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Organizational culture assessment before and after implementing patient-focused care.

Administration of a baseline multidisciplinary cultural assessment survey prior to any change effort (to evaluate as well as redesign units) is essential to success in any work redesign effort. Training efforts can then be directed toward effecting the desired changes in perceived norms and values. All involved groups should be surveyed using the same survey tool to elicit potential differences in perceptions of values among various work groups. Proactive values which are seen as predictive of greater change readiness include high teamwork (clan) values, flexibility, as shown by comfort with adhocracy, and recognition of external or market driven realities. Values and norms which are found to be problematic in change efforts include: a reactive orientation marked by strong hierarchical values, a command and control orientation, and strong reliance on rules. Predictors of success include a history of shared governance, while greater difficulties could be anticipated in both unionized and academic health care settings.