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MODULE 8 - FACTORS INFLUENCING ORGANIZATIONAL CULTURE



Factors affecting Organizational Climate - Sumit Sharma


Individual


Organizational Climate can be shaped by individuals working in the organization. Newcomers are especially important to an organization because they bring with them lot of expectations about culture, environment etc. when they join. Socialization of newcomers focuses on how individuals learn the beliefs, values, orientations, behaviors, and skills necessary to fulfill organizational roles. Thus, socialization facilitates the transmission of organizational climate and its culture to the newcomers in organizations.


Individuals also facilitate climate change through leadership that clarifies values and develops a common organizational vision. For instance, Manley demonstrated how the social process of clinical nursing leadership facilitated a cultural transformation in a general intensive care unit over three years, contributing to clinical effectiveness, increased accountability, and clinical governance. This finding was consistent with the perspective that leadership that transforms practitioners’ interpretations and experience of health care influenced climatic change in an organization.




External and Internal Factors to the Organization


There are various internal and external factors that influence organizational climate to a great extent. Some of them are listed below:


Internal Factors:


Business Results

Flexibility

Recognition

Leadership

Respect

Customer Satisfaction

Role Models

Ethics


External Factors:


Excellence

Economy

Image

Political Uncertainty

Media

Customer Satisfaction

Deep integrity

Admiration

Perception

Market Recognition






Organizational Features


Organizational Climate is shaped and articulated not just by individuals but also by organizational features such as organizational structure, routines, command and control expectations, and operational norms. Organizational features have a fundamental framing effect on individuals’ expectations and perceptions, setting the context for the social construction of roles and relationship. Examination of organizational structure have focused on how an organization’s climate might facilitate or hinder the implementation of new models of care as well as how new models have influenced the organizational and work group culture over time.


According to the structural approach, different aspects of organization such as the organization size, the extent of centralization in decision making, the number of levels in the hierarchy, the nature of technology and the scope that determines the behavioral policies, are effective in determining and forming the diverse organizational climates.


In other words, according to this approach, the organizational structure plays a basic role in the formation of the organizational climate independent of the perceptions of the personnel.


In the perceptual approach the organizational climate is dependent on the perceptions of the personnel. And these perceptions are affected by the external and internal factors. In this approach the individual understands the organizational situations and then creates an abstract or psychological sample of the climate.


In the interactive approach, the organizational climate is the product of the interaction of the personnel and the organizational situations. This approach, considers the organizational climate as the product of the personality characteristics and the structural elements of the organization.


According to the cultural approach the organizational groups create a common sense of values, history, purposes and goals that are the product of the group interpretation. In this approach, the organizational climate arises from the organizational culture.


The empirical findings show that some of the organizational climate aspects have effects on the organizational performance. But it should be mentioned that different organizations have different climates, and no particular factor can be definitely specified as facilitating or inhibitive for all of them.


The most important factors that affect the organizational climate are morale, leadership, formal and informal organization, and personality.


  • Morale: The effectiveness of the personnel in achieving the organization goals is directly dependent upon their morale; therefore, the manager should know the personnel's morale and the ways to improve it.


  • Personality: Two major factors affect the personality. These factors are the hereditary factors and the environmental factors. The manager must have the necessary information about the personnel's personality and the method of its study.


  • Leadership: From the organization point of view, the leadership is of vital importance because of its powerful influence on the individual's and the group's behavior and the leadership guide the group efforts towards the goals that may be his or her own goals too. These goals might or might not be in harmony with the organizational goals.


  • Formal organization: The formal organization is making a set of rational and logical relationships between different organizational positions and occupations with a special hierarchy designed to achieve particular and definite goals.




Factors Affecting Organizational Performance: A Five-country Comparison


It has been extensively documented that, due to factors such as national and organizational cultures, strategic orientations, and management styles, there are significant differences between organizations operating in different countries. Less clear, however, is whether there are significant differences in the factors that drive performance in the most successful firms, regardless of country.


Study was focused to know how organizational culture and climate, customer orientation, and innovativeness affect performance in firms in the U.S., England, France, Germany, and Japan.


In a nationally representative sample of firms in these countries, they found unsurprising differences in organizational cultures (the Japanese businesses had more clan-oriented cultures and the French firms more hierarchical ones, for instance). Despite these differences, however, they found that successful firms transcended national culture differences to develop a common pattern of drivers of business performance. These included a primary focus on organizational innovativeness, a friendly climate, and a competitive culture.


Managerial Implications of the five-country comparison


Successful innovativeness is paramount. Organizational climates that encouraged trust, participativeness, and entrepreneurial behavior were effective across all five countries.


Organizations with relatively flexible, externally oriented corporate cultures perform better. Even when a national culture tended to be more insular, this result held.


The best-performing firms in all five countries have similar corporate cultures. They did not find strong evidence of country-specific slope differences for relationships between organizational culture and performance.


Organizations are not polar in terms of organizational culture. All organizations in their sample see themselves as mixtures of four types of organizational cultures: market, adhocracy, hierarchy, and clan. Relative emphasis on one or another of these is often subtle. Various combinations may produce good results; for example, successful Japanese firms, while generally hierarchical and clan oriented, also tended to develop relatively strong market cultures.




Tension and Resistance to Change for a Fast-Paced World


From empirical study, it has been found that tension and resistance to change are two primary dimensions of the organizational climate. Climate can be measured in terms of trust, conflict, morale, rewards equity, leader credibility and scapegoat: all of which combine into tension.


