The original CFIR (Laura J. Damschroder et al. 2009) had extensive elaboration on Culture, including a general description of culture concepts and a more in-depth description of one concept of culture, the Competing Values Framework (CVF). Broadly, culture includes the norms, values, and basic assumptions in a setting (Gershon et al. 2004). Culture is often viewed as relatively stable, socially constructed, and subconscious (Martin 2002). However, culture is not defined consistently in the literature (Gershon et al. 2004) and many definitions exist for culture (Martin 2002). Some researchers have a relatively narrow definition of culture, while other researchers incorporate nearly every construct related to the Inner Setting. Culture and climate can be interchangeable across studies, depending on the definition used (Martin 2002). One review identified 54 different definitions for organizational climate (Gershon et al. 2004).
Often, change efforts are targeted at visible, objective aspects of an organization that include work tasks, structures, and processes. Despite variation in use and definition, culture has been shown (Christian D. Helfrich et al. 2007; Shortell et al. 2001) or theorized (A. Kitson, Harvey, and McCormack 1998; Rycroft-Malone, Kitson, et al. 2002) to have significant influence on implementation effectiveness. One explanation for why so many implementations fail centers on the failure to change the less tangible organizational assumptions, thinking, or culture (van Eijnatten and Galen 2002). Individuals within a setting impart organizational culture to new members, and culture influences how people within a setting relate to one another (see Inner Setting: Relational Connections) and their work environment (Christian D. Helfrich et al. 2007).
The CVF was originally developed by Quinn and Rohrbaugh (Quinn and Rohrbaugh 1981) and has been used in healthcare (Shortell et al. 2001) and in the VA (Christian D. Helfrich et al. 2007). It is an example of a “variable definition” 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 – not from non-supervisors. The CVF characterizes organizations along two dimensions, each representing a basic challenge that every organization must resolve 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 (see Inner Setting: Structural Characteristics: Work Infrastructure). 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)) (Christian D. Helfrich et al. 2007; Shortell et al. 2001). These “archetypes” 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 (Shortell et al. 2001). Formalization is negatively associated with innovation because of lack of flexibility and/or low acceptance of new ideas (Damanpour 1991) and can foster continuance of status quo (Klein, Conn, and Sorra 2001). A “balanced” culture with respect to the CVF (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 the number of changes implemented (though not the depth of change) (Shortell et al. 2004).