Every organisation introduces to the employees the values, objectives and norms that make up the organisational culture (Bezrukova et al., 2012). Organisational culture assist employees get familiar with the operations and practices of the organisation. Effective understanding of organisational culture can contribute towards improvement of employees’ performance. It is very essential for organisations to identify the value, objectives and norms of the organisation in order to boost their competitive advantage (Wong and Giallonardo, 2013). Just like in most sectors, healthcare sector need to identify and establish tier organisational culture in order to succeed. Healthcare services often than not are offered to patients in an environment encompassed by complex interactions and various factors such as diseases process, clinicians, resources, values and polices, technology and medical procedures (Wong and Giallonardo, 2013). With these factors interacting every day in a healthcare environment, harmful and unanticipated results can take place compromising patient safety and quality (Bezrukova et al., 2012). The fundamental challenge facing the healthcare organisation is the nurturing of organisational cultures that encourage delivery of quality, safe and compassionate healthcare to the patients (Bezrukova et al., 2012). This paper will describe the impact of organisational culture on the organisation and will discuss nursing practices in the healthcare system. In addition, it will detail out the structure of authority in healthcare system and its effects on organisational culture and conflicts in healthcare services.
Organisational culture can be defined as the arrangement of several qualities that represents an organisation and differentiate it from other organisations (Chang and Daly, 2016). Culture is expected to be learnt and shared in any company. Organisational culture helps to explain how the management and the entire employees behave and make decisions. It is founded upon multifaceted set of norms, values and beliefs that regulate the way organisations conduct its operations. Chang and Daly (2016) define organisational culture as the normative glue that holds the operations of businesses together. There are different features that are related to organisational culture. For instance, clearly stated rules in the organisations are related to productivity and high performance of the employees.
Organisational culture has an impact on organisations. It influences productivity and performance. Performance is the achievement of the goals and objectives of an organisation. According to Chang and Daly (2016), performance represents the ability to accomplish mission effectively and efficiently by use of the available resources. It is reported that there is a relationship between organisational performance and organisational culture. The report that organisational culture can bring about enhanced performance is depended on the fact that culture plays an important role in boosting competitive advantage (Bezrukova et al., 2012). Competitive advantage is partly brought about by the formation of organisational competencies, norms and values that are not imitable or substitutable by the competitors. The performance of employees in the organisation relies on the level to which the norms and values of the organisational culture are shared (Bell, 2014).
Strong organisational culture has the ability to enhance the productivity and performance of the employees (Mandal et al., 2012). It has the capabilities of enhancing self-confidence and commitment, improves employee ethical behaviour and reduces stress. Generally, strong and weak organisational culture affects organisational performance. Strong organisational culture is characterised by viability, rarity and imitability (Mandal et al., 2012). For organisational culture to enhance performance and productivity, it should be viable, rare and imperfectly imitable. In addition, strong organisational culture has the ability to attract high level talent (Mandal et al., 2012). People with high level of skills and expertise often want to go to organisations that give a number of opportunities to advance and exploit their talent.
Strong organisational culture creates a positive working environment that supports enhancement of career and exploit talent. This tends to attract and retain the best talent available (Bezrukova et al., 2012). Organisational culture also creates energy and momentum for work. When an effective organisational culture is developed, it gains momentum and assist people to feel values and important. It also can change employee’s view of work. A huge number of people view work as boring, tiresome and stressful. A solid stated organisational culture enables employees to love their jobs and put efforts in accomplishing goals and objectives (Chang and Daly, 2016). This raises employee morale and commitment. It can also enhance employees’ efficient and success. From the subordinate employees to the highest management, a strong organisational culture assists employees and improves the cooperation and coordination within a team. This boosts competitive advantage and breed success. Generally, performance of the employees is enhanced and productivity increased.The organisational culture of many healthcare system conflicts with nursing practices thereby affecting patient outcomes (Huston, 2013). The capabilities of nurses to operate in a professional way are influenced by organisational culture and organisational structure. Patient outcomes are dependent on the promotion of scarce health resources. In the nursing practice, organisational culture plays a fundamental role in influencing happy and healthy working environment in the healthcare sector (Stevens, 2013). By communicating and enhancing the organisational vision, values and beliefs to nurses, it is very possible to influence nurses’ work behaviour, commitment and attitudes.
When there is constructive organisational culture in the nursing practice, there will be effective team communication and nurses will be encouraged to accomplish the mission and visions of the organisation (Stevens, 2013). Communicating organisational culture enhances patient safety. According to a research conducted in Veterans Health Administration hospitals in the United States, higher levels of patient safety and nurse’s satisfaction were associated with higher levels of organisational culture (Bell, 2014). This means that hospitals and healthcare systems can improve patient safety and nursing practices by communicating constructive organisational culture. In the nursing practice, a culture that promotes learning and fairness, patient safety, patient-centred care and team work promotes good nursing practices (Buchbinder, Shanks and Buchbinder, 2014).
Healthcare sector and nursing practices are made up of hierarchical structure that is made up of several lines of command from top to bottom level (Wong and Giallonardo, 2013). Healthcare organisations are moulded by the values, beliefs and norms of those in authority and those who establish rule, design the structure and guide the system. Therefore, organisational culture in the nursing practice results from the norms and values that direct manager’ decisions in the organisational structure (Detels et al., 2015). Authority and power are concepts that are defined as the ability to impose will upon other people and to influence what they are doing. Authority in the nursing practise is divided into senior nurse leadership, middle manager leadership, first-line manager and professional practice leaders (West et al., 2014).
