Almost every organization, whether public or private, on paper or in practice, has a culture that fairly dictates its everyday functioning. The term culture has many definitions but in this discussion it is defined as shared beliefs, values, symbols, and behaviors. Culture binds a workforce together and is its control mechanism, or purpose, to facilitate its functioning. These items are powerful driving forces in the success of an organization and their value to the community they serve whether it is a public or private entity will affect the success of any organization.
While cultures are found in some organizations more prominently than in others, there are those organizations where the culture of that specific organization’s ideal stands out above others. Police departments, military units and religious organizations all have a strong, centralized culture that forms its base and permeates its entire existence. Many times people outside of those professions do not understand the mentality or job commitment a person from one of these career fields shares with his/her co-workers.
An example would be the duty and honor commitment of a United State Marine, especially when considered by a person who was anti-military; the Marines belief or core value system is not understood. The medical profession and more specifically hospitals, demonstrate a common goal that simply stated, is the care and healing of the sick or injured. For the most part, the medical staff employed at a hospital is there for that specific purpose. The medical field brings together a vast array of individuals from different backgrounds and cultures.
But once they become a doctor, hospital nurse, surgical technician, etc. they take on a new life and thereby absorb a new culture into their lives. Subcultures, as defined by organizational theorists John van Maanen and Stephen Barley, are “a subset of an organization’s members who interact regularly with one another, identify themselves as a distinct group…and routinely take action on the basis of collective understandings unique to the group” (Cheney, 2011, 78-79) The organizational culture in a hospital is based on the premise that the hospital is there to provide a place for the care and healing of the sick or injured.
Organizational theorist Mary Jo Hatch puts forth that there are five (5) “Degrees of Cultural Integration and Differentiation” (Cheney, 77) identified as follows: Unitary, Diverse (Integrated), Diverse (Differentiated), Diverse (Fragmented) and Disorganized (Multi-cephalous) (Hatch, 1997, 210). A hospital in its purest form would be well represented as a Unitary culture because the staff as a whole all have the same values or beliefs. But individual staff or even medical units may fall into any of the other cultures identified as well.
A particular unit, i. e. cardiac telemetry floor, may be a Diverse (Fragmented) unit due to a group of nurses who do not view their critical task requirements in the same way and as a result the level of patient infections or deaths rises, causing unrest among the staff, supervisors, patient families and resulting in legal ramifications thereby fragmenting the staff’s solidarity. Social psychologist Edgar Schein formulated a theoretical model that shows an organization’s culture is built on three levels: artifacts, values and norms, and assumptions and beliefs.
Artifacts are usually the most common and visible sign of a specific culture. Schein puts forth that things such as nursing uniforms, terminology, surgical protocols and more, actually and accurately represent the basic aspects of organization’s culture. The values and norms aspect of his theory, while not always visible, can be seen through behavior of the individual or group; it reveals what is important to the group and how they treat each other within their organization. Each aspect of the profession may have an operating procedure or environment nique to that area of specialization, but still have the same values and norms for their actions.
In a surgical room, sterilization of the environment is much more important than it would be in a patient’s room on a medical/surgical floor, but they still have the same belief in keeping an open wound as clean as possible. While values in the medical profession do not vary as a whole, values do define accepted behavior and action. Genuine assumptions and beliefs are nurtured by a persons or organizations values and norms. Values vary only slightly in the various medical professions and facilities.
Depending on the medical specialty area, operational norms and methods may differ according to training priorities, equipment and environment unique to that specialty. For instance, the hospital in-patient wound care team may have the same desire to treat a patient’s wounds as a home health nursing team, but the methods of treatment or medications used may be different. Differences begin to surface when a patient is sent home on a negative pressure wound therapy system, i. e. a wound V. A. C. ®, that aids in the healing of wounds via suction (http://www. kci1. com/KCI1/vactherapy).
Many home health nurses does not know how to properly change the intricate dressing or fully understand this equipment or the damaging results that can occur if not changed properly. Faulty assumptions are therefore made based on the beliefs of the home health nurse of what should be done for the patient. When that happens, problems arise in this particular scenario that could result in the patient being brought back to the hospital for a further period of hospitalization due to a breakdown of their wounds or even the creation of new wounds as a result of improper V. A. C. ® placement.
The overriding culture of the medical field is based on the Physician’s Creed of “First, do no harm” (author uncertain but it is based on the Hippocratic Oath which states “to abstain from doing harm”). This belief echoes throughout the medical field all over the world. And while there are individual exceptions or exceptions in areas such as animal research for the betterment of mankind or the ethical issue of abortion, the creed has gone unchanged since the time of the ancient Greeks and before. Schein’s three (3) levels of artifacts, values and norms, and assumptions and beliefs, are evident in every clinical setting.
With further exploration, Hatch’s five (5) Degrees of Cultural Integration and Differentiation will also be found, albeit not everyone will be seen on every hospital floor or unit. Medical facilities are a kaleidoscope or a microcosm of many subcultures under the roof of the main culture of being a place for the care and healing of the sick or injured. Without that organizational culture giving guidance to all of the subcultures involved in this humanitarian career field, the death rate for minor injuries and diseases would compound exponentially.
Courtney from Study Moose
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