Nursing 621

Introduction

Every organization has a life cycle that requires rebirth or transformation periodically. As an organization grows, it builds the structure and processes to keep the organization stable while continuing to innovate and adapt new services. At some point in its life cycle, stability overcomes adaptability and the health of the organization is threatened. Also impacting the organizational life cycle is the external environment. Organizations must evolve to keep up with changes in demographics, customer expectations, technology, economic conditions etc. The status quo is no longer acceptable and large transformative change is required (Padfield, 2017).

Transformative change is defined as:
-A philosophical, practical and strategic process to effect revolutionary change within an organization, i.e., culture transformation (Cleveland counseling, 2019).
-It is a systems approach applied to broad-based change to catalyze rapid shifts in the mental constructs inhibiting solutions to complex problems or in the organization’s culture that prevent it from realizing its full potential (Cleveland counseling, 2019).
-It seeks to discover and integrate personal and organization development as an overarching approach to rapid change at all levels of system (Cleveland counseling, 2019).

Large transformative change in organizations brings a lot of uncertainty. In times of uncertainty, the focus of people working in that environment tends to narrow and certain aspects consume the people working in that organization. For example, people may experience fear of job loss, feelings of lack of control, or perceive that the changes do not align with their professional or personal values (Hunt, Paulsen, Toursih, & DiFonzo, 2004) (LEADS Canada, 2019). This can threaten the culture of the organization.

Organizational Culture Defined

Organizational culture is defined as the underlying beliefs, assumptions, values and ways of interacting that contribute to the unique social and psychological environment of an organization. (The business dictionary).

Organizational culture includes an organization’s expectations, experiences, philosophy, as well as the values that guide member behavior, and is expressed in member self-image, inner workings, interactions with the outside world, and future expectations. Culture is based on shared attitudes, beliefs, customs, and written and unwritten rules that have been developed over time and are considered valid (Needle, 2004).


Culture also includes the organization’s vision, values, norms, systems, symbols, language, assumptions, beliefs, and habits (Needle, 2004).

Culture express how the construct plays out in the workplace, other definitions stress employee behavioral components, and how organizational culture directly influences the behaviors of employees within an organization (The business dictionary).

Under this set of definitions, organizational culture is a set of shared assumptions that guide what happens in organizations by defining appropriate behavior for various situations (Ravasi & Schultz, 2006).

Organizational culture affects the way people and groups interact with each other, with clients, and with stakeholders. Also, organizational culture may influence how much employees identify with their organization (Schrodt, 2002).

Different Types/ Aspects of Organizational Culture

The Clan Culture:

This culture is rooted in collaboration. Members share commonalities and see themselves are part of one big family who are active and involved. Leadership takes the form of mentorship, and the organization is bound by commitments and traditions. The main values are rooted in teamwork, communication and consensus (Tharp, 2009)

The Adhocracy Culture:

This culture is based on energy and creativity. Employees are encouraged to take risks, and leaders are seen as innovators or entrepreneurs. The organization is held together by experimentation, with an emphasis on individual ingenuity and freedom. The core values are based on change and agility (Tharp, 2009)

The Market Culture:

This culture is built upon the dynamics of competition and achieving concrete results. The focus is goal-oriented, with leaders who are tough and demanding. The organization is united by a common goal to succeed and beat all rivals. The main value drivers are market share and profitability (Tharp, 2009)

The Hierarchy Culture:

This culture is founded on structure and control. The work environment is formal, with strict institutional procedures in place for guidance. Leadership is based on organized coordination and monitoring, with a culture emphasizing efficiency and predictability. The values include consistency and uniformity (Tharp, 2009)

Components of Organizational Culture

There are many factors that influence culture. However, these main six components can provide a firm foundation for shaping a new organization’s culture. And identifying and understanding them more fully in an existing organization can be the first step to revitalizing or reshaping culture in a company looking for change.

Vision: A great culture starts with a vision or mission statement. These simple turns of phrase guide a company’s values and provide it with purpose. That purpose, in turn, orients every decision employee make. When they are deeply authentic and prominently displayed, good vision statements can even help orient customers, suppliers, and other stakeholders.

Values: A company’s values are the core of its culture. While a vision articulates a company’s purpose, values offer a set of guidelines on the behaviors and mindsets needed to achieve that vision.

