CRANFIELD UNIVERSITY

ASSESSMENT OF

ORGANIZATIONAL CULTURES AT

MUNICIPAL AND PRIVATE HOSPITALS

IN

MUMBAI, MAHARASHTRA

_______________________________________________________________________

RUELLA D’COSTA FERNANDES

CRANFIELD REGISTRATION No. s044939

CRANFIELD HEALTHM.Sc. THESIS

CRANFIELD UNIVERSITY

CRANFIELD HEALTHM.Sc. THESIS

Academic Year 2010 – 2011

Ruella D’Costa Fernandes

ASSESSMENT OF

ORGANIZATIONAL CULTURES AT

MUNICIPAL AND PRIVATE HOSPITALS

IN

MUMBAI, MAHARASHTRA

Supervisor: Mr. Shovan K. Baidya

September 2011

This thesis is submitted in partial fulfillment (40%) of the requirements for the degree of

Master of Science

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© Cranfield University 2005. All rights reserved.

No part of this publication may be reproduced without the written permission of the

copyright owner.

ABSTRACT

Background - Organizational culture is the basis that holds the very foundation of every

organization. It can either lead to an organization’s prosperity or its downfall. Hospitals

have been observed for their poor performance due to adoption of incorrect types of

organizational cultures. Patient safety is a critical factor that is dependent upon the type of

culture taken up by hospitals.

Objectives - To assess the type of organizational culture adopted by municipal and private

hospitals in Mumbai, Maharashtra. To determine whether their culture is affecting the

employees’ attitude towards their organization’s growth as well as patient safety.

Methods - A questionnaire was prepared to collect information from employee’s

working at two types of hospitals, being municipal and private hospitals in Mumbai, India.

Secondary research was conducted by reviewing articles using internet search engines and

with this data an evaluation of assessing the type of culture at the hospitals was performed.

Results - Eight dimensions of an organizational culture were captured in municipal and

private hospitals. Each of these dimensions were calculated and compared between the two

types of hospitals to assess the type of culture that was adopted.

Conclusion - It has been observed that no single type of organizational culture is adopted at

any of the hospitals. A mix of cultures is what forms the organization, with hierarchical

culture domineering over the other cultures. The type of culture in an organization is seen to

be dependent on how their management decides to nurture the values and beliefs into the

employees’ to form the hospital’s culture.

Abbreviations - 3 | P a g e

CVF: Competing Value Framework HIT: Health Information Technology

MMC: Memorial Medical Centre WOW: Within Our Walls

ACKNOWLEDGEMENTS

Firstly I would like to thank Cranfield University, UK and the Institute of Clinical Research,

India (ICRI) for giving me an opportunity to conduct this dissertation.

I would like to express my gratitude to my supervisor, Mr. Shovan K. Baidya for his

encouragement and suggestions which have helped me in developing my dissertation.

I would like to also express thanks to Dr. Poonam Kasawlekar (MHA, BHMS) and Dr.

Shrikant Kasawlekar (MHA, BHMS) for proof reading my dissertation and suggesting their

inputs for the same.

I would also like to express my gratitude to the management belonging to the following

hospitals for permitting me to carry out my study:

1) Dr. Bhalabai Nanavati Hospital located at S.V. Road, Vile Parle (West),

Mumbai - 400 056

2) Holy Spirit Hospital located at Mahakali Road,Andheri (East), Mumbai - 400 093

3) Holy Family Hospital located at 51 Andrews Road, Bandra (W), Mumbai - 400 050

4) Sion Hospital located at Dr Ambedkar Road, Sion, Mumbai – 400 022

5) MIDC Hospital Center located at MIDC, Center Road, Andheri (E), Mumbai

6) Employee State Insurance Scheme (E.S.I.S) Hospital located at L.B.S. Marg,,

Mulund (W), Mumbai – 400 080, Maharashtra

Lastly I would also like to thank all the respondents for participating in the survey and

providing their opinions which have helped in formulating my thesis.

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Sr. No. Table of Contents Page No.

1. List of Figures 6

2. List of Tables 7

3. Background 8

4. Chapter I- Introduction 10

4.a. I.1. Definition 10

4.b. I.2. Organizational Culture Elements 10

4.c. I.3. Categories of Organizational Cultures 12

4.d. I.4. Organizational Culture Types 17

5. Chapter II- Literature Review 23

5.a.II.1. Relationship between Organizational Culture and

Organizational Behaviour25

5.b. II.2. Impact of Culture on General Practitioners 28

5.c. II.3. Impact of Culture on Organization Behaviour 30

5.d. II.4. Impact of Ethical Behaviour on Organizational Culture 32

5.e. II.5. Techniques on improving organization performance 35

5.f. II.6. Case Study 39

6. Chapter III- Aims and Objectives 41

7. Chapter IV- Methods and Materials 42

8. Chapter V- Results 44

8.a. V.1. Employee’s Perception towards the Management 47

8.b. V.2. Openness within the Staff 50

8.c. V.3. Involvement in Social Activities within the Organization 52

8.d. V.4. Performance – Orientation of the Employees 54

8.e. V.5. New Recruits 56

8.f. V.6. Employee’s judgement towards their Hospital 58

8.g. V.7. Hierarchy Structure in Hospitals 60

8.h. V.8. Code of Conduct 62

9. Chapter VI- Discussion 64

10. Chapter VII- Conclusion 79

11. Chapter VIII- Limitations 81

12. Chapter IX- Recommendations/ Future Work 82

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13. Appendix 83

14. References 87

LIST OF FIGURES

Sr. No. Content Page No.

I.a. Organizational Culture Categories 12

II.a. Culture Chart 23

V.a. Municipal Hospital Employee’s Perception towards the

Management49

V.b. Private Hospital Employee’s Perception towards the Management 49

V.c. Municipal Hospital Employees’ Openness Within the Staff 51

V.d. Private Hospital Employees’ Openness Within the Staff 51

V.e. Municipal Hospital Employees’ Involvement in Social Activities

within the Organization53

V.f. Private Hospital Employees’ Involvement in Social Activities

within the Organization53

V.g. Municipal Hospital Employees’ Performance Orientation 55

V.h. Private Hospital Employees’ Performance Orientation 55

V.i. Municipal Hospital Employees’ Perception to New Recruits 57

V.j. Private Hospital Employees’ Perception to New Recruits 57

V.k. Municipal Hospital Employees’ judgement towards their Hospital 59

V.l. Private Hospital Employees’ judgement towards their Hospital 59

V.m. Municipal Hospital Employees’ Hierarchy Structure in Hospitals 61

V.n. Private Hospital Employees’ Hierarchy Structure in Hospitals 61

V.o. Municipal Hospital Employees’ Code of Conduct 63

V.p. Private Hospital Employees’ Code of Conduct 63

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LIST OF TABLES

Sr. No. Content Pg. No.

