated by the CEO.While cultural analysis has revealed the irrational face of organisations and can bring to conscious awareness the taken-for-granted beliefs which inform behaviour, the cultural integrationists have a further agenda. They aim tomanipulate organisational culture to subtly control employees' beliefs and hence behaviour. Cultural control is a covertform of top down authority that can be just as directive and centralising as bureaucratic control. The author alsomaintains that cultural change programs alone cannot fix a problem that arose in the macro-economic sphere: a chroniclack of resources ever since the state responded to the economic crisis by cutting funds to health and welfare services.

Teamtraining zur Integration ausländischer Mitarbeiter

“…Lifelong learning is evident in the development of a positive and enabling learning environment and culture (McCance, 2003;Shimko et al, 2000;McMahon et al, 2000;McCormack et al, 2002;Sim et al, 2003) where learning is active (Shimko et al, 2000;Dewing, 2008) and encouraged constantly (Chan, 2001); where feedback is pervasive (Clark, 2002); and people learn from their mistakes rather than from blame (Mahony, 2000;Scott et al, 2003). Learning in and from practice is a manifestation of this approach (Mulchey and Betts, 2005) and there is a commitment to learning and sharing knowledge Peplar et al, 2005).…”

“…The role-modelling of evidence-based practice by clinical staff is valued (Mahony, 2000;Manley, 2001;Rycroft-Malone, 2004;Newman et al, 2000) and is linked to facilitation expertise and leadership (Manley, 2001;Peplar et al, 2005;Rycroft-Malone, 2004). Its importance within the culture will rely on whether there is active use of information to improve effectiveness (Clark, 2002); a focus on evaluation (Rycroft-Malone, 2004) as well as the skills and personal mastery of staff (Chan, 2002) with opportunities to rigorously research one's own practice (Titchen, 2000).…”

“…It should be noted that staff well-being (feeling and being valued as a staff member in addition to physical and psychosocial wellbeing) is strongly related to positive patients' experience and outcomes (Patterson et al, 2011;Maben, 2010; NHS Institute for Innovation and Improvement, 2010)  Individuals and teams achieve pre-stated goals, corporate objectives and local and national standards, for example, in the areas of patient safety, reduced waiting times, improved access, and improved outcomes etc. (Manley, 2001;Stordeur et al, 2000;Welford, 2002;Mahony, 2000;Tiernan et al, 2002;Martin, 2000;Parisi et al, 2003;Jabnoun, 2001)  Evidence-based practice exists with explicit knowledge development from practice, knowledge sharing and knowledge use (Manley, 2001;Peplar et al, 2005;Clark, 2002;McCormack et al, 2002;Newman et al, 2000;Waldman et al, 2003;Lewis, 2001;Binnie and Titchen, 1998;Ruvol and Bullis, 2003;Manley and Titchen, 2011). This consequence recognises that evidence based standards and national guidelines are implemented consistently across patient pathways and services…”