- Open Access
- Authors : Eugene Bennett , Surbhi Ojha , Chintalachervu Vishnu Vardhan
- Paper ID : IJERTV10IS020031
- Volume & Issue : Volume 10, Issue 02 (February 2021)
- Published (First Online): 12-02-2021
- ISSN (Online) : 2278-0181
- Publisher Name : IJERT
- License: This work is licensed under a Creative Commons Attribution 4.0 International License
Indian Healthcare and Organisational Culture: A Review
Eugene Bennett, Surbhi Ojha, Chintalachervu Vishnu Vardhan
(MBA- Hospital and Healthcare Management) Supervised by: Divya Kalra (Assistant Professor) Affiliation: Lovely Professional University, Punjab, India
Abstract:- Organisational culture is a set of combined principles, values and beliefs that are determinants of how individuals act in an organisation. An organisations culture consists of common beliefs and values that leaders establish, which are communicated and emphasized using different methods, ultimately aligning perceptions, behaviours and comprehension of employees.
This article is on defining and interpreting the organisational culture in the Indian healthcare industry and how the performance of health facilities is affected. The study is done through thorough analysis of secondary data and scholarly research on organisational culture, with more highlights on healthcare.
The objectives of this article were to explain in detail, what makes up the organisational culture in Indian healthcare facilities and examine the impact of how organisational culture affects overall performance and delivery of healthcare in the country. Related literature was carefully analysed, and this revealed that in hospitals, organisational culture has tremendous influence on the staff relation, patient overall satisfaction, and a bulk of the processes which go on in the organisation.
There is great room for more academic and research studies in the area of organisational culture, especially in the healthcare sector and more attention should be given to the involvement of all stakeholders in contributing to patient care and quality delivery of health services in all facilities in the country.
Keywords:- Organisation, culture, principles, healthcare, hospitals, satisfaction, performance.
The expression of life of an organisation lies in its culture, thus organisational culture can be likened to the personality of that organisation (1). Culture differs from one to the other, and no two distinct areas are likely to have the same organisational culture. An immanent part of humans is culture, and this manifests in different forms such as national, regional, organisational, department culture among others (2). Healthcare has evolved from home remedies, traditional medicine and practices to systems of complex and sophisticated procedures and technologies.
Development is dependent on the lasting culture that is prevalent in the organisation, as it tends to be a pivotal player in the development. In an organisation, culture directs and shapes the way and thinking of staff of the organisation. There are significant variations among managers in the private, public and international sectors. Organisation culture profile can provide a reasonable mapping of organisation culture. Commitment of employees is found when their values are similar to those of the organisation (3). Behavioural norms and values encourage activities that represent the expression of organisational culture (4).
The culture of an organisation identifies the appropriate way to behave within the organisation. This consists of common beliefs and values that leaders establish, which are communicated and emphasized using different methods, ultimately aligning perceptions, behaviours and comprehension of employees. Organisational culture sets the basis for everything done in an organisation (5).
Three distinct levels of organisational culture were laid out by Edgar Henry Schein: artifacts and behaviours, espoused values and assumptions. He also indicated organisational culture as the most challenging organisational attribute to alter (6).
There exist two key disciplinary foundations of organisational culture, thus the sociological and anthropological foundations. The sociological believes that organisations have cultures, whereas the anthropological believes that cultures are organisations (7). For each of these foundations, two separate approaches to culture have been developed: a functional approach in which culture derives from collective behaviour; and a pragmatic approach in which culture consists of individual perceptions and understanding (8).
Healthcare Organisational Culture
In healthcare organisations, vision statements, mission statements, organisational structure, management approaches, and other factors define organisational culture. Organisational culture is associated with outcomes of patient care such as mortality rates, readmission, patient satisfaction, clinical outcomes, hospital acquired infections and more (9). Care in health facilities with less effective staff cohesion put patients at greater risk outcome challenges, compared with facilities with more effective cohesion (10). A hospital with shared culture may emphasize working as a team, while consistency and cohesion flourish in a more controlled culture. Competition-based culture needs to operate plainly and be change sensitive; creative culture, on the other hand, promotes innovation, risk-taking, and individual resourcefulness (11).
Working with these objectives in mind, this paper seeks to bring to understanding:
Composition of the organisational culture in Indian healthcare facilities.
Examine the impact of how organisational culture affects overall performance and delivery of healthcare in the country.
Review of Related Literature
The hospital's organisational ethos can be seen in its facilities, organisation process, vision, and mission statements (12). Culture in the hospital depends on the output of the workers. Organisational culture in health care relies on the type of patients, physical discomfort, managerial types, emotions, and the actions of staff.
There are major gaps between private and government hospitals. The hospitals do not expect benefit from the government sector, yet still provide services for patients. Private hospitals are run in order to make something out of them. There are certain cultural characteristics in any hospital that stress clinical and non-clinical staff (13). The organisation will be profoundly influenced by the cultural forms of the organisation. Some contribute to the results being down because of economic issues. The organisation can be defined according to management and human resource (14).
