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HCA 822 TOPIC 1 Discussion Question One

HCA 822 TOPIC 1 Discussion Question One

What are the most important factors for leaders to consider when selecting a method for assessing the culture of a health care organization? Why?

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

HCA 822 TOPIC 1 Discussion Question One

HCA 822 TOPIC 1 Discussion Question One

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.
Keywords: organisational culture; healthcare culture; NHS; patient safety culture; defining culture;
clinical governance; patient safety measurement; measuring culture
1. Introduction
Across the international healthcare sector, organisational culture (OC) and working environments
have become central to all things patient safety. Culture is a term that has become synonymous
with patient experience, satisfaction, mortality, and morbidity. Francis [1] chaired an independent
public inquiry into catastrophic failings in care at Mid Staffordshire NHS Foundation Trust UK,
the inquiry highlighted how healthcare OC was a major contributing factor in the repeated failure to
meet patients’ needs. Francis made a total of 290 recommendations based on the official enquiry, one
of his recommendations was the need to develop a culture of care barometer, to accurately measure
OC in practice.

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Over the past 20 years, we have witnessed the rise of research engagement and activities
involving stakeholder groups made up; of clinical experts, educational institutions, professional bodies
and regulators all of whom are trying to decipher the complexities of the working environment.
Understanding local culture has become a primary focus of clinical governance work internationally,
Healthcare 2019, 7, 127; doi:10.3390/healthcare7040127 www.mdpi.com/journal/healthcare
Healthcare 2019, 7, 127 2 of 10
there is a recognised urgent need to disentangle the complexity of how healthcare OC is impacting on
patient care and staff wellbeing.
The Care Quality Commission (CQC) is the United Kingdom’s (UK) healthcare regulator [2].
The UK Department of Health (DH) is a branch of the UK government concerned with the maintenance
of public health and provides leadership for the NHS [3]. The Health Foundation is an independent
UK charity that focuses on healthcare improvement by making links between knowledge, research
and analysis [4]. Each of these organisations openly acknowledge that cultural change is essential to
creating a safe and sustainable NHS which can meet future challenges of increasingly complex patient
groups [5–7].
This notion of needing to develop a greater understanding of healthcare OC has been echoed in
more recent reports such as The Morecambe Bay Investigation, which investigated failings in maternity
care at Furness General Hospital UK [8]. The investigation concluded that there were at least seven
missed opportunities at almost every level, which meant poor clinical care was not investigated and
led to the preventable deaths of one mother and eleven babies [8]. The report highlighted that one of
the biggest factors which impacted on these missed opportunities was OC.
Culture was again in the spotlight in the serious case review into failings at Gosport War
Memorial Hospital UK. The investigation found an institutionalised culture of practice that accepted
the shortening of lives through prescribing and administering opioids without medical justification [9].
Over a period of 12 years, a culture developed where concerns were ignored and unsafe practices went
unchallenged, resulting in 456 people having their lives unnecessarily shortened [9,10].
Work by Jones [9], Budd [10], and Kirkup [8] reveals an urgent need to understand how and why
these incidents occur and why it is that individual health professionals and teams perform in this way.
It is imperative to establish and understand what shapes the basic values, beliefs and assumptions that
underpin patterns of this type of behaviour. Similarly, with the Francis inquiry [1], health professionals
were found to be neglectful and destructive in their behaviours. These major scandals warrant further
analysis by calling for a deeper understanding of the nature of how healthcare OC is assessed and
measured in practice.

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