NURS 6231: Week 4: Organizational Systems and Structures, Part 2

As Edgar Schein points out in his seminal work Organizational Culture and Leadership, both the Egyptians and the Mayans built pyramids. It would be easy to make the assumption that the building of pyramids must have similar meaning. However, in some cultures, pyramids housed tombs, while in others, they were temples. Within each culture, the meaning of the pyramid was likely evident, but to an outsider’s eye, incorrect assumptions could be made rather easily.

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Last week, you began to analyze an organization’s systems and structures as groundwork for promoting patient safety and health care quality. The culture of an organization is also critically important. Leader-managers must understand the nuances of an organization’s culture to effectively address organizational issues.

This week you examine the influence of culture on the organization, and on efforts to promote positive systems-level change.

In addition, this week you continue your evaluation of a health care organization and identify a quality improvement issue to inform development of your Course Project.

Learning Objectives

Students will:

  • Analyze essential elements of organizational culture
  • Evaluate the influence of organizational culture on achieving organizational goals
  • Analyze strategies for aligning organizational culture with quality improvement initiatives
  • Identify a quality improvement issue in a health care setting

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Hickey, J. V., & Brosnan, C. A. (2017). Evaluation of health care quality in for DNPs (2nd ed.). New York, NY: Springer Publishing Company.

  • Chapter 10, “Evaluation of Patient Care Standards, Guidelines, and Protocols” (pp. 207-226)
  • Chapter 12, “Evaluating Populations and Population Health” (pp. 265-280)

Chapter 10 reviews methods for using national, local, and organizational standards to evaluate the quality of health care practices. Chapter 12 examines strategies for identifying quality issues through the evaluation of populations.

Sadeghi, S., Barzi, A., Mikhail, O., & Shabot, M. M. (2013). Integrating quality and strategy in health care organizations, Burlington, MA: Jones & Bartlett Publishers.

  • Chapter 3, “General Concepts in Quality” (pp. 45–82)

See the six aims for quality proposed by the Institute of Medicine (IOM).

Bellot, J. (2011). Defining and assessing organizational culture. Nursing Forum, 46(1), 29–37.

Defining and assessing organizational culture by Bellot, J., in Nursing Forum, 46(1), 29–37. Copyright 2011 by John Wiley & Sons – Journals. Reprinted by permission of John Wiley & Sons – Journals via the Copyright Clearance Center.

Bellot reviews the definition of organizational culture, methods for evaluating organizational culture, and the application of Schein’s framework to defining the culture of health care organizations.

Dixon, M. A., & Dougherty, D. S. (2010). Managing the multiple meanings of organizational culture in interdisciplinary collaboration and consulting. Journal of Business Communication, 47(1), 3–19.

This article demonstrates the importance of not only understanding the culture of an organization, but also how these dynamics affect workplace performance and retention of employees.

Dorgham, S. R. (2012). Relationship between organization work climate & staff nurses organizational commitment. Nature and Science, 10(5), 80–91. Retrieved from http://www.sciencepub.net/nature/ns1005/009_9000ns1005_80_91.pdf

The correlation between organizational climate and commitment and its effect on an organization is evaluated in this study.

Hartnell, C. A., Ou, A. Y., & Kinicki, A. (2011). Organizational culture and organizational effectiveness: A meta-analytic investigation of the competing values framework’s theoretical suppositions. Journal of Applied Psychology, 96(4), 677–694.

This article presents a study on the relationship between culture types and organizational effectiveness. The authors apply specific values frameworks to determine the relationships while also assessing the competing values framework.

Schein, E. H. (1996). Three cultures of management: The key to organizational learning. Sloan Management Review, 38(1), 9–20.

In this seminal article, Schein identifies three subcultures found within an organization and the effects of these competing cultures on an organization’s effectiveness.

Wait, S. T., & Dayman, M. A. (2012, July/August). Company culture drives business value. Value Examiner, 30–31.

The authors connect company culture to innovation and success.

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Retrieved from http://nationalacademies.org/hmd/reports/2001/crossing-the-quality-chasm-a-new-health-system-for-the-21st-century.aspx?_ga=2.170524387.297520899.1521127102-1768630473.1521127102

This report briefly outlines the six aims of the IOM to improve the quality of health care.

Schein, E. H. (1997). Organizational culture & leadership. Retrieved from http://www.tnellen.com/ted/tc/schein.html

Edgar Schein is one of the early writers on organizational culture. In this foundational article, Schein outlines various dimensions of organizational culture, and how leaders create, transmit, and embed organizational culture.

Required Media

Laureate Education (Producer). (2013e). Organizational culture. Retrieved from https://class.waldenu.edu

Note: The approximate length of this media piece is 3 minutes.

Dr. Carol Huston discusses the influence of organizational culture on the delivery of quality care

A company’s culture is often buried so deeply inside rituals, assumptions, attitudes, and values that it becomes transparent to an organization’s members only when, for some reason it changes.

—Rob Goffee

Culture is embedded within every organization. Yet, because culture is woven throughout the everyday interactions and atmosphere of an organization, it can be difficult to assess and explain how the culture influences the inner workings of the organization.

As a nurse leader-manager, developing a sound understanding of an organization’s culture can help you to achieve quality improvement initiatives and identify strategies for enacting sustainable change.

For this Discussion, you analyze the culture of an organization and consider how this relates to achieving goals related to quality improvement. You may wish to focus on the same organization that you have selected for your Course Project.

To prepare:

  • Review the information on organizational culture in this week’s Learning Resources.
  • Reflect on the culture of an organization with which you are familiar. Consider the following:
    • What elements of the organization’s culture seem most prominent or significant to you?
    • What beliefs, dispositions, and/or actions seem to be most valued? Why do you think so?
    • What do you notice about the expectations, assumptions, and more demonstrated among people within the organization?
    • What artifacts provide clues about the culture?
    • How do these cultural elements contribute to or detract from the organization’s ability to meet prominent goals and objectives?
  • Consider how you, as a nurse leader-manager, could apply your knowledge of this culture to facilitate quality improvement initiatives within this organization. How would you leverage the strengths of the culture, and address limitations or obstacles that may arise within it?

By Day 3

Post an analysis of the culture of the organization that you selected. Explain how you think this particular culture contributes to or detracts from the organization’s ability to meet goals. Explain how you, as a nurse leader-manager, could utilize your knowledge of this culture to facilitate quality improvement initiatives within this organization.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

  • Analyze similarities and differences between your colleague’s organizational culture and the organization that you selected.
  • Ask a probing question, substantiated with additional background information or research.
  • Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
  • Suggest leadership strategies that your colleague could use to overcome obstacles in the organization’s culture to facilitate quality improvement initiatives.

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