Practices: Of course, values are of little importance unless they are enshrined in a company’s practices. If an organization professes, “people are our greatest asset,” it should also be ready to invest in people in visible ways.

People: No company can build a coherent culture without people who either share its core values or possess the willingness and ability to embrace those values. That’s why the greatest firms in the world also have some of the most stringent recruiting policies.

Narrative: Any organization has a unique history; a unique story. And the ability to unearth that history and craft it into a narrative is a core element of culture creation.

Place: Place, whether geography, architecture, or aesthetic design, impacts the values and behaviors of people in a workplace. (Coleman, 2013)

What Role Does Organizational Culture Have During Change Implementation?

Organizational culture has a valuable role in helping implement large transformational changes in an organization. If the culture among the employees of an organization has values and beliefs that are inline and reflect the organization, then that culture can help progress the change. Change agents who are transparent and display values and beliefs that change is sometimes valuable and necessary can transfer these values onto employees and co-workers which creates a culture receptive of change.

The need of a change or at least the understanding that a change is required would be more welcome if the organizational culture was receptive to changes, and day to day operations of the organization could withstand a large change without too much disruption.

A transformational leader can transform attitudes, values, and beliefs of its employees or co-workers through inspiration and enthusiasm creating a change in culture that inspires the followers to accept the change process. A great leader who understands the culture and knows how to change a culture when needed is the best to be charged with the responsibility to be the change agent of an organization during a large transformational change (Bommer, Rich, & Rubin, 2005).

Organizational Culture during a Large Transformational Change can give you:

This 

 Or This 

How Culture Can Affect Large Transformational Change

During transformational change the organization’s culture is either supporting or blocking the implementation of change (Ackerman-Anderson & Anderson, 2018).
Ensuring the success of a large transformational change, organizations and change agents need to understand the culture of an organization. Understanding the values and normative behaviour in an organization can give the change agent foundations that can help change be accepted and implemented.

Change agents sometimes must first change a culture in an organization to ensure a large transformational change will be successfully implemented. Large organizational changes are often the most difficult for employees to accept and if the organization aligns values that create attitudes that are more receptive to change the implementation will be accepted more readily. Changing organizational culture into a change-making culture can be critical in achieving large-scale changes, (Celep, Brenner, & Mosher-Williams, 2016). Cultural incongruence frequently requires an organizational cultural change before large transformational changes can be implemented as the difference in values and goals between employees can lead to resistance of change (Davis & Cates, 2018).

Aligning the organizational values to ensure transparency and create cultural norms that reflect the values and daily behaviours of organization culture that is best equipped to handle large organizational change in one of the first steps a change agent needs to implement if the culture is not receptive to change.

Culture not ready for change

 Incongruence of Culture 

Transformational Leader

A Culture ready for a Large Transformational Change 

If Culture was a Monster;  change the Monster then make the Organizational Change 

Tools and Strategies for Managers

As the organization moves through the transformation, it is important to know that intense emotions are a natural psychological and physiological response. Even if staff agree with the change concept, they can feel a range of emotions about how the process unfolds. Prolonged uncertainty and instability can impede the change implementation as it moves through stages of transformation. People must be supported through this transition. With the right support from their managers, people can be wonderfully resilient and adaptive (Mind Tools, 2019) (Veitch, 2018).


The image below is adapted from the Change Curve attributed to psychiatrist Elisabeth Kubler-Ross, resulting from her work on personal transition in grief and bereavement (Mind Tools, 2019)

Stage 1

Reaction: shock, denial

1. Recognize people need time to adjust
2. Build awareness of the need for change and risk for not changing
3. Communicate often, but do not overwhelm people.  Take time to answer questions.

Stage 2

Reaction: anger, fear

1. Allow people to express their feelings and vent their anger.  Do not try to resolve people’s feelings-just listen.
2. Consider the questions and objections that people may have and be prepared to address them early.
3. Listen and watch carefully so you can respond to the unexpected.  Reactions to change are personal and it is impossible to anticipate and pre-empt everything.

Stage 3

Reaction: Acceptance

1. Encourage people to test and explore what the change means, allowing time for experimentations and making it safe to make mistakes.
2. Provide ample training and opportunities to experience the new state.
3. Accept that performance and productivity typically decline for a period of time as people learn and accept the new way of working.

