Diagnosis of organisational culture within an NHS Emergency Department

Abstract

Background The academic literature demonstrates that organisational culture contributes to variation between healthcare organisations in outcomes and performance, patient satisfaction, innovation, healthcare quality and safety and employee job satisfaction. Objectives/methods The aims of this research were: (1) to review literature on organisational culture; (2) to identify the dominant culture within the Belfast RVH Emergency Department by using a combination of both the 'Organisational Culture Assessment Instrument' and 'Rich Pictures' soft systems methodology; and (3) to formulate recommendations. Results/conclusion We found that the dominant organisational culture is a market culture (29.74 points), followed by hierarchy culture (28.97 points) then a clan culture (25.55 points) and an adhocracy culture (15.74 points), this infers an emphasis is placed predominantly on results and profitability. The results also look at the difference between current and preferred organisational culture. The largest desired difference can be seen in clan culture, with an increase of 12.93 points. Market culture decreases by 12.39 points. Hierarchy culture decreases with 3.58 points and adhocracy culture increases with 3.04 points. The dominant culture in the preferred situation becomes clan culture, followed by hierarchy culture, adhocracy culture and market culture. The results also show there was a differing gap within all professional groupings with admin (24.97 points), doctors (33.71 points), nurses (40.36 points) and others (11.08 points). The Rich Pictures results highlight contrasting multidisciplinary dynamics in regard to hierarchy, interteam cooperation and a team while working under extreme pressure, and were committed to quality, patient safety and service innovation.