IHP 600 Module 2 Organizational Culture Paper Example

Patients First, People Always? Assessing the Culture at Summit Valley Medical Center

[Student Name]

Southern New Hampshire University

IHP 600: Social and Organizational Issues in Healthcare

Module Two Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Patients First, People Always? Assessing the Culture at Summit Valley Medical Center

Every hospital has a mission statement on the lobby wall. Fewer have looked hard at whether daily working life matches it. Summit Valley Medical Center's motto is patients first, people always, yet one in four of its registered nurses left last year. This paper assesses the hospital's culture using four sources of evidence, explains what the findings mean and considers how culture may be feeding turnover.

What Organizational Culture Means

Scott et al. (2003a) describe culture as operating at several levels: visible artifacts such as rituals, dress and routines; the values an organization espouses; and the deeper, often unspoken assumptions that shape how people actually behave. They caution that the deeper levels are hard to see from outside and slow to change, and that hospitals contain many subcultures shaped by profession, unit and shift. A useful assessment therefore has to look beyond what leaders say and compare it with what staff experience.

Choosing How to Measure It

Scott et al. (2003b) reviewed the instruments available for measuring culture in health care and found wide variation in scope, format and evidence of validity. Some tools sort organizations into types, while others score them on dimensions such as teamwork or openness. They advised choosing an instrument according to the purpose of the assessment and combining questionnaires with qualitative methods, since surveys capture only what respondents are willing and able to report. Following that advice, this assessment pairs the hospital's annual staff survey with interviews and direct observation.

Sources of Evidence

Four sources were used. The annual staff survey, completed by 612 of 1,040 nursing staff, asks about teamwork, communication and whether people feel safe speaking up. Exit interviews from 97 departing nurses were coded by theme. Turnover rates were compared across nine inpatient units. Finally, the author observed twelve shift huddles on four units over two weeks, noting who spoke, how long huddles lasted and whether concerns raised were acted on.

What the Survey Shows

Overall, 72% of respondents agreed that staff on their unit support one another, a genuine strength. Only 48% agreed that they could raise a concern about patient safety without fear of blame, and just 39% agreed that senior leaders act on what staff tell them. Results varied sharply by unit, and the units with the lowest scores on speaking up also had the highest turnover.

Table 1. Selected Survey Results and Turnover by Unit Type

Note. Composite data from 612 survey respondents and annual turnover records.

What Departing Nurses Said

Exit interviews added detail the survey could not. The most common theme, raised by 61 of 97 nurses, was workload, often described as being assigned six or seven patients with no break relief. The second, raised by 44, was a sense that complaints went nowhere. One nurse wrote that she stopped reporting unsafe assignments after the third time nothing changed. Only 18 mentioned pay as a primary reason for leaving.

What Huddles Reveal

Observation showed the artifacts behind the numbers. In the ICU, the charge nurse opened huddles by asking each nurse for concerns, and huddles averaged nine minutes. On two medical-surgical units, huddles lasted three minutes, consisted mostly of announcements from the manager and ended before anyone else spoke. On one unit a nurse raised a broken bed alarm; the same alarm was mentioned again a week later, still unfixed.

Why Some Nurses Stay Silent

Nembhard and Edmondson (2006) studied neonatal intensive care teams and found that leader inclusiveness, meaning a leader who asks for views and visibly values them, was associated with greater psychological safety, which in turn predicted engagement in improvement work. They also found that staff lower in professional status felt less safe speaking up, and that inclusive leadership narrowed that gap. The contrast between the ICU and medical-surgical huddles fits this pattern closely: where the leader invites input, nurses speak; where huddles are announcements, they learn to stay quiet.

Espoused Values Versus Lived Assumptions

The espoused value is people always. The lived assumption on several units appears to be that staffing gaps will be absorbed by whoever is on shift and that raising problems is pointless. That gap matters more than any single survey score, because staff judge an organization by what it does when its values are inconvenient. When mandatory overtime is routine and concerns go unanswered, the slogan on the wall begins to feel ironic.

Strengths to Build On

The assessment is not all negative. Peer support is strong across units, the ICU offers an internal model of inclusive huddles and 59% of survey respondents said they would recommend the hospital to a friend needing care. These strengths mean change can build on existing practice rather than importing a foreign model. The ICU charge nurses, in particular, could coach peers on other units, which would spread a proven routine through colleagues staff already trust rather than through another directive from administration.

Limits of This Assessment

The survey response rate was 59%, and it is unclear whether unhappy staff answered at higher or lower rates than content ones. Exit interviews capture only those who left. The author is a manager in the hospital, which may have changed behavior during observed huddles and shaped interpretation. Physician, pharmacy and support staff cultures were not assessed.

Implications for Turnover

The evidence suggests culture is part of the turnover story, especially on medical-surgical units where speaking up feels unsafe and feedback seems ignored. Workload drives departures directly, but a culture that does not respond to workload complaints turns a hard job into one that feels hopeless. Later milestones will test this link through a root cause analysis and design responses aimed at both conditions and culture.

Conclusion

Summit Valley has a supportive peer culture and pockets of inclusive leadership, but on several units its lived assumptions contradict its stated value of putting people first. Measuring culture through surveys, interviews, turnover data and observation made that gap visible, and closing it will require leaders to act on what staff report.

References

Nembhard, I. M., & Edmondson, A. C. (2006). Making it safe: The effects of leader inclusiveness and professional status on psychological safety and improvement efforts in health care teams. Journal of Organizational Behavior, 27(7), 941-966. https://doi.org/10.1002/job.413

Scott, T., Mannion, R., Davies, H. T. O., & Marshall, M. N. (2003a). Implementing culture change in health care: Theory and practice. International Journal for Quality in Health Care, 15(2), 111-118. https://doi.org/10.1093/intqhc/mzg021

Scott, T., Mannion, R., Davies, H. T. O., & Marshall, M. N. (2003b). The quantitative measurement of organizational culture in health care: A review of the available instruments. Health Services Research, 38(3), 923-945. https://doi.org/10.1111/1475-6773.00154