Stage 4

Reaction: Commitment

1. Celebrate accomplishments and recognize contributions.
2. Reinforce the new processes and procedures with strategies such as performance tools, audits, and accountability systems.
3. Continue to listen to feedback from employees and use it to continue to enhance the new systems and processes. 
(Mind Tools, 2019)

Why are managers so important?

• Employees trust them

• Managers mitigate resistance

• Managers build support

(Prosci Inc, 2015)


How do managers affect culture?

Staff engagement is imperative for a healthy organizational culture. It is important to realize that the drivers of staff engagement are altered during times of uncertainty and transformation. Regardless of the amount of change taking place, employees value three factors:

1) Control (involvement and empowerment)
2) Career (understanding of one’s path)
3) Capability (training and development)
(AON Hewitt, 2013)


This means that the most critical roles for managers are:
• Communicator
• Advocate
• Coach
• Liaison
• Resistance manager
(Prosci Inc, 2015)


Employees undergoing change uncertainty have a greater need for connection:

1) Connection with leaders – two way dialogue with organizational managers/leaders
2) Connection with coworkers – pulling together with coworkers to provide each other with reliable support (Aon Hewitt, 2013)


To successfully manage change and uncertainty and foster a healthy organizational culture, managers can engage employees by empowering them to be part of the solution, rather than giving them reason to perceive they are part of the problem (LEADS Canada, 2019).  


They can use moments of uncertainty to promote learning and express genuine care and concern. They must continue to build relationships by fostering trust, communicating effectively, constructively managing conflict, and creating shared meaning and values (LEADS Canada, 2019). 

Case Studies

Case Study – Improving patient safety at Ascension Health: How culture affects transformational change.

Ascension health is a large US Catholic non-profit healthcare system that is comprised of 67 acute care facilities that employs 106,000 staff. In 2002 the organization launched a five year transformational change strategy to improve patient safety in identified areas. Culture was listed as one of five key challenges to successful transformational change within the system.

“The entire organization must embrace the safety initiative”

Prior to implementing the strategy quality improvement was a focus for many facilities, and culture survey results showed that employee attitudes towards safety and teamwork were positive and ahead of other comparable healthcare institutions. This openness to change and alignment of attitudes with the goal of the change was likely key to their success. The organization also planned a follow up culture survey to be administered, demonstrating their dedication to valuing the culture of their organization.

This case study demonstrates how culture can improve the likelihood of transformational change to be successful, and the importance for leaders to be aware of what the organization culture is prior to change initiation, as well as prioritizing keeping a pulse on it throughout and following the change implementation.

McCarthy, D., & Staton, E. (2019). Case study: A transformational change process to improve patient safety at Acsension Health. The Commonwealth Fund. Retrieved from: https://www.commonwealthfund.org/publications/newsletter-article/case-study-transformational-change-process-improve-patient-safety


Case Study – Organizational transformation to a patient-centric culture: How transformational change can affect culture.

Baylis Medical has manufactured and distributed medical devices worldwide since 1985. From inception a patient-centered focus was a core guiding principle in the culture of the organization. Over the years with company growth - customer service, leading technology, employee development, and corporate social responsibility were added to guiding principles of the corporate mission and culture. With the retirement of the company’s creator, and the continued transformational change of the company, senior leadership began to be concerned that the focus on the patient was beginning to be lost within its organizational culture. It was found through surveying employees that overall the company continued to have a strong patient-centric culture, however it was at risk of this deteriorating due to the large increase in new staff (less than 5 years with the organization). A strategy was developed to prevent this through implementation of 4 recommendations:

Improve visual artifacts throughout the organization that reflect patient-centricity
Establish a customer feedback system to increase accountability
Strengthen employee empowerment to make decisions
Introduce a training program for new employees


This case study demonstrates the effect transformational change can have on the culture of an organization, and the importance of management awareness of how it can be effected so that strategies can be used to mitigate a negative outcome on culture.

Appelbaum, S. H., Seyed, M. Z., MacDonald, A., & Amiri, Y. (2010). Organizational transformation to a patient centric culture: A case study. Leadership in Health Services, 23(1), 8-32. doi: https://0-www-emeraldinsight-com.aupac.lib.athabascau.ca/doi/full/10.1108/17511871011013742

How to Deal with Resistance to Change

What Is Corporate Culture?