I.a. Culture Element Chart14

V.a. List of Municipal Hospitals Selected Staff45

V.b. List of Private Hospitals Selected Staff46

V.c. Percentage Variation of Municipal Hospital Employee’s Perception towards the Management

47

V.d. Percentage Variation of Private Hospital Employee’s Perception towards the Management

48

V.e. Percentage Variation of Municipal Hospital Employees’ Openness Within the Staff

50

V.f. Percentage Variation of Private Hospital Employees’ Openness Within the Staff

50

V.g. Percentage Variation of Municipal Hospital Employees’ Involvement in Social Activities within the Organization

52

V.h. Percentage Variation of Private Hospital Employees’ Involvement in Social Activities within the Organization

52

V.i. Percentage Variation of Municipal Hospital Employees’ Performance Orientation

54

V.j. Percentage Variation of Private Hospital Employees’ Performance Orientation

54

V.k. Percentage Variation of Municipal Hospital Employees’ Perception to New Recruits

56

V.l. Percentage Variation of Private Hospital Employees’ Perception to New Recruits

56

V.m. Percentage Variation of Municipal Hospital Employees’ judgement towards their Hospital

58

V.n. Percentage Variation of Private Hospital Employees’ judgement towards their Hospital

58

V. o. Percentage Variation of Municipal Hospital Employees’ Hierarchy Structure in Hospitals

60

V.p. Percentage Variation of Private Hospital Employees’ Hierarchy Structure in Hospitals

60

V.q. Percentage Variation of Municipal Hospital Employees’ Code of Conduct

62

V.r. Percentage Variation of Private Hospital Employees’ Code of Conduct62

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BACKGROUND

Human beings are differentiated from other species because of their culture and their social

environment. Anthropology defines culture as transmitted patterns performed socially

within a group1. Culture is also referred as “regularly recurring patterns of life”. Since

people are not aware of analysing their cultural patterns, the study of culture is complex5.

Organizations define culture as assumptions that are taken for granted, wherein cultural

patterns overpowers all the formalizations2. Each and every organization has a culture, but

the components that contain this culture are not known. No two organizations will possess

the same culture or is either suppose to have identical cultures since the pattern of cultures

differs in their values, behaviours, ritual which varies for different organizations.

An organizational culture is critical as it is the basic foundation of the entire organization

which shapes the culture of the personnel to achieve their goals, develop plans and to utilize

the company’s infrastructure and system processes6. The culture in an organization does not

develop on an overnight’s basis but instead it eventually grows since it is formed by

conventions, decor, decision making processes, procedures for executing decisions,

formalizations like formation of formal or informal groups and communication processes4.

Organizational culture is very different from normal culture, since the culture in an

organization is very formal and may have their values, beliefs and norms listed in a written

format within a manual to be followed by the employees or it may be highlighted in their

website or may be unwritten but verbally delivered to the employees and the organization

would expect them to follow so likewise7. But at times the organizational culture that is

supposed to be reflected is not consistent with culture portrayed by the employees8. This is

because an individual’s culture may contradict with the organization’s culture8.

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In turn the cultural norms reflect the value of the culture within the company4. Ultimately

the basic need for an organization’s culture is to relate between the organizational

psychology and social psychology1.

An attempt to comprehend the differences between distinct cultures or the factors that lead

to resistance in change or the maintenance of new introduced cultures needs to be

established2.

To determine these issues, the thoughts processing at conscious, subconscious and

unconscious levels need to be determined. Hence organizational culture plays a vital role in

determining this analysis.

Usually an organizational culture determines how things work around the company so as to

perceive the employee’s culture and apply it accordingly2. These cultures cannot be

inculcated into the employees within a day; instead they evolve gradually in time and it

grows over people who collectively work together2. The culture usually has a direct massive

impact on the performance and ultimately productivity of the organization9.

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Chapter I - INTRODUCTION

I.1. Definition: Organizational culture is defined as a pattern of basic assumptions

shared in a particular group who discovers, invents or develops to learn to cope with the

internal integration and external adaption problems such that the work is considered valid

enough to be taught to new personnel in the exact manner to think, perceive and feel in

respect to those difficulties3,4.

The values, beliefs and norms comprise of elements of an organizational culture9. But any of

these beliefs followed in a sub-group of an organization does not count as part of the

organizational culture11. The beliefs, values and behaviour should represent the organization

as a whole11.

I.2. Organizational Culture Elements:-

Beliefs: An organization’s belief may represent the methodology used to attain their goals

and hence enhance productivity10. Mutual respect and humour in an organization can

heighten a personnel’s job satisfaction thus leading to increased productivity10.

Values: Value in general is an element that is reflected by us only if considered important. In

case of an organization, values may be incorporated as considered essential to them10. These

values represent the expected behaviour from the organization’s personnel. Usually the

organization’s website will portray the values its company follows, which usually includes

their society contribution, creativity, dedication and mutual respect10.

Norms: Organization’s norm reflects the expected company’s environment which usually

involves the manner in which they dress, communicate, behave and accomplish tasks10. The

norm can also involve the way in which the leadership qualities are followed10.

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Examples can include an organization involving all personnel within the organization in the

decision making process or the choice of decisions to be made by allowing employees’ to

choose between the given decision options. Norms can also include casual wear dress codes

to make the environment very relaxed and pleasurable.

Symbols in an organization represent objects and words used that reflect the jargons,

abbreviations and dress codes used by the organization’s employees12. The symbols can also

reflect the organization’s design, décor and the type of ambience it shows12.

Organizational culture helps people to attain their identity by taking up initiatives and

enhancing their communications as well as committing themselves; thus providing them

with a basis to stabilize, gain control and leading them in the right direction4.

The elements that usually comprise of an organization’s culture are the following:

a) Attitudes and norms shared between the employees15.

b) The values and dominant philosophies raised in an organization15.

c) The rules required to be obeyed in an organization and to be followed by new

personnel15.

d) Employees’ observable behaviours when they usually interact15.

e) The ambience and climate that conveys the organization’s feelings15.

It has been seen that if organizations build up strong and vibrant cultures, it enhances the

overall performance of the employees in the long run13. A culture being strong helps its

employees evaluate the events within the organization and analyse as to which actions needs

prioritizing; helps in focussing on strategising key objectives thereby improving their

communication and cooperation with one another while decreasing task’s uncertainty14.

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Organizations involved in healthcare must uptake a culture such that it meets the ever

changing consumer expectations and demands by focussing primarily on employee

development and customer service16.

Two challenges that contradict each other though required in every organization is the need

for external adaptation versus maintenance of one’s internal integration17. A culture should

be seen to bring upon stabilization, meaning, comfort and prediction to the organization’s

employees; hence in this way the culture can connect between the actual strategy and

acquiring goals in a health care organization15.

Healthcare organizations at times are seen to have subcultures within the organization itself

that may have the tendency to improvise onto the dominant’s culture belief, norms or values

or the subculture may be such that it can act in contradiction to the dominant culture thereby

opposing the norms created by it11. It is seen that medical practitioners develop a distinctive

set of values for themselves that sets them apart from the other healthcare providers10. Such

occurrences may be endured since the subunits within the organization work with different

goals and requirements10.

I.3. Categories of Organizational Cultures:

Figure I.a. Organizational Culture Categories

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Alienated Culture: This category of culture indicates that disputes are present but the

personnel compulsory require following the regulations18. This culture enforces that the

rules and regulations be followed rather than resolving the present disputes18. Solution to

this culture is that the employees either should not raise their voice or can leave the

organization if they cannot cope up to it18. This culture supports a one way learning but

declines to voice any employee’s inputs18. Informal groups in this type of an organizational

culture may bring about disagreements and nurturing alienated culture would avoid these

arguments18.

