Identifying organizational culture and subcultures within Greek public hospitals

Spiritual Climate as is Perceived by Greek Clinical Nurses. A Validation study

Introduction:

Organisational climate generally refers to issues such as information sharing climate, appreciation and recognition, concern for employee well-being, ethics and quality performance. In hospitals, it represents the shared beliefs and values that may affect the quality of care in health care groups and which could be managed to improve the quality of care.

Aim:

Aim of the study was the translation of the Spiritual climate Scale (SCS) in Greek language and the validation of the scale for the Greek population.

Methods:

The SCS is an anonymous self-administered questionnaire that contains four, five-point Likert scale, closed questions. The questionnaire was translated into Greek language and then back translated in the English in order to be checked for any inconsistencies. The sample of the study was 275 nurses, working in two public hospital in Athens. Exploratory factor analysis, with principal components analysis was performed for checking the construct validity of the questionnaire. The test–retest reliability and the internal consistency were also examined. Statistical analysis performed by the use of SPSS 25.0. Statistical significance level was set at p=0.05.

Results:

From the total 275 of the participants 238(86.5%) were women and the mean age was 43.8±8.7. The final Greek version of the questionnaire includes all of the four questions and one factor was exported from the exploratory factor analysis. The Cronbach-α coefficient was 0.902 for the total questionnaire.

Conclusions:

The SCS is a valid and reliable questionnaire that can be used for assessing spiritual climate in Greek clinical areas.

Doctors' Perceptions and Practices of Breaking Bad News: A Qualitative Study From Greece

There is limited information about doctors' communication behaviors and their salient beliefs with regard to bad news disclosure in Greece. In this qualitative study we investigated the self-reported practices of doctors on breaking bad news, their perceptions about the factors affecting the delivery of such news, and their beliefs about the most appropriate disclosure manner. A focus group discussion and individual interviews were conducted. Twenty-five resident and specialist doctors from primary health care and hospital settings participated. We analyzed the collected data with content analysis techniques. Participants were found to acknowledge the importance of appropriate and effective delivery of bad news; however, none of them reported the implementation of empirically informed communication practices. They described communication patterns mainly formed by their work experience and often guided by the patient's family requests. Doctor, patient, and family characteristics and organizational features and resources were reported to affect the delivery of bad news. Participants perceived the most appropriate disclosure manner as an individualized approach to each patient's unique needs. They suggested an interdisciplinary, collaborative management of the delivery process and the establishment of formal supportive services. These findings may provide useful information for the development of tailored, empirically informed curriculum interventions and educational programs in order to address several barriers to communication. Sociocultural characteristics that influence the disclosure practice, as well as physicians' perceptions that are consistent with the optimal information delivery, should be taken into account. System-level strategies that focus on the development of patient-centered communication also need to be prioritized.

Organizational Culture and Individual Values in Greek Public Hospitals

Purpose:

The values are particularly important in the research of organizational culture and the person–organization (P–O) fit. This article tries to identify the culture dimensions that exist within public procurement in Greek public hospitals, based on employee characteristics.

Design/methodology/approach:

We have used exploratory factor analysis for the evaluation of multidimensional structure of organizational culture profile (OCP) scale. Then, we investigated the extent to which the OCP, with 54 items, that constitutes eight factors in the causative analysis of factors can be incorporated into the Quinn and Cameron theory of competitive values framework (CVF). In order to investigate this subject, we have developed a non-standard multidimensional scaling (MDS) that imposes the OCP on the solution space with the permutation test that evaluates the cohesion of engagements, which represents MDS and then we have extended our work to test our results by using structural equations modelling (AMOS).

Findings:

Internal consistency of all components was moderate to strong (a = 0.61 until 0.89). We realized that the OCP can be incorporated in the CVF, in a way the four quadrants which emerged have been formulated in four types of organizational culture.

Research limitations/implications:

The results have implied that the P–O fit can be assessed simply by the congruence of the person’s and the organization’s positions, measuring organizational culture in a way that is consistent with the CVF.

Practical implications:

We believe that our preliminary study can serve as an audit tool for managers and policy makers as well as a guide for recruitment of new employees in health care sector.

Originality/value:

This research fills the gap between organizational culture and the P–O fit in procurement offices in Greek public hospitals.

The association between subcultures and resistance to change – in a Swedish hospital clinic

Purpose

– The purpose of this paper is to explore the different subcultures and the employees’ preparedness for change at an orthopaedic clinic in a university hospital in Sweden.

Design/methodology/approach

– Surveys were sent out to 179 nurses and physicians. The survey included the two instruments Organisational Values Questionnaire and resistance to change (RTC) Scale.

Findings

– The results suggest a dominance of a human relations culture, i.e. flexibility, cohesion and trust, in the orthopaedic clinic. These characteristics seemed to decrease RTC. Opposite to this, planning, routines and goal setting appeared to increase change-resistant behaviour.

Practical implications

– By predicting potential obstacles in a certain context prior to a change process, resources can be used in a more optimal way. An instrument that pinpoints the culture of a particular healthcare setting may be a useful tool in order to anticipate the possible outcome of change.

Originality/value

– The rational goal/internal processes dimension exerted a stronger association with RTC than in earlier studies. Deeply rooted standards and routinised care models, governed by work schedules, could be an obstacle to introducing a care model based on the individual needs of the patient. There was, however, a surprisingly low RTC. The results are contrary to the accepted understanding of public organisations known to be slow to change.

