Patients-people-place: developing a framework for researching organizational culture during health service redesign and change

Implementation Science

Alistair Hewison⁴  Sabi Redwood²  Hugh S T McLeod³  Jonathan Shapiro⁵  Nicola K Gale¹ 

[1] University of Birmingham, Health Services Management Centre, University of Birmingham, Edgbaston, Birmingham B15 2RT, UK;School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK;Health Economics, Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK;Department of Nursing, Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK;Independent Researcher, Birmingham, UK

关键词: Realist evaluation;    Theory;    Place;    People;    Patients;    Organizational culture;   

Others  :  1146744
DOI  :  10.1186/s13012-014-0106-z

 received in 2013-12-03, accepted in 2014-08-08,  发布年份 2014

【 摘 要 】

Background

Organizational culture is considered by policy-makers, clinicians, health service managers and researchers to be a crucial mediator in the success of implementing health service redesign. It is a challenge to find a method to capture cultural issues that is both theoretically robust and meaningful to those working in the organizations concerned. As part of a comparative study of service redesign in three acute hospital organizations in England, UK, a framework for collecting data reflective of culture was developed that was informed by previous work in the field and social and cultural theory.

Methods

As part of a larger mixed method comparative case study of hospital service redesign, informed by realist evaluation, the authors developed a framework for researching organisational culture during health service redesign and change. This article documents the development of the model, which involved an iterative process of data analysis, critical interdisciplinary discussion in the research team, and feedback from staff in the partner organisations. Data from semi-structured interviews with 77 key informants are used to illustrate the model.

Results

In workshops with NHS partners to share and debate the early findings of the study, organizational culture was identified as a key concept to explore because it was perceived to underpin the whole redesign process. The Patients-People-Place framework for studying culture focuses on three thematic areas (‘domains’) and three levels of culture in which the data could be organised. The framework can be used to help explain the relationship between observable behaviours and cultural artefacts, the values and habits of social actors and the basic assumptions underpinning an organization’s culture in each domain.

Conclusions

This paper makes a methodological contribution to the study of culture in health care organizations. It offers guidance and a practical approach to investigating the inherently complex phenomenon of culture in hospital organizations. The Patients-People-Place framework could be applied in other settings as a means of ensuring the three domains and three levels that are important to an organization’s culture are addressed in future health service research.

【 授权许可】

   
2014 Gale et al.; licensee BioMed Central

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