Democratic Culture: This category checks if the aroused disputes would be highlighted and

analyse the problems thus resolving them18. It associates everyone’s suggestions to solve the

arguments which result in forming informal groups18. These groups are more interactive and

channels will be provided via which their contributions would be communicated18. This

culture also reduces any disagreements and also bonds the employees to their groups and to

the organization18.

Antagonistic Culture: This category enforces that the decisions communicated by one

employee will be ultimate and should be followed by the remaining co-employees or

subordinates18. This type of environment usually raises an antagonistic culture. This culture

may arouse raised voices such that disputes may occur to an extent where the employees’

may not realize that the organization’s development should be primarily considered

instead18. The employees would not cooperate with any other employee’s perspective since

the fear of being threatened to obey others orders would not be considered18.

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Table I.a. Culture Element Chart

Culture Category

Group Types

Interpersonal Behaviour

Strategies Available to Employees

Employee Participation

Cognitive Reaction

Alienated Culture

Formal Groups

Partially-Accommodative

Forced loyalty with no voice inputs

Calculative Disagreed

Democratic Culture

Informal Groups

Accommodative Voice and Loyalty

ConsideredEthical Agreed Upon

Antagonistic Culture

Antagonistic Relations between Groups

Non-Accommodative

No Voice input or Exiting the System

Alienated Irrelevant

Factors that affect the effectiveness of the company depends on the organization’s culture.

Three factors guide the influence of an organization’s effectiveness:

a) The Strong Culture

b) The Strategic Fit

c) The Adaptation

The Strong Culture: This perspective is usually seen in organizations where the bulk of the

employees follow the same set of core values and norms14. Strong cultures are used to bring

about social control to guide the behaviour of employees thereby leading to a more effective

organization since it enhances the cooperation, communication amongst employees by

uniting them14. Using the strong culture perspective has its own strengths and limitations

which comprise of the following:

Strengths:

(i) Clear and concise corporate philosophy which unifies employees to target their

goals19.

(ii) Ensures job satisfaction amongst employees19.

(iii) Enhancement in communication levels aiding the employees to voice their opinion

to their seniors14.

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(iv) Main goal is to achieve increased productivity by focussing them on developing

the employee’s culture14.

(v) Trustful superiors portraying uniform core values and norms making them

trustworthy to the employees19.

Limitations:

(i) Usage of a strong culture perspective on an organization can only affect its

economic performance only to a moderate level19.

(ii) The dominant culture suppresses the usage of any subculture thus the development

of any other value is limited which would otherwise encourage the organization to

handle amendments14.

(iii) Adapting of a dominant improper value or norm can worsen the performance of the

organization20.

(iv) Strong cultures are seen to be often resistant to any change that may contradict the

values set even though those values are considered most valuable to the employees

of that organization20.

(v) Enforcing inappropriate values on the employees can result in diminished

performance due to disagreements and conflicts. It may also force the employees to

uptake or not report prohibited or unethical activities21.

(vi) It focuses exclusively on certain objectives which may cause the employees to

relate the problems to only those objectives causing them to overlook the other

solutions14. These objectives may include efficiency and productivity taken up in

the healthcare organizations.

(vii) Unintentional adopting of incorrect strategies and goals in a strong cultured

organization would cause an intense decrease in the productivity20.

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The Strategic Fit: This perspective focuses on the aspect than an organizational culture can

only prove to be effective only if it continuously commits itself to work on the goals using

the implemented strategies that the organization desires to execute14. It is seen that

healthcare organizations focus on cultures that determine customer centred values and

compete with others by polishing their service quality14.

For organizations to be effective in their strategies and accomplish higher economic

performance, the following attributes need to be resolved on:

a) The culture should be seen that it cannot be imitated by any other organization in the

similar field22.

b) The culture should be such that it is unique to that specific organization and is not

disclosed with any other personnel of the same organization22.

c) The organizational culture should be determined to obtain its objectives which are

usually formally specified22.

Strengths:

Organizations that are found to respond immediately to market openings are seen to gain

an advantageous competition14.

Limitations:

The Strategic Fit perspective cannot explain as to how certain organizational cultures can

cope up quickly to market openings while other cultures struggle hopelessly14.

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The Adaptation: This perspective recommends that cultures that act in response to

environmental changes within the organization will only help them to excel in their

performance14. Cultures that adopt the adaption perspective tend to be more hierarchical and

bureaucratic than those who focus on achieving control via following the implemented

rules14.

Strengths:

(i) Promotes entrepreneurial values, experimentation, innovations and in taking risks14.

(ii) Helps healthcare organizations to actively promote their responses to the stake

holder’s needs23.

(iii) Encourages confidence within the employees of the organization since it supports

them on taking up risks as well as helping them during environmental threats by

focussing on shifting and also helps in promoting change14.

The value of this culture is that it mainly focuses on the growth of individuals as well

as the organization14.

I.4. Organizational Culture Types:-

There also exist four types of organizational cultures:

a) Rational: Focuses on achieving goals and increasing productivity14.

b) Hierarchical: Aimed at following the rules and procedures put forth formally14.

c) Group: Organizations that attain group cultures focus on empowering, developing its

human resources and participating employees14.

d) Entrepreneurial: This culture values innovations, taking risks and developing new

services and products14.

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These four cultures are in strong relation with the perspectives previously mentioned24.

The perspective dealing with strong culture does not conclude that any of the four cultures

are better than the other14. The strong culture specifies that an organization possessing only

that type culture will be highly effective since it creates a unified and consistent perspective

among the employees14.

Strategic fit perspective mentions that the culture focuses on the organization’s ability to

achieve its objectives14.

A healthcare organization would always want to obtain consistent quality improvement and

hence it would prove effective if it uptakes cultures like either group which involves

teamwork or rational which focuses on attaining goals14.

The adaptation perspective prefers that an organization chooses a culture that focuses on

attaining responsiveness to the market and its environmental change. For this case an

entrepreneurial culture bests suits this perspective14.

Another approach known as the stakeholder approach determines the effectiveness of the

organization’s culture and it relation in fulfilling the demands at various places10.

Competing value approach evaluate the leaders’ or managers to uptake certain cultures that

can retaliate to the unforeseen changes in environments or changes in the organization’s

goals and objectives10. Whichever approach is taken up it should be made sure that the

leaders should be able to easily switch the culture in an organization to respond to any

strategic changes10.

But when an organization’s culture and strategy are not running in the same parallel

direction and instead are incompatible, then prolonging of such a climate makes the

workforce very brittle which may rekindle disputes10. This thus weakens the organization’s

goal in the attempt to make the new strategy acceptable to the employees.

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Usually hospitals opt for strategies that would tend to raise their turnover and decrease their

cost or put into affect their new and improved human resources to adapt to the

organization’s climate more effectively or to reform their present operating procedures10.

