Organizational Culture in Nursing: A Systematic Review

Setiawan
Lecturer at Program Studi Ilmu Keperawatan, Fakultas Kedokteran, Universitas Sumatera Utara
Doctoral Student, Faculty of Nursing, Prince of Songkla University, Thailand

literature by summarizing large

bodies of evidence. By conducting systematic reviews, we can learn how to apply scientific
strategies, in ways that limit bias, to the assembly, critical appraisal, and synthesis of all relevant
studies that address a specific question. This systematic review is found to be useful in
understanding a concept by careful reviews of several studies and assist to get the confident of the
findings.
This study reviewed 11 papers related to organizational culture. The results were grouped into 3
categories: domains of organizational culture, factors influencing organizational culture, and
effects of organizational culture. Issues of organizational culture in health care setting, especially
in nursing, are needed to be understood because it has effects on job satisfaction, job
commitment, team functioning, and team action.
Keywords: systematic review, organizational culture, nursing

Abstrak: Penelusuran sistematik sangat bermanfaat untuk mendapatkan kelengkapan literatur

dengan membuat ringkasan dari serangkaian hasil penelitian. Dengan melakukan penelusuran
sistematik, kita dapat belajar bagaimana menerapkan strategi ilmiah, dengan cara mengurangi
bias, merangkai, melakukan penilaian secara kritis, dan melakukan sintesis terhadap semua
penelitian yang relevan yang berupaya menjawab sebuah pertanyaan yang spesifik. Penelusuran
sistematik sangat berguna dalam memahami sebuah konsep dengan cara penelusuran yang cermat
dari beberapa penelitian dan membantu meningkatkan rasa percaya terhadap hasilnya.
Penelitian ini menelusuri 11 makalah yang terkait dengan budaya organisasi. Hasilnya
dikelompokkan ke dalam 3 kategori: ranah budaya organisasi, faktor-faktor yang mempengaruhi
budaya organisasi, dan efek budaya organisasi. Isu-isu tentang budaya organisasi dalam bidang
kesehatan, terutama dalam keperawatan, perlu dipahami karena budaya organisasi berpengaruh
pada kepuasan kerja, komitmen terhadap pekerjaan, berfungsinya suatu tim, dan aksi suatu tim.
Kata kunci: penelusuran sistematik, budaya organisasi, keperawatan

INTRODUCTION organization as a group of people intentionally

Within organization, people interact with
each other in a variety ways. Patterns of
interaction then are formed, and share of
cultural knowledge occurs. This shared
knowledge is used by organizational members
to make sense of past experience and provide
framework for interpreting situations and
deciding present and future actions.
Culture is defined as the totality of socially
transmitted behavior patterns, arts, beliefs,
institutions, and all other products of human
1 4
work and thought. While organization is defined
as a group of persons organized for a particular
1
purpose. McNamara basically defined an
organized to accomplish an overall, common
2
goal or set of goals.
An organizational culture is the ways of
thinking, behaving, and believing that members
3
have in common. Organizational culture refers
to a pattern of shared basic assumptions that the
group learned as it solved its problems of
external adaptation and internal integration, that
has worked well enough to be considered valid
and, therefore, to be taught to new members as
the correct way you perceive, think, and feel
in relation to those problems.
Every organization has its distinct
characters. People make organizations work,

