Oraganisation Culture

To talk of an organization's culture is to assess that which is shared by individuals within the organizationвЂ"their beliefs, values, attitudes, and norms of behaviour, for example; or the established routines, traditions, ceremonies and reward systems6. Organizational culture encompasses the shared meanings that individuals place on their working life, the narratives they use in making sense of their organizational context. The ways in which people understand, describe and make sense of their working context in turn help to define what is legitimate and acceptable in that context; they act as a kind of social and normative glue. They are вЂ?the way things are done around here’.

Such shared understandings may operate at different levels. The most superficial are the visible manifestations (sometimes called cultural artefacts)вЂ"the doctor's white coat; the surgeon's list; the use of professional titles, and the commonly accepted reward structures. At a deeper level are those espoused values that are said to influence standard practiceвЂ"a belief in evidence, for example, or a commitment to patient-centred care. Deeper still, and much harder to access, are the hidden assumptions that underpin day-to-day choicesвЂ"assumptions, for example, about the relative roles of doctors and nurses, assumptions about patients' rights, or assumptions about the nature and sources of ill-health. While we would expect some relationships between these assumptions, espoused values and visible manifestations, such relationships will not be simple; incoherence, self-deception and dissonance are more likely. What is clear however is that much of health systems reform tackles surface rather than deeper cultural issues.

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