The features that are associated with an organization’s culture and tend to affect its

performance directly or indirectly are its financial performance, innovations as well as

customer and employee satisfaction25. Healthcare industries performances are associated

with improvement in patient safety, job satisfaction and nursing care which tend to enhance

the quality of the culture25.

Symbols that are reflected in the organization represent the emotional responses from the

employees that form the basis of the culture and also represent the norms and values that are

inculcated within the organization7. They characterise the behaviour of the staff helping

them to communicate amongst each other regarding any organizational issues7.

Internal and external factors can also affect the organization’s culture9. The internal factors

comprise of employee satisfaction whereas external factors comprise of the ability of the

organization to function as per the present culture9. Developmental culture is an external

factor since it is dependent upon the growth of the organization9.

Inspiring leaders will support the values of entrepreneurial orientation and encourage the

employees’ innovations to help develop new resources for the organization9. A balanced

culture comprises of cultures wherein the balance between cultures is strongly placed26.

Organizations utilizing balanced cultures usually ensure the ability to cooperate during

environmental changes26.

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An organization opting for a group culture is seen to have a positive result on its

effectiveness since none of the other cultures can produce all the values and norms the

organization expects from it26. An organization is seen to use one or other culture at some

point in time depending on the circumstances that arise9. Hence requiring a culture that can

balance all the other cultures to utilize each one whenever necessary is essential9.

Superiors who inculcate equivalent amount of all cultures being practised is noticed to have

a better rating from the staff in comparison to other superiors who do not26. The staffs are

usually noted to have a higher satisfactory ratio both in their job as well as their personal

lifestyle. Hence theoretically a balanced culture will prove effective for an organization26.

Usage of a particular culture in excess will be seen to have a negative effect since a

particular culture will demand for a specific set of values and norms, thus leaving the other

cultures overlooked and ignored26. Healthcare organization’s mission statements have to be

effective since it is dependent on how they deliver to patient care as well as the insurance

companies, physicians and staff26.

It is also theoretically seen that organizations with strong balanced cultures will be more

effective than unbalanced cultures27. Cultures can influence an organization’s effectiveness

indirectly and hence it is difficult to interpret the relationship between the two. Since culture

affects an employee’s morale and their job satisfaction, it then directly has an effect on the

organization’s effectiveness27.

Hence it should be seen that a balanced culture containing equal proportions of all the other

cultures should be inculcated to induce a satisfactory environment26. Based on the type of

culture put forth, the organization expects a certain type of behaviour from the staff. The

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employees develop the corresponding behaviour dependent on the type of culture

encouraged26.

Hence portraying a balanced culture to expect a behaviour that develops a positive effect

from the employees will directly help in the organization’s effectiveness27. The employees

will adjust very well to environmental changes and also enhances a long term relationship

with the organization due to job satisfaction3.

It is known that employees only when satisfied work better than unsatisfied employees since

they put in their full potential into their assigned tasks28. It is the managerial personnel who

should be aware of their employees’ job satisfaction and it is dependent on them to change

the attitudes of the unsatisfied employees in order to bring about positive attitudes28. They

should also manage sustaining the positive attitudes of those satisfied employees in order to

maintain the organization’s growth28.

In a healthcare organization, no specific culture is best suited for it since all four culture

types exist within this type of an organizations. Rituals are required within an organization

to keep the social bond alive12. These rituals can be taken up in any form which includes

creating memos, holding meetings and planning group activities12.

The values in a culture are usually nonverbal, unconscious and thus come from the

organization’s deepest feelings12. These values are usually brought upon by the leaders in

the organization and their power in making decisions4. It is usually seen that executives try

to bring about change by changing the employees’ attitudes instead of changing the values

followed by the organization4. It had been noted that values influence behaviour, hence in

order to implement a change in value one has to focus on changing related behaviours4.

The socialization process of converting the values our guardians inculcated into us into the

required organizational behaviour usually takes years2. The same process is applied in case

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of an organizational culture2. If a hospital has set its core values, the time taken to transform

these values into the behaviour is called as cultural transformation2.

An organization possesses visible and invisible elements by which the company regulates its

norms10. The visible elements comprise of an organization’s physical outlook, dress codes

for employees, presence of artefacts, rituals and ceremonies that take place, the stories,

legends or myths and the behaviour that one produces10. Whereas the invisible elements

comprises of an organization’s beliefs, values, assumptions and attitudes10. These invisible

elements can be made evident in many symbolic approaches.

Culture enhances social bonding and thus transforms itself through the employees via a

process known as socialization29. Cultures are seen to function on various levels that shape

an organization’s behaviour since it helps to focus on precise activities and outcomes, and

not divert itself to other unrelated events10. The need for the right culture is a must since it

acts as a form of control on an individual’s behaviour tending them to compel themselves to

abide by those cultures and share it with others in the organization20.

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Chapter II - LITERATURE REVIEW

A previous research was conducted to define which organizational culture promotes towards

patient safety. They had first assumed that a strong culture would bring about enhanced

patient safety29. They used a competing value framework (CVF) to determine the

organizational cultures within the hospitals30. They considered four organizational cultures

that could affect the patient safety. Namely being hierarchical, entrepreneurial, production

oriented and group cultures30.

The hierarchical culture signifies dealing with assignments that are already predicted and

can be resolved by following the assigned procedures and rules30. Entrepreneurial culture

deals with taking risks which focuses on their growth30. Risk taking does not involve taking

risks with the patient’s safety but in improving the safety processes for patients30.

Production oriented culture emphasis on producing rewards to employees on the basis of

their accomplished targets30. Group culture deals with involving employees working as a

team, their participation in decision making, consistency and equal work distribution among

the team members30. Prior to their research they had a couple of hypotheses via which they

developed their patient safety questionnaires. CVF was used to analyse the correlation of

the cultures.

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Flexible Orientation

Figure II.a. Culture Chart

The hypotheses they considered were the following:

a) Hierarchical culture adopted at higher levels is assumed to be followed by lowered

safety climatic levels30. A strong hierarchy culture is seen to inhibit employees with

expertise from making decisions and can also distort important information such as

learning of safety programs and processes from being shared34. A hospital that

empowers its procedures by rules and definite policies makes it difficult for the

employees to stand up for taking any actions or voice themselves when confronted with

any safety issues32,33. Hence they hypothesized that lowered employee performance was

seen with higher levels of hierarchical culture.

b) Entrepreneurial culture taken up on higher levels was assumed to be followed by also

higher safety climate levels30. This is observed since a hospital which provides

flexibility and encourages employees to give initiatives offers a very wide range of

opportunities for the staff to approach accordingly during safety related issues32,33,35.

Hence entrepreneurial cultures have been hypothesized to have better employee

compliance leading to positive results.

c) Production Oriented culture when implemented at higher levels produces a lowered

safety climate30. In hospitals placing efficiency or production prior to patient’s safety

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Internal Orientation External Orientation

Control Orientation

does not produce effective patient compliance30. A hospital environment free of

production oriented culture will focus the staff on dedicating themselves to patient safety

primarily30. Holding meetings to discuss the prior and latter procedures on handling

patients should be discussed in order to attain effective patient compliance30.

d) Group cultures if used at higher levels are seen to have higher safety level climate since

it has been previously observed that strong cultures involving staffs to be open regarding

their view and to voice their inputs during decision making processes promotes a healthy

work environment31. Such behaviours and attitudes will be shared among all the

employees thus helping them to pass the same on to the new personnel so that their

colleagues and subordinates follow the same32.

