Measuring and Assessing Healthcare Organisational Culture in the England’s National Health Service: A Snapshot of Current Tools and Tool Use

Abstract

Healthcare Organisational Culture (OC) is a major contributing factor in serious failings in healthcare delivery. Despite an increased awareness of the impact that OC is having on patient care, there is no universally accepted way to measure culture in practice. This study was undertaken to provide a snapshot as to how the English National Health Service (NHS) is currently measuring culture. Although the study is based in England, the findings have potential to influence the measurement of healthcare OC internationally. An online survey was sent to 234 NHS hospital trusts, with a response rate of 35%. Respondents who completed the online survey, on behalf of their representative organisations, were senior clinical governance leaders. The findings demonstrate that the majority of organisations, that responded, were actively measuring culture. Significantly, a wide variety of tools were in use, with variable levels of satisfaction and success. The majority of tools had a focus on patient safety, not on understanding the determining factors which impact upon healthcare OC. This paper reports the tools currently used by the respondents. It highlights that there are deficits in these tools that need to be addressed, so that organisations can interpret their own culture in a standardised, evidence-based way.

A Case Study of a Whole System Approach to Improvement in an Acute Hospital Setting

“…A case study approach [47,48] was adopted here to understand the deployment of a whole system change in the acute hospital along the four dimensions of STS outlined above. A case study is an approach that is used to generate an in-depth, multi-faceted understanding of a complex issue in its real-life context [49]. This case study sets out to address the question 'Was the deployment of LSS and person-centred care in this hospital a change on a whole system level?'.…”

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“…Table 2. Reflective questions derived from Oshry's Organic Systems Framework [48,49]. To what extent and how were they empowered to act to design and implement (agency)?…”

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“…Then, the values were normalized. Finally, the RPN was found using Equation (2). The results are presented in Table 9.…”

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