Organizational Culture and Change

Collection of articles on Organizational Culture and Change is available here.

Using a Generalizable Photo-Coding Methodology for Assessing Organizational Culture Artifacts.
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Byrne ZS, Cave KA, Raymer SD.
Journal of business and psychology 2021 oct:1-15.
Despite scholars’ reliance on Schein’s (1990) three-interconnected layer framework of organizational culture (i.e., artifacts, values/norms, underlying assumptions), few, if any, measure artifacts. This gap is significant because artifacts are readily visible and provide valuable insight into understanding the perpetuation of norms through their manifestation in the work environment. Moreover, existing assessments focus on one layer only, either values/beliefs or underlying assumptions, resulting in only a partial picture of culture. In this tutorial-based paper, we demonstrate a grounded theory approach comprising content analysis, thematic analysis, and intensity scoring, to develop an unobtrusive method for coding artifacts seen in photos of office spaces. Unobtrusive methods reduce participant burden, which is critical because existing assessments of culture are time consuming and/or rely on numerous participants. We demonstrate how to use the photo coding method and wrap-up the tutorial by showing how artifact coding augments an existing qualitative culture assessment, emphasizing the added value of artifact assessment. We hope by providing an unobtrusive method to artifact coding, researchers will start assessing this important layer of culture to achieve a more comprehensive understanding of organizational culture.

Nurses’ perception of the organisational context of nursing homes: a descriptive study [Article in Italian]
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Conti A, Campagna S, Clari M, Gianino MM, Dimonte V.
Assist Inferm Ric 2021;40(1):20-29.
. Nurses’ perception of the organisational context of nursing homes: a descriptive study. INTRODUCTION: The increasing number of the elders admitted to nursing homes (NH) requires a particular emphasis on improving the quality of nursing care. The evaluation of the organizational context has recently received growing interest, for its contribution to understanding of care outcomes and staff’s needs. AIM: To describe the characteristics and the nurses’perception of organizational context of NHs in which they work. METHODS: A cross-sectional study was conducted in 50 NHs in the Piedmont and Aosta Valley regions. The following data were collected: sociodemographic information on nurses, years of work experience, contract type, and work-hour profile; organizational information included ownership, size, occupancy rate; and for the organizational context, the Alberta Context Tool was administered. RESULTS: Of the 312 nurses, 266 (85%) participated in the study; 79% had a university degree. Perceived organisational context scored low (median values 2.5) in terms of the availability of Interactions (Formal and Informal), Resources, Personnel and time, but good with median values above 3.5/5 on Leadership, Culture, Evaluation, Social Capital and Space, with differences according to years of experience, type and size of facility; for example, nurses working in private facilities perceived their organisational context as better than those working in public facilities. CONCLUSIONS: NHs are workplaces that are still not frequently chosen by nurses and essentially considered as places of transition or end of the career. In spite of organizational contexts perceived as positive, tangible efforts are needed to improve working conditions and the perception of nurses’ role.

