Nurses as Implementers of Organizational Culture

Lynn Perry Wooten, PhD; Patricia Crane, MS, CNM


Nurs Econ. 2003;21(6) 

In This Article


Organizational culture has been a buzzword in Corporate America for the past 20 years, ever since managers began to realize that an organization's dominant philosophy and values could determine its success and be a competitive advantage. However, the health care industry has lagged in its understanding of how to develop effective organizational cultures. This knowledge lag is unfortunate since an effective organizational culture is crucial in health care organizations that face issues such as complex managed health care structures, competitive labor markets, and declining levels of patient satisfaction.

What Is Organizational Culture?

Organizational culture refers to a shared value system derived over time that guides members as they solve problems, adapt to the external environment, and manage relationships (Schein, 1992). Organizational culture explains how an organization's members do things to succeed, as well as how their behaviors can contribute to a group's failure. In other words, organizational culture serves as a cognitive map for members so they can understand what is valued in their organization, and how to direct their behaviors accordingly.

The culture of a health care organization can powerfully influence its ability to manage human resources and serve patients, and ultimately has a strong impact on its economic performance (Kotter & Heskett, 1992). Constructive organizational cultures that enhance both employee satisfaction and patient satisfaction consist of work environments where members have positive colleague interactions and approach tasks in a manner that helps them to attain high-order personal satisfaction and meet organizational goals (Cooke & Rousseau, 1988). In other words, health care organizations that typify constructive cultures put people first by encouraging positive interpersonal relationships, but also they value self-actualization and employees who are achievement oriented.

For example, when Baptist Hospital in Pensacola, Florida crafted a vision to become "the best healthcare system in America," the chief executive officer began by revamping the hospital's organizational culture. The cognitive map or driving force for this culture transformation was based on empowerment, as communicated through Baptist Hospital's mission, values, and patient service philosophy (Reeder, 2002). Constructive relationships between patients and employees became the top priority. Because of these cultural changes, the hospital was acknowledged for its patient service quality by the prestigious Baldrige group and received high patient satisfaction ratings on the Press, Garney & Associates' survey, all while generating substantial cost savings.

Similarly, when Griffin Hospital in Derby, Connecticut transformed itself from a bureaucratic culture to a caring culture, patient satisfaction soared 96%, nursing turnover decreased, and the hospital was in a better strategic position to compete against neighboring hospitals (Freedman, 1999). This transformation of Griffin's culture entailed creating a work environment where nurses were empowered to develop ways to cater to their patients' needs.


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