The resistance to change is a second independent dimension of the organizational climate. Tension is defined as: a state of strained relations; uneasiness due to mutual hostility; stress: a balancing of forces or elements in opposition.


Tension involves stress and a balance of the combined factors. Tension is similar to and can include: anxiety, edginess, nervousness, stress, tightness and worry. It is the opposite of: amicability, calmness, laxness, looseness and relaxed atmosphere.


On the surface, tension is a pejorative: high tension is not desirable and low tension is good. But, is it possible that high tension can also be good for the organization and low tension might not be so good. Machiavelli’s Florence was a city of high tension; yet, we know that it was also the birth place of a new intellectual era.


Tension helps create the balance of exploration and exploitation for learning. It then seems that tension can be desirable, at least, at some levels for the viable organization.


The resistance to change and the management of change has a rich and vast history in organization science. Lewin’s early work on change suggests that the change process must be managed.


The three phases of change: unfreeze, change and re-freeze, remain the basis and starting point for our thinking about change. The underlying notion is Newtonian: the natural state of affairs is that things will not change. To realize change, we must supply energy and manage the change process. Lewin’s notions on change remain fundamental to the understanding of change.


Lewin asserted that one cannot understand an organization unless you attempt to change it. Weick

and Quinn (1999), in their review of change, indicate that our current knowledge on change rests

firmly upon Lewin’s foundation. Two views of change are episodic and continuous.


Episodic change, or punctuated equilibrium, tends to view change as an event to describe, explain and understand. For continuous change, we tend to focus more on the process of change and how we can intrude or manage it. Going beyond the Lewin process of change, Weick (1995) and Schein (1993) argue that change management involves the “sense making” and interpretation of change.


Change management is a framing of reality for the organization; it is creation of reality for the organization so that the change process does make sense for the organizational participants. So, change management involves speech, the application of symbols and giving meaning to what is going on.


Eisenhardt and Brown (1998) make a compelling argument that continuous change is easier to manage than episodic change which requires the Lewinian change process of: unfreeze, change? and re-freeze. The idea is to make change the norm of the organization. Change itself becomes the expected activity for a fast paced world.




Organizational climate has been defined as the relatively enduring quality of the internal environment of an organization that


a) Is experienced by its members,

b) influences their behavior,

c) Can be described in terms of the values of a particular set of characteristics (or attitudes) of the organization


Other Factors affecting climate are;


Trust


“I trusted everyone on my team. Every week we have our own goals, and when you see everyone is delivering on time and delivering quality, it starts to build trust. When you get mid-way through the project, you know you can trust everyone. That’s what made this project great.”

“If you don’t have trust, it circumvents communication.”


Participative Safety


“One of the reasons we were successful is because we criticized each other.”

“I tried to emphasize throwing out ideas, even if they sounded off the wall. I tell them that some

ideas might sound off the wall, but they might lead someone to come up with a great idea.”


Autonomy


“A member is given a problem, but how to solve it is up to them.”

“I try to give them a bigger picture of the project. Hopefully, the more information they get, without bogging them down, will help them.”


Some of the factors that affect the organizational climate was studied in a survey and following was the outcome of the survey.


The Organizational Vital Signs (OVS) assessment provides a snapshot of the current organizational climate – an overview of the employees’ relationships with the organization. The climate is the context in which employees work each day and the data show it strongly influences how they do their jobs.


Measuring the climate provides leaders with insight into improving organization performance. It can help focus and measure change and development efforts, and improve management practice.

In October 2004, Six Seconds (the publisher of OVS) invited professionals from many careers and nations to complete the survey via the organization’s internet site. The initiative yielded 395 usable responses from a wide variety of job levels within a broad spectrum of organizations (see Demographics).


The value of the OVS process lies in the engaging dialogue that arises from the survey; we see these statistics as questions – not answers. This report is intended to assist leadership in continuing the discussion of their organizational climate. The survey addresses five climate factors plus an overlay dimension of Trust:


• Accountability: To what extent do people in the organization see themselves and others following through on commitments? Are they motivated and do they take responsibility?


• Collaboration: How well do people communicate with one another and share information? Do they work and solve problems together?


• Leadership: What level of commitment do employees have to their leaders? How do they perceive their leaders and leadership throughout the organization?


• Alignment: To what extent are people involved in their organization’s stated mission and the

execution thereof? Do they feel a sense of belonging to the organization?


• Adaptability: Are people seeking change? Are they ready to adapt?


• Trust: In addition to the five factors that define climate, trust is a critical ingredient that affects all these areas. It is measured by questions selected from across the five factors and looks at people’s sense of faith and belief in the organization.


A new research study by Six Seconds Institute for Organizational Performance shows that key relationship factors predict 57% of the difference between low and high performers in organizations. Trust alone predicts 46% of the difference showing how feelings about the workplace have a significant impact on employee performance. Other findings show how different groups are motivated differently by these factors.


Using the "Organizational Vital Signs" assessment -- a highly effective measure of workplace climate -- the study examined how organizational climate affects performance. The test examines six factors: Accountability, Collaboration, Leadership¸ Alignment, Adaptability, and Trust. These climate factors were tested to see how they affect performance -- measured as a combination of customer service, job performance/productivity, and retention.