In practise it has been observed that a hospital will not comprise solely of a single

organizational culture30. They may contain a mix of these cultures which might prove to be

very advantageous to bring about an effective patient safety climate. A mix containing

openness for employees inclusive of hierarchical culture which contains rules and

regulations would help focus the employees in achieving their targets in a healthy work

environment30.

II.1. Relationship between Organizational Culture and Organizational Behaviour:

The type of behaviour found in an organization running successfully plays a major role in

nourishing its culture36. It is critical to determine the type of behavioural culture that has a

massive impact to help control the culture of a member’s behaviour within an organization36.

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Behaviour is usually a habit that is learnt and within an organization, the employees’

behaviour is dependent on the behaviour of the leaders or managers36.

The type of behaviour that is encouraged by the higher authorities will be usually followed

on by the remainder of the organization36. Through the process of socialization is the type of

behaviour passed on.

Decision making process is dependent on the culture and hence also on the behaviour of the

employees36. Certain conflicting issues may arise during the decision process that can

highlight the behavioural condition of the organization.

The following are certain common issues usually faced in organizations:

a) Budget Control versus Content Customers:

This subject determines whether the employees and their managers’ care for their

customer’s content rather than focussing their duties to minimize operational costs such

that they might reconsider the price charged to the customers for service36.

b) Social Focus versus Task Focus:

This determines whether the employees will focus on developing their relationship at

work or focus themselves on the tasks assigned to them36.

c) Powerful distances:

This is dependent on the managers and leaders’ attitude to their employees; whether they

overpower them thus having complete control of them, thereby being able to change the

attitudes and behaviours of the employees considerably36.

d) Individual Play versus Team Play:

This depends on whether the leaders want an individual to work only on the assigned

task or collectively encourage a group to handle the assigned project36.

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Since organizational culture shows the beliefs, values and behavioural norms reproduced by

the employees to certain situations within that organization; it usually influences the

behaviours and attitude of the respective staff36.

It is seen that organizational culture is related to leadership type of behaviour since the

culture is learnt socially and then transmitted to the other via socialization. The culture

offers the rules for the organization’s behaviour which is created by the leaders of the

organization37. The core values of the organization are inherited from the leaders which then

develop into the respective leadership styles37.

The employees will have to follow the values that have been inculcated by the leaders so

that the behaviour of every personnel within the organization is on the same wavelength37.

The culture consistency would help the organization to minimize disagreements thereby

creating a healthy working environment. It is the duty of the leaders to check, manage and

maintain the organization’s culture37.

If a leader promotes strong unifying values, norms and behaviour, then the same would be

up taken by their subordinates37. This strong culture would thereby help the employees

achieve their targets and goals10. This helps them attain work recognition, hence increasing

their job satisfaction. Therefore a positive culture is likely to spring up an employee’s job

satisfaction10.

Only leaders who are supportive will balance his power and the beliefs and values of the

organization thereby helping in minimizing internal disagreements37. These types of leaders

prove to be successful since they balance their use of power and status whenever required to

generate an equal hospital environment37. This creates a very positive work attitude thereby

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enhancing the job satisfaction among employees. Hence it is seen that positive leadership

can bring about job satisfaction37.

II.2. Impact of Culture on General Practitioners:

Physician’s satisfaction is known to be associated with their patient’s satisfaction and how

well they respond to their medical treatment which would thereby describe the performance

of the physicians and their prescribing patterns38. Any disputes that occur with a culture’s

norms and values will automatically result in lowered physician satisfaction levels38. This

will also determine the adherence of the physicians to their organization. Arousal of

disputes occurs since the organization’s culture operates at a certain level whereas the

physicians are taught to function and behave at another professional level38. Hence the

clashes between the two cultures may arise numerous disagreements.

Physicians always prefer their own independence in the work they do and function

according to their own rules and regulations and do not feel the need to comply with the

organization’s values and norms38. Hence to mould into the physician’s culture, a group

culture should be adopted by the organization since it would reflect a positive attitude from

the physicians38. This type of culture would help the organization involve the physician’s

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participation to be in relation with their values. At times physicians feel they do not need to

be a part of the organization’s culture and such arrangements may be made which is

dependent on their organization, but the values of a group culture in these cases would run in

opposition to the physician’s need38.

Group practise by physicians is selected by themselves within the organization helping them

perform better especially when the organization adopts values and norms according to a

group culture38. This would thus enhance the job satisfaction of each and every physician

within the group practise. If a group culture enforces on following its rules and adapting to

its format and all their formalities, it would thereby arise disputes since it would contradict

with the physician’s way of desiring self independence38.

Adopting of a hierarchical culture is noted to have a negative impact on the physician’s

attitude which will thereby have an effect on their performance38. Inculcating cultures like

risk taking and entrepreneur will help physicians to immediately adjust to any environmental

change38. This would thereby increase the need of the physician’s expertise, hence

increasing the physician’s satisfaction especially in the aspect of a competitive

environment38.

Taking up of a developmental culture will prove effective in terms of adjusting to a

competitive environment as well as new technologies, thereby proving to be fruitful towards

a physician’s satisfaction38. Rational cultures focus on achieving their tasks and thus up

taking such a culture would interfere with the physician’s desire of independence since this

culture would control the way the physician’s require to perform38. It would determine the

amount of time a physician requires to attend to a patient which would hamper their

functioning since the physicians would have to complete their targets by examining a

required number of patients within a given time span38.

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Rational cultures are adamant on reaching their targets to gain a competitive status in both,

physicians practice as well as the price charged to the patients38. A culture that stresses

upon attaining productivity and acquiring their targets cannot employ a physician’s group

practice that requires focusing their attention on patients in order to improve their quality on

patient care by improvising on their skills, thereby increasing the hospital’s reputation38.

Hence adopting a rational culture would have a negative impact on the physician’s practice

but will have a positive effect on individual physicians competing for prices within the

group38.

II.3. Impact of Culture on Organization Behaviour:

Culture plays a vital role in shaping the behaviour within an organization and it is available

in five dimensions which are namely the following:

a) Uncertainty Avoidance

b) Short term-Long term Orientation

c) Power Distance

d) Masculinity-Femininity

e) Individualism-Collectivism

Uncertainty Avoidance: This dimension denotes the relation between a particular culture

and its uncertainty to the near future39. An organization which proceeds with an uncertain

future is likely to adopt rules and procedures for carrying out tasks which determines a

predictable future rather than opting for a culture that does not determine a distinct type of

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behaviour39. This type of dimension can help reduce internal conflicts within the

organization39.

Short term-Long term Orientation: This dimension determines the culture’s view for the

future. The short term orientation refers to obtaining values for the present or from the past

and abiding by them to fulfil the social responsibilities39. Whereas long term orientation

focuses on the future aspect, thereby is concerned with the future profits or savings39. Long

term orientation helps organizations to uptake training programs to educate their employees

and assure them of their job security39.

