Analysis of organizational culture factors that influence the performance of health care professionals: A literature review

Abstract

Hospitals in today’s healthcare system are under pressure to boost their competitiveness. A number of studies have shown the disconnect between corporate culture and the enhancement of healthcare professionals’ performance. While it is well accepted that an organization’s culture has a substantial impact on the performance of its health care professionals in clinical practice, the mechanisms by which culture might enhance health care professionals’ performance remain unclear. This paper draws on 22 literature reviews and database searches using keyword syntax from Sciencedirect, Pubmed, Google Schoolar, and other relevant publications published between 2011 and 2021. Research in the field demonstrates that a company’s culture may influence the efficiency and effectiveness of its healthcare employees. This overarching issue was dissected into the following themes: nurse performance mediated by discipline; the existence of cultural groups; a central focus on health care professional management; and individual, organizational, and psychological aspects. The optimal performance of nurses and the outcomes of patient care are contingent on management in the health care business knowing the cultural factors that exist in the workplace.

Introduction

In today’s health-care environment, health-care professionals are confronted with the need to enhance the competitiveness of hospitals, which necessitates the exploitation of human resources.¹ Considering that at least 30-40 percent of patients do not receive treatment based on scientific evidence and that 20 percent or more of health care provided is either unneeded or may cause harm to the patient, this assertion is reasonable.² Integration of research into clinical practice is frequently advocated as a way of improving performance, addressing unexpected variation in individual physician decision-making, and improving patient and system outcomes. While the application of research findings to practice is frequently advocated as a solution, statistics such as those given above demonstrate that there is a misalignment between corporate culture and health care professional performance improvement efforts.²

This divide between theory and practice is essentially a failure of corporate culture to motivate health care professional to achieve at their highest levels. Understanding and addressing organizational culture issues requires a thorough understanding of a variety of factors, such as practitioner obstacles, the environment in which choices are made, and transformational impediments.³ To far, the majority of nursing research has been devoted to determining the impact of doing research at the person rather than organizational level. A comprehensive assessment of the individual drivers of improved health care professional performance discovered minimal consistency in study findings addressing the individual variables that predicted better health care professional performance via organizational culture.⁴

Additionally, when studying individual factors (e.g., age, gender, years of nursing experience), researchers generally look at irreversible determinants (e.g. age, gender, years of nursing experience). Given the fact that the vast majority of healthcare professionals work in complex organizations, this shift in emphasis toward examining the organizational factors that influence research use is critical.⁵ However, little is known regarding the effect of organizational culture on health care professional performance improvement. As part of an ongoing initiative exploring how health care professional choose their research use, we did a review of the literature on nursing organizational culture studies to ascertain the status of the science. The goal of this essay in its whole is to: ascertain the organizational culture elements that influence health care professional performance.

Materials and Methods

This article is a literature review of the literature conducted in accordance with the PRISMA declaration. The PRISMA declaration contributes to the clarity and transparency of systematic review reporting. The analysis methods and inclusion criteria for this study were established. References are examined to see whether they fulfill the following criteria: Ten-year source limitation, publication in English and Indonesian, and open access to abstracts and papers. These inclusion criteria enable the study to assess only variables linked to organizational culture in hospitals that influence health care professionals’ (nurses’) performance improvement. If reportage and literature are grayed out, articles are omitted. The search approach was independently carried out by scanning internet databases such as Google Scholar, PubMed, and Science Direct. This article provides a systematic review of the literature that adheres to the PRISMA statement. The PRISMA statement adds clarity and openness to the reporting of systematic reviews. The study’s analytic methodologies and inclusion criteria were devised. References are screened to see whether they meet the following criteria: ten-year source limitation, English and Indonesian publishing, and free access to abstracts and full articles. These inclusion criteria enable the study to evaluate only variables related to organizational culture in hospitals that impact the performance improvement of health care workers (nurses). Articles are omitted when reportage and literature are grayed out. Independently, the search was conducted by examining online databases such as Google Scholar, PubMed, and Science Direct. The phrases “organizational culture,” “factors affecting hospital organizational culture,” “nurse performance,” “effect of organizational culture,” and “factors affecting organizational culture” were used to identify relevant publications.

