Teamwork in Medical Organizational Cultures

Discussion On Organizational Cultures

The acceptance or rejection of an organizational culture, the decision to consolidate it or, on the contrary, to change it, is based both on humoral reactions, and also on certain compatibility matrices between types of employees, types of objectives, and types of cultures. Thus, the study of these matrices emerged.

A pioneer in this direction is Harrison, who speaks, in 1972, of organizational ideologies. Ideologies are defined by Beyer (1981) as relatively coherent systems of opinions and values that keep people together and explain the actions to which they resort in order to achieve specific purposes. This approach does not differ much from the definition, perhaps the best known, which Schein (1992) gives to the organizational culture: “set of unanimously shared basic concepts that the group has learned during the adaptation to the external environment and integration in the internal environment” (p. 12, t.m.). Meyer (1982) speaks of organizational ideologies in the hospital environment, in the context of the learning experience caused by a strike of the doctors. Depending on their ideologies, some hospitals learn from this experience, adapt, while others reject it without processing it.

As stated by Ashkanasy, Wilderom and Peterson (2000), managerial ideologies can be related to the so-called competing values theory (competing values framework - CVF). Quinn and McGrath have developed this theory in the early 80s, by organizing polarized values on two axes: interior-exterior and flexibility-control.

According to their study, the orientation towards control is correlated with the focus on external coercion elements (rules, taboos, etc.), and the inclination towards flexibility has its origin inside the organization, in creating a sense of belonging, through training and socialization. By transferring to the organizational context the distinction made by Dodds (1951) at socio-cultural level, between shame cultures and guilt cultures, the shame cultures are those in which the external control is very emphasized – you do what you are required because you are ashamed to be marginalized, and the guilt cultures are those primarily based on being conscious of one’s own role and responsibilities, which are accomplished through belief rather than through a conditioned reflex of control.

In other words, there are cultures, and implicitly organizational cultures, able to choose, take decisions based on considering each alternative and reach, with certain costs, a consensus, and organizational cultures in which the decision is institutionally imposed by the existence of a more or less inflexible set of rules, which provide the control component.

The human relationship model, as a closed but flexible system, brings a sense of family within the organization. The organization that adopts this model values relationships of trust between its members, and transforms its leaders into mentors, mediators, by no means autocrats. Decision-making within the organization is decentralized, which lowers the degree of control. Leaders are trusted with the same trust encountered in interpersonal relationships within the organization, which generates a relatively low resistance to change, given the authority earned, not imposed, by the one that proposes the change, and the consensus within the organization.

The open systems model gives great importance to the external environment from which the organization obtains its resources. The acquisition of resources needed by the organization, considering the uncertainty of the external environment and the limited adaptability of the internal environment, requires the presence of a leader who is oriented towards innovation and change. The learning organization theory best fits this quadrant of the “map” of organizational cultures, flexible and oriented towards the external environment (to a certain extent a paradoxical hybrid, since flexible cultures are more likely to “grow” from inside) from where the directions of change that the organization must face come.