There are two key findings that will help leaders improve performance,” says Joshua Freedman, director of the study and the Institute. First, there is a measurable and strong link between how your people feel and how they perform. Second, different groups in your organization have dramatically different drivers of performance, and youll miss the opportunity if you stick to conventional ways of tracking those groups.”


1. Relationships Drive Performance

The strong link between climate and performance is specifically tied to customer service, productivity, and retention. Using a forward stepwise regression” statistical analysis, research scientist Dr. Carina Fiedeldey-Van Dijk was able to show how specific elements of the climate predict performance in each area. In customer service, for example, 47% of the difference between low and high scores is predicted by climate factors of accountability, collaboration, alignment. Different factors play in each area; 43.4% of retention, for example, is predicted by leadership, alignment, collaboration.


According to Freedman, it means that Relationships can no longer be a‘ soft area that gets a passing nod – building strong relationships is a core leadership competency.” Its an area Freedman knows well. A leading expert in the field of emotional intelligence (EQ”), Freedmans team of top EQ consultants works with organizations from Amex to Sheraton to Pfizer, as well as with schools and government agencies. The team provides highly effective tools to enhance the relationship skills that improve performance.


2. Different Groups Have Different Drivers

The second key finding is that different groups in the study have very different predictors for performance. For example, for the group that is least satisfied with the organizational climate overall, collaboration predicts almost 30% of customer service. By contrast, collaboration only accounts for 3% among people who are satisfied -- for this group alignment (having a connection with the organizations mission) is by far the most important factor. While a generally positive climate helps improve performance, the study shows that training and development efforts tailored to a groups satisfaction level are more likely to be effective.


The 395 people in the study range from their 20s to 60s, from entry level workers to CEOs; they work in education, industry, government, and service businesses. Just over half the subjects were from the US, others from Europe, Canada, Asia, Latin America, and Africa. These demographics were thoroughly scrutinized to detect how they might impact on organizational climate or job performance.


Neither gender, age, nationality, nor even differences in industry sector was found to significantly impact the results. Dr. Fiedeldey-Van Dijk states: As in many of our projects, traditional demographics proved inadequate for explaining climate and performance differences. If you really want to understand the people in your organization, youve got to look beneath the surface.”


The study found five accurate demographic groupings that shed light on performance - for example, Non-executive long-serving employees.” In this group, 44% of customer service is predicted by collaboration, accountability and leadership. Meanwhile, 56.2% of retention is predicted by factors of alignment and adaptability. Understanding these groups clearly lets leaders and HR professionals more effectively manage the people side” of the business.


The Organizational Vital Signs (OVS) test is available to help organizations gain a clear understanding of their climate. The Institute team uses it to design organizational development programs and measure their impact. The tool quantifies the hidden drivers of organizational performance,” Freedman explains, which lets leaders keep these factors on the radar. Thats a key benefit – just paying more attention to these areas makes a tremendous difference.”



Organizational Climate: Implications for the Home Healthcare Workforce


Organizational climate generally refers to staff members’ perceptions of organizational features like decision making, leadership, and norms. It is widely acknowledged that these perceptions influence patient, employee, and system outcomes. However, there has been little consensus on how best to measure these important relationships. This article examines how organizational climate has been defined and measured in health services research and identifies factors most important in home healthcare delivery. Standardization of climate measures will facilitate the ultimate goal of translating results into evidence-based management practices to improve the quality-of-care delivery.


In the 1980s the introduction of managed care led to unprecedented industrywide organizational changes in the U.S. healthcare system. This national movement toward healthcare reorganization included initiatives aimed at introducing capitated payment arrangements, reducing length of hospital stay, and developing gatekeeping mechanisms to manage the use of specialty services. Wide variation in Medicare home healthcare utilization also became apparent in the 1990s.


With these changes came reports of widespread employee and patient dissatisfaction. Healthcare workers reported high levels of work stress and a decreased ability to supervise support staff and to provide high-quality care. Three IOM reports identified major safety and quality problems in the U.S. healthcare system and directed attention to system-level sources of these problems. In response to these concerns, researchers, policymakers, and provider organizations intensified their efforts to understand and change organizational and health-system structures and processes.


Organizational climate has been defined as the employees’ perceptions of organizational features such as decision making, leadership, and norms about work. This article provides a brief review of evidence on organizational factors and employees’ perceived organizational climate as they relate to employee and patient outcomes. These relationships are discussed first in broad terms and then in more detail for home healthcare. Similarities and differences in home healthcare and other healthcare settings are highlighted. A model of organizational climate that was developed and tested across healthcare settings (including home healthcare) is discussed, along with potential applications for the home healthcare industry.


Employee Outcomes


Job Satisfaction and Turnover


Evidence links organizational climate to employee outcomes such as job satisfaction and turnover. In addition, more satisfied and stable nursing staff may more readily contribute to patient satisfaction, help reduce errors, and assist in the implementation of other steps toward improving healthcare quality. Many studies outside of healthcare settings and a growing number of studies in healthcare show that employees are more satisfied and experience less stress and burnout when they work in climates that have more supportive and empowering leadership, along with more positive group environments that foster peer support, collaboration, and consensus. Furthermore, employee satisfaction and commitment have repeatedly been found to reduce absenteeism and turnover intentions.