Power Distance: This dimension focuses on the aspect of status and power that lies within

the organization39. The ability for the subordinates to communicate freely with the managers

is dependent on the freedom invocated by the leaders39. At times the managers may not

verbally associate with their employees during social occasions or may not negotiate the

assigned tasks with them. Hence it is dependent on the leader’s attitude towards their

employees on the development of their and the organization’s behaviour on a whole39.

Masculinity-Femininity: This dimension determines whether the culture follows masculine

traits which involve domination and aggressiveness or feminine traits which comprises of

care, concern or emotional frankness39. Masculinity dimension usually focuses on achieving

their goals and targets and less on the organization’s environment quality; whereas a

feminine dimension holds employees’ participation and job satisfaction as a priory39.

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Individualism-Collectivism: This dimension determines whether an organization decides to

resolves issues involving sole individuals or collectively as a whole39. It is usually seen that

collectivism dimension is proved to be more effective since the inputs given by various team

mates is creating a wider potential of attaining solutions rather than individual efforts39.

These cultures can be either effective or detrimental to the organization’s behaviour and

hence the leaders of the organization must evaluate the relation between the organization’s

required behaviour and the employees’ behaviour and only then should they inculcate that

particular culture’s values, beliefs and norms to bring up the required behaviours.

II.4. Impact of Ethical Behaviour on Organizational Culture:

Due to the hastened environment in organizations, very little notice is paid to the ethical

behaviour’s impact on the decision-making process40. Because moral attitudes are very

cryptic, it significance on the objectives specified is considered minuscule40. For an

organization to be effective, it should support ethical behaviour and reject unethical form of

behaviour41. This era requires that the organizational culture requires obtaining ethical and

positive attitudes to move forward40.

It is seen that in some organizations, they adopt a formal correspondence with the employees

using a Standards of Conduct or Code of Ethics40. Unethical behaviour can be justified

when one pretends that the unethical behaviour is ethical or not illegal or when one assume

that it can be carried on since no one will notice it or by creating excuses to say that it would

benefit the organization or expecting the manager’s support for their wrong doings40.

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An organization’s ethical climate defines a set of rules that requires to be followed and the

handling of such unethical situations at the workplace41. These rules usually describes the

decision making process within the organization in all types of situations.

The sections usually given importance are efficiency in operating procedures, moralities for

self, personal interests, team interests, profits of the company, social responsibilities,

employee friendships, professional codes and their laws and standard procedures and

regulations41.

When the ethical climate is not properly conveyed or not comprehended by the employees, it

can arise into situations cropping to unethical behaviour42. At times certain organizations

may influence the employees to behave unethically. If this occurs then such behaviour is

usually seen to continue where they may ask the employees to forgo with their unethical

doings as a part of their normal tasks42.

To promote ethical behaviour, certain management strategies can be taken up. One of the

basic strategies is if the organization requires certain behaviour then it should simply be

reinforced40. After reinforcement of the behaviour, it is all dependent on the employees’

portrayal of the same. Hence the enforced behaviour should be monitored to measure the

performance and also organizations should encourage the rewards and recognition awards to

be judged on the basis of one’s expected ethical behaviour40. Thus if an organization

expects a high level of ethical climate, then such issues should be conveyed as well as

enforced in that manner to the employees40.

Organizations can improve on their ethical climate by focussing on issues that mostly crop

up disagreement43. The disputes should be prioritized and focussing on the primary issues

will help connect the organization to their ethical climate43. It has been seen that

approaching the employees with principled dissent which signifies to correct the staff that

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show immoral behaviour instead of punishing them will be better dealt with and hence

should be encouraged43.

Providing ethical training can help in enhancing the ethical structure of an employee. Hence

the organization must focus their attention during the ethical training providing additional

resources and answer to clarify any of their ethical structure doubts40. This thus helps the

staff in making their decisions and framing their overall ethical structure. A set of items that

needs to be clarified to the employees that will help them deal with ethical issues comprise

of the following:

a) Acknowledge and sort the issue

b) Accumulate the probable evidence

c) Keep all options open

d) Check if each option is correct, legal and helpful

e) Come to a conclusion by making a decision

f) Check on how everyone would feel regarding your decision if publicized

g) Take the required action accordingly

At times ‘doing the right thing’ can be a loss to the organization. An example includes an

organization declining to pay a bribe to seal a deal. Usually when employees are encouraged

to act unethically they do not last for prolonged period40. They are usually are of short term.

But in case this type of unethical culture prevails for a prolonged period, then the

organization is likely to collapse40.

To create an unethical free environment, the following can be implicated:

a) Practical goals and objectives need to be set such that the organizational does not

guarantee something that it cannot provide40.

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b) Employee’s inputs should be voiced and hence the same should be encouraged. Hence

the values and norms that allow this type of culture need to be implemented40.

c) Inculcating a strong culture directly is not recommended, instead an internal review of

the employees needs to be conducted to analyse the present culture40.

d) Ensure that a proper procedure is present for deriving and solving ethical issues40.

e) An ethical training program needs to be employed to aware the employees’ of the

organization’s expected moral concern so that they can form their own ethical structure

regarding the same and how they would tackle situations that arouse concern40.

f) Rewards and recognition be provided over the influence of one’s ethical behaviour40.

Organizations should be concerned about their ethical behaviour if they pursue to remain

competitive and survive in the market. Hence the organizations should be aware of their

employees’ ethical or moral behaviour outside their workplace, so that they develop on it

to create a positive ethical climate and would know how to handle ethical concerns40.

This will help the staff to also notify any sort of unethical conditions and correct the

same or bring it to notice of the higher authorities.

II.5. Techniques on improving organization performance:

To improve their organizational performance, hospitals need to speed up their improvements

in quality processes in order to achieve improved patient outcomes44. Health care

organizations in this era are seen to focus their objectives on budget, safety, organization’s

transparency and obtaining their outcomes44. It is seen that the leaders have limited control

over the external demands and are not seen to balance it with the internal concerns in the

organization44. Focussing on the needs of the community, balancing between internal issues

and external demands, monitoring customer needs and responding to the interests of

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stakeholders will help the organization to absorb the right values thus helping them attain a

place in the market44.

Eight Dimensions of Quality have been identified to improve the overall organizational

performance. They include the following:

(i) Quality Business

(ii) Measuring Performance and Reporting

(iii) Culture and Communication

(iv) Strategy and Methodology Improvement

(v) Leadership

(vi) Physician and Employee Commitment

(vii) Information Technology

(viii) Focussing Patients

Quality Business: Only hospitals that improve their quality and patient safety are seen to

have an improved performance in their business44. Organizations which improve their

processes are seen to obtain better outcomes. Enhanced outcomes pertains to decreased

infection rates, decreased patient stay, improved administration of medicines and decrease in

patient readmission rates44.

Improved customer satisfaction involves cleanliness within the organization, reducing the

patient care cost and elimination or minimizing of errors during patient care44. Thus by

enhancing the organization’s quality, it will help them gain a position in the competitive

market44.

