Work Culture


Article Author:
Marlon Bayot
Prasanna Tadi


Article Editor:
Nancy Sharts-Hopko


Editors In Chief:
Sherri Murrell


Managing Editors:
Avais Raja
Orawan Chaigasame
Khalid Alsayouri
Kyle Blair
Radia Jamil
Erin Hughes
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Navid Mahabadi
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Abbey Smiley
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beenish Sohail
Hajira Basit
Phillip Hynes
Sandeep Sekhon


Updated:
8/14/2019 12:40:57 PM

Definition/Introduction

Work culture is an organizational management concept which deals with the attitudes, beliefs, and perceptions of employees relative to the principles and practices adhered to by the institution. In the healthcare setting, work culture determines how medical, nursing, ancillary staff and other professionals actually work together in the pursuit of achieving organizational goals -- whether they work in clinics, hospitals, health centers, and other health institutions.

Major components of the work culture as it applies in healthcare practice include the statement of its mission and vision, institutional policies, work procedures, and organizational rules. Additionally, the current state of organizational development is an essential element for every healthcare setting as it determines the maturity of the organization which could directly influence the work culture as a whole. Considering these essential elements, every member of the organization, both from healthcare managers and staff, expects that a strong work culture must exist to maximize potentials in serving patients. Positive work culture is geared towards progressive improvement for the individual staff and the organization while a negative work culture fosters disintegration, loss of cooperation and collaboration among staff. Thus, this will result in regressing organizational value and overall performance. With this, it is crucial that work culture is assessed and improved in every health organization as it will significantly impact healthcare staff, leaders and managers, the organization itself and more importantly patient outcomes in terms of health.

Issues of Concern

The following factors have been described to be associated work culture of specific health care organization, dichotomized into positive and negative work cultures. Positive work cultures must be continually enhanced while learnings from negative work cultures must be sought and applied so as not to cause any further problems in the future.[1] 

  • Positive Work Culture

To create a work culture that will bring about a significant positive change in an organization, good leadership behavior is essential in maintaining the relationship of the team. Leaders who can scan the situation and the needs of the individual staff is a necessary skill to identify and bridge possible gaps in work implementation. Aligning the members to the direction of the organization sets the tone of the work for every member. When each staff at every level of the organization becomes fully aware of the situation, it will then become more natural for the leaders to mobilize the whole team and to delegate appropriate tasks in carrying out individual functions. Lastly, a leader who can inspire his colleagues in the organization will develop a positive work culture for all. Emphasis on these essential roles must be well taught to healthcare managers since every organization or team is unique on its own. When members of the organization have established a harmonious relationship with its leaders and vice versa, performance and satisfaction at work will be enhanced.[2][3]

Aside from leadership abilities, management skills require emphasis for all persons who are tasked to manage a unit, a section, a department or the administrative body of any healthcare organization. Managers must be well skilled in developing plans for the organization, organizing staff and attending to their needs at work. They should be able to have control of the organization especially to the implementation of the organization's mandate as a whole. Furthermore, managers who always monitor the progress of work implementation, and those who evaluate the organizational impact of its work on patients, do always have a more accurate view of the status of any healthcare institution. Managers and leaders can be two different things, but real leaders who strongly influence positive work culture always demonstrate both sets of skills. No employee could ever be more motivated and empowered to do the work when there are elements of trust and supportive supervision of one's performance and welfare at work.[4]

Another critical aspect that mediates the positive culture at work is the value of teamwork. Teamwork is the union of individual members to achieve a specific goal. Every healthcare organization, just like in other business entities, usually conduct activities that will enhance teamwork in the organization. Regularly, team building activities can help with the primary goal of uniting the members and not for rest and recreation. Healthcare managers should be able to come up with strategies that will engage the participation of all members that would soon break barriers to a good relationship at work.[5][6] When improving on teamwork, there are two central relationships involved: one between individual members; and one between managers and staff. Additionally, teamwork in healthcare settings should not include only healthcare professionals but also all other staff (ancillary services, administrative services, and the like) that are part of the organization. Successful teams sustain a positive work culture.[7][8]

  • Negative Work Culture

Excessive and prolonged stress among healthcare staff leads to burnout.[9] Hospitals, medical centers, and other health institutions are known to be demanding in terms of work. Work shifts among staff are in place, however, cannot still cope up with the demands required by each unit or department especially in government healthcare institutions and large healthcare private institutions as well. When these burnouts continue to inflict our healthcare teams who provide direct patient care and services, it will later impact negatively on the quality of care that they provide. Individual patients themselves can feel these changes. Recommendations may include the formulation of strategies that will determine the source of the stress and to apply interventions that will aid in minimizing if not eliminating stress and burnout at healthcare settings.