Recently, researchers have found similar relationships in home healthcare. However, although similarities exist, important differences in hospital-based and home-healthcare–based employees’ values and predictors of satisfaction have been noted.



For example, researchers in Canada directly compared nurses’ perceptions of their work environment in both hospital and community settings. Mail surveys were completed by a random sample of community and hospital nurses (n = 1,248). Organizational factors such as quality of immediate supervisor support, amount of decentralized decision making, quality of nurse-physician relationships, and work-group cohesiveness were measured, as were job-specific factors such as level of challenge and work demands, fair treatment, level of status; and satisfaction with career, salary, and physical working conditions. Nurses in both hospital and community settings sought additional opportunities to participate in decision making and to gain recognition for their contributions to their organizations. In addition, similarities were found in nurse-physician relationships, degree of job challenge, and career satisfaction by sector. However, hospital-based nurses reported significantly lower levels of perceived organizational and supervisory support and autonomy; hospital nurses were also less satisfied than their community-based colleagues with working conditions and scheduling. Nurses employed in the community sector were more dissatisfied with salary than were hospital nurses.


Another group of researchers compared work attitudes of 126 home healthcare registered nurses (RNs) and 145 hospital RNs employed in multiple settings in a single state. Both groups experienced similar levels of stress because of recent changes in the healthcare system. Home healthcare nurses, however, reported less anger and frustration than did hospital nurses. With regard to the demands of the different work environments, home healthcare nurses reported significantly lower levels of role ambiguity and workload conflicts than did hospital nurses (p < .05). Also, home healthcare nurses reported significantly more positive attitudes and had stronger emotional attachments to their work than did hospital nurses (p < .05).


Using the 2000 National Sample Survey of Registered Nurses, Sochalski found 67% of nurses working in home healthcare to be satisfied with their employment. This satisfaction level was comparable to that of hospital nurses but contrasted sharply with the 78% satisfaction level found among ambulatory care nurses.


In a qualitative study, organizational attributes described by home healthcare nurses as important to the support of their practice were, for the most part, similar to those described in the magnet hospital literature as important to hospital-based nurses. Home healthcare nurses, however, reported requiring organizational conditions to facilitate off-site connection to resources. These findings were supported in other quantitative surveys where home healthcare employees identified support for education, a knowledgeable and supportive manager, dedication to quality care, and a strong, supportive administration as important organizational traits.


These comparative studies suggest that home healthcare nurses feel less frustrated and at least as—if not more—satisfied with their role than do hospital nurses. On the other hand, home healthcare nurses may be less satisfied with their salaries, although more comparative research is needed. A growing body of literature links job satisfaction with intention to leave. Any dissatisfaction with employment may take on added importance if the anticipated shortage of home healthcare personnel materializes. If a personnel shortage increases, workers will have more options and be less likely to work in suboptimal environments.


Employee Safety Outcomes


It is now being recognized that organizational factors contribute to the health and safety of workers. In a review of the literature, Shannon and colleagues found organizational factors such as management style and culture, organizational philosophy, and workforce characteristics (e.g., turnover and seniority) consistently related to lower injury rates across multiple industries. For example, hospitals in which nurses believe that their practice environments are characterized by high nurse autonomy and control over the practice setting and effective nurse-physician relationships also have lower rates of needle sticks. Other researchers have found that nurses’ perceptions of management’s commitment to safety correlated significantly with their compliance with universal precautions (r = .18, p < .05). One county home health agency found employee injuries to be related to agency communication, employee training, patient home environment, nursing assistant body mechanics, and failure to use safety. The agency implemented a number of organizational changes, and employee injuries gradually declined from 4–10 per quarter to 0–3 per quarter.


Patient Outcomes


A small group of studies has explored direct links between organizational climate and patient outcomes. However, solid evidence showing direct relationships is scarce. An important exception includes findings of a positive association between a teamwork-oriented culture and patient satisfaction in Veterans Health Administration (VHA) Medical Centers. In instances where organizational climate does not independently predict patient outcomes, climate features may still act as important mediating or contextual factors. For example, in Canadian long-term care facilities, a climate supporting organizational learning and employee development was a necessary condition for quality improvement programs to achieve their organizational objectives. More than 10 years ago, Dansky and colleagues found that human resource management practices such as full-time staffing and nurse educational preparation predicted patient satisfaction. Further research is needed, however, to investigate how these management practices relate to patient clinical outcomes.


Developing an Integrative Model of Organizational Climate to Predict Key Outcomes


Investigators inside and outside of healthcare have used a wide variety of definitions, concepts, measures, and methods to study organizational climate. Although this broad array of measures and definitions reflects the complexity of the phenomena under study, a lack of definitional and methodological consistency makes it hard to generalize across studies and develop evidence-based implications for practice.


To help bring order and consistency to this line of inquiry, Stone and colleagues (2005) developed and tested a model of organizational climate in healthcare across diverse delivery settings. Six research teams funded by the Agency for Healthcare Research and Quality sought to compare measures of organizational climate in ongoing patient-safety studies, to identify similarities and setting-specific dimensions, to develop a model of climate domains hypothesized to affect outcomes across settings, and to test aspects of the model.


The investigators in this group studied acute care (n = 1), home healthcare (n = 1), long-term care (n = 1), primary care (n = 2), and multiple healthcare settings in the VHA system (n = 1). Survey data from more than 80,000 workers were examined.