Inclusion criteria

We evaluate papers written in the English language that explore corporate culture. We reran our search without specifying English as a language, and this time we discovered a flood of titles in languages other than English. As an example, when we compared the two searches using CINAHL, we found that 97 percent of the articles retrieved were confined to English-only articles, suggesting that when English-only articles are used as the inclusion criterion, there is little bias. There are no restrictions on the kind of publications that can be included in the study design. Over 1500 titles and abstracts were returned as a result of the search technique. The first author utilized the original inclusion criteria to search for and evaluate the title and abstract (if available) of articles that were published online. Our wide search keywords yielded a large number of articles that were not appropriate for our purposes. A large number of unconnected articles discuss organizational culture in general, cross-cultural work settings, and techniques for establishing certain forms of organizational culture, many of which are not related to each other (i.e., how to create a safety culture). This article is completely unrelated to this review. The initial inclusion criteria resulted in the finding of 102 items, which exceeded the expectations of the researchers. Following the elimination of duplicates, a total of twenty articles are left to be reviewed throughout the remainder of the inclusion/exclusion phase. The results of this approach are illustrated in Figure 1. The recovery of all twenty items was a complete success.

Data extraction and filtering

This final screening process was driven by three criteria: (1) the publishing of an original research study; (2) the study’s focus on health care professionals; and (3) the notion of performance-enhancing culture. The first writer just finished the last edit. After all the data was filtered out, we were left with 29 items. Summarizes the reasons studies were excluded from the final data collection and how often they were excluded. Features such as research design, setting, sample type, sample size, theoretical underpinnings, cultural definitions, cultural perspectives, instruments used, units of analysis, and analytical methodologies were gathered from the remaining investigations. The complete set of evaluated studies and their characteristics are summarized. In general, the researchers in this study saw cultural factors as metaphors for or strategies for improving nurse effectiveness. The symbolic-interpretive researcher looks into the ways in which businesses create their own versions of reality and truth,⁶ whereas the researcher is interested in the ways in which culture may improve nursing performance.

Results

During the course of the search, a total of 1567 different things were found (see Figure 1). In addition, using a backward reference search, 654 articles were found using Google Scholar, 358 publications were found using PubMed, and 555 publications were found using ScienceDirect; all of these were incorporated into the research. Out of the original 102 articles, a total of 73 were eliminated after it was discovered that they were identical to other articles. After going over all of the papers that were handed in and looking at their titles and abstracts, we discovered that 29 of them did not meet the exclusion criteria, which are as follows: publications in the end, in order to arrive at our conclusion, we conducted a study of 22 publications that were pertinent to the topic of the influence of corporate culture on the performance of health care professionals.

Discipline has a role in the effect of corporate culture on health care professional performance

The findings of the path analysis that was conducted in order to provide evidence in support of the hypothesis show that organizational culture does have an effect on the performance of health care professionals when this influence is mediated by work discipline. When a company has a strong culture, the work atmosphere is more disciplined, and as a result, the performance of health care professionals is improved. On the other hand, when there is a reduction in the company’s culture, there is also a decline in the work discipline, which leads to a decline in performance. Culture, discipline, and employee performance are three aspects of an organization that have a significant bearing on one another.³ Culture of an organization has a positive and significant indirect impact on performance when it comes to matters pertaining to discipline. In addition, the culture of the organization has an impact on the performance of its employees, with work discipline acting as an intervening element in this relationship. The descriptive analysis revealed that the directions from the RSUD leadership and management were still not detailed enough for health care professionals to understand, that the leadership of the hospital did not consult with subordinates when making the majority of their decisions and only rarely solicited input from subordinates, and that the hospital also did not encourage employees to prioritize their own well-being as a top priority in their work lives.

Making use of cultural groupings

Health care professional (nurses) are a critical component of health care. Based on studies done by Jun et, al, 2020⁵ The outcomes of this study suggest that the hospital’s culture has an effect on health care professionals’ performance. The formation of work culture groups (for health care professionals) is critical for performance improvement. According to a research Eskola, 2016,⁷ health care professionals who participated in work groups had a more positive attitude toward their job tasks and enhanced their use of evidence-based practice in their practice. Communication is one of the characteristics that cultural groups share.

Emphasizing health care professional management

Clinical performance management is a management technique that aims to enhance the clinical skills of health care professionals in health care settings. Clinical Performance Management Development on health care professional Performance in Hospitals is used by hospitals for nursing services.⁸ It is critical for health care professional managers to develop an understanding of the many manifestations of workplace culture, particularly in nursing management.⁹

Factors affecting the individual, the organization, and the individual’s psychological well-being

The people in Indonesia is becoming increasingly interested in healthcare services, especially those offered in hospitals. Professionals in the health care industry are expected to make substantial contributions to improving the overall quality of health care provided by their company, which in turn benefits the lives and well-being of their patients. Health care professionals’ productivity at a hospital may be measured by observing the standard of care they provide. Quality of care provided by a hospital may be gauged by looking at how well its medical staff does their job.¹⁰ Individual health care professional performance is impacted by a variety of elements, including personal, organizational, and psychological.