Organizational culture in the primary healthcare setting of Cyprus

Background

The concept of organizational culture is important in understanding the behaviour of individuals in organizations as they manage external demands and internal social changes. Cyprus healthcare system is under restructuring and soon a new healthcare scheme will be implemented starting at the Primary Healthcare (PHC) level. The aim of the study was to investigate the underlying culture encountered in the PHC setting of Cyprus and to identify possible differences in desired and prevailing cultures among healthcare professionals.

Methods

The population of the study included all general practitioners (GPs) and nursing staff working at the 42 PHC centres throughout the island. The shortened version of the Organizational Culture Profile questionnaire comprising 28 statements on organizational values was used in the study. The instrument was already translated and validated in Greek and cross-cultural adaptation was performed. Participants were required to indicate the organization’s characteristic cultural values orientation along a five-point Likert scale ranging from “Very Much = 1” to “Not at all= 5”. Statistical analysis was performed using SPSS 16.0. Student t-test was used to compare means between two groups of variables whereas for more than two groups analysis of variance (ANOVA) was applied.

Results

From the total of 306 healthcare professionals, 223 participated in the study (72.9%). The majority of participants were women (75.3%) and mean age was 42.6 ± 10.7 years. Culture dimension “performance orientation” was the desired culture among healthcare professionals (mean: 1.39 ± 0.45). “Supportiveness” and “social responsibility” were the main cultures encountered in PHC (means: 2.37 ± 0.80, 2.38 ± 0.83). Statistical significant differences were identified between desired and prevailing cultures for all culture dimensions (p= 0.000).

Conclusions

This was the first study performed in Cyprus assessing organizational culture in the PHC setting. In the forthcoming health system reform, healthcare professionals will face challenges both at organizational level and professional status. Results of the study can serve as background knowledge for leaders and policy makers who seek interventions to improve performance before the implementation of a new national healthcare scheme.

Constructing the health care system in Greece: responsibility and powerlessness

OBJECTIVES

Based on health care professionals' (HPs) and patients' interviews about work demands and quality of care in hospitals, the study explores the way that patients and HPs constructed their identities to describe and construct the health care system in Greece.

DESIGN

This is a qualitative study using a focus group (FG) design.

METHODS

Seven FGs discussions were conducted: three FGs discussions were conducted for the assessment of job stressors (1 for doctors, 1 for nurses and 1 for residents) and four FGs discussions for the assessment of quality of care (1 for doctors, 1 for nurses, 1 for residents and 1 for patients). The sample consisted of health care professionals working in a teaching hospital in the region of Thessaloniki, Greece, and patients who had at least one experience of any kind in the same hospital. Transcripts of the FGs discussions underwent discourse analysis.

RESULTS

The results showed that both HPs and patients construct the health care system based on bipolar constructions of responsibility and powerlessness. In particular, participants use these constructions to allocate the responsibility to different levels of the health care system hierarchy or to the system per se constructing, at the same time, themselves as the 'viewers' of this system.

CONCLUSIONS

The study allowed a deeper understanding of issues related to quality of care in hospitals providing context-specific information. Identity in health care organizations was inextricably linked to power and responsibility. The need to deconstruct this responsibility/powerlessness ideology is discussed.

The role of learning and customer orientation for delivering service quality to patients

PURPOSE

This study seeks to investigate the impact that learning orientation, internal and external customer orientation have on quality of care delivered to patients. Additionally, given the differences between managerial and non-managerial employees regarding organizational value perception and focus on the needs of internal customers and patients, the study aims to examine potential variations in these relationships.

DESIGN/METHODOLOGY/APPROACH

The study took place in ten out of 31 public hospitals operating in the five largest districts in continental Greece. Hospitals were chosen on a random basis. Out of 800 questionnaires that were personally administered, 499 usable responses were gathered.

FINDINGS

The extent to which employees create and use knowledge and focus on satisfying the needs of both internal customers and patients is indicative of the quality of care provided. In addition, only managerial employees believe that learning orientation reinforces quality of care.

RESEARCH LIMITATIONS/IMPLICATIONS

The fact that employees rated quality of care delivered to patients and that most employees had extended tenure should be taken into consideration when interpreting these findings.

PRACTICAL IMPLICATIONS

Top management needs to create a strong and clear culture that emphasizes learning, as well as internal customer and patient orientation, and infuse them among all organizational members. Moreover, human resource management policies should be aligned to meeting or exceeding patients' requests and expectations.

ORIGINALITY/VALUE

The paper enhances existing knowledge with regard to the antecedents of offering medical care of high quality.

Identifying important motivational factors for professionals in Greek hospitals

Background

The purpose of this study was to identify important motivational factors according to the views of health-care professionals in Greek hospitals and particularly to determine if these might differ in the public and private sectors.

Methods

A previously developed -and validated- instrument addressing four work-related motivators (job attributes, remuneration, co-workers and achievements) was used. Three categories of health care professionals, doctors (N = 354), nurses (N = 581) and office workers (N = 418), working in public and private hospitals, participated and motivation was compared across socio-demographic and occupational variables.

Results

The range of reported motivational factors was mixed and Maslow's conclusions that lower level motivational factors must be met before ascending to the next level were not confirmed. The highest ranked motivator for the entire sample, and by professional subgroup, was achievements (P < 0.001). Within subgroups, motivators were similar, and only one significant difference was observed, namely between doctors and nurses in respect to co-workers (P < 0.05). Remuneration (and salary in particular) was reported as a significant incentive only for professionals in managerial positions. Health professionals in private hospitals were motivated by all factors significantly more than their public-hospital counterparts.

Conclusion

The results are in agreement with the literature which focuses attention to management approaches employing both monetary and non-monetary incentives to motivate health care workers. This study showed that intrinsic factors are particularly important and should become a target for effective employee motivation.