What do we really assess with organisational culture tools in healthcare? An interpretive systematic umbrella review of tools in healthcare

Abstract

IntroductionA toxic organisational culture (OC) is a major contributing factor to serious failings in healthcare delivery. Poor OC with its consequences of unprofessional behaviour, unsafe attitudes of professionals and its impact on patient care still need to be addressed. Although various tools have been developed to determine OC and improve patient safety, it remains a challenge to decide on the suitability of tools for uncovering the underlying factors which truly impact OC, such as behavioural norms, or the unwritten rules. A better understanding of the underlying dimensions that these tools do and do not unravel is required.ObjectivesThe aim of this study is to provide an overview of existing tools to assess OC and the tangible and intangible OC dimensions these tools address.MethodsAn interpretive umbrella review was conducted. Literature reviews were considered for inclusion if they described multiple tools and their dimensional characteristics in the context of OC, organisational climate, patient safety culture or climate. OC tools and the underlying dimensions were extracted from the reviews. A qualitative data analysis software program (MAX.QDA 2007) was used for coding the dimensions, which resulted in tangible and intangible themes.ResultsFifteen reviews met our inclusion criteria. A total of 127 tools were identified, which were mainly quantitative questionnaires covering tangible key dimensions. Qualitative analyses distinguished nine intangible themes (commitment, trust, psychological safety, power, support, communication openness, blame and shame, morals and valuing ethics, and cohesion) and seven tangible themes (leadership, communication system, teamwork, training and development, organisational structures and processes, employee and job attributes, and patient orientation).ConclusionThis umbrella review identifies the essential tangible and intangible themes of OC tools. OC tools in healthcare do not seem to be designed to determine deeper underlying dimensions of culture. We suggest approaching complex underlying OC problems by focusing on the intangible dimensions, rather than putting the tangible dimensions up front.

Open organisational culture: what does it entail? Healthcare stakeholders reaching consensus by means of a Delphi technique

“…21 29-43 The main researcher (RFM) developed a first set of 100 statements to represent different perspectives covering 16 OC themes in healthcare: 9 intangible themes (ie, commitment, trust, psychological safety, power, support, communication openness, blame and shame, morals and valuing ethics, and cohesion) and 7 tangible themes (ie, leadership, communication system, teamwork, training and development, organisational structures and processes, employee and job attributes, and patient orientation). 21 The statements were initially based on the statements of three validated and most commonly used questionnaires to measure organisational culture in healthcare: Hospital Survey on Patient Safety Culture (HSOPSC), Safety Attitudes Questionnaire (SAQ) and Patient Safety Climate in Healthcare Organizations (PSCHO). 21 Subsequently, all statements were iteratively discussed by the research team across five meetings.…”

“…21 The statements were initially based on the statements of three validated and most commonly used questionnaires to measure organisational culture in healthcare: Hospital Survey on Patient Safety Culture (HSOPSC), Safety Attitudes Questionnaire (SAQ) and Patient Safety Climate in Healthcare Organizations (PSCHO). 21 Subsequently, all statements were iteratively discussed by the research team across five meetings. As the majority of statements in these three questionnaires overlapped, the most appropriate wording of the statements was considered by the research team, and the remaining overlapping statements were removed.…”

“…Within the patient safety literature, 'communication' covers structured communication processes (eg, reporting, hand-offs, time-outs and transparency about results) as well as the openness of communication in terms of speaking-up. 20 Although communication is a key dimension in the majority of patient safety culture tools, 21 its openness is still under-represented compared with the structured processes 22 and speaking-up is difficult to address. 23…”

Overcoming Obstacles to Develop High-Performance Teams Involving Physician in Health Care Organizations

“…A toxic organizational culture has been recognized to be a major contributing factor of serious failings in health care delivery [ 47 ]. Qualitative analyses distinguished two different types (a) (so called) intangible themes (commitment, trust, psychological safety, power, support, communication openness, blame and shame, morals and valuing ethics, and cohesion) and (b) (so called) tangible themes (leadership, communication system, teamwork, training and development, organizational structures and processes, employee and job attributes, and patient orientation) that can identify a health care organization with a toxic culture [ 47 ]. Failure to recognize a toxic culture in the entire organization or in smaller components of the organization leads to the destruction of the possibility to produce high-performance teams.…”

“…Tools to assess (survey) for the presence of a toxic work culture should be routinely be used in the organization [ 47 ] by an outside body that reports to the board. When it becomes apparent that a toxic work culture exists in section of the organization or the entire organization, action should be taken immediately to correct this problem.…”