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Measuring Performance and Reporting: Improvement on hospital performance is

dependent on the leader’s managing. To enhance improvement, apt performance

corresponding with its reporting is required44. Hence these areas are used to measure the

organization’s performance with its continuous reporting which will thereby help in

improving the quality44. Monitoring and acknowledging of one’s performance will help

improve the behaviour and attitude of the employees which can in turn improve the patient’s

safety and healthcare quality44.

Culture and Communication: Both communication and culture are required to achieve

patient safety and quality. Attaining quality and patient safety will directly reflect the

organization’s values, employees’ attitudes and behaviours44. Effective communication

either verbally or via messages or mails from the leaders to their subordinates should be

valuable enough for the employees to obtain the core objectives of the organization44.

Strategy and Methodology Improvement: Hospitals which want to improve their quality

processes will always be seen to contain various methodologies of applying their strategies

on required situations44. These organizations usually uptake assignments that require low

costs. Assignments need to be prioritized accordingly in order to decide on improving their

quality system and efforts in producing effective patient care44.

Leadership: Leadership needs to be very effective if the hospital decides to take up changes

based at system level which has a direct effect on the quality of patient safety44. Type of

displayed leadership is dependent on the managers; the manner in which they decide to

adapt to create an environment involving improved quality processes, managing all the

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medical and clinical staff44. Leadership is a crucial factor since it can raise the hospital

standards in the market.

Physician and Employee Commitment: Enhancing the quality as well as patient care in the

hospital requires the total focus and commitment of the complete staff to procure those

objectives44. It is dependent on the managers who encourage the staff by providing positive

vibes leading to a good hospital environment via their leadership44. This way the employees

experience a positive attitude and closeness towards their work and organization thereby

helping them to work effectively and be focused on achieving their objectives44.

Information Technology: Health information technology (HIT) is seen to improve the

patient’s outcome as well as aid in improving the performance of the healthcare

professional’s financially44. HIT is seen to have a very frequent buy since it provides an

ease to operate and helps to speed up their work rates44. Due to the advancement in the

technological aspects, HIT has improved the functioning at the workplace. Thus it is seen to

have a higher market demand and investment into it by hospitals is increasing by the day44.

Focussing Patients: Focussing on both patients and their respective families creates a bond

and defines trusts within the families44. This thereby develops a partnership between the

healthcare practitioners and the patients along with their families. The healthcare providers

make sure they attend to the needs of the patient to ensure that all the right care has been

delivered in deciding they take the right decisions to benefit themselves44.

Focussing on patients helps delivers improved their health outcome thereby increasing their

reputation in the market making them highly competitive44. Thus by improving patients’

care and safety, has a direct effect on the job satisfaction of the hospital staff.

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II.6. Case Study:

In the year 1999, Conemaugh Memorial Medical Centre (MMC) located at Johnstown in

Penn in the United States of America faced loads of financial problems thereby leading to a

lowered self-esteem of the hospital staff and heightened the complains of patients45. MMC

then collaborated with another local hospital causing the majority of the staff to reapply for

their positions45. Cost cutting due to a tight budget led to cut offs of a lot of personnel

leading to a complete lowered morale on the employee45. This further led to a poor

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customer satisfaction due to increase in patient complains45. The overall hospital faced a

complete downfall and required immediate attention to meet their objectives and targets45.

Solution: To improve the current status of the hospital, the higher authorities had

determined that the employees’ job satisfaction is connected to patient satisfaction and

decided to conduct formal as well as informal programs for rewards and recognition as a

way to enhance the staff satisfaction45. To perform these programs, a satisfaction scale had

to be developed. So MMC outsourced this category to a company who analysed that the

satisfaction scores for inpatient was 22% whereas outpatient scores was seen at 32% when

compared with hospitals of the same status45. The managers concluded that such low scores

were as a result of them not paying much attention to the patients nor the employees45. In

order to improve the employee performance, the managers formed a team to coordinate with

the hospital’s employee relation team to design a program which determines the employee’s

performance and also invest in the same to grant recognition awards45. Using it strategy

over the years, it was found that in the year 2004 the job satisfaction of the hospital

employees on an average as increasingly improved45.

The scores increased from 5.09 in the year 2001 to 5.35 to 2004. MMC scored a 64% in

employee job satisfaction when compared to similar status hospitals in 2001 which later

increased to 74% in 2004. They hold their satisfaction survey every two years to analyse

their job compliance45.

Another measurement of job satisfaction was usage of the Within Our Walls (WOW)

certificates which was distributed on an everyday basis45. These certificates were handed

when any good performance was immediately recognized and on accumulation of a certain

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amount of certificates, the employees could collect their corresponding rewards45. This

technique help boosted the employee satisfaction immensely. Reports regarding these

recognition and rewards were stated to the managers every 3 months45. This increased the

employee job satisfaction score to a 94 %.

MMC’s profit enhanced increasingly giving them a good competitive market45. Hence only

via their improved culture programs was MMC able to bring out the best in every employee

every day. The reward and recognition helped motivate and inspire the employees on their

job performance and helps them recognize their worth and status within the organization.

Hence this case study proved that organizational culture has a great affect on an

organization’s bottom line.

Chapter III - AIMS AND OBJECTIVES

Aim:

To determine the type of organizational cultures followed in private hospitals and municipal

hospitals located in Mumbai, Maharashtra.

Objectives:

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1. To determine and describe the dominant organizational culture in private and municipal

hospitals.

2. To describe the strength of the culture type and the culture profile of individual groups

present at private and municipal hospitals.

3. Compare the organizational cultures adopted at private and municipal hospitals.

Chapter IV - METHODS AND MATERIALS

This is a descriptive study to determine the type of organizational cultures followed in at

private and municipal hospitals located in Mumbai, Maharashtra. To accomplish this study,

a semi-structured 39 item written questionnaire was developed and employed to assess the

organization’s culture.

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The eligibility criterion for attempting the questionnaire is restricted to only the permanent

employed staff working at the private and municipal hospitals. Six hospitals were selected,

3 being municipal and 3 being private. The questionnaire was put forth to 180 hospital staff,

30 from each of the three municipal hospitals and 30 from each of the private hospitals. The

hospital employees were allowed to fill the questionnaire only after they were notified that

this study is only for an academic purpose and that none of their identities would be

disclosed. The approached employees were also informed that their participation to

complete the questionnaire was not compulsory and can be only volunteered for. The

questionnaires were completed within a span of two months. The hospital employees’ from

both the hospitals were picked at random according to the post they held. The identities of

all the approached hospital employees will not be disclosed and hence kept confidential.

The questionnaires’ had to be answered by choosing only one of the rating’s from 0-5.

Where ‘0’ indicated they cannot comment on the question, ‘1’ rating indicated that they

strongly disagree, ‘2’ indicated they disagree, ‘3’ indicated they somewhat agree, ‘4’

indicated that they agree and ‘5’ indicated that they strongly agree. Multiple ratings for the

questions were not allowed. Approached hospital employees were asked to leave a question

blank if they did not know how to respond to it instead of rating a question according to

their assumptions.

Blank spaces were left in the questionnaires at the side of every question for the participants

to feel free in writing any relevant comments. No participant was forced in answering all

the questions since they were suppose to feel comfortable while rating the questions. The

questions were verbally rephrased to the understanding of the approached hospital staff if

any participant could not comprehend to the question.