Discussion

Organizational culture is a reality or set of habits that are shared by the majority of its people (culture in action), it does not just represent desired ideals. Essentially, organizational culture serves a variety of tasks, including delineating borders, establishing identities, bringing commitments together, and sustaining societal ideals.¹¹ When evaluating corporate culture, it is critical to focus on its expressions, as culture is a complex term. The common appreciation of a value is expressed in the attitudes, actions, and symbols experienced on a regular basis by workers. Numerous studies have established a link between culture and productivity. ¹² A strong and relevant organizational culture drives its employees’ conduct in a certain direction in order to accomplish business goals, which eventually improves the firm’s performance.¹³ According to the paradigm,¹⁴ culture shows itself on three essential levels that are portrayed hierarchically: (1) visible objects, (2) values, and (3) underlying fundamental assumptions. Additional organizational culture conceptual frameworks include the following:⁹

This conclusion, which has been supported by a large number of studies, posits that aspects of the corporate culture and the discipline itself have an influence on the performance of health care professionals. The atmosphere of the workplace has a significant bearing on how well employees do their jobs. The culture of the organization has a significant and disproportionate influence on both the work discipline and the performance of its employees.³

The results of this study provide credence to previous studies which have shown that a person’s level of competence has a direct bearing on their level of performance. The performance of health care professionals is only partially impacted by their organizations’ level of dedication.¹⁵ The level of competence that employee possesses has a significant and positive influence on the performance of that person. The performance of the employee is significantly improved. The person’s level of performance will be significantly greater if they have a higher level of education. It should also be mentioned that it is emphasized that training has a positive and significant influence on the performance of an employee.¹⁶

The role of the head of the room and the management of nursing management have an effect on the performance of health care professionals in hospitals, and thus nursing management stakeholders such as the head of the room must improve and maintain their role as head of the room to ensure that nursing is implemented properly and in accordance with standards.¹⁷ According to study¹⁸ statistical analysis using the fisher exact test revealed a value of p=0.014 (p=0.05), indicating that there is a link between the function of the head of the room or management and the performance of nurses in organizational culture.¹⁹

This is consistent with study performed by Mandagi, et al.¹⁰ which indicates that these variables include individual characteristics such as talents, skills, knowledge, demography, and family history. Perception, attitude, motivation, personality, and learning are all considered psychological factors.²⁰ Resources, incentives, workload, structure, supervision, and leadership are all examples of organizational factors. The fact that the present award may reach into sectors of health care professional and performance is a major factor in the award’s potential to boost performance.²¹ Satisfied with income, participating regularly in hospital activities, advancing in hospital career in a regulated manner, earning a salary rise, and receiving financial prizes for good work and suggestions. Salary is in line with the UMP.¹⁰

Hospital is one of the health sector’s public service providers. Hospitals play a critical role in attempts to improve the state of public health.²² Hospital is one of the health sector’s public service providers. Hospitals play a critical role in attempts to improve the state of public health.²³ According to,²⁴ after examining the effect of organizational characteristics on health care professionals’ performance in providing health care professional care in hospitals, it was concluded that organizational culture characteristics, specifically the variables of resources, leadership, organizational structure, and job design, had a statistically significant effect on performance. According to study²⁵ about the relationship of individual factors and organizational factors with caring behavior of health care professionals shows the relationship between working age, leadership, organizational structure, rewards and job design with caring behavior of health care professionals.

Figure 1.

Results in PRISMA flowchart.

The largest number of resources in hospitals and those who have an important role in providing health services are health care professionals.²⁶ This is because health care professionals have a function in serving the health of patients as implementers of health care professional care and are health workers who are near patients for 24 hours to do various things related to patient care.²⁷ The large number of workloads received by health care professionals and the threat of fatigue that can cause work stress can also occur if health care professionals cannot balance the demands of work with their abilities.²⁸ One of the main tenets of positive psychology is the promotion of a person’s psychological health, or how effectively they are able to realize their own potential.²⁹ An employee’s level of mental health is a significant role in their productivity on the job. Evidence from Jamal’s 2017.³⁰ study corroborates this idea, showing that happy workers are more productive in the office.

Conclusions

Appreciation of a value shown in the attitudes, actions, and symbols of the workplace is what makes up an organization’s culture. Individual, organizational, and psychological elements, as well as those mediated by discipline and the presence of cultural organizations that focus on health care professional management, all have a role in how effectively health care professionals work in an organization.

Funding Statement

Funding: None.