Leadership and culture are often discussed within the organisational de·elopment literature
as being mutually dependent. Many researchers believe that the most important
role of a formal leader is to create and manage culture (Schedlitzki & Edwards, 2014). To
understand workplace culture, to know what is a positive culture and to know how to
develop a positive culture are essential for formal leaders in healthcare settings.
Leaders must be clear about the type of culture they want for their organisation. They
must strategise and plan to create the conditions required to support a positive workplace
culture. It is essential to deliver consistent messages through all the workplace mechanisms
to contribute to building positive organisational culture.
WE11M Part 5 Drives Innovation
Edgar Schein is recognised for his notable research into organisational development.
In his text Organizational culture ancl leadership he describes primary and secondary
embedding mechanisms (Schein, 2010). These are drawn on below to describe the role of
the formal leader in building and embedding positive workplace cultures.
‘What leaders pay attention to, measure, and control on a regular basis has a critical
impact on organisational culture’ (Schein, 2010, p. 237). This is a particularly powerful
mechanism in highly regulated industries such as health and aged care, which have tight
measures and controls set by regulators outside the organisation. In creating a positive
workplace culture within these industries, the leader must be conscious of how compliance
measures, such as legal, ethical, clinical and quality measures, impact on the culture
within the organisation.
‘How leaders allocate resources’ influences workplace culture (Schein, 2010, p. 245).
However, this needs to be considered within the context of the quantity of resources that
are available and the financial risks involved. Carney (2011, p. 523) states that health
leaders need to be able to ‘place excellence at the forefront of care delivery, whilst at the
same time being capable of managing the tensions that exist between cost effectiveness
and the quality of care’. Decisions about how to allocate scarce resources are not value- or
risk-free. It is the act of deciding how they are allocated that will reveal important aspects
of an organisation’s culture and attitude to risk.
‘Deliberate role modeling, teaching, and coaching’ contribute to dispersing a positive
workplace culture (Schein, 2010, p. 246). Leaders must themselves be conscious of the
behaviour they are modelling. Similarly, those who are promoted to supervisory positions
or who are responsible for training or coaching others must be champions of the
positive workplace culture. This is particularly important when inducting or orientating
‘How leaders allocate rewards and status’ can also influence workplace culture
(Schein, 2010, p. 247). Both Tomlinson (2010) and Hickey (2010) say that there needs to
be meaning[ ul employee recognition that exemplifies and rewards the sorts of behaviours
and outcomes the organisation is promoting. For example, if internal customer service is
a priority within a values-based culture, then the reward and recognition program must
The use of the performance appraisal process by managers and leaders acts as an
important means for linking rewards and behavioural change to the type of culture and
organisational values that they wish to promote. Schein (2004, p. 259) states that ‘if the
founders or leaders are trying to ensure that their values and assumptions will be learned,
they must create a reward, promotion and status system that is consistent with those
assumptions’. The system and process that are established in effect provide the means for
evaluating the effectiveness of change on an ongoing basis.
‘How leaders recruit, select, promote and excommunicate’ has a significant impact
on changing, reinforcing and promoting an organisation’s culture (Schein, 2010, p. 249).
In the first instance, managers and organisations need to look at recruiting practices.
‘Creating cultures starts with hiring the right people and then helping them develop
Chapter25 Building positive workplace cultures
critical relationships’ (Hegland et al., 2010, p. 57). Ideally, leaders should use their selection
and recruitment process to recruit and advance those they perceive as having the values
they want and to remove those they consider not to share these values. Schein (2004,
p. 11) describes secondary embedding mechanisms that leaders must be conscious of in
creating the desired organisational culture to include the following:
• Organizational design and structure
Organizational systems and procedures
Rites and rituals of the organization
• Design of physical space, facades, and buildings
Stories about important events and people
Formal statements of organizational philosophy, creeds, and charters.