The investigators started with a prior systematic review of the literature. The working group reached consensus on an integrative model by sharing known models, discussing important domains and definitions, proposing additional domains, drawing new models, and identifying hypothesized relationships.


Leadership represents the organizational values and strategies used by senior management. Organizational structure encompasses the formal communication processes in place such as governance structures and information technology infrastructure. It was hypothesized that the direct effect of these variables on patient and healthcare worker outcomes would be mediated by four process domains: supervision, work design, group behavior, and quality emphasis.


Although other researchers have developed similar models, an important aspect of this model is the clear delineation between leadership and supervision. Leadership is provided by senior management. Supervision refers to the direct manager’s style or the recognition and appraisal that an employee receives daily. The four process domains influence worker outcomes and patient outcomes. Finally, worker outcomes are expected to affect patient outcomes.


To test different aspects of the model, each investigative team conducted multivariate regressions using comparable survey measures. The multivariate regression outputs provide standardized beta coefficients for each variable that indicate the direction of the relationship and independent contribution of the variable in predicting the outcome; the R2 number indicates the percentage of variance explained in the outcome (i.e., employee satisfaction) by the overall model. Table 1 provides the regression results predicting employee satisfaction. In home healthcare, the model explained 57% of the variance in employee satisfaction, which was similar to the VHA multisite study (58% variance), and less than the acute care study (65% variance). Although the direction of the relationships was similar across settings, the model explained less variance in the outpatient settings (24% and 40% variance, respectively).


Use of a variety of settings strengthened the development of the model. However, it must be noted that the home healthcare data represented only one setting and therefore may not be generalizable to all settings.


Clinical Implications


Despite its limitations, the model may be helpful to home healthcare leaders in developing strategies to monitor and improve employee satisfaction, patient safety, and quality of services, as well as other organizational outcomes in a number of contexts. For example, it is quite likely that an expanded informatics infrastructure (e.g., telehealth home monitoring and electronic medical records) will be introduced into the home healthcare setting. However, as the model illustrates, the effect of such technology on provider satisfaction, patient satisfaction, and clinical outcomes is not clear. Therefore, systematic information could be collected to suggest how well the strategies are working and whether more rigorous research might be required.


In addition, the model may be used more proactively by routinely assessing employees’ perceptions of the organizational climate. This may help organizations better understand the work environment and help healthcare leaders track their own organization’s progress over time. For example, on the basis of the literature review and as illustrated in the model, the quality of direct supervision is important. If an agency implements initiatives to support and train selected direct supervisors, standardized longitudinal assessment of the perceived organizational climate and such related outcomes as job satisfaction and turnover of those reporting to the supervisor would help the leadership staff understand the effectiveness of this training. Routine organizational climate assessments are being conducted in many governmental agencies for benchmarking purposes. In healthcare, databases containing climate measures already serve some systems, for example, Kaiser Permanente and the VHA.


The paucity of data on evidence-based practice management intervention inhibits the efforts of home healthcare leaders to improve the climate in their organizations. Therefore, just as many home health agencies have joined together to determine best practices in diabetes management, the home healthcare industry may benefit by cooperating in determining best practices in management to improve organizational climate. In the acute care setting, many hospitals are contributing data to the National Database of Nursing Quality Indicators, which has adapted measures of nurses’ perceptions of work environment and job satisfaction. If the healthcare worker shortage materializes, the home healthcare industry may increasingly find itself competing for workers with other segments of healthcare. If the industry is to remain competitive, positive work environments will be needed.


Last, development and adoption of standardized climate tools that are appropriate to the home health setting and that support analyses at various organizational levels are needed. An existing measure of work environment commonly used in hospitals has been used in home health settings. Overall, hospital-based and home healthcare nurses had a high level of agreement regarding the importance of organizational traits to the support of their practice. However, in the rapidly changing healthcare environment, the applicability of the NWI-R in the hospital setting and its ability to measure essential relevant elements has been questioned. Reliable and valid organizational climate measurement tools that are appropriate to the home healthcare industry, and that reflect concepts outlined in the model proposed, would be helpful.


Conclusion


A growing evidence base documents the effect of employees’ perceptions of the healthcare organization on important outcomes, such as employee satisfaction, turnover, employee safety, and patient satisfaction. However, less evidence addresses how these perceptions affect patient safety outcomes. Evidence on how to establish best practices to promote positive climates is also lacking. Certainly, assessing key aspects of organizational climate and outcomes before and after an implementation of change would assist with the ability to evaluate the effect of the change. Routine longitudinal assessment of organizational climate may also help. Establishing evidence-based best management practices in home healthcare may even draw personnel to the industry. However, before any of these suggestions can be implemented, attention to the actual measurement tool is needed. As they face issues of patient safety, the personnel shortage, and managed care fiscal constraints, organizations may be more efficient, and at the same time may ensure best care practices, if the work environment is perceived more positively by employees.



In another survey the factors that contribute to Organizational climate are cited as:

  1. Clarity: everyone in the organization knows what is expected of them


  1. Standards: challenging but attainable goals are set


  1. Responsibility: employees are given authority to accomplish tasks


  1. Flexibility: there are no unnecessary rules, policies and procedures


  1. Rewards: employees are recognized and rewarded for good performance


  1. Team Commitment: people are proud to belong to the organization


Culture Change and Climate Research


In early 1980s, Judd and Robert Allen performed a retrospective study of 20 culture change projects organized by the Human Resources Institute. The researchers asked those involved in these projects to identify: (1) factors that most contributed to the successes that were achieved; and (2) what factors seemed to interfere with desired change. The results of this analysis formed the basis for identifying key work climate factors. Three primary and interrelated work climate factors were identified: a sense of community, a shared vision and a positive outlook.






