|InterJournal Complex Systems, 883
|Manuscript Number: |
Submission Date: 2004
|Organizational Culture from a Complex Dynamic Systems Perspective: Moving from Metaphor to Action in Healthcare|
Organizational Culture from a Complex Dynamic Systems Perspective: Moving from Metaphor to Action in Healthcare Frank R. Funderburk In*Compass Systems email@example.com As noted by Boan and Funderburk (2003), people in healthcare organizations work, relate, and generally behave in ways that are guided by the norms of their organization and the healthcare industry as a whole. Organizational culture is often called upon as a descriptive, organizing and/or explanatory construct to characterize the shared beliefs, perceptions, expectations, norms and acceptable behaviors of individuals as they interact within and between the various groups and organizations that they represent. The construct has been linked in the literature to various aspects of organizational performance including profitability, quality, customer and employee satisfaction, safety, and innovation. Organizational culture influences how outcome information is used in organizational decision-making (e.g., Hodges & Hernandez, 1999) and thus impacts efforts to implement and sustain clinical quality improvement, assure patient safety, and improve the quality of life of individuals while meeting the challenges of a changing competitive marketplace. Improved psychometric development procedures have produced reliable and valid measures of various dimensions of organizational culture. Denison and colleagues (Denison, 1984; Denison & Mishra, 1995; Fisher & Alford, 2000) for example have developed a quantitative multidimensional assessment tool that rates an organization on four key cultural traits (involvement, consistency, adaptability, and mission). Their work notes that high performing organizations are able to simultaneously cope with seemingly contradictory or paradoxical goals and demands (i.e., are both flexible and stable; simultaneously maintain an internal and external perspective). However, strategies to change organizational cultures in a positive manner are less well documented. Many recent discussions of organizational culture and change have contrasted mechanistic management theories, stressing hierarchical command and control mechanisms, with the more holistic view of the organization as complex adaptive systems, stressing decentralized flexibility and continuous learning (e.g., Zimmerman et al., 1998). Such discussions help to illustrate the pervasive role of our own mental models, descriptive linguistic conventions, and belief systems as we strive to develop successful and responsive business enterprises (e.g., Lissack, 1999; Weick, 1995) but the “complexity sciences” offer more than just a convenient conceptual framework (with a new set of metaphors) to the leaders of healthcare organizations as they strive to bridge what has become known as the “Healthcare Quality Chasm,” as described in the recent Institute of Medicine report (2001; Berwick, 2002). This paper presents a survey of several formal dynamic models that have relevance for healthcare policy development and evaluation giving special attention to the class of social phenomena typically subsumed under the broad category of organizational culture. After this overview, the focus will be on the practical implications of findings derived from this methodological approach. How might this knowledge be put to use to improve healthcare systems today? How might existing models be refined further to guide future improvements? The models being considered include the exploratory policy methods discussed by Bankes (1993, 2002), the computational organizational modeling approach of Carley (1996, 2002), agent-based models of cooperation (Axelrod, 1997), conflict resolution (e.g., Klein et al., 2000), and approaches that aim to diagnose and suggest systemic interventions for troubled organizational cultures (e.g., Schein, 1996; Senge, 1990, Sterman, 2000, Wolsterholme, 2003). Each of these approaches has developed practical knowledge that can be used by researchers, policy-makers, and healthcare leaders to improve the quality of healthcare, and the quality of life, for people in the communities that we serve.
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