Gale Nicola K, Shapiro Jonathan, McLeod Hugh S T, Redwood Sabi, Hewison Alistair
Implement Sci. 2014 Aug 20;9:106. doi: 10.1186/s13012-014-0106-z.
Organizational culture is considered by policy-makers, clinicians, health service managers and researchers to be a crucial mediator in the success of implementing health service redesign. It is a challenge to find a method to capture cultural issues that is both theoretically robust and meaningful to those working in the organizations concerned. As part of a comparative study of service redesign in three acute hospital organizations in England, UK, a framework for collecting data reflective of culture was developed that was informed by previous work in the field and social and cultural theory.
As part of a larger mixed method comparative case study of hospital service redesign, informed by realist evaluation, the authors developed a framework for researching organisational culture during health service redesign and change. This article documents the development of the model, which involved an iterative process of data analysis, critical interdisciplinary discussion in the research team, and feedback from staff in the partner organisations. Data from semi-structured interviews with 77 key informants are used to illustrate the model.
In workshops with NHS partners to share and debate the early findings of the study, organizational culture was identified as a key concept to explore because it was perceived to underpin the whole redesign process. The Patients-People-Place framework for studying culture focuses on three thematic areas ('domains') and three levels of culture in which the data could be organised. The framework can be used to help explain the relationship between observable behaviours and cultural artefacts, the values and habits of social actors and the basic assumptions underpinning an organization's culture in each domain.
This paper makes a methodological contribution to the study of culture in health care organizations. It offers guidance and a practical approach to investigating the inherently complex phenomenon of culture in hospital organizations. The Patients-People-Place framework could be applied in other settings as a means of ensuring the three domains and three levels that are important to an organization's culture are addressed in future health service research.
政策制定者、临床医生、卫生服务管理者和研究人员认为组织文化是卫生服务重新设计取得成功的关键调节因素。找到一种既能在理论上站得住脚，又对相关组织中的工作人员有意义的捕捉文化问题的方法是一项挑战。作为对英国英格兰三个急症医院组织服务重新设计的比较研究的一部分，在该领域先前工作以及社会和文化理论的基础上，开发了一个用于收集反映文化的数据的框架。
作为一项以现实主义评价为依据的关于医院服务重新设计的大型混合方法比较案例研究的一部分，作者们开发了一个在卫生服务重新设计和变革过程中研究组织文化的框架。本文记录了该模型的开发过程，这涉及到一个反复的数据分析过程、研究团队中的跨学科批判性讨论以及来自合作组织工作人员的反馈。来自对77名关键 informant 的半结构化访谈的数据被用于阐释该模型。
在与国民保健服务体系（NHS）合作伙伴分享和讨论该研究早期结果的研讨会上，组织文化被确定为一个需要探索的关键概念，因为它被认为是整个重新设计过程的基础。用于研究文化的患者 - 人员 - 场所框架聚焦于三个主题领域（“范畴”）以及可以组织数据的三个文化层面。该框架可用于帮助解释在每个领域中可观察到的行为与文化产物、社会行为者的价值观和习惯以及支撑组织文化的基本假设之间的关系。
本文为医疗保健组织文化的研究做出了方法学贡献。它为调查医院组织中本质上复杂的文化现象提供了指导和实用方法。患者 - 人员 - 场所框架可应用于其他环境，作为确保在未来卫生服务研究中涉及对组织文化重要的三个范畴和三个层面的一种手段。