WWW ….. … ~ .. Part5 .. DrivesJnnovation
• Workplace culture is formed by an organisation’s unique behaviours, beliefs, values,
ceremonies, experiences and history.
• A widely used approach to categorising workplace cultures is the Competing Values
Framework, which identifies four main cultures: clan, hierarchy, adhocracy and
• A health manager’s actions (or inactions) – their approach to organisational systems, policies
and procedures, and customs and rituals – have a direct impact on the culture of a department
• A health service manager can build a positive workplace culture through role-modelling,
teaching and coaching, by ensuring new staff are recruited, selected and promoted according
to the organisation’s stated values, and through clear, transparent, regular and purposeful
communication with staff.
1 What is your role and function in
developing the culture of your organisation
2 What are some of the rituals, beliefs, values
and assumptions in your organisation that
differentiate it from others?
3 Look at the mission, vision and values
statements of your organisation. How is the
culture reflected in them?
4 Are the actions of your organisation in line
with its stated vision, values and mission?
What is the impact of the lived and the
espoused values on the culture of your
5 Using the Competing Values Framework
as a guide, identify the type of culture
in your department or organisation.
Consider the culture in your organisation or in an organisation you have worked in. What role do
you or the healthcare manager play in contributing to that culture? What would you do personally
to change or improve the culture you are in? What leadership and management traits would you
have to call on to make this change or improvement?
Andersson, L. M. & Pearson, C. M. (1999). Tit for tat? The spiraling effect of incivility in the
workplace. Academy of Management Review, 24, 452-471. doi: 10.2307 /259136
Braithwaite, J., Westbrook, M. T., !edema, R., Mallock, N. A., Forsyth, R. & Zhang, K. (2005).
A tale of two hospitals: Assessing cultural landscapes and compositions. Social Science and
Medicine, 60, 1149-1162. doi: 10.1016/j.socscimed.2004.06.046
Callen, J. L., Braithwaite, J. & Westbrook, J. I. (2007). Cultures in hospitals and their influence on
attitudes to, and satisfaction with, the use of clinical information systems. Social Science and
Medicine, 65, 635-639. doi: 10.1016/j.socscimed.2007.03.053
Chapter25 Building positive workplace cultures. … WPM
Cameron, K. S. & Quinn, R. E. (2011). Diagnosing and changing organizational culture: Based on
the Competing Values Framework (3rd ed.). San Francisco, CA: Jossey-Bass.
Carney, M. (2011). Influence of organizational culture on quality healthcare delivery.
International Journal of Health Care Quality Assurance, 24(7), 523-539. doi: 10.1108/
Casali, G. L. & Day, G. E. (2010). Treating an unhealthy organisational culture: The implications
of the Bundaberg Hospital Inquiry for managerial ethical decision making. Australian Health
Review, 34(1), 73-79. doi: 10.1071/AH09543
Fernandez-Araoz, C. (2014). Creating a culture of unconditional love. Harvard Business Review,
(January 8). Available from https://hbr.org
Garling, P. (2008). Final report of the Special Commission of Inquiry: Acute Care Services in
NSW Public Hospitals; Overview. Retrieved from New South Wales Department of Premier
and Cabinet website: http://www.dpc.nsw.gov.au/ _ data/assets/pdf_file/0003/34194/ Overview–Special Commission_ Of_! nquiry Into Acute Care_Services_l n_New South_
Goh, S. C., Chan, C. & Kuziemsky, C. (2013). Teamwork, organizational learning, patient safety
and job outcomes. International Journal of Health Care Quality Assurance, 26(5), 420-432.
Graber, D. & Fitzpatrick, A. (2008). Establishing values-based leadership and values systems
in health care organisations. Journal of Health and Human Services Administration, 31(2),
Gregory, B. T., Harris, S. G., Armenakis, A. A. & Shook, C. L. (2009). Organizational culture and
effectiveness: A study of values, attitudes, and organizational outcomes. Journal of Business
Research, 62, 673-679. doi: 10.1016/j.jbusres.2008.05.021
Hegland, L. T., Tarcon, K. A. & Krueger, M. (2010). Building culture from the ground up in a new
hospital. Physician Executive, 36(1 ), 56-60.
