Workplace Culture and Practice Development in Healthcare

This article discusses the importance of workplace culture in healthcare settings and its impact on practice development. It explores the relationship between workplace culture and patient outcomes, staff well-being, and the provision of effective and safe care. The article also highlights the role of different stakeholders in creating a positive workplace culture and the steps involved in cultural change.

Practice Development
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Simplest form of workplace culture is the different ways of doing tasks. Another form of
workplace culture is psychological predispositions of all the stakeholders of an organisation
to influence the ways of working. Values and practices of the organisation should be shared
among all the stakeholders of an organisation for implementation of effective workplace
culture. Practice development is a constant process of establishing person-centred cultures.
Personal qualities, creative imagination, practice skills and practice wisdom are the
prerequisites of practice development. Practice development has strong association with
culture and person-centred care development (Villar and Serrat, 2017).
Workplace culture in the healthcare setting influence patients’ experience, motivate staff
members for commitment and effectiveness, implement evidence-based practice, ensure
patient safety and ensure innovation and productivity. It is evident that ineffective culture
development lead to poor patient outcomes, weakened staff-wellbeing and loss of valuable
economic resources. Hence, it is essential to understand the relationship between the
workplace culture and practice development in the clinical setting specifically at the level of
service delivery to the patients where patients and service providers interface. It advocates
recognising, understanding and developing effective workplace culture for the provision of
improved services to the patients (Arundell, Mannix, Sheehan, and Peters, 2018).
Different stakeholders like policy makers, clinical leaders, healthcare organisation regulators
and policy analysts should play significant role in the effective workplace culture. Positive
workplace culture plays important role in recruiting and retaining experienced and expertise
staff members; hence, needs and requirements of the patients can be efficiently met.
Workplace culture is not about an individual; however, it is about social framework which
affects people’s behaviour and social norms which should be accepted by all the people in an
organisation. Practice development in the healthcare organisation is not a single process;
however, it should be segregated for the individual departments because clinical services
usually provided under different departments. Hence, culture should be adopted according to
the pattern of working of individual department for the successful practice development.
Even though work pattern is different for different departments of an organisation, there
should be common interests, assumptions and values to facilitate uniform culture (Catling,
Reid, and Hunter, 2017).
Effective workplace culture in healthcare organisation can be effectively achieved through
different steps and progress against each step should be judged. Following are the steps
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involved in the cultural change : agreeing shared values, purpose and ways of working
together, discussing about purpose and values, challenging and supporting each other to fulfil
shared values and purpose and incorporating shared values and purposes in the systems and
practice development. Effective workplace culture in the practice development necessitate
change in attitude and behaviour of all the stakeholders with respect to the values, beliefs and
assumptions of organisational culture. Literature suggests that effective culture in the
healthcare organisation achieved through influential leadership, team work and learning from
the practice. Operative workplace culture has more significance in healthcare sector in
comparison to the other corporate and organisational culture because culture in the clinical
settings affects day-to-day outcome of the patients (Kurjenluoma et al., 2017).
Concept of organisational culture comprises of different schools of thoughts and these are
beneficial in understanding culture in the organisational context. First, cognitive school;
which consider culture as a source of knowledge, beliefs and evaluations which permit people
to work in a group with acceptable criteria with other members of the group. Cognitive
process is beneficial in group discussions among team members and constructions of
processes for practice development. Psychological process is another thought of school for
organisational culture. Psychological processes are beneficial in facilitating social conduct
which produces visible manifestation in the organisational environment. It is also beneficial
in demonstrating consciousness and dynamics to become significant in the organisational
culture. Values and norms of the organisation have strongest influence on the organisational
culture. Norms are usually invisible; however, for the effective implementation of the
organisational culture, norms should be addressed on the priority basis (Hahtela et al., 2015).
Organisational culture for practice development should comprise of content and practice.
Content comprises of values, norms and beliefs which are beneficial in uniting people in an
organisation and allowing them to interpret, analyse and understand the organisational world.
Practices are the expressions and communications of information and knowledge through
actions. Workplace culture comprises of both external and external integration to feel, think,
address and act on these issues. Culture is socially constructed and establishes interaction
among meaning, assumptions, beliefs and expectations. Workplace culture is the implicit
aspect of the organisation and outside individual can not observe or interpret it. It represent
the agreement among each group member of an organisation (Shepherd, Willis-Esqueda,
Newton, Sivasubramaniam, and Paradies, 2019).
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There is a strong association between the organisational culture and professional healthcare
practice. Research established that there is positive correlation between the organisational
culture and reduced turnover of healthcare employees and reduced patient mortality (Peet,
Theobald, and Douglas, 2019). However, more importance is given to the workplace
environment; hence, merit of organisation culture for the success or failure of the clinical
practice is difficult to conclude. Well established culture in the healthcare organisation
provide healthcare professionals opportunity for self-sufficiency and accountability, provide
control over environment for patient care and facilitate healthcare professional and patient
collaboration for patient care. Success of the organisational culture also proved beneficial
because management’s of healthcare organisations understands importance of facilitating
cultural environment to provide effective and safe healthcare services to the patients
(Hennessey and Fry, 2015).
Organisational culture is beneficial in establishing clinical targets and strategies for
improvement in the clinical practice. It is also helpful in improving expertise of healthcare
professionals which is one of the most important attributes of the professionalism (Locke,
Bell, Scallan, Ozguler, and Caesar, 2018). Healthcare profession is an ever changing
profession; hence, implementation of organisational culture is more appropriate in this
profession because it can efficiently implement modifications and improvements in the
healthcare practice. Healthcare services might move away from the professionalism because
hospitals are corporations and mainly focus on the productivity and achieving the goals.