Institutional heads and managers have duties that are very vital and pivotal in planning and delivering of quality healthcare to the public. Research was conducted amongst managers, which revealed that organisational culture stems from complex processes contrary to old ideologies. The culture affects how healthcare is delivered and the quality-of-care delivery. Care delivery excellence, right and ethical values, participation, expertness, value-for-money, fealty to delivery of quality and strategic thinking are some of these influencers. There is however a disparity between delivery of quality healthcare and cost effectiveness (15).
In comparing group and nongroup cultural elements in a study, researchers found that group elements contributed positively to the care of patients, while nongroup elements led to negative interactions and outcomes. Flexible management, unity and teamwork contribute as group elements, leadership conflicts, complacency and hierarchy fall under nongroup cultural elements (16).
The Government of India has not focused much research in organisational culture in the health sector, especially when it focuses on the core organisational values. Using OCAPACE (Openness, Confrontation, Trust, Authenticity, Proaction, Autonomy, Confrontation and Experimentation), a specialised tool to collect data from health workers in primary health facilities, researchers concluded that organisational culture needed more focus by promoting open expressions and idea-sharing. Further, primary health centres should not be put under stringent bonds, and staff should be allowed to partake in decision making in order to advance the organisational culture (17).
Significant growth has been observed in the healthcare market in India, and both the public and private sectors are having dominance in the market. With the rise in the health industry worldwide, theres increasing competition among providers of modern healthcare. Government is focusing funds on health provision to meet the obligations to the people for the provision of quality healthcare (18).
In determining the relation between perceptions and how well hospitals perform, research was conducted, outlining that rules and regulations as well as empowerment were key to the organisational culture. Cost control and focus on customers have an influence on healthcare delivery and patient satisfaction. Management has the role of balancing the organisational culture and the dynamic environment to give the best output (19).
Attributes of organisational culture enhances the coordination of care in hospitals. Clan culture, according to research can be adapted by management to improve coordination of delivery of healthcare in hospitals. Organisational culture was categorised under hierarchy, clan, adhocracy and market. In study, service climate was tied to commitment to work and staff attitude towards patients during care delivery, and establishment of good relation and coordination among care providers significantly improves overall quality of care delivered (20).
Manpower has always been a challenge in the healthcare industry, and Human Resource personnel are on the edge when it comes to recruiting health workers, because the care offered to patients must not be compromised. Healthcare is in high demand in rural India, which constitutes a greater portion of the population, pressurising health managers due to weak staff strength in these areas. Doctors, nurses and administrative workers are scarce, and the output from the training institutions is not meeting the increasing demand. Attrition is a crippling force in the industry, and healthcare is suffering at the peril of the unfilled vacuums that the high attrition rate is causing. Health workers seeking for greener pastures and better service offerings does not reduce the demand for healthcare in the areas or facilities they leave. In the instance where staff refuse to modernise their ways and resist digitalisation, quality care is put a number of steps behind (21).
With the aim of examining hospital organisational culture in relation to commitment to the hospital among nursing executives, a study was conducted which indicated a positive correlation between organisational culture in hospitals and organisational commitment. The higher the quality of nursing managers, the more positive impact it has on the organisational culture. Even though conventional training yields good results, good hospital culture promotes and enhances individual performance. In order to increase the overall performance of the hospital, management should be attentive to driving forces that increase affective, continuous and normative commitment (22).
Reviewing low- and middle-income countries, and how their health sector reforms are influenced by organisational culture, researchers found distance in power, avoidance of uncertainty and in-group and institutional collectivism as dimensions of organisational culture which affect reforms in the health sector. Practices in the organisation mediate these effects (23).
Organisational culture is a shaping tool for behaviour and actions in an organisation. In a cross-sectional study to understand the relationship between organisational culture and job satisfaction in primary hospitals, employees of hospitals were found to have positive work attitude in environments with innovative and clan culture. Key players and management must improve their work towards reinforcing social interaction of staff of the hospitals (24).
The review recognised organisational culture as very essential to productivity and quality healthcare delivery in India and across the globe. In both the government and private sectors, organisational culture was seen to influence staff behaviour and patient satisfaction. The full implementation of organisational culture to the benefit of the citizenry goes beyond the confines of only management, but the entire staff strength. The complexity of organisational culture means that both internal and external factors act as influencers to the culture affecting the health sector. The issue of cost versus quality was also identified. Since the healthcare industry is patient-centred, the focus of all organisational culture is to attain excellent patient satisfaction. Health facilities who offer the basic care (primary health) should be given decision-making mandates, to promote organisational culture in the hospitals and health facilities. The culture existent in hospitals was found to play a pivotal role in hospital performance. Challenges that arise in the healthcare institutions also affect the organisational culture and in effect the quality of care. Staff shortages, attrition, urbanisation among others are devastating challenges in health facilities. Health reforms were identified as being negatively impacted by poor work culture, and in low- and middle-income nations, these reforms are crippled.
An understanding has been achieved on organisational culture in Indian healthcare. In conclusion, it can be established that organisational culture influences staff attitudes to work, delivery of care and overall patient satisfaction. All structures, policies and traditions clearly outline the organisational culture of health facilities. Both subtle and notable changes in in the healthcare industries, develop and transform the culture that is present in the sector. Since theres limited research in the area of healthcare- related organisational culture, scholars can take the opportunity to explore other areas of this subject area.
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