Abstract
Organisational culture has long been recognised as one of the crucial factors in determining healthcare organisational performance and subsequent outcomes, including clinical, operational, and financial performance. This research study addressed an acknowledged gap in the literature concerning the effect of organisational culture on the management of healthcare systems. Given the lack of research examining the influence of governance on organisational culture, there exists a need to examine this relationship further. The research described here examines the influence of governance on organisational culture and in turn the impact of organisational culture on the performance of District Health Boards (DHBs) in New Zealand.
This study utilised a mixed methodological approach to investigate the perceived role and influence of selected Board chairs and members, and their associated senior executive teams, on their DHB’s organisational culture. Invitations to participate in this research were sent to twelve DHBs, selected based on their performance against the ‘Shorter Stays in Emergency Departments’ health target, published by the New Zealand Ministry of Health (MoH), with nine DHBs agreeing to take part. Data collection was conducted in two phases; the first phase involving interviews with selected DHBs’ Board chair, Board members, and their associated CEO, and the second phase involving the administration of a questionnaire to selected DHB Board chairs, Board members, CEOs, and their associated senior executive teams.
The first phase produced a set of findings about the differing perceptions of selected Board chairs, members, and CEOs regarding their potential to influence the DHB’s organisational culture. The interview data also informed the development of the second phase questionnaire, identifying aspects such as communication, organisational learning, blame-free culture, and the institution/establishment/development of a gaming culture due to an overemphasis on meeting the MoH’s health targets.
Findings from analysis of the second phase questionnaire suggest that the current organisational culture profiles of most, and especially the lower performing DHBs, emphasise the ‘Hierarchical’ and ‘Rational’ cultures of Mannion et al.’s modified Competing Values Framework (CVF). This is supported by the literature, which informs us that ‘Hierarchical’ and ‘Rational’ cultures are not ideal for the implementation of performance improvement initiatives, such as Total Quality Management (TQM), continuous improvement (CI), and Lean Thinking initiatives. In addition, discriminant analysis indicates a misalignment of values among DHB Board members and their associated senior executive teams, which raises concerns regarding possible performance impacts on the healthcare system. These findings suggest that DHB Boards should consider more carefully their role and ability to influence a DHB’s culture, by reducing ‘Hierarchical’ and ‘Rational’ cultural traits and emphasizing the alignment of values among the organisational teams, thereby cultivating a culture that fosters performance improvement. Finally, the thesis recommends further research be undertaken to gain a deeper understanding of how aligned values influence healthcare performance. Given the rollover of New Zealand DHB Board Chairs and Board members every three years, a future longitudinal study would be valuable to examine the changes of organisational culture with subsequent changes in the DHB governance team.