| Abstract |
Introduction Organizational culture is an important variable in health care organization management. In recent years it has captured the attention of researchers due to its influence on organizational effectiveness and performance or job satisfaction and security. Role ambiguity and role conflict have a strong influence on the formation of work relationships, the work stress and satisfaction they may cause, and the smooth and effective functioning of health care organizations.
Aim The aim of the present study was to identify the organizational culture as experienced by physicians, nurses and other health care professionals working in public Health Centers and Hospitals of Crete, and to investigate possible correlations in the type of organizational culture, by professional group and within levels of health care organizations (primary, secondary and tertiary). A further objective was to measure the degree of role ambiguity and role conflict by level of health care and to investigate possible correlations between organizational culture type and the degree of role ambiguity and role conflict among physicians, nurses and other health care professionals in health care organizations of Crete.
Population and methods The study was carried out at seven (50%) of the 14 public Health Centers of the Region of Crete, which were selected randomly and proportionally to their number in each prefecture (Lassithi: Tzermiado; Heraklion: Agia Varvara – Ano Viannos – Harakas; Rethymno: Anogeia – Spili; Chania: Vamos) and the public Hospitals of the island (Chania, Rethymno, Heraklion, Agios Nikolaos). The sample consisted of 231 Physicians, Nurses and Health Care Professionals, selected by multistage stratified sampling. The total population in 2006 of the Health Centers, University Hospital and General Hospitals was 3609 individuals (1420 Doctors, 1670 Nurses and 519 Health Care Professionals). The total sample of 231 participants in the study was divided into 3 groups for each health care level (77 from Health Centers, 75 from General Prefectural Hospitals and 79 from the University Hospital). Each group consisted of a random sample of about 25 Physicians, 25 Nurses and 25 Health Care Professionals from every health care level. The data sampling was carried out between September and November 2006.
To identify the organizational culture of the physicians, nurses and other health care professionals working at the Hospitals and Health Centers of Crete, the Greek weighted version of the Organizational Culture Inventory (OCI) was used to assess health care organizations’ current operating culture based on the average (mean) responses of all members who completed the OCI. The OCI is recognized as one of the most widely used and thoroughly researched organizational surveys in the world.
Unadjusted mean scores for each of the twelve cultural styles from the OCI were converted to percentile scores and were analyzed by Human Synergistics International, the copyright holder of the survey instrument. The highest percentile score, presents the dominant – primary culture style, the next highest percentile score indicates secondary culture style.
Two weighted scales, modified and translated into Greek, were employed to measure the degree of role ambiguity and role conflict. The attribute distributions of all employees were calculated.
Both the role ambiguity and role conflict scales and the organizational culture scales were found to follow normal distribution using Blom's Q-Q plot. Their mean values were calculated, together with the corresponding 95% confidence intervals for comparison (95% CI). The monovariable correlations of the role ambiguity/conflict scales in the organizational culture types were analysed using r-Pearson correlation coefficients. Analysis of covariance was used to compare any differences in the role ambiguity/conflict scales with regard to the health care levels (primary, secondary, tertiary) and professional groups (medical staff, nurses and other health professionals). The dependent variables used were gender, age, educational level, health care level or professional group, and length of employment. Heterogenity was tested by Levene’s test, the level of significance was chosen at a P value of less than 0.05. Descriptive statistics were used to analyze the data. The results are presented in tables and circumplexes. All statistical analysis methods were carried out by the IBM SPSS software (IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp).
Results The study comprised a total of 71 male and 160 female respondents (n=231) working in health care organizations of Crete. Of these, 33.3% worked in Health Centers, 32.5% in public General Hospitals and 34.2% in the University Hospital. 44.6% of respondents had been with the health care organizations for ≥10 years, while 77% were University or technological Educational Institute graduates.
The total of respondents working in health care organizations of Crete (physicians, nurses and other health care professionals) considered that these structures are best described by the Aggressive/Defensive organizational culture, which has the highest average percentile score (89%ile). The primary culture styles are Power (95%ile) and Avoidance (95%ile), followed by Oppositional (94%ile) as a secondary style. There was no significant variation based on participants’ gender or age.
According to the respondents, the Aggressive/Defensive organizational culture pervades health organizations at every level of care (primary: 91%ile, secondary: 86.5%ile and tertiary: 87.8 %ile). As regards behavioral norms (culture styles) in primary health care, the respondents (n=77) consider that the Oppositional culture style is primary (98%ile), followed by Avoidance and Power (95%ile). In secondary-level health care organizations, respondents (n=75) revealed that the Power (95%ile) and Competitive (91%ile) culture styles predominated. Finally, the respondents (n=79) in the tertiary health care organization demonstrated that the primary behavioral norm is Avoidance (98%ile) followed by Power (95%ile).
More specifically, the medical staff overall (n=75) present Aggressive/Defensive culture (92%ile), in health care organizations with a primary culture style of Power and Avoidance (97%ile) and an Oppositional secondary culture style (94%ile). The same type of organizational culture was recorded in the study of medical staff when analyzed by the health care level of the organization they were employed by.
The total nursing staff (n=81) is also characterized by Aggressive/Defensive organizational culture (86.5%ile), independent of health care level.
Finally, according to the other categories of health care professionals (n=75) (physiotherapists, midwives, social workers, etc.), the health care organizations of Crete also feature the Aggressive/Defensive organizational culture (88.75%ile), independent of the health care level of the organization the respondents are employed by.
The measurement of role ambiguity and role conflict across the total of respondents involved in the study (n=231) presented a mean role ambiguity score of 3.00±1.25 and a mean role conflict score of 4.61±1.22. Correlating the two scales with the particular variables of the sample, increased ambiguity is strongly associated with female gender (r=0.150, p<0.05), younger ages (r=-0.215, p<0.001) and the nursing profession (r=-0.208, p<0.001). In contrast, role conflict is associated with physicians (r=-0.166, p<0.05) and the level of health care organizations (r=-0.145, p<0.05).
As regards the correlation between role ambiguity / role conflict and the organizational culture that employees believe represents health care organizations in Crete in total, no significant correlation was found between role ambiguity and types of organizational culture (Constructive, Passive/Defensive and Aggressive/Defensive). On the contrary, role conflict presents a strong negative correlation with Constructive organizational culture (r=-0.181, p<0.05) and a strong positive correlation with the Passive/Defensive and Aggressive/Defensive organizational culture of Cretan health care organizations in total (r= 0.369, p<0.001 & r= 0.373, p<0.001 respectively).
Conclusions According to health care professionals, the Aggressive/Defensive organizational culture is dominant across all the health care organizations of Crete, with Avoidance and Power as the primary behavioral norms and Oppositional as the secondary norm.
Role ambiguity in the total of respondents was not found to be correlated with the type of organizational culture prevalent in Cretan health care organizations. Role conflict, on the contrary, presented a strong correlation with the Passive/Defensive and Aggressive/Defensive organizational culture that dominates the health care organizations of Crete.
The results of this study can be used in the planning and implementation of specific management interventions with the aim of changing the organizational culture type and reducing role ambiguity and conflict in the health care organizations of Crete. Developing human resources and strengthening interdisciplinary cooperation with clearly differentiated roles for each professional group, with the common objective of patient-centered care, will lead to even more efficient, quality health care services, covering the needs of the population in an effective way.
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Μέτρηση της οργανωσιακής κουλτούρας των ιατρών, νοσηλευτών και λοιπών επαγγελματιών υγείας σε κέντρα υγείας και νοσοκομεία της Κρήτης