The RELATE model: strategies to effectively engage healthcare organisations to create amenable contexts for implementation.
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De Brun Aoife, McAuliffe E.
Journal of health organization and management 2021 jun;ahead-of-p(ahead-of-print).
PURPOSE: The field of implementation science has emerged as a response to the challenges experienced in translating evidence-based practice and research findings to healthcare settings. Whilst the field has grown considerably in recent years, comparatively, there is a conspicuous lack of attention paid to the work of pre-implementation, that is, how we effectively engage with organisations to support the translation of research into practice. Securing the engagement and commitment of healthcare organisations and staff is key in quality improvement and organisational research. In this paper the authors draw attention to the pre-implementation phase, that is, the development of an amenable context to support implementation research. DESIGN/METHODOLOGY/APPROACH: Drawing from examples across an interdisciplinary group of health systems researchers working across a range of healthcare organisations, the authors present a reflective narrative viewpoint. They identify the principal challenges experienced during the course of their work, describe strategies deployed to effectively mitigate these challenges and offer a series of recommendations to researchers based on their collective experiences of engaging in collaborations with healthcare organisations for research and implementation. This reflective piece will contribute to the narrative evidence base by documenting the challenges, experiences and learning emerging from the authors’ work as university researchers seeking to engage and collaborate with healthcare organisations. FINDINGS: The RELATE model is presented to guide researchers through six key steps and sample strategies in working to secure organisational buy-in and creating a context amenable to implementation and research. The six stages of the RELATE model are: (1) Recognising and navigating the organisation’s complexity; (2) Enhancing understanding of organisational priorities and aligning intervention; (3) Leveraging common values and communicating to key individuals the value of implementation research; (4) Aligning and positioning intervention to illustrate synergies with other initiatives; (5) Building and maintaining credibility and trust in the research team; and (6) Evolving the intervention through listening and learning. RESEARCH LIMITATIONS/IMPLICATIONS: The authors hope this guidance will stimulate thinking and planning and indeed that it will encourage other research teams to reflect and share their experiences and strategies for successful engagement of organisations, thus developing a knowledge base to strengthen implementation efforts and increase efficacy in this important enterprise. ORIGINALITY/VALUE: Researchers must relate to the world’s everyday reality of the healthcare managers and administrators and enable them to relate to the potential of the research world in enhancing practice if we are to succeed in bringing the evidence to practice in a timely and efficient manner. Climates receptive to implementation must be developed incrementally over time and require actors to navigate messy and potentially unfamiliar organisational contexts. In this paper, the often invisible and lamentably underreported work of how we begin to work with healthcare organisations has been addressed. The authors hope this guidance will stimulate thinking and planning and indeed that it will encourage other research teams to reflect and share their experiences and strategies for successful engagement of organisations, thus developing a knowledge base to strengthen implementation efforts and increase efficacy in this important enterprise.

Contextual factors and mechanisms that influence sustainability: a realist evaluation of two scaled, multi-component interventions.
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Flynn R, Mrklas K, Campbell A, Wasylak T, Scott SD.
BMC health services research 2021 nov;21(1):1194.
BACKGROUND: In 2012, Alberta Health Services created Strategic Clinical Networks(TM) (SCNs) to develop and implement evidence-informed, clinician-led and team-delivered health system improvement in Alberta, Canada. SCNs have had several provincial successes in improving health outcomes. Little research has been done on the sustainability of these evidence-based implementation efforts. METHODS: We conducted a qualitative realist evaluation using a case study approach to identify and explain the contextual factors and mechanisms perceived to influence the sustainability of two provincial SCN evidence-based interventions, a delirium intervention for Critical Care and an Appropriate Use of Antipsychotics (AUA) intervention for Senior’s Health. The context (C) + mechanism (M) = outcome (O) configurations (CMOcs) heuristic guided our research. RESULTS: We conducted thirty realist interviews in two cases and found four important strategies that facilitated sustainability: Learning collaboratives, audit & feedback, the informal leadership role, and patient stories. These strategies triggered certain mechanisms such as sense-making, understanding value and impact of the intervention, empowerment, and motivation that increased the likelihood of sustainability. For example, informal leaders were often hands-on and influential to front-line staff. Learning collaboratives broke down professional and organizational silos and encouraged collective sharing and learning, motivating participants to continue with the intervention. Continual audit-feedback interventions motivated participants to want to perform and improve on a long-term basis, increasing the likelihood of sustainability of the two multi-component interventions. Patient stories demonstrated the interventions’ impact on patient outcomes, motivating staff to want to continue doing the intervention, and increasing the likelihood of its sustainability. CONCLUSIONS: This research contributes to the field of implementation science, providing evidence on key strategies for sustainability and the underlying causal mechanisms of these strategies that increases the likelihood of sustainability. Identifying causal mechanisms provides evidence on the processes by which implementation strategies operate and lead to sustainability. Future work is needed to evaluate the impact of informal leadership, learning collaboratives, audit-feedback, and patient stories as strategies for sustainability, to generate better guidance on planning sustainable improvements with long term impact.

