Abstract

The academic literature demonstrates that organisational culture contributes to variation between health care organisations in outcomes and performance, including patient satisfaction, innovation, health care quality and safety, and employee job satisfaction.The objectives of this study were as follows: 1. To review literature on organisational culture within the NHS and to identify key themes relating to cultural change, service improvement and collective leadership. 2. To identify the dominant culture within the RVH Adult Emergency Department by using a combination of both the ‘Organisational Culture Assessment Instrument’ (OCAI) and ‘Rich Pictures’ soft systems methodology. 3. To formulate recommendations. The results of this study indicates the dominant organisational culture is a market culture (29.74 points), followed by hierarchy culture (28.97 points) then a clan culture (25.55 points) and an adhocracy culture (15.74 points), this infersthat there is a mixture of cultures where an emphasis is placed predominantly on results and profitability. The results also look at the difference between current and preferred organisational culture. The largest desired difference can be seen in clan culture, with an increase of 12.93 points. Subsequently market culture with a decrease of 12.39 points. Hierarchy culture decreases with 3.58 points and adhocracy culture increases with 3.04 points. The dominant culture in the preferred situation becomes clan culture, followed by hierarchy culture, adhocracy culture, and market culture. The results also show there was a differing gap within all professional groupings with admin staff (24.97 points), doctors (33.71 points), nurses (40.36 points) and others (11.08 points).The Rich Pictures results highlight contrasting multidisciplinary dynamics in regards to hierarchy, inter team cooperation anda team whom whilst working under extreme pressure, were positively committed to quality, patient safety and service innovation.