Another aspect related to the negative culture at work is absenteeism.[10] Due to the accumulation of stress at work, healthcare staff tends to lose satisfaction in performing their tasks and would eventually result in absence from work, which reduces productivity for the organization and would limit the quality of services that they provide. Aside from the demands from work, the staff sees going to work as a burden when they feel dissatisfied with leadership, experience blame, confusion, and discrimination, as well as incivility among colleagues.[11]

As both leaders and managers of a healthcare organization, it is imperative that these concerns receive proper attention other than just focusing on how to increase work output and profit. Leadership must remember that all healthcare staff, encompassing administrators, doctors, nurses, laboratory staff, pharmacists, technicians, hospital engineers, clerks, and housekeeping service personnel and other parts of the workforce are the essential resource of the healthcare system. Applying strategies that will work out a solution to sustain and continuously improve the positive work culture should always be a priority.

Clinical Significance

Work culture whether positive or negative significantly impacts the quality of care and delivery of health services to patients.[12] Positive work culture will always support the healthcare professional-patient relationship. It will build patient trust and gain confidence among staff who provide patient care. It will allow them to feel that other than the goal of working to cure their diseases, they receive care. When patients see doctors and nurses who are satisfied in doing their work and providing services, it enables them to follow instructions given to them (e.g., compliance with medications). When they feel teamwork is active among staff and stable leadership exists from their managers, these patients may be more than willing to allow themselves to seek medical advice and treatment.


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Work Culture - Questions

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An individual was working as a pharmacist in a hospital for almost five years. He knows all the routine activities and complies with the hospital rules and regulations in relation to his work. The management of the hospital is approachable, so he does not need to worry much about requesting for emergencies or leaves when necessary. He feels relaxed at work. Which of the following is indicative of a relaxed climate and culture?



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Which of the following indirectly influences the culture of an organization?



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You are the leader of the new healthcare organization and you have to establish a culture at work. You develop the core values of the organization. You have formulated its mission and vision. The direction has been set. Aside from a leader, you are also acting as a manager. Which of the following activities stated below will correctly guide you on the functions of a leader and a manager?



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Four staff nurses were interviewed at the human resource management office. They were asked about what ideally drives or provides them "reason they exist" in organizational culture. Staff A answered "patients". Staff B answered "peers" at work. Staff C answered "management", while Staff D answered "senior staff". Which of the following nursing staff should be appropriately promoted on the basis of their responses?



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A new diagnostic and multispecialty clinic established within the city started to develop a results-based culture because the administration wanted to attract more patients. Return of investment has been the focus, finances are well scrutinized before and during the clinic started operations and the work is highly controlled by the clinic manager. In cultivating a results-based work culture, what should be the second step?



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A new research scientist in an infectious disease organization was just accepted to her position two months ago, but she feels she is very much welcomed by all her colleagues within her new team, both by her workmates and her supervisor. She becomes open to learning new stuff about the organization and the work assigned to her. She believes that she will stay for long in the organization. The pressure at work is there, but it becomes manageable with the help of her new team. The scientist perceptions of her new work can be best described and can be caused by which of the following?



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Which of the following is not a barrier to change?



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A molecular assay was just implemented to rapidly diagnose a specific disease within a public health laboratory of a certain community. A laboratory professional received a copy of the new policy on the use of the new test. There is a strong political commitment from the local authorities. All out support was given including the supplies and logistics. The provider underwent a short-course training before they started work. Every patient counts on this person. Based on the facts presented, which of the following can be the reason why this provider did not meet the expected performance at work?



