In recent years, the influence that organizational culture has on shaping performance in social care practice is of growing concern (Commission for Social Care Inspection, 2008). It has seen lots of discussion in the media with international scandals dominating headlines such as the Orchid View case and Winterbourne View tragedy (West Sussex Adults Safeguarding Board, 2014; Department of Health, 2012). Often, the failings of the system to prioritize the needs of the most vulnerable citizens have been blamed on organizational culture, with the Department of Health in England (2012) stating that the management “allowed a culture of abuse to flourish” in Winterbourne (p. 8). Learning from these cases it is evident that the influence of organizational culture on performance in social care and the absence of constructive leadership is of increasing concern. Even in organizations that don’t make the media headlines, organizational culture holds significant importance. Managers need to have an understanding of whether a failure to achieve outcomes and quality of care is directly related to organizational culture.
Organizational culture is a widely used term but one that seems to give rise to a degree of uncertainty in terms of evaluating its impact on differing variables in an organization. In its entirety, organizational culture comprises of the assumptions, values, and norms shared by and influencing how members of an organization behave and interact (Schein, 1990). In simpler terms, it’s basically “how things are done around here” (Schein, 1996).
Schein (1990) identified three levels of organizational culture: visible artifacts; espoused values and underlying assumptions. He states that culture develops over time and is individual to each organization. As Schein (1996) also notes, once organizations learn to see their organization through cultural lenses, different types of issues become clearer, such as why, despite explaining in detail why some practices must be updated, there is an overall tendency towards inertia, that ‘we’ve always done it this way, even when the evidence suggests a different course of action to be more suitable.
This literature review seeks to examine how organizational culture shapes practice in social care with the investigation of emerging themes from nine peer-reviewed international research papers published on the topic. It seeks to review the evidence that shows why managing organizational culture is important to effectively enhance organization performance, provide effective leadership and result in high quality of care.
Methods
A review of the literature was undertaken in order to answer the aforementioned research question. Originally, the search criteria aimed to examine the impact of organizational culture on social care practice in Ireland in the past ten years. However, due to a shortage of relevant literature, it was expanded internationally to the United Kingdom, Australia, and Scandinavian countries, who are known to lead other countries in social care practice. The search was extended to journals published between 2003 and 2018. This timeframe was considered suitable due to the infrequent and sparse evidence of relevant articles. Then, databases were searched for peer-reviewed English-language articles. The databases which were searched included: Scopus, CINAHL, Social Care Online, SAGE Journals Online, Social Services Abstracts, and the Social Care Institute for Excellence. The databases were searched using key search terms which included: ‘organizational culture’ and ‘social care’ or ‘organizational culture’ and ‘shaping social care practice’. The majority of the search terms were found in either the title or the abstract.
Following the database search, an initial analysis of the abstract of the articles was undertaken to examine whether they were relevant to the review. Reference lists and bibliographies of relevant papers were also reviewed for related materials. Both qualitative and quantitative papers were included in order to get a broad understanding of the area and for numerical data. Following the initial inclusions and exclusions, there were 9 remaining studies for review.
Findings/Themes/Results
Social care is a rapidly changing and developing field, in Ireland and across the globe (Share & Lalor, 2013). The nature of social care practice involves the planning and delivery of quality care and other support services for individuals and groups with particular needs (Share & Lalor, 2013). Reflecting on this wide-ranging nature of social care practice, this review examined organizational culture across a broad range of social care settings, and various participants involved including social care staff, managers, and service users. Different levels of organizational culture were assessed in each study, and varying methodologies were applied. The findings revealed the common themes of leadership, communication, and impact on service delivery.
Leadership
Throughout the qualitative data, leadership was consistently observed to be of note in developing the culture in organizations. The importance of leadership as a key element of the organizational culture was shown to have a direct impact on outcomes of both staff and service users (Etherton-Beer, Venturato & Horner, 2013). Some studies suggest that successful leadership is a process that involves influence, which occurs in groups, and shares common goals (Klinga, Hansson, Hasson & Andreen Sachs, 2016). This proposes that leaders must know how to direct staff so as to achieve positive outcomes for the people supported in the organizations. The importance of management in creating and maintaining the culture of an organization was also emphasized, “to establish and maintain a culture based on collaboration, visionary and stable leadership over a long period of time is needed” (Klinga, Hansson, Hasson, & Andreen Sachs, 2016, p.2).
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Values
Going hand in hand with effective leadership in an organization are shared values between management and staff. In an effective work environment shared values at an organizational level and an individual level can lead to a unified and consistent approach and enhance care provision. As shown in one study: “Staff understandings of what may be needed to practice person-centered care, such as compassion and making emotional connections, developed into assumptions: ‘you’ve got to have a compassionate side and be able to connect with someone before you can do any personal care, because it’s not fair otherwise. I wouldn’t like a stranger looking after me that I couldn’t talk to (interview with care assistant)” (Killett et al, 2016, p.174). This importance of shared values is backed up by Mitchell and Pattison (2012) where they argue that similarity in values also plays a critical role in shaping intersectoral work collaboration and the uptake of new roles.
