Healthcare performance and organizational culture
International Journal of Integrated Care, 14 April 2004 - ISSN 1568-4156
Book review
Healthcare performance and organizational culture
T Scott, R Mannion, H Davies, M. Marshall
Abingdon, Oxon: Radcliffe Medical Press, 2003, pp 131,
ISBN 1 85775 914 1
R.H. van Linge, Senior Lecturer Innovation Management, Discipline group of Nursing, Julius Centre for Health Sciences and Primary Care, University Medical Centre of Utrecht, The Netherlands

Attempts to realise integrated care systems often fail because the existing shared values and belief systems of the different disciplines and organisations involved are too powerful. Changing these cultural manifestations may be inevitable but this also raises questions about what organisational cultures really are, how they can be assessed, and what different cultural change strategies are available. Healthcare performance and organisational culture offers a rich and detailed description of a number of central themes concerning organisational culture and its relation to healthcare performance. The book contains three extended parts. Part 1 deals with the different organisational culture theories as well as the different types of subcultures that exist in organisations. Part 2 contains a detailed description of eight instruments for assessing organisational culture, some of which have been developed specifically for assessment and research in health care organisations. Part 3 is a rich description and analysis of studies (non-healthcare and healthcare) that have related organisational culture to performance.

Let us look further from the perspectives of the possible target groups of the book.

The book seems very useful for educational purposes. If an instructor would like to introduce students to the subject of organisational culture, this book would be a first class choice. If, however, the goal is to let students reflect on organisational culture theories, the book is less useful. Although the theories are presented in an orderly and readable way, there is hardly any attempt to relate the theories to each other or to develop a meta theoretical framework that can be used for reflection and critical analysis.

Healthcare managers and professionals, and clinicians with management responsibilities, may be most interested in the part about the relationship between organisational culture and performance. They will not get a simple answer. Although it is more likely than not that culture influences performance, a lot of factors are involved in determining this relationship. For instance, the outcomes and the cultural variables chosen, as well as the level of analysis of these factors.

Managers interested in strategies to change organisational culture are not offered much. An opportunity is missed here. The theories described in Part 1 all have more or less explicit assumptions about the possibility of cultural change and the ways to realise change.

Researchers in the field of culture and cultural change in health care will feel comfortable after reading the book. There is little knowledge coming from research and a lot of questions are still unanswered. For researchers that are especially interested in the instruments used to assess organisational culture the book offers a good overview of existing instruments. However, if the question is ‘what instrument to choose for what type of research question’ the book is not very helpful.

The book offers a detailed and solid literature based introduction to the field and is structured in a user-friendly manner. For people who are interested in the subject, it can be recommended. The book offers little for the advanced student, manager and researcher, although the extensive literature list may lead the way to more reflective sources. And lastly, the book is surely not of interest for those searching for a concrete answer to the question ‘how to deal with organisational culture in the case of integrated care’.