Organizational context and the learning and change readiness climate for implementing an evidence-based shared decision-making aid in US rheumatology clinics.
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Hearld L, Hall A, Kelly RJ, Karabukayeva A, Singh J.
Journal of health organization and management 2021 jul;ahead-of-p(ahead-of-print).
PURPOSE: The purpose of this study was to examine the organizational context that may support learning and change readiness climates that previous research has found to be conducive to implementing evidence-based interventions. DESIGN/METHODOLOGY/APPROACH: An exploratory, mixed method evaluation that included 15 rheumatology clinics throughout the United States was performed. Quantitative data were collected using a web-based survey completed by 135 clinic members. Qualitative data were collected via semi-structured interviews with 88 clinic members. FINDINGS: In general, clinics reported strong, positive learning and change readiness climates. More complex organizations (e.g. multispecialty, academic medical centers) with rational/hierarchical cultures and members with longer tenure were associated with less supportive learning and change readiness climates. The authors’ findings highlight opportunities for organizational leaders and evidence-based intervention sponsors to focus their attention and allocate resources to settings that may be most susceptible to implementation challenges. ORIGINALITY/VALUE: First, the authors address a deficit in previous research by describing both the level and strength of the learning and change readiness climates for implementing an evidence-based shared decision-making aid (SDMA) and examine how these vary as a function of the organizational context. Second, the study examines a broader set of factors to assess the organizational context (e.g. organizational culture, organizational structure, ownership) than previous research, which may be especially salient for shaping the climate in smaller specialty clinics like those we study. Third, the authors utilize a mixed methods analysis to provide greater insights into questions of how and why organizational factors such as size and structure may influence the learning and change readiness climate.

From Theory to Implementation: Adaptations to a Quality Improvement Initiative According to Implementation Context.
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Olaniran AA, Oludipe M, Hill Z, Ogunyemi A, Umar N, Ohiri K, et al.
Qual Health Res 2021 nov:10497323211058699.
As countries continue to invest in quality improvement (QI) initiatives in health facilities, it is important to acknowledge the role of context in implementation. We conducted a qualitative study between February 2019 and January 2020 to explore how a QI initiative was adapted to enable implementation in three facility types: primary health centres, public hospitals and private facilities in Lagos State, Nigeria.Despite a common theory of change, implementation of the initiative needed to be adapted to accommodate the local needs, priorities and organisational culture of each facility type. Across facility types, inadequate human and capital resources constrained implementation and necessitated an extension of the initiative’s duration. In public facilities, the local governance structure was adapted to facilitate coordination, but similar adaptations to governance were not possible for private facilities. Our findings highlight the importance of anticipating and planning for the local adaptation of QI initiatives according to implementation environment.

Context, mechanisms and outcomes of dementia special care units: An initial programme theory based on realist methodology.
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Palm R, Fahsold A, Roes M, Holle B.
PloS one 2021;16(11):e0259496.
BACKGROUND: Dementia special care units represent a widely implemented care model in nursing homes. Their benefits must be thoroughly evaluated given the risk of exclusion and stigma. The aim of this study is to present an initial programme theory that follows the principles of realist methodology. The theory development was guided by the question of the mechanisms at play in the context of dementia special care units to produce or influence outcomes of interest in people with dementia. METHODS: The initial programme theory is based on qualitative interviews with dementia special care stakeholders in Germany and a realist review of complex interventions in dementia special care units. The interviews were analysed using content analysis techniques. For the realist review, a systematic literature search was conducted in four scientific databases; studies were appraised for quality and relevance. All data were analysed independently by two researchers. A realist informed logic model was developed, and context-mechanism-outcome (CMO) configurations were described. RESULTS: We reviewed 16 empirical studies and interviewed 16 stakeholders. In the interviews, contextual factors at the system, organisation and individual levels that influence the provision of care in dementia special care units were discussed. The interviewees described the following four interventions typical of dementia special care units: adaptation to the environment, family and public involvement, provision of activities and behaviour management. With exception of family and public involvement, these interventions were the focus of the reviewed studies. The outcomes of interest of stakeholders include responsive behaviour and quality of life, which were also investigated in the empirical studies. By combining data from interviews and a realist review, we framed three CMO configurations relevant to environment, activity, and behaviour management. DISCUSSION: As important contextual factors of dementia special care units, we discuss the transparency of policies to regulate dementia care, segregation and admission policies, purposeful recruitment and education of staff and a good fit between residents and their environment.