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An individual believes that his workplace has a healthy organizational culture. He feels he is part of the team and the active support of the management. He decides and accomplishes things on his own and keeps on improving his work with the assistance of his supervisor and teammates at work. He is willing to take more challenges at work as he believes his efforts will be appreciated even when there is no reward, such as an increase in salary. How would one best describe the culture of work does this person has?



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A newly hired doctor in a government hospital has a specialty focused on emergency medicine. She was very popular to all staff because in the past she was able to an emergency situation involving a well-known authority in the locality. Now that she new to the organization, which of the following is an important initial interaction that she should prioritize?



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A hospital employee has been involved as a victim of workplace violence. He reports the incidence to the management and later received support and assistance. He was then transferred to a new post. What should be done best to prevent the reoccurrence of such violence at work?



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Reducing stress, threat, and anxiety are the key and impacting factors in creating a safe emotional environment. Reducing interruptions increases productivity but is not usually an impactful factor when creating a safe emotional environment. Applying these principles, which of the following can be inferred when one learns that a hospital nurse already suffers from burnout, commits a lot of absences at work and feels emotionally unsafe at work?



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A research analyst was fortunate to be hired in a prestigious research organization that focuses on the prevention and control of leprosy after she graduated from college. Through time she received many awards and recognition for doing exemplary work. She believes that her immediate supervisor is fair to her because her works are duly recognized. She trusts the administration so much because of the promotions she got in the past which provided her the same eligibility with other colleagues. She is now the section head and was the only head assigned to her own office apart from the rest of the staff. Based on this scenario, which of the following elements of the award system could be best felt by most of this person's colleagues? What type of incentive is this?



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Work Culture - References

References

Almost J,Wolff A,Mildon B,Price S,Godfrey C,Robinson S,Ross-White A,Mercado-Mallari S, Positive and negative behaviours in workplace relationships: a scoping review protocol. BMJ open. 2015 Feb 4;     [PubMed]
Tsai Y, Relationship between organizational culture, leadership behavior and job satisfaction. BMC health services research. 2011 May 14;     [PubMed]
Kane-Urrabazo C, Management's role in shaping organizational culture. Journal of nursing management. 2006 Apr;     [PubMed]
Körner M,Wirtz MA,Bengel J,Göritz AS, Relationship of organizational culture, teamwork and job satisfaction in interprofessional teams. BMC health services research. 2015 Jun 23;     [PubMed]
André B,Sjøvold E, What characterizes the work culture at a hospital unit that successfully implements change - a correlation study. BMC health services research. 2017 Jul 14;     [PubMed]
Mijakoski D,Karadzinska-Bislimovska J,Basarovska V,Montgomery A,Panagopoulou E,Stoleski S,Minov J, Burnout, Engagement, and Organizational Culture: Differences between Physicians and Nurses. Open access Macedonian journal of medical sciences. 2015 Sep 15;     [PubMed]
Mendoza Llanos R, [Job satisfaction and organizational culture as predictors of absenteeism]. Revista medica de Chile. 2015 Aug;     [PubMed]
Nkomazana O,Mash R,Phaladze N, Understanding the organisational culture of district health services: Mahalapye and Ngamiland health districts of Botswana. African journal of primary health care     [PubMed]
Sfantou DF,Laliotis A,Patelarou AE,Sifaki-Pistolla D,Matalliotakis M,Patelarou E, Importance of Leadership Style towards Quality of Care Measures in Healthcare Settings: A Systematic Review. Healthcare (Basel, Switzerland). 2017 Oct 14     [PubMed]
Babiker A,El Husseini M,Al Nemri A,Al Frayh A,Al Juryyan N,Faki MO,Assiri A,Al Saadi M,Shaikh F,Al Zamil F, Health care professional development: Working as a team to improve patient care. Sudanese journal of paediatrics. 2014     [PubMed]
McEwan D,Ruissen GR,Eys MA,Zumbo BD,Beauchamp MR, The Effectiveness of Teamwork Training on Teamwork Behaviors and Team Performance: A Systematic Review and Meta-Analysis of Controlled Interventions. PloS one. 2017     [PubMed]
Dodwad SS, Quality management in healthcare. Indian journal of public health. 2013 Jul-Sep     [PubMed]

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