Senior nurse leadership is occupied by nurses who hold the most influential nursing leadership in the healthcare system with direct responsibility towards the operations of nursing practices (Buchbinder, Shanks and Buchbinder, 2014). They include Chief Nursing Officer, President Patient Care and Chief Nurse Executive among others. Middle management position is held by nurses or even non-nurses who are responsible for coordinating nursing and acute care patient areas such as ambulatory care area. This position is occupied by managers and directors in the healthcare system (Buchbinder, Shanks and Buchbinder, 2014). On the other hand, the first-line management position is occupied by nurses or sometimes non-nurses with the role of coordinating operations with operational nurses reporting directly to them. They include supervisors and coordinators who are in charge of staff nurses (Austen and Zacny, 2015). Professional practice leaders are responsible for coordinating nursing practices in hospitals and regional health authority. They include Chief of Nursing and Nursing Practice Leaders.
Decisions in the nursing practise are made by the nurses in authority. Senior nurses and senior management teams have high level of involvement in staff and policy decision making (Thunders, 2015). Middle managers are responsible for only making decisions within the range of their portfolio area. Generally, nurses in authority and leadership within the healthcare system are considered experienced and are responsible for a high level of administrative activities. The chain of authority in the nursing practice has an impact on organisational culture (Bell, 2014). Hierarchical organisational structure has a direct impact on culture as a result of the placement of people within the structure.
The structure of authority in the nursing practice determines how human resources are managed and how customers are served. Constructive structure of authority may bring about constructive organisational structure that improves employee satisfaction and patient safety and quality (Mandal et al., 2012). Although decisions are made by the nurse management, most at times, staff nurses are involved in decision making. This results to positive employee interaction and commitment and therefore they have a higher order satisfaction which enable them achieve organisational goals (Mandal et al., 2012). Through such management decision, constructive organisational culture is developed that leads to patients satisfaction and effective delivery of quality care.
Health care delivery happens within a complicated system of organizational environment as well as multidisciplinary professionals financial, legal and regulatory necessities and community based needs (El-Showk, 2014). Within this arrangement, there tend to be cases of competing priories which most at times lead to both personal and professional misunderstandings that arise among health care providers. Strong personalities most at times clash beneath the pressure of crucial decisions, changing degrees of understanding, necessity to coming to closure with both issues and their impacts and also time limits to achieve a task. The problems leading to conflicts occur in a number of instances and involves quite a number of professionals such as physicians, administrators, social workers and also pharmacists to name a few (Johansen, 2012).
Some of the key potential areas which may bring about conflicts are lack of both personal as well as inter-professional respect; administrative issues as competing for scarce resources and also intervention disputes such as treatment protocols. Lack of interpersonal and inter-professional skills is one source of conflicts within the healthcare system (Johansen, 2012). Conflict often comes about when there is a lack of mutual respect as well as recognition. For instance, a doctor may demand a certain task to be done with immediate effect whereas the nurse is handling another equally important task (El-Showk, 2014). These behaviours result in a quick escalation of conflict between the doctor and the nurse since one of the parties feels scared through misunderstanding and hurtful behaviour whereas the other party feels angered.
In addition, treatment protocols also are a potential source of conflict within the health care industry. Decisions which are made with regard to treatment protocols are always an issue of professional judgment based on the effects experienced by other patients with the same condition (Johansen, 2012). Examples of treatment protocols includes: do not resuscitate orders and palliative care versus aggressive therapy to name a few. Conflict often arises when there is a disagreement of what makes up and effective as well as appropriate care for a patient. These conflicts centres around ethical principles of what is best for a patient based on scientific advances that may provide potential effective health effect (Johansen, 2012). Therefore, whenever a treatment option is ordered without any prior discussion, the opportunities for a disagreement increase as well as the conflict arise.
Furthermore, resource allocation and resource leveraging is another source of conflict within the health care system since the ability to acquire resources within an institution is a very significant in terms of position and power (Glouberman, 2014). Therefore, conflict comes about when individuals view resources to be inequitably distributed and also inadequate. This kind of conflict can occur between individuals directly or even indirectly between intermediaries who have their own interests. Perceiving the inadequacy of resources in performing a certain task is another source of conflict. For instance, the expectation that both hospital beds as well as patient care services will be up and running in the face of nurse shortages brings about conflict between the physician, nurse and the administration (Glouberman, 2014).
Therefore, in order to understand the issue of conflict that arise amongst care providers, it is very important to properly understand the healthcare environment where health care is offered, the various ways conflicts comes about in such a setting and also possible methods of minimizing conflict and improving conflict resolution (Barr and Dowding, 2012). In addition, functional conflict also known as constructive conflict increases individual as well as unit efforts and at the same time directs attention in achieving organizational goals and objectives. It also synthesizes differing viewpoints.
To sum up, organizational culture can be defined as the arrangement of several qualities that represents an organization and differentiates it from other organizations. It is influenced by the identification of the various factors that leads to effectiveness of an organization. In addition, organizational culture assists employees get familiar with the operations as well as practices of an organization. Organizational culture has a great influence in the productivity and performance of an organization. It also creates a positive working environment that supports enhancement of career and exploits talent. Furthermore, health care sector are made up of hierarchical structures which are moulded by the values, benefits and norms of those in authority. This structure follows a hierarchical order from top to bottom. On the other hand, there are conflicts that arise amongst professionals within the health care sector. This conflict involves quite a number of professionals such as physicians, administrators, social workers and also pharmacists to name a few. Some of the key potential areas which may bring about conflicts are lack of both personal as well as inter-professional respect; administrative issues as competing for scarce resources and also intervention disputes such as treatment protocols.
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