اثر تغییر سازمانی و محدودیت مالی در فرهنگ سازمانی The impact of organisational change and fiscal restraint on organisational culture

Background Health service organisations are coming under tighter management to contain costs and improve outcomes [1–3]. Fiscal restraint, where growth in health expenditure is controlled to stay within budget, is a reality that is viewed as not necessarily inconsistent with delivering quality health care [4]. One strategy to achieve this is by implementing evidence-based practice (EBP). Dissemination and implementation of innovations (as would be necessary to introduce EBP in a health setting) require attention to external organisational factors (e.g. political, social, and economic factors) and internal organisational factors (e.g., culture, climate, and workforce skills) [5]. There is also a recognition that these contextual variables operate at multiple levels and interact in a bidirectional way [6]. Ideally, health policy and funding work in concert with internal organisational processes to improve system performance and health care outcomes. In practice, however, health service organisations often have to absorb unplanned challenges while undergoing the change necessary to introduce EBP. The ability of an organisation to incorporate change depends, in part, on its organisational culture [7]. Organisational culture, in this study, refers to the underlying values, and shared assumptions that influence behaviour within an organisation and is taught to new members. [8]. Proposed change dissonant to the prevailing organisational culture can present barriers or cause innovation to fail [9]. To facilitate innovation, the literature points to the need to address the so called implementation drivers of organisational systems, workforce competence and capability and leadership [9]. Some organisational culture measures tap into related domains of leadership, communication, planning and perceived support of the work force [10]. Implementation of system change occurs in stages and over time. It can be difficult to predict and to account for emergent challenges over the implementation period [9, 11]. Planned change management processes will often take organisational culture into account, with attention to ensuring buy-in from staff to assist staged change [12]. Unplanned change, especially that arising from external forces, combined with limited organisational control and limited ability for proactive planning, can adversely impact organisational culture [2, 9]. In the last 30 years there has been a focus on organisational culture as a possible malleable factor to address organisational performance [13]. It has been suggested that organisational culture in mental health services influence work attitudes, staff retention and work performance [14]. In addition, organisational culture has been shown to influence the implementation of EBP in mental health services [15]. Despite this interest in organisational culture, there seems to be little evidence of an effective strategy to improve organisational culture [2].