Organizational Climate is a background factor in culture that makes it possible for people to work together constructively. Other words for climate are work atmosphere, teamwork, cohesion, group synergy and social capital. In a good work climate, people are likely to say that they “really click” or “work well together.”


Climate is comparable to yeast in the making of bread. It is a necessary ingredient that helps an organization fully utilize resources such a creativity, effort, time and money.


In the nearly two decades since the original research, it was found that work groups can integrate the three work climate factors into their day-to-day functioning. The rewards for proactively creating a better climate have been both large and diverse. On a personal level, a better climate has been associated with improved job satisfaction, performance, creativity and wellness. On a collective level, a better work climate has made it possible for teams and entire organizations to tackle pressing problems and exceed bottom-line goals.


Organizational climate reflects the way that organizations operationalize their culture in daily routines and behaviors. Organizational climate represents workers perception of their objective work situation, including the characteristics of the organization they work for and the nature of their relationships with other people while doing their job.


Issues regarding communication, supervisory interactions, and job design are key drivers the climate within an organization. Communication within the organization is critical to disseminate information and create an environment where employees feel valued. In addition, employees’ perceptions of supervisory behavior have considerable impact on their work attitudes. Effective job design and empowerment enable employees to act on behalf of the customer, improve decision making, and increase autonomy, all of which should lead to greater job satisfaction.



Organizational Climate Factors


Program staff ’s view of outcome measurement—as a process to learn more about programs so they can be improved or a punitive process used to fault programs. This former perspective is a more productive view of outcome management and more readily accepted by program staff. Outcome data, whether positive or negative, can be used constructively to improve services to clients.


Involvement of program staff in developing the organization’s outcome measurement program.


A sense of ownership and investment in the use of outcome data can be empowering for employees. Involving staff in developing outcome measures for an agency furthers their understanding of how using outcome information benefits the organization.


Support of both program staff and organizational leadership. Outcome management is at times a resource-intensive process. The support of both staff and leadership is important to ensure that the organization commits to putting the outcome management structures and processes in place. This includes providing time and providing resources (e.g., funding, technology) to support the collection and use of data.


Integration of outcome management as a regular staff job responsibility. Staff are in a much

better position to use outcome data if outcome measurement is a regular part of their job, rather than an added responsibility. One way to accomplish this is to incorporate data collection as part of standard client intake and tracking procedures. Another is to empower staff with sufficient responsibility to make changes based on outcome data. Program managers and caseworkers are often the people best positioned to use outcome data. Thus, it is important for them to be responsible for using it.


Board involvement in outcome management. Participants noted that the proper role of the board is to hold the organization accountable for achieving results. They expressed concern, however, that failure to achieve results might bring heavy-handed action from their board. For staff to feel comfortable with reporting and using outcome data, the role of the board in the accountability process should be clearly defined. Staff should feel supported in using data without fear of interference in their day-to-day operations.


Use of outcome data to recognize successful programs and their staff—and not to threaten staff. Outcome data are more likely to be used by staff if it is viewed as a way to “tell their story” and receive recognition for accomplishments. Staff members generally have only partial control over outcomes. Thus, outcome information is intended to be used to help identify needs and raise questions. Organizations that focus on identifying who is to blame will likely discourage use of the outcome information.


Flexibility and responsiveness of the outcome management program. Symposium participants noted that data are more likely to get used if the agency is responsive to needed changes in the data to be collected and how data are shared within the organization.


Influence of funders, accrediting agencies, and national professional associations. Funder support for, or requirements to, undertake outcome measurement contribute substantially to efforts by nonprofits. However, if an organization is required by an external source to report on outcomes, this is not a guarantee that the organization will use the information to improve its programs. Currently, funders appear to focus primarily on achieving accountability, contributing to the lack of emphasis on using outcome information to improve services.


Funders can, however, encourage their grantees to use the outcome information to improve their programs. They could be asked to identify how they expect to use, or have used, the outcome information in proposals or renewal applications. For example, if a program’s outcomes fall short of targeted goals, a funder might ask the nonprofit to address how the program will be improved.


Funders can also support the use of information by funding staff training in outcome management and by approving funds for outcome management in grants.


Use to support “Lessons Learned” forums within the organization (or across organizations

providing common services). Symposium participants felt this would significantly increase the use of the information by staff on a continuing basis, as well as for use at the forums.


Factors Affecting Organizational Climate and Retention


  1. Organizational Change


Change refers to new reporting relationships, responsibilities, procedures, policies, equipment, tools, and/or software used on the job. Think about how an organization or work unit responds to change as a whole, rather than how individuals respond.



  1. Communication


Communication addresses how information flows in an organization.


  1. Service


Service is defined as meeting the needs and expectations of the persons (children, youth and families) for whom you are performing your work. This does not refer to the management, but the persons who benefit from the work.


  1. Compensation


Monetary compensation is an employee’s gross payroll pay rate and benefits programs funded by an organization or agency. Flextime and benefits like agency-based childcare are closely related to compensation.