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References

Ackerman -Anderson, L,. & Anderson, D. (2018, September 11). Transforming organizational
culture to ensure successful transformational change [Blog post]. Retrieved from
https://blog.beingfirst.com/transforming-organizational-culture-to-ensure-successful-
transformational-change

Aon Hewitt. (2013). Managing employee engagement during times of change. Retrieved from  https://www.aon.com/attachments/human-capital-consulting/2013_Managing_Engagement_During_Times_of_Change_White_Paper.pdf
Appelbaum, S. H., Seyed, M. Z., MacDonald, A., & Amiri, Y. (2010). Organizational
transformation to a patient centric culture: A case study. Leadership in Health
Services, 23(1), 8-32. doi:http://0-
dx.doi.org.aupac.lib.athabascau.ca/10.1108/17511871011013742

Bommer, W., H., Rich, G., A., & Rubin, R., S. (2005). Changing attitudes about change:
longitudinal effects of transformational leader behavior on employee cynicism about
organizational change. Journal of Organizational Behavior, 26(7), 733. Retrieved from
http://0-search.ebscohost.com.aupac.lib.athabascau.ca/login.aspx?direct=true&db=edsjsr&AN=edsjsr.4093953&site=eds-live

Celep, A., Brenner, S., & Mosher-Williams, R. (2016). Internal culture, external impact: how a
change-making culture positions foundations to achieve transformational
change. Foundation Review, 8(1), 116–129. https://0-doi-org.aupac.lib.athabascau.ca/10.9707/1944-5660.1288

Coleman, J. (2013). Six components of great corporate culture. Harvard Business Review.
Retrieved from: https://hbr.org/2013/05/six-components-of-culture

Cleveland counseling (2019). Transformative change. Retrieved from: http://www.clevelandconsultinggroup.com/services/transformative-change.php

Davis, R., & Cates, S. (2018). The implementation of the organizational culture assessment
instrument in creating a successful organizational cultural change. International Journal
of Business & Public Administration, 15(1), 71–94. Retrieved from http://0-search.ebscohost.com.aupac.lib.athabascau.ca/login.aspx?direct=true&db=bth&AN=132129457&site=eds-live

Hunt, E., Paulsen, N., Toursih, D., & DiFonzo, N. (2004). Uncertainty during organizational
change: Is it all about control? European Journal of Work and Organizational
Psychology, 13, (3).

LEADS Canada, 2019. Retrieved from www.leadersforlife.ca

Mind Tools. (2019). Retrieved from https://mindtools.com/pages/article/newPPM_96.htm

Needle, D.  (2004). Business in context: an introduction to business and its environment.
  Retrieved from: http://www.gbv.de/dms/zbw/819045446.pdf

Padfield, S. (2017). Shifting Paradigms in Canadian Healthcare to Support the Scale and Spread
of Innovation. HealthcarePapers, 16(3), 19–26. PMID: 28671541

Prosci Inc. (2015). Program for Managers: A Manager’s Guide to Becoming a Great Change
Leader.

Ravasi, D.; Schultz, M. (2006). “Responding to organizational identity threats: Exploring
the role of organizational culture”. Academy of Management Journal, 49 (3):
433–458.

https://doi.org/10.1108/JOCM-06-2015-089

Schrodt, P (2002). “The relationship between organizational identification and
organizational culture: Employee perceptions of culture and identification in a
retail sales organization”. Communication Studies 53: 189–202.
Veitch, D. (2018). One province, one healthcare system: A decade of healthcare transformation in Alberta. Healthcare Management Forum, 31(5), 167–171. PMID: 30133340 https://doi.org/10.1177/0840470418794272
Stagl, H. (2015, June 30). How to deal with resistance to change. TEDx Georgia State University
[Video file]. Retrieved from https://www.youtube.com/watch?v=79LI2fkNZ2k

Strategy and Business. (2016, February 16). What is corporate culture. [Video
file]. Retrieved from https://www.youtube.com/watch?time_continue=1&v=gficoigz1xs
Tharp, B. (2009). Four organizational Culture Types. Retrieved from:
https://pdfs.semanticscholar.org/b0e2/fd342fcf402920e264f15070276b79be1e25.pdf

The Business Dictionary. Organizational culture. Retrieved from:
http://www.businessdictionary.com/definition/organizational-culture.html