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and the culture of the organization ties people
together, giving them meaning and a set of
principles and standards to live and work.
Basically, organizational culture is the
personality of the organization. Culture is
comprised of the assumptions, presuppositions,
values, norms and tangible signs (artifacts) of
5
organization members and their behaviors.
Culture is one of those terms that's difficult to
express distinctly, but everyone knows it when
they sense it. The culture or personality of an
organization, by its nature, places certain
restrictions and boundaries around behavior.
Significance of the Organizational Culture
Several case studies demonstrated how
health care organization can successfully foster
organizational culture resulting in improved
quality, efficiency, safety, and patients and
staff satisfaction. Elements of culture should
be reflected in human resources policies in
form of hiring practices and performance
expectations related to professional values.
Health care organizations have a promising
opportunity to foster organizational culture
given the values taught and socialized in
nursing, the prevalence of nurses in the health
care work-force, and the central role that
6
nurses play in care delivery.
Within a health organization, culture are
likely to found practices, beliefs, values and
assumptions that tend by their very nature to
strongly resist attempts to change them. In
common with the human relations movement,
organizational culture emphasizes the socially
dynamic aspect of organizations. An infusion of
the organization by values, and an associated
resistance to change, are both important aspects
of the study of organizational culture.
The organizational culture that is
conceived as comprising shared key values and
7
beliefs fulfils several important functions.
1. It conveys a sense of identity for
organization members.
2. It facilitates commitment to something
larger than the self.
3. It enhances social systems stability.
4. It provides a sense-making device to guide
behaviors.
Organizational culture also has impacts
on individual such as on employee morale,
commitment, productivity, physical health,
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8
and emotional well being. The culture of a
work organization drives the behavior of its
employees. Organizational culture can serves
as cognitive map for members so they can
understand what is valued in their
organization and how to direct their behaviors
accordingly.
The concept of culture is particularly
important when attempting to manage
organization-extensively change. Practitioners
are coming to realize that, despite the best-
laid plans, organizational change must include
not only changing structures and processes,
but also changing the organizational culture as
well. Understanding the organizational culture
is helpful in understand why change does not
take place in an organization, or why a project
fails. It will also be helpful to determine
where to strive to make changes to the
culture.
Objectives of the Study
Objectives of this study are to present the
available information about the organizational
culture for development of an instrument to
measure the culture of nursing organizations
and for effectiveness of interventions designed
to improve quality of nursing service. The
study also provide a narrative summary of the
domains of organizational culture, factors
influencing organizational culture, and impact
of organizational culture.
Method of the Study
Search sought to identify published
studies and utilized a range of electronic
databases using accepted search techniques, and
included CINAHL, MEDLINE, Findarticles.com
website, and Sciencedirect.com website range
from 1980-2005. These are databases of
literature emanating from a variety of disciplines
including nursing, medicine, and general
disciplines for the websites of findarticles and
sciencedirect. The key words used were:
organizational and culture.
To filter the articles being reviewed,
selection criteria was used. The criteria to select
material for inclusion in the review were as
follows: studies of organizational culture;
English language; publication in journal from
1980 up to 2005; and any qualitative or
quantitative methods. Dissertation and
published abstracts were excluded.
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Tinjauan Pustaka
Each paper selected for review was
evaluated by the author by using constructed
a matrix to record the following data for each
reviewed paper: type of study, purpose of
enquiry, method and participants, summary of
findings, and summary for implication for
practice.
Results of the Study
This study reviewed 11 papers which
appeared to meet the inclusion criteria. Papers
that were exclusively theoretical or
methodological or not specific to organizational
culture were excluded.
The research methods used by the studies
cited in this review were: 9 quantitative studies
(survey, evaluation approach, correlational study,
and exploratory study), qualitative studies
(ethnography study), and using both methods
quantitative and qualitative.
The results of this study are presented in
the following categories:
1. Domains of organizational culture.
2. Factors influencing organizational culture.
3. Effects of organizational culture.
Domain of Organizational Culture
Domain of organizational culture has been
described as forms of central category of core
values and beliefs. Understanding values and
beliefs is an important part of understanding a
workplace culture. This review revealed that a
study of the workplace culture of a special care
nursery proposed 4 key categories of domain of
organizational culture: teamwork, learning in
practice, inevitability of change and family-
9
centered care. In teamwork, there are values
and beliefs of cooperation and harmony. In
learning in practice category there are values
and beliefs of partnership, questioning, and
team focused. Enablers and new ideas are the
values and beliefs under category of inevitability
of change. Finally for family-centered care
category, the values and beliefs are
empowerment of families, continuity, and
enabling environment. Delobbe, Haccoun and
Vandenberghe identify five fundamental core
dimension of organizational culture:
recognition-support, commitment-solidarity,
innovation-productivity, control, and
continuous learning.
10
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Factors Influencing Organizational Culture
Culture of an organization is influenced by
many factors. These factors could be from
11
external and internal environment. Economic
and political system, external regulation, and
public attitudes are the external factors that can
influence organizational culture. Whilst, the
organizational arrangements of job design,
reporting hierarchy, rewards system, and teams
are internal environmental factors that can
influence organizational culture.
Effects of Organizational Culture
Several studies addressed the effect of
organizational culture on the organization.
Strength of organizational culture predicted
12
job satisfaction well and positively. The
concepts of organizational core task and
organizational culture could be useful as
management tools to anticipate the consequences
13
of organizational change. It is confirmed that
organizational culture plays a mediation role
between HR system and firm’s innovation
14
outcome.
There is a relationship between the degree to
which individual believes in the values of the
company and the individual’s amount of job
15
satisfaction and job commitment. In medical
setting, a study found that organizational culture
model can show opportunities for better
information exchange and open dialogue
16
between groups in the organization.
Organizational culture is also predictor of
17
commitment of employee to the organization.
In the study of influence of hospital culture, it is
found that the culture is associated positively
with the team functioning in term of team
relation (interprofessional relations, physician
support, organization, task orientation, and
innovation) and team action (teamness,
communication, effectiveness, and
18
collaboration).
CONCLUSION
A systematic review is a summary of the
healthcare literature that uses explicit methods to
perform a thorough literature search and critical
appraisal <http://en.wikipedia.org/w/index.php?
title=Critical_appraisal&action=edit> of individual
studies to identify the valid and applicable
evidence, and then uses appropriate techniques
to combine these valid studies. Systematic
review on organizational culture was
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conducted in this study, which its purposes
was to present the available information about
the organization culture and to provide a
narrative summary of the domain, factors
influencing, and effects of organizational
culture.
This systematic review of organizational
culture revealed, from 11 research papers, the
domain of organizational culture, factors
influencing organizational culture, and the effects
of organizational culture. Teamwork, learning in
practice, inevitability of change, and family
centered care, recognition-support, commitment-
solidarity, innovation-productivity, control, and
continuous learning are the identified domain of
organizational culture found this study. There are
two main factors influencing organizational
culture that are external factor (such as economic
and political system, external regulation and
public attitudes) and internal factors (such as
arrangement of job design, reporting hierarchy,
reward system, and teams). This systematic
review also found the effects of organizational on
various aspects of organization such as on job
satisfaction, job commitment, team functioning,
and team action.
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