  1. Organizational Culture


Culture describes how things are done in an organization or agency.


  1. Decision-making


Decision-making is the process used in selecting a solution to a problem, deciding how to allocate funds or resources and how to reorganize work.


  1. Individual Competencies


Competencies refer to work related skills and knowledge.


  1. Morale


Morale is how an employee feels about him or herself. How good or bad do they feel about their self-image in relationship to what they do where they work and how they are doing at their place of employment.


  1. Performance Evaluation


Performance evaluations are formal, written appraisals of an employee's work as well as informal verbal feedback given to employees about work by supervisors or by team members in self-directed work teams.


  1. Quality


Quality refers to doing things right the first time. Quality services means meeting the needs, standards, and expectations of clients being served.


  1. Supervision


Relate to the employee's relationship with the person to whom they report in an organization.


  1. Training and Development


Training and development refers to work related educational experiences offered by the organization to its employees to increase their skills and knowledge.


  1. Mission


The organization’s mission is its purpose for providing services to its clients (children, youth and families)


Balancing the internal and external factors is the great challenge to meeting clients’ needs. Successful organizations—and their clients—require skilled, dedicated leaders who can strike the right balance. Leadership is the key.


Within the organization, there are five elements that affect the delivery and quality of services:


The mission and goals of the organization;


  1. The structure of the organization - the distribution of tasks, responsibilities, and functions among all levels of the staff;

  2. The relationships among the staff - how staff members interact with each other as they carry out their tasks, including how decisions are made and communicated;

  3. The reward system - the way people are compensated for their work as well as the non-financial benefits they receive;

  4. Support functions, such as finance, logistics, supervision, training, client flow process, program evaluation, and physical facilities.


Leadership is central to all these elements. The organization’s leaders are responsible for integrating the various elements, setting the standards and tone of CPI, and advancing the organization in a direction that supports positive CPI. It is essential that the leaders be committed to CPI and to focusing the organization on meeting clients’ needs.


Beyond the organization lie many additional factors that affect services. Within the outside environment, donors, community organizations, social hierarchies, and sociocultural factors may influence the organization’s standards, services, and even structures. The recognition and management of external influences are tasks for the organization’s leaders.




Mission and Goals


An organization’s mission serves to set the stage for all the organization’s programs, internal functioning, and external relationships. This mission statement summarizes the organization’s purpose and provides the rationale for defining goals and objectives. It usually is communicated in annual reports, personnel policies, information brochures provided to donors or community members, and other documents.


Sound Climate can be better promoted if the organization’s explicit mission is client-focused, with an emphasis on meeting individuals’ needs and empowering clients to make decisions and engage in behaviors that enhance their reproductive health. An organization with a client-focused, community-oriented mission—well understood and accepted by all staff members, clients, and the community—facilitates informed choice of family planning methods and an appropriate concern for reproductive health needs. The client-focused mission is reflected throughout the organization: in the organization’s structure, its approach to rewarding staff members, its community outreach efforts, etc.


The organization’s goals describe the concrete expectations for achieving the mission and set the framework for developing strategies, staff members, and all management systems. Goals may influence climate either by stating clear and measurable client-centered objectives or by suggesting priorities that may support or impede positive climate.


Structure


The organization’s structure refers to how the responsibilities, tasks, and functions are allocated among staff members. The structure serves to define the reporting relationships and the lines of authority for different levels of the staff. The structure is usually outlined in an organizational chart and in job descriptions.


Organization’s climate can be positive when the organization’s structure is hierarchical or flat, whether it is based on functions (e.g., training, counseling, clinical services, administration, development) or projects (e.g., an adolescent project, a breastfeeding support project). What matters is that all individuals in the organization have client service as a central component of both their formal job description and their actual responsibilities. Even those whose responsibilities do not involve direct client contact (such as personnel involved in logistics management or facility maintenance) are carrying out tasks that can be defined in client-service terms.


The benefit of broad involvement of all staff members is demonstrated through the results of a quality improvement project in Latin America. The International Planned Parenthood Federation/Western Hemisphere Region reports major system-wide impact on positive climate in three family planning associations that trained all staff members—including drivers, sweepers, receptionists, and others—in quality improvement.


Relationships


The concept of relationships refers to how all levels of the staff interact with one another and how decisions are made and communicated. Many aspects of organizational relationships are determined by the organization’s structure (as described on the previous pages). Relationships serve the functions of collaboration, communication, and supervision, allowing work to be carried out toward the mission and goals. Relationships also serve to build the organizational culture. For example, relationships may help create a client-centered organization or a donor-centered organization.


Staff members who have contact with clients are often the best source of information about client needs and experiences. Studies show that staff members have stronger, more positive contacts with clients when they themselves participate in decision-making and are valued by the organization.


Rewards and Incentives


Rewards serve to recognize good performance. Rewards include both financial compensation - the basis on which an organization pays its employees - and non-financial compensation, such as promotions, titles, authority, status in the community, opportunities for personal growth, and recognition of contributions. Incentives serve to motivate staff members’ performance. Incentives can include giving staff members time for consulting outside the organization, providing training aimed at improving or developing skills, recognizing excellent programming, and ensuring strong organizational support for any new initiative.


