Table 1.

Organizational Culture Measurement Instruments that Have Potential to Be Used in Health Care Settings

Name and Key References	Cultural Dimensions and Outcome Measures	Number of Items	Nature of Scale	Examples of Use in Health Settings	Scientific Properties in Health Settings	Strengths	Limitations	Comments
Competing Values Framework (Cameron and Freeman 1991; Gerowitz et al. 1996; Gerowitz 1998)	Key dimensions are staff climate, leadership style, bonding systems, prioritization of goals. Assessment results in four different culture types, described as: clan, adhocracy, hierarchy, and market types. Each organization usually has more than one of these types.	16	Brief scenarios describe dominant characteristics of each type. Respondents divide 100 points between these scenarios depending on how similar each scenario is to own organization.	Applied to top managers in 265 hospitals in U.K., U.S., and Canada (Gerowitz et al. 1996; Gerowitz 1998).	No details provided.	Simple and quick to complete, high face validity, used in several studies in health settings, strong theoretical basis, assesses both congruence and strength of culture.	Narrow classification of organizational types.	Originally developed for use in educational organizations.
Quality Improvement Implementation Survey (Shortell et al. 2000)	Key dimensions are: character of organization, managers' style, cohesion, prioritization of goals, and rewards. Assessment results in four different culture types, described as: group, developmental, hierarchy, and rational.	20	Brief scenarios describe dominant characteristics of each type. Respondents divide 100 points between these scenarios depending on how similar each scenario is to own organization.	Used to assess relationship between culture and implementation of TQM in 16 hospitals (Shortell et al. 2000), and examination of relationship between implementation of evidence-based medicine and culture.	Validity unknown. Internal consistency for one of the scales 0.79 (Shortell et al. 2000)	Simple and quick to complete. High face validity. Used in health settings by one of the leading teams in the field Adds extra dimension (rewards) to CVF.	Narrow classification of organizational types.	Based closely on the CVF but some terms modified to increase relevance to health organizations.
Organizational Culture Inventory (Cooke and Lafferty 1987; Thomas et al. 1990; Seago 1997; Ingersoll et al. 2000)	Shared norms and expectations that guide thinking and behavior of group members, resulting in 12 thinking styles of individuals within a group: humanistic-helpful, affiliative, approval, conventional, dependent, avoidance, oppositional, power, competitive, competence/perfectionalist, achievement, self-actualization Analysis of these 12 styles results in three factors—people/security culture, satisfaction culture and task/security culture.	120	5-point Likert scale.	Various.	Internal consistency 0.67-0.92. Convergent and discriminant validity established (Cooke and Szumal 1991).	Good face validity, widely used, graphic illustration of results.	Analysis results in limited number of aspects of culture, initial impression that it is long and complex to complete, under copyright and may be expensive to use.	Used in wide variety of different settings, strong psychometric underpinning.
Harrison's Organizational Ideology Questionnaire (Harrison 1975; Ott 1989; Litwinenko and Cooper 1994)	Assesses ideology of organization in terms of orientation to power, roles, tasks and individuals.	15	Respondents rank four statements in each item in terms of how representative they are of (a) the organization and (b) the respondents own attitudes and beliefs.	Used to assess cultural implications of organizational change in U.K. (Litwinenko and Cooper 1994).	No data.	Good face validity, addresses both existing and preferred culture.	Limited number of culture types.	Used widely in variety of settings, strong theoretical underpinning.
Hospital Culture Questionnaire (Sieveking, Bellet, and Marston 1993)	Employee opinions of organization in eight different dimensions: supervision, employer attitudes, role significance, hospital image, competitiveness, staff benefits, cohesiveness, workload.	50	6-point scale.	10 U.K. private hospitals (Sieveking, Bellet, and Marston 1993).	No data on validity, factor analysis with coefficient scores of 0.61-0.93 (Sieveking, Bellet, and Marston 1993).	Developed for use in health context.	Developed for private sector and would have to be adapted for use in public sector, under copyright.	Limited development after initial study.
Nursing Unit Cultural Assessment Tool (Coeling and Simms 1993; Rizzo, Gilman, and Mersmann 1994; Goodridge and Hack 1996; Seago 1997)	Individual and group preferred behavior, rated by respondents as those behaviors that they prefer in comparison to those that typically occur in their unit.	50	4- or 6-point Likert scale.	Nursing units.	Construct validity established through preliminary qualitative studies Reliability unknown (Goodridge and Hack 1996).	Detailed assessment in one staff group within organization.	Lack of subscales, limited to assessment of one stakeholder group.	Useful for assessment of professional culture but less good for organizational culture.
Practice Culture Questionnaire (Stevenson 2000)	Attitudes to and engagement with quality improvement (clinical governance) and resistance to change.	25	5-point scale.	Pilot-tested in 110 primary care practices in U.K.	Test-retest and split-half reliability (Stevenson 2000).	Detailed assessment focused on primary care.	Origin of items unclear, generalizability outside U.K. primary care uncertain. Examines superficial manifestations of culture only.	Recently developed instrument, development on-going.
MacKenzie's Culture Questionnaire (MacKenzie 1995)	Employee commitment, attitudes to and belief about innovation, attitudes to change, style of conflict resolution, management style, confidence in leadership, openness and trust, teamwork and cooperation, action orientation, human resource orientation, consumer orientation, organizational direction.	76	Respondents tick each statement which they feel is broadly true of their organization.	One NHS trust (MacKenzie 1995).	Unknown.	Simple to complete.	Origin of items unclear, scientific properties unknown.	Designed to assess specific business units of hospitals.
Survey of Organizational Culture (Tucker, McCoy, and Evans 1990)	Describes culture in terms of 13 dimensions: orientation to customers, orientation to employees, congruence amongst stakeholders, impact of mission, managerial depth/maturity, decisionmaking/autonomy, communication/openness, human scale, incentive/motivation, cooperation versus competition, organizational congruence, performance under pressure, theory S/theory T.	55	5-point scale.	Applied within three hospitals in U.S. (Tucker, McCoy, and Evans 1990)	Good internal reliability, median alpha scores for 14 scales of 0.62–0.9 (Tucker, McCoy, and Evans 1990).	Detailed qualitative work conducted as part of development, has been used in public and private sector.	Only used in U.S. and mostly used on senior leaders and managers, rather than on all levels of workforce.	Used in range of health and nonhealth organizations.