Hickey, P.A. (2010). Building a culture of excellence in Boston and beyond. World Journal for
Pediatric and Congential Heart Surgery, 1(3), 314-320. doi: 10.1177/2150135110380240
Laschinger, H. K. S., Cummings, G. G., Wong, C. A. & Grau, A. L. (2014). Resonant leadership
and workplace empowerment: The value of positive organizational cultures in reducing
workplace incivility. Nursing Economic$, 32(1), 5-15.
Line, M. B. (1999). Types of organisational culture. Library Management, 20(2), 73-75. doi:
Manley, K., Sanders, K., Cardiff, S. & Webster, J. (2011). Effective workplace culture: The
attributes, enabling factors and consequences of a new concept. International Practice
DevelopmentJournal, 1 (2), Article 1.
Mid Staffordshire NHS Foundation Trust Public Inquiry. (2010). Independent inquiry into care
provided by Mid Staffordshire NHS Foundation Trust, January 2005 – March 2009:
Volume 1 (Chaired by R. Francis QC). Retrieved from National Archives website: http://
O’Farrell, C. & Nordstrom, C. R. (2013). Workplace bullying: Examining self-monitoring and
organizational culture. Journal of Psychological Issues in Organizational Culture, 3(4), 6-17.
WJ@M Part 5 Drives Innovation
Quinn, R. E. & Rohrbaugh, J. (1983). The spatial model of effectiveness criteria: Towards a
competing values approach to organizational analysis. Management Science, 29(3), 363-377.
Schedlitzki, D. & Edwards, G. (2014). Studying leadership: Traditional and critical approaches.
London, United Kingdom: Sage.
Schein, E. (1992). Organizational culture and leadership (2nd ed.). San Francisco, CA: Jossey-
–. (2004). Organizational culture and leadership. (3rd ed.). San Francisco, CA: Jossey-Bass.
–. (2010). Organizational culture and leadership (4th ed.). Hoboken, NJ: Wiley.
Scott, T., Mannion, R., Davies, H. & Marshall, M. (2003). The quantitative measurement of
organizational culture in health care: A review of available instruments. Health Services
Research, 38(3), 923-945. doi: 10.1111/1475-6773.00154
Sergeant, J. & Laws-Chapman, C. (2012). Creating a positive workplace culture. Nursing
Management, 18(9), 14-19. doi: 10.7748/nm2012.02.18.9.14.c8889
Siourouni, E., Kastanioti, C. K., Tziallas, D. & Niakas, D. (2012). Health care provider’s
organizational culture profile: A literature review. Health Science Journal, 6(2), 212-233.
Available from http://hsj.gr
Stock, G. N., McFadden, K. L. & Gowen Ill, C. R. (2007). Organizational culture, critical success
factors, and the reduction of hospital errors. International Journal of Production Economics,
106, 368-392. doi: 10.1016/j.ijpe.2006.07.005
Tomlinson, G. (2010). Building a culture of high employee engagement. Strategic HR Review,
9(3), 25-31. doi: 10.1108/14754391011040046
Tyler, D. A. & Parker, V. A. (2011). Nursing home culture, teamwork, and culture change. Journal
of Research in Nursing, 16(1), 37-49. doi: 10.1177/1744987110366187
Westrum, R. (2004). A typology of organisational cultures. Quality and Safety in Health Care,
13(Suppl 2), ii22-ii27. doi: 10.1136/qshc.2003.009522
Wolniak, R. (2013). A typology of organizational cultures in terms of improvement of the quality
management. Manager, 17, 7-21.
Leadership and culture are often discussed within the organisational de·elopment literature