WHAT CAUSES AND CREATES CULTURE?

How do organizations—such as your college, your favorite store, and HCOs—end up with the cultures they have? What causes and creates culture? Why does culture differ among HCOs? For example, some HCOs have a cautious, risk-averse culture whereas others have an innovative, risk-taking culture. Organization culture is partly a result of leaders deciding which norms, behaviors, and values they want in the HCO. But there is more to it than leaders deciding which culture they want. Strong forces and factors determine what the culture actually will be, and as we learned earlier, that might be different from what managers want it to be! Many forces and factors—some external and others internal—influence an HCO’s cultural values, norms, and beliefs (Daft 2016). A model of these forces and factors is shown in exhibit 11.1; the forces and factors (Daft 2016; Griffin, Phillips, and Gully 2017; Walston 2017) are listed here, with relevant healthcare-related examples. The Using Chapter 11 in the Real World sidebar has additional real-world examples from HCOs.

WHAT CAUSES AND CREATES CULTURE?

How do organizations—such as your college, your favorite store, and HCOs—end up with the cultures they have? What causes and creates culture? Why does culture differ among HCOs? For example, some HCOs have a cautious, risk-averse culture whereas others have an innovative, risk-taking culture. Organization culture is partly a result of leaders deciding which norms, behaviors, and values they want in the HCO. But there is more to it than leaders deciding which culture they want. Strong forces and factors determine what the culture actually will be, and as we learned earlier, that might be different from what managers want it to be! Many forces and factors—some external and others internal—influence an HCO’s cultural values, norms, and beliefs (Daft 2016). A model of these forces and factors is shown in exhibit 11.1; the forces and factors (Daft 2016; Griffin, Phillips, and Gully 2017; Walston 2017) are listed here, with relevant healthcare-related examples. The Using Chapter 11 in the Real World sidebar has additional real-world examples from HCOs.

  • External laws, standards, demands (e.g., nondiscrimination laws, accreditation standards, public demands for diversity and inclusion)
  • Organization mission (e.g., mission to improve the population health status of all people in the local community)
  • Organization structure (e.g., decentralized structure giving lower-level employees more autonomy in their work)
  • Rewards and punishments (e.g., praise for improving clinical integration throughout the continuum of care)
  • Training and education (e.g., an online video tutorial that demonstrates how to use active listening to improve the patient experience)
  • Physical work setting (e.g., remodeling and redecorating work spaces to support creativity)
  • Beliefs, values, and norms of formal leaders (e.g., the vice president believes that too much competition among staff might cause unethical behavior)
  • Beliefs, values, and norms of informal leaders (e.g., a longtime employee telling new employees during lunch that honesty is what really matters in the HCO)
  • Beliefs, values, and norms of employees (e.g., a dental hygienist values cleanliness)
  • Ceremonies, symbols, rituals, and activities (e.g., the daily morning huddle celebrates yesterday’s handling of an emergency and then prepares the team for today’s priorities)
  • Stories and legends (e.g., the story about how Andrea made it to work despite three feet of snow—or was it four?—back in 2007 because her patients needed her)
  • Language (e.g., the way the supervisor talked enthusiastically about teamwork and collaboration)
  • External laws, standards, demands (e.g., nondiscrimination laws, accreditation standards, public demands for diversity and inclusion)
  • Organization mission (e.g., mission to improve the population health status of all people in the local community)
  • Organization structure (e.g., decentralized structure giving lower-level employees more autonomy in their work)
  • Rewards and punishments (e.g., praise for improving clinical integration throughout the continuum of care)
  • Training and education (e.g., an online video tutorial that demonstrates how to use active listening to improve the patient experience)
  • Physical work setting (e.g., remodeling and redecorating work spaces to support creativity)
  • Beliefs, values, and norms of formal leaders (e.g., the vice president believes that too much competition among staff might cause unethical behavior)
  • Beliefs, values, and norms of informal leaders (e.g., a longtime employee telling new employees during lunch that honesty is what really matters in the HCO)
  • Beliefs, values, and norms of employees (e.g., a dental hygienist values cleanliness)
  • Ceremonies, symbols, rituals, and activities (e.g., the daily morning huddle celebrates yesterday’s handling of an emergency and then prepares the team for today’s priorities)
  • Stories and legends (e.g., the story about how Andrea made it to work despite three feet of snow—or was it four?—back in 2007 because her patients needed her)
  • Language (e.g., the way the supervisor talked enthusiastically about teamwork and collaboration)

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