Towards developing a comprehensive conceptual understanding of positive hospital culture and approaches to healthcare organisational culture change in Australia

Abstract

PurposeThe key aim of this narrative literature review, therefore, is to identify the key conceptual categories that inform the construction of positive person-centred culture within hospitals, and how these frameworks are brought to bear upon organisational culture within healthcare systems in Australia.Design/methodology/approachThis narrative review presents a thematic synthesis of literature identified through a systematic search protocol undertaken across 19 academic databases and Google Scholar as an additional search tool. Thematic qualitative analysis was performed on the research results to determine the common themes within the diverse literature presented within this study.FindingsCulture change interventions in hospitals attempt to address the problem of widespread unprofessional behaviour within healthcare systems. However, diverse definitions and seemingly fragmented approaches to understanding and enacting organisational culture change present a significant hurdle in achieving cohesive and sustainable healthcare reform. This narrative literature review offers a comprehensive conceptual view of the key approaches that inform positive person-centred culture within hospital settings. In total, three primary dimensions, belonging, behaving and being, aligned against organisational goals, individual behaviours and worker as well as organisational identity were identified. Other individual and group interactional dynamics that give rise to negative organisational culture are further analysed to understand the fault lines along which existing culture change interventions are typically operationalised.Research limitations/implicationsThis review is not exhaustive and is limited in its methodological scope. The central values and themes identified within the literature are integral to designing humanised healthcare systems. However, owing to the qualitative nature and contextual variability of these factors, these themes do not lend themselves to replicable quantification.Social implicationsThis analysis contributes to foundational research efforts towards transforming healthcare practice to be more aligned with humanised and equitable values within increasingly complex healthcare organisational settings. Designing culture change interventions that align more suitably with the values-driven categories identified in this literature review may increase the effectiveness and sustainability of these interventions and reform efforts at organisational and systemic levels.Originality/valueThis article presents a comprehensive framework to approach healthcare organisational reform through shared and equitable models of operation, management and governance rather than continuing to promote narrowly defined outcomes derived from commodified models of healthcare practice.

Speaking up as an extension of socio-cultural dynamics in hospital settings: a study of staff experiences of speaking up across seven hospitals

“…Within the literature related to psychological safety in the workplace, the link between social, cultural and psychological capital is often highlighted in terms of its impact on performance (Santos et al, 2018), learning (Turner and Harder, 2018), job satisfaction (Ommen et al, 2009), Speaking up dynamics among hospital staff work engagement and more recently, wellbeing (Clausen et al, 2019) and speaking up (O'Donovan and McAuliffe, 2020). However, the burden of speaking up across all these bodies of work appears to be placed on victims within a system that is primed against them, in how it is structured to incentivise the very behaviours employees are expected to speak up against (Pavithra, 2021). Therefore, Bourdieusian concepts of symbolic capital appear to have been reduced and misrepresented in practice among organisational improvement practitioners whose priorities are framed by narrowly defined metrics of profitability, risk avoidance or deflection and organisational productivity and efficiency (Ernst et al, 2018).…”

“…, 2019 ) and speaking up ( O'Donovan and McAuliffe, 2020 ). However, the burden of speaking up across all these bodies of work appears to be placed on victims within a system that is primed against them, in how it is structured to incentivise the very behaviours employees are expected to speak up against ( Pavithra, 2021 ). Therefore, Bourdieusian concepts of symbolic capital appear to have been reduced and misrepresented in practice among organisational improvement practitioners whose priorities are framed by narrowly defined metrics of profitability, risk avoidance or deflection and organisational productivity and efficiency ( Ernst et al.…”

“…Culture change interventions have in the recent past gained popularity across healthcare organisations, in response to the prevalence of normalised unprofessional behaviours in healthcare work (May et al, 2018;Jones et al, 2021). Unprofessional behaviour is characterised as wrongdoing which spans instances of individual, group and systemic misconduct involving illegal, illegitimate, or immoral behaviours and dynamics within organisations (Skivenes and Trygstad, 2014;Pavithra, 2021). Within healthcare organisations, unprofessional behaviours which range from interprofessional incivility to professional misconduct have been found to impact patient safety, staff wellbeing and organisational outcomes (Douglas et al, 2021;Westbrook et al, 2020).…”

“…, 2021 ). Unprofessional behaviour is characterised as wrongdoing which spans instances of individual, group and systemic misconduct involving illegal, illegitimate, or immoral behaviours and dynamics within organisations ( Skivenes and Trygstad, 2014 ; Pavithra, 2021 ). Within healthcare organisations, unprofessional behaviours which range from interprofessional incivility to professional misconduct have been found to impact patient safety, staff wellbeing and organisational outcomes ( Douglas et al.…”

The Moderation of Perceived Comfort and Relations with Patients in the Relationship between Secure Workplace Attachment and Organizational Citizenship Behaviors in Elderly Facilities Staff

“…Our study lies within the theoretical framework of positive organizational behaviors (POBs) enacted by individuals, teams, organizations, and the health network as a whole [ 8 , 99 ], in the light of the promotion of healthcare humanization for the older adults [ 82 , 83 ], consistently with a healthy and active aging perspective [ 1 , 2 ]. In this view, caregivers’ OCBs can be considered as desirable outcomes promoting HAA.…”