An organization may have a client-focused and community-oriented mission and goals, a structure in which all staff members are expected to address clients’ needs, and relationships that emphasize integrated services. In some organizations, the reward system encourages staff members to provide contraceptive methods that yield high numbers of couple-years of protection (CYP), rather than to help clients select the method that best meets their individual needs and circumstances. In other organizations, the reward system distributes recognition equally to all providers - those who practice positive Client Provider Interaction as well as those who arrive late at the clinic, are rude to clients, and violate client confidentiality. In such organizations as these, staff members are unlikely to perceive any reason to improve Client Provider Interaction. On the other hand, if staff members are praised, given bonuses or promotions, or otherwise rewarded for being sensitive to and responding to clients’ needs, they are more likely to carry out positive Client Provider Interaction (CPI).


Traditionally, reward systems have targeted mid- and upper-level managers. To have an impact on CPI, rewards also need to focus on the front-line workers—those who interact directly with clients, deliver services to clients, and gather information and opinions from clients about services. Rewarding these staff members requires a fair and objective performance evaluation system.


As an example, the Government of Bangladesh makes annual awards to lower-level family planning workers (including community-based volunteers) who have made significant achievements during the year. These awards are given by the Prime Minister and receive wide media coverage. Other international organizations such as PROFAMILIA (Colombia) and PROSALUD (Bolivia) have long recognized the importance of incentives—including creative non-monetary rewards—in attracting and maintaining high-quality employees who are dedicated to client-centered programs.


Support Functions


Support functions are systems and activities that facilitate the organization’s work. Although these functions are often administrative, they not only support but also help create the organizational context for CPI. As such, it is important to ensure that they are efficient and that their standards and protocols are client focused. The following support functions that have the most significant effect on CPI are discussed below:


  • Finance and accounting;

  • Logistics;

  • Client-flow process;

  • Supervision;

  • Training;

  • Information, education, and communication (IEC);

  • Program evaluation;

  • Physical infrastructure.


Financial Systems


The way in which service fees are structured and communicated can enhance or detract from the quality of the client-provider interaction. For example, fees may have a negative effect on client choice of method if sterilization is free of charge while pills and condoms are relatively expensive, or if the organization does not promote natural methods of family planning simply because there is no commodity to sell. Optimally, fees for service should reflect the client’s ability to pay and should not influence the client’s choice of method. Communication with the client about payment should be confidential and respectful.


Logistics


Logistics systems can also enhance or detract from CPI. For example, a wider range of methods carried may reflect attention to client needs, while a smaller range of methods may reflect provider preferences. An adequate range and supply of family planning methods, educational materials, and other supplies (antibiotics, disposable needles and gloves, iron tablets, etc.) should be available, dated, stored, and distributed appropriately.


From the client’s point of view, logistics systems also involve location and operation of service delivery facilities. Facilities should be located so that clients can walk or take convenient public transportation to receive services. Similarly, hours of operation should reflect clients’ needs rather than the needs of the clinic staff.


Client-Flow Process


A client’s path from the moment of arrival at the SDP through registration, waiting, seeing a provider, receiving supplies, and setting up a new appointment can be complicated and time-consuming. An effective client-flow process optimizes the efficiency of both the client’s and the provider’s time, minimizes waiting, and allows sufficient opportunity for interaction to meet the client’s needs.


Supervision


Supervision involves performance evaluation, staff management, and technical assistance to staff members: all of these can be used to strengthen CPI. Supervision can be an important tool to increase staff members’ awareness and competencies in CPI. A collegial, constructive supervision style - one that emphasizes facilitation and respect for staff members’ opinions, experience, and knowledge - can serve as an effective model for providers’ interpersonal relations with clients.


To affirm the importance of CPI, performance evaluations should incorporate an assessment of how each staff member interacts with clients. There should be consequences (whether positive or corrective) associated with the evaluation findings. Supervisors should also provide constructive feedback to staff members and should coach the staff members - or arrange for CPI training - in areas needing improvement.


Training


Training can improve the competency of the staff at all levels to provide client-centered services. Training is more effective when the importance of CPI is woven throughout the process, starting with the training needs assessment and continuing with the training objectives, curriculum development, follow-up support, and evaluation. The focal areas to include in the training depend on the role staff members play with regard to CPI, but they may include:


Counseling skills;


  • How to assess client needs quickly (e.g., determining whether the client needs a complete overview of family planning or information or reassurance on a specific issue only);

  • How to work with clients in collaborative problem-solving;

  • How to help clients receive the methods and access the services they need;

  • How to help clients enlist or negotiate support from partners or others;

  • How to follow up with clients in a sensitive and supportive way.


The Leadership Challenge


At the center of the framework, leadership is the key element that brings together the other organizational elements. The leadership element is also responsible for recognizing and managing influences stemming from organizations, communities, or trends in the outside environment. Successful leaders are those who:


  • Are committed to the organizational mission and goals;

  • Can develop and communicate the vision of what the organization can and should accomplish as well as the strategic approaches to achieve this vision;

  • Have skills in mobilizing financial and human resources;

  • Provide direction to facilitate staff members’ contribution toward the stated goals;

  • Can expect and manage change.


Successful leaders should recognize the importance of positive client-provider interactions for their organization. They should be committed to improving CPI in their organization, understand the interrelationships of the elements influencing CPI, and recognize the influence of the external environment. As they focus on improving CPI, leaders can ask themselves the following questions to assess the strengths, commitment, and challenges facing them personally as well as their organization:



References:








Organizational Behavior – Stephen P. Robbins

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