Hence, it would unfavourably impact patient care and patient outcome (Hennessey and Fry,
2015). However, organisational culture proved beneficial in the retaining and maintaining
professionalism among healthcare professionals.
Workplace culture is beneficial in improving clinical practice through developing patient-
centred care and evidence-based practice. It facilitates judgement of quality in spite of
facilitation of engagement for the effective practice development. It enables articulation of
interrelated and synergistic association between the knowledge and skills, planning strategies
and empowering systematic and rigorous change to accomplish evidence-based person-
centred care (Jones, 2011). Workplace culture is beneficial in practice development through
incorporating values, beliefs and assumptions, establishing targeted intent of all the
stakeholders, establishing moral framework, targeting influence of framework on practice
development, applying self-reflection and promoting self-reflection in others, encouraging
others as part of change, adopting widespread participation and collaboration and bringing
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change in practice. By virtue of implementation of these changes, all the healthcare workers
improve awareness of pattern of their practice, activities which should be taken as granted,
expand consciousness of impact of organisational system on pattern of their work, recognise
contrasting relationship between the adaptation by system and their actual practice, anticipate
disagreement with the system for the improved implementation of the practices for improved
patient care, modify and improve actions on regular basis to implement new skills advanced
through reflection on practice. Facilitated processes empowered through culture proved
helpful for the healthcare professionals to break the barriers for action and implement
culturally effective processes. Workplace culture provide framework for development and
utilization of current practice in patient care, its analysis and improvement through practice
development principles. Framework for the practice is beneficial in improving experimental
learning, sense of ownership and making practice development real for the healthcare
professionals at the ward level. Adaptation of the framework would be challenging for the
healthcare professionals in the initial period; however, in longer term these frameworks
would be valuable for the healthcare professionals for practice development espouse effective
ways of practice provision in the real clinical setting (Trus et al., 2019).
Practice development through collaboration, Inclusion and Participation (CIP) principle
permit healthcare professionals for data collection and patients with prescribed changes. The
process of change and practice development are largely controlled by the practice providers
and ownership of this practice development lies with healthcare professionals. Moreover, CIP
principle facilitate involvement of patients and clients for the improved clinical practice
development to improve patient outcome (McCormack, McCance, and Maben, 2013).
Implementation of CIP principle is beneficial in developing ownership and direction for
change in practice, also it provides opportunity for self-empowerment. CIP principle is
beneficial to identify and implement shared values and beliefs among all the members of
workforce in the clinical setting, to implement change through diverse evidence based
resources, to create imagination and expression of real practice, to practice active learning for
improvement in self-confidence and self-awareness and to implement shared values
(McCormack, Manley, and Titchen, 2013).
Theoretical basis for implementation of CIP principle comes from social science and critical
creativity. CIP principle is helpful in the implementation of intervention in the practice
through realistic synthesis of procedure and contextual analysis of related aspects. Healthcare
service is a multi-disciplinary service and integrated efforts of diverse stakeholders are
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mandatory for improved practice development in clinical setting. CIP principle is useful in
implementing integrated and collaborative practice through enhancing collaborative working
relationships, establishing common and collective vision, establishing critical intent and
establishing sharing engagement. Integrated and collaborative practice can be effectively
developed through effective communication strategies, addressing challenges in the effective
manner and implementation of practice through sharing and dissemination (Vella, Page,
Edwards, and Wand, 2017).
Workplace culture of effective health-care setting is beneficial in giving attention to micro-
system level. Attention to the micro-level settings facilitate improved practice development
because most of the heath-care services are experienced and provided at the micro-level with
support from the macro-level. Practice-development can be effectively improved through
work-based learning process and culture to enable learning in the workplace environment to
transform and inform care (Braithwaite, Herkes, Ludlow, Testa, and Lamprell, 2017). Culture
of developing evidence and implementation of developed evidence in the real clinical
practice is beneficial in improving real clinical practice. Culture should be developed for the
evaluation of CIP work; hence, constant improvement in the work can be achieved for
improved practice development. Complex methodology should be incorporated to improve
interface among all the members of healthcare teams and across different teams. Moreover,
there should be improved interface among internal and external stakeholders. This complex
methodology facilitates effective exchange and sharing of ideas among the different
stakeholders for improvement in the practice development (Manley, Parlour, and Yalden,
2013).
Research demonstrated that improved practice development can be achieved through
implementation of transformational principles through every level of the organisation and
solution-based approach is beneficial in implementation of person-centred care (Jackson and
Thurgate, 2011). Another study reported that practice development for person-centred care
can be achieved through engagement through shared processes, incorporation of context in
the person-centred care and consideration of preparedness and willingness for improved
engagement in the practice development. Person centred care can be effectively improved
through intensive understanding and consideration of the person centredness, establishing
shared vision, understanding quality of practice user experience, systematic development of
practice and celebrating practice (Manley, Crisp, and Moss, 2011).
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Research established that change in culture and practice development attributed to autonomy,
empowerment of employees and constructive team dynamics which are helpful in
engagement of all the stakeholders. Practice development through person centred care also
proved beneficial in changing perception of healthcare staff towards care, improving
perception of service users from hope and hopelessness to choose, belonging and
connectedness. Social norms are also responsible for the effective implementation of the
person centred care (Manley, Sanders, Cardiff, and Webster, 2011). Research also concluded
that constant support is necessary for the staff members for the sustained implementation of
the person-centred care (Hardiman and Dewing, 2019).
In summary, effective implementation of productive workplace culture in the healthcare
organisation is beneficial in improved practice development in the clinical setting to improve
patient outcome, to improve patient satisfaction and to achieve organisation goal of provision
of effective and safe care to the patients.
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