Implementing culture change in health care: theory and practice
Implementing culture change in health care: theory and practice
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DOI：
10.1093/intqhc/mzg021
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发表时间：
2003-04-01
影响因子：
2.6
通讯作者：
Marshall, MN
中科院分区：
文献类型：
--
作者：
Scott, T;Mannion, R;Marshall, MN
目标.回顾一些关键的辩论有关的性质，组织文化和文化变革的卫生保健组织和系统。进行了文献综述，涵盖了理论贡献和发表的研究的过程和结果的文化变革计划在一系列的健康和非医疗保健setting.Results.学者们对组织文化的确切含义还没有达成共识。关于组织文化是否能够通过外部操纵而形成有益效果，存在着相互竞争的主张。已经制定了一系列文化变革模式。可以确定一些通常削弱文化变革方案的基本因素。似乎阻碍跨部门文化变革的关键因素包括：领导不足或不当;外部利益相关者和专业人员的限制;感知缺乏所有权;以及医疗保健组织和系统内的亚文化多样性。管理组织文化越来越被视为卫生系统改革的重要组成部分。要改变整个卫生系统的文化，如英国国家卫生服务将是一个复杂的，多层次的，不确定的过程，包括一系列的连锁战略和支持战术展开了一段时间。
Objectives. To review some of the key debates relating to the nature of organizational culture and culture change in health care organizations and systems.Methods. A literature review was conducted that covered both theoretical contributions and published studies of the processes and outcomes of culture change programmes across a range of health and non-health care settings.Results. There is little consensus among scholars over the precise meaning of organizational culture. Competing claims exist concerning whether organizational cultures are capable of being shaped by external manipulation to beneficial effect. A range of culture change models has been developed. A number of underlying factors that commonly attenuate culture change programmes can be identified. Key factors that appear to impede culture change across a range of sectors include: inadequate or inappropriate leadership; constraints imposed by external stakeholders and professional allegiances; perceived lack of ownership; and subcultural diversity within health care organizations and systems.Conclusions. Managing organizational culture is increasingly viewed as an essential part of health system reform. To transform the culture of a whole health system such as the UK National Health Service would be a complex, multi-level, and uncertain process, comprising a range of interlocking strategies and supporting tactics unfolding over a period of years.