Norms, values, and basic assumptions of a given organization. 

Norms, values, and basic assumptions of a given organization [1].¬†Most change efforts are targeted at visible, mostly objective, aspects of an organization that include work tasks, structures, and behaviors. One explanation for why so many of these initiatives fail centers on the failure to change less tangible organizational assumptions, thinking, or culture [2].¬†Some researchers have a relatively narrow definition of culture, while other researchers incorporate nearly every construct related to inner setting. In the next section we highlight the concept of ‘climate.’ As with ‘culture,’ climate suffers from inconsistent definition. Culture and climate can, at times, be interchangeable across studies, depending on the definition used [3].¬†A recent review found 54 different definitions for organizational climate [1]¬†and, likewise, many definitions exist for culture [3].¬†Culture is often viewed as relatively stable, socially constructed, and subconscious [3].¬†The CFIR embraces this latter view and differentiates climate as the localized and more tangible manifestation of the largely intangible, overarching culture [1].¬†Climate is a phenomenon that can vary across teams or units, and is typically less stable over time compared to culture.

We include Culture in the CFIR because, despite variation in use and definition, it has been shown to have significant influence on implementation effectiveness [4][5].¬†Employees impart organizational culture to new members, and culture influences in large measure how employees relate to one another (see Networks and Communications) and their work environment [5].¬†Nearly all change efforts are targeted at visible, largely objective aspects of an organization that include work tasks, structures, and processes. One explanation for why so many of these initiatives fail, centers on the failure to change the less tangible organizational assumptions, thinking, or culture [6]. Theorists propose that organizational culture is among the most critical barriers to leveraging new knowledge and implementing technical interventions. Culture is an important component of the inner setting [7][8].¬†It is measured by eliciting information from individuals ‚Äď information can then be consolidated by team or unit and for the organization as a whole (though this is admittedly, a reductionist approach that falls short of describing how culture is defined through very fluid interlacings of people and networks at many levels). The next paragraph describes one measurement approach, the competing values framework (CVF) that has been used in healthcare [4],¬† and it has been used in the VA with mixed success [5].¬†However, we do not espouse any particular approach. We include a description of the CVF because of the frequency of its use in healthcare.

The CVF was originally developed by Quinn and Rohrbaugh [9] and is an example of a ‚Äúvariable definition‚ÄĚ approach to culture: a quantitative measure that purports to capture key aspects of the complicated dynamics of culture. Often measures of culture are elicited from senior leaders in the organization ‚Äď not from nonsupervisors. The CVF characterizes organizations along two dimensions, each representing a basic challenge that every organization must resolve in order to function effectively. The first set of competing values is the degree to which an organization emphasizes central control over processes versus decentralization and flexibility. The second set of competing values is the trade-off between focus on its own internal environment and processes versus the external environment and relationships with outside entities. Four archetypical organizational cultures arise: 1) team culture (high internal focus with high flexibility (aka personal)); 2) hierarchical culture (high internal focus with high control (aka formalized and structured)); 3) entrepreneurial culture (high external focus with high flexibility (aka dynamic and entrepreneurial)); and 4) rational culture (high external focus with high control (aka production oriented)) [4][5].¬†These ‚Äúarchetypes‚ÄĚ are not mutually exclusive. In one study, CVF culture was not found to be influential in the number of evidence based practices used by healthcare organizations [4].¬†However, organizational cohesion and adaptability to change are important [10], which are features found in entrepreneurial-leaning organizations. Formalization is negatively associated with innovation because of lack of flexibility and/or low acceptance of new ideas [11] and can foster continuance of status quo [12].¬†A ‚Äúbalanced‚ÄĚ culture with respect to the Competing Values Framework (how close organizations are to 25-25-25-25% on each of the four archetypical quadrants using a Herfindahl-type measure) contributes to perceptions of team effectiveness and in the number of changes implemented (though not depth of change) [13].

Inclusion Criteria

Include statements related to concepts captured in the Competing Values Framework (CVF). Note: You may use this to assign an interpretive ‚Äúattribute‚ÄĚ code to the site as a whole. Due to the way interview questions are structured, culture may not be addressed directly in the study. However, you may believe the site is predominantly one of four quadrants based on an overall assessment. Please see the Competing Values Framework.

  • ‚ÄúIt‚Äôs impossible to get anything done around here because you have to get approvals from 2-3 different committees and purchasing is so bureaucratic.‚ÄĚ

Exclusion Criteria

Currently no criteria are listed; as we become aware of criteria, we will post them here. Please contact us with updates.

Maria Fernandez and colleagues developed 18 items related to Culture. Measures are available for review here. For permission to use, please contact Dr. Fernandez at: Maria.E.Fernandez at uth-dot-tmc-dot-edu

Also, check out SIRC’s Instrument Review project and published systematic review protocol, which has cataloged over 400 implementation-related measures. 

Note: As we become aware of measures, we will post them here. Please contact us with updates.

  1. Gershon R, Stone PW, Bakken S, Larson E: Measurement of Organizational Culture and Climate in Healthcare. J Nurs Adm 2004, 34:33-40.
  2. van Eijnatten FM, Galen M:¬†Chaos, dialogue and the dolphin’s strategy.¬†Journal of Organizational Change Management¬†2002,¬†15:391-401.
  3. Martin J: Organizational culture: Mapping the terrain Thousand Oaks, CA: Sage Publications; 2002.
  4. Shortell SM, Zazzali JL, Burns LR, Alexander JA, Gillies RR, Budetti PP, Waters TM, Zuckerman HS: Implementing evidence-based medicine: the role of market pressures, compensation incentives, and culture in physician organizations. Med Care 2001, 39:I62-78.
  5. Helfrich C, Li Y, Mohr D, Meterko M, Sales A: Assessing an organizational culture instrument based on the Competing Values Framework: Exploratory and confirmatory factor analyses.Implementation Science 2007, 2:13 [ePub, ahead of print].
  6. Eijnatten FM, Galen M:¬†Chaos, dialogue and the dolphin’s strategy.¬†Journal of Organizational Change Management¬†2002,¬†15:391-401.
  7. Kitson A, Harvey G, McCormack B: Enabling the implementation of evidence based practice: a conceptual framework. Qual Health Care 1998, 7:149-158.
  8. Rycroft-Malone J, A., Kitson G, Harvey B, McCormack K, Seers AT, Estabrooks C: Ingredients for change: revisiting a conceptual framework. (Viewpoint). Quality and Safety in Health Care 2002, 11:174-180.
  9. Quinn R, Rohrbaugh J: A Competing Values Approach to Organizational Effectiveness. Public Productivity Review : 1981:122-140.
  10. Simpson DD, Dansereau DF: Assessing Organizational Functioning as a Step Toward Innovation. NIDA Science & Practice Perspectives 2007, 3:20-28.
  11. Damanpour F: Organizational Innovation: A Meta-Analysis of Effects of Determinants and Moderators. The Academy of Management Journal 1991, 34:555-590.
  12. Klein KJ, Conn AB, Sorra JS:¬†Implementing computerized technology: An organizational analysis.’¬†J Appl Psychol¬†2001,¬†86:811-824.
  13. Shortell SM, Marsteller JA, Lin M, Pearson ML, Wu SY, Mendel P, Cretin S, Rosen M: The role of perceived team effectiveness in improving chronic illness care. Med Care 2004, 42:1040-1048.