Support
Support is another factor that the research proposed influences and is influenced by organizational culture. A lack of support within organizational culture can result in unmotivated staff and low job satisfaction. The provision of supervision and training provides staff with professional development opportunities and support. Beardsmore and McSherry (2017) argue that the organizational culture influences service provision in a positive manner within their research where they state that “the results indicate that valued employees create more positive working environments, can influence culture and can contribute to the delivery of compassionate quality care through a positive and supportive working environment.” (p. 52). Furthermore, support to engage in professional development was consistently associated with positive organizational culture and its importance expanded upon: “flexibility and support for staff members to explore and develop innovative practice; encouragement of information sharing and regular reflection on practice” were all seen as constructive to the culture of an organization (Mitchell & Pattison, 2012).
Communication
Another emerging theme from the review found that communication can affect organizational culture in a positive or negative manner. Communication is an essential aspect of the role of a social care practitioner. Communication between the service and staff, and staff and service users are essential for successful service delivery. An organizational culture that fails to communicate effectively will undeniably make profound errors and fail to co-operate. When the interaction between management and practitioners is constructive, practitioners will make a greater contribution to team communication and collaboration and will also be encouraged to work under the ethos of the organization to accomplish objectives, which in turn increases job satisfaction. This is highlighted in the studies which suggest that “it is through the process of translation and communication that decisions are made regarding what is workable and acceptable in practice.” (Hawkins, Prashar, Lusambili, Ellard, & Godfrey, 2018, p. 1837).
Implications for practice
The findings which have emerged from the research show various implications for social care practice. Leadership, both effective and dysfunctional as explored in the papers, has many consequences on practice. Staff in an organization are led and influenced by the behavior of their leaders. A strong, supportive leadership style results in a motivated workforce. Schein (1992) proposes that “much has been said about the need for vision in leaders, but too little has been said about their need to listen, to absorb, to search the environment for trends, and to build the organization’s capacity to learn” (p.383). On the other hand, when leadership becomes stagnant and dysfunctional, it has a negative impact on frontline staff which in turn affects job satisfaction and stress levels among staff. This has many implications on practice such as staff turnover and absenteeism (Gillett & Stenfert‐Kroese, 2003).
Furthermore, with all leadership comes to the dynamics of power. Leadership indicates authority in the broadest sense of the word (Lorentzon,1992). Power dynamics in an organization can be shared, as shown in the studies where it is suggested that bottom-up management structures create new types of knowledge (Virtanen, Laitinen, & Stenvall, 2018). The implications of this structure on social care practice signify a shift in work practices from the traditional hierarchical approach. It recognizes the significance of expert knowledge and power in supporting staff to empower service users to have control over their own lives (Virtanen, Laitinen, & Stenvall, 2018). This calls for more accountability for social care practitioners to become experts in their field. This is reflected in current practice by the increased pressure for the professionalization of social care practitioners under CORU, The Health and Social Care Professionals Council, under the Health and Social Care Professionals Act 2005 (Coru.ie, 2017). It also has many benefits for social care practice by findings showing that it reduces fragmentation and duplication of assessment information and that it is more cost-effective and better for the care as a whole (Virtanen, Laitinen, & Stenvall, 2018).
As noted by the findings of the studies, an organization that possesses a strong culture shares common values among its team, which assists them in accomplishing the organization’s strategic outcomes and goals. This approach, alongside collaborative practice, results in a workplace where different professionals share their knowledge and value the opinions of the individuals working together (Hawkins et al, 2018). This horizontal and vertical collaborative practice is discovering new solutions in the creation of better services (Virtanen, Laitinen, & Stenvall, 2018; Klinga, Hansson, Hasson, & Andreen Sachs, 2016).
On the other hand, a particular organizational culture in a social care organization cannot be achieved merely by just importing a certain set of organizational values or the 'correct' staff. The evidence shows that it is essential to figure out new ways of resolving the “everyday demands of practice in a method that is conducive with the espoused values (Killet et al, 2016). These findings have implications for all social care organizations, leaders, and social care staff. The organization must be responsible for the appropriate allocation of resources such as time, funding, and staff to tackle day-to-day issues that arise. In turn, frontline staff must communicate issues and barriers effectively to leaders and managers, who then must work as a cohesive unit and be actively involved in guiding staff on how best to overcome these issues. The evidence suggests the most appropriate tools for this are engaging in supervision, reflective practice, and regular progress meetings (Killett et al, 2016).
Additionally, the implications organizational culture has on communication within an organization requires consideration. In line with the ever-changing nature of social care practice and the updating of various laws and policies, the evidence shows that most organizations are continuously evaluating what they do and how they can best accomplish their goals and objectives to be in line with best practice. Once such implication is the management of change. Tyler and Parker (2011) as cited in Killett et al (2016) highlight that a culture that understands change and pursues development is likely to yield positive reactions from staff and service users. The implication of this on social care practice resonates with the recent development in social care organizations on the change in The General Data Protection Regulation (GDPR) which came into effect across the European Union on 25 May 2018. This new regulation increases employers' responsibilities in relation to how they gather, store and protect personal data (CitizensInformation.ie, 2018). Under this, organizations must communicate all the requirements now placed upon staff and provide training on GDPR. The direct implication of this sort of change on social care practice is noted in Kellett et al (2016) where it found that “a lack of responsiveness to change at management level along with failings at organizational level were cited as contributing factors to the serious, chronic, understaffing” (p. 178).
Conclusion
Many times in recent years failings of social care organizations have been blamed on organizational culture. This can lead to a failure to prioritize the needs of often the most at-risk members of our society. This review has sought to shed light on organizational culture in social care organizations, what is meant by the term, the prevailing themes of organizational culture, the importance of effective leadership to a functional organizational culture, and the association between organizational culture and performance.
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