Alignment of governance and senior executive perceptions of culture: implications on healthcare performance

Purpose: The purpose of this paper is to examine the alignment of perceived organizational culture between Health Board chairs and Board members with that of their respective senior executive teams. It compares the degree of alignment between these two groups, and analyses them against District Health Board (DHB) performance using the New Zealand Ministry of Health’s national measure “shorter stays in Emergency Departments.” Design/methodology/approach: Primary survey data were collected across eight DHBs using a modified version of the Organizational Culture Assessment Instrument and utilizes a sample of both higher and lower performing DHBs as defined by the “shorter stays” measure. Findings: Many health organizations cite Ovseiko and Buchan’s (2012) preferred culture as an ideal model. However, this study’s findings indicate that most DHBs scored higher than the preferred score for “Hierarchical” and “Rational” cultures, and lower for “Clan” and “Developmental” cultures, and therefore calls into question the validity of this organizational profile as the “preferred” cultural state. Research limitations/implications: This research considers perceived organizational culture from the perspective of the Board members and their respective senior executive teams. It uses a relatively small sample size and excludes potential interactions of national culture. Practical implications: The findings indicate that healthcare organizations should de-emphasize the dominant “Hierarchical” and “Rational” cultures, and promote “Clan” and “Developmental” cultures within their organizations as a means of potentially improving healthcare performance. Originality/value: Organizational culture has been highlighted as a major component of performance within healthcare organizations, yet very few studies examine how organizational culture is perceived by governance and executive groups. This study empirically counters prevailing knowledge regarding the most appropriate organizational cultures for healthcare organizations.