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The questionnaires were available as hard copies and given to the participants who were able

to answer them on the spot, whereas soft copies were provided to those participants who

would answer the questionnaires on a later basis. The responses of the provided soft copy

questionnaires were retrieved via electronic mail later within a week’s time.

Analysis of the responses to all the questions was calculated using the basic percentage

method. Using this methodology the pie charts were formulated indicating the average

responses of the participants. This helped in determining their overall organization’s

culture.

Chapter V - RESULTS

The 39 item organizational culture written questionnaire covered questions that comprise of

8 covered dimensions. The dimensions that the questions were based on are the following:

1. Employee’s Perception towards the Management

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2. Openness within the Staff

3. Involvement in Social Activities within the Organization

4. Performance – Orientation of the Employees

5. New Recruits

6. Employee’s judgement towards their Hospital

7. Hierarchy Structure in Hospitals

8. Code of Conduct

Each dimension has a certain number of questions under it that were confronted to the

participants.

Sampling Size:

The research sample comprised of a total of 90 employees from municipal organizations and

90 employees from private hospitals for the study. Utmost care was taken to cover

employees from all cadres within the organization in a proportionate manner.

Sampling Method:

Subjective Sampling Method was used for this study.

Sample Size = N / [1 + (N/population)]

In which N = C* C [P (1-P)/(CI*CI)]

P = Expected frequency value (10%)

CI = Confidence Interval (5%)

C = Confidence Level (95% or 1.960)

For Municipal Hospitals, the total number of employees working are 6014, thus as per

Subjective Sampling Method the number of staff selected from each cadre is as follows:

Sample Size = N / [1 + (N/population)]

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N = 1.96*1.96 [0.10(1 - 0.10) / (0.05 * 0.05)]

N = 216.09

Hence, Sample Size = 216.09 / [1 + (216.09/ 6014)]

Total Required Sample Size = 361

Selected Sample Size = 90

Table V.a. List of Municipal Hospitals Selected Staff

CadresTotal

Number of Staff

Total Required Number of

Participating Staff

Total Number of Selected Staff from Municipal

HospitalsSenior Medical Staff 495 29 6

Resident Medical Officers 722 43 3

Nurses 1066 65 15

Paramedical Staff 259 15 6

Administrative Staff 597 36 9

Labour Staff 2875 173 51

TOTAL 6014 361 90

For Private Hospitals, the total number of employees are 2500, thus as per Subjective

Sampling Method the number of staff selected from each cadre is as follows:

Sample Size = N / [1 + (N/population)]

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N = 1.96*1.96 [0.10(1 - 0.10) / (0.05 * 0.05)]

N = 216.09

Hence, Sample Size = 216.09 / [1 + (216.09/ 2500)]

Total Required Sample Size = 333

Selected Sample Size = 90

Table V.b. List of Private Hospitals Selected Staff

CadresTotal Number of

Staff

Total Required Number of

Participating Staff

Total Number of Selected Staff from Private

Hospitals

Resident Medical Officers 187 26 9

Nurses 715 93 21

Technicians 213 26 6

Clerks 259 33 9

Ward boys 477 60 12

Hospital Maids 160 20 6

Male Sweepers 151 20 6

Female Sweepers 171 20 6

Peons 39 7 3

Attendants 32 7 3

Doctors 7 7 3

Officers 69 7 3

Nursing Officers 20 7 3

TOTAL 2500 333 90

V.1. Employee’s Perception towards the Management

Table V.c. Percentage Variation of Municipal Hospital Employee’s

Perception towards the Management

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QuestionsCannot

Comment%

Strongly Agree

%

Agree%

Somewhat Agree

%

Disagree%

Strongly Disagree

%

Is the hospital management keen towards staff knowledge and their enhancement?

- - 45 5 50 -

Does hospital management provide adequate resources to the staff to function optimally?

- - 10 50 30 10

Is hospital management principled and disciplined and do not hesitate to take action against the guilty?

- - - 60 30 10

Is hospital management considerate regarding the suggestions/complaints of the staff?

- - 20 30 5 45

Is performance assessment practised genuinely and promotions given to deserved employees?

- - - - 30 70

Does the hospital management put patient’s first?

- 90 10 - - -

Is the hospital management highly sensitive towards patient's feedback?

- - - 5 20 75

Is the hospital management highly conscious of the expenses and preach regarding cost containment?

- - 20 10 - 70

Total Percentage – 800 % 0 90 100 160 165 285

Total Percentage – 100% 0 11.25 12.5 20 20.625 35.625

Municipal Hospitals

The percentage was brought down from 800% to 100% for easy interpretation of the

collected data. The percentages reveal the observation of the municipal hospitals employees

towards their hospital management’s attitudes.

Table V.d. Percentage Variation of Private Hospital Employee’s Perception

towards the Management

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QuestionsCannot

Comment%

Strongly Agree

%

Agree%

Somewhat Agree

%

Disagree%

Strongly Disagree

%

Is the hospital management keen towards staff knowledge and their enhancement?

- 40 25 25 10 -

Does hospital management provide adequate resources to the staff to function optimally?

- 50 30 20 - -

Is hospital management principled and disciplined and do not hesitate to take action against the guilty?

- - 30 60 10 -

Is hospital management considerate regarding the suggestions/complaints of the staff?

- - 55 25 20 -

Is performance assessment practised genuinely and promotions given to deserved employees?

9 - 40 4 22 25

Does the hospital management put patient’s first?

- 82 18 - - -

Is the hospital management highly sensitive towards patient's feedback?

15 - 80 5 - -

Is the hospital management highly conscious of the expenses and preach regarding cost containment?

- 5 50 45 - -

Total Percentage – 800 % 24 177 328 184 62 25

Total Percentage – 100% 3 22.125 41 23 7.75 3.125

Private Hospitals

The percentage was brought down from 800% to 100% for easy interpretation of the

collected data. The percentages reveal the observation of the private hospitals employees

towards their hospital management’s attitudes.

Employee’s Perception towards the Management

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Majority of the municipal hospitals employees (36%) are seen mostly to strongly disagree

with the attitudes and approaches made by their hospital management. Only a minority

(11%) of the staff strongly agrees with the hospital management’s perceptions.

Figure V.a. Municipal Hospital Employee’s Perception towards the Management

Majority of the staff (63%) at private hospitals agree on an average and are satisfied with

their hospital management’s approaches. Only the minority (3%) disagree with attitudes put

forth by the management.

Figure V.b. Private Hospital Employee’s Perception towards the Management

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V.2. Openness within the Staff: The percentages reveal the level of liberty and

freedom of openness each employee shares with one another.

Table V.e. Percentage Variation of Municipal Hospital Employees’ Openness Within the Staff

QuestionsCannot

Comment%

Strongly Agree

%

Agree%

Somewhat Agree

%

Disagree%

Strongly Disagree

%

Is the staff openly informative to others about what work they are doing?

- 100 - - - -

Does the staff strive to maintain confidentiality whenever required and are not very particular about matters?

- 50 50 - - -

Does the staff generally trust their colleagues and not doubt anyone?

- 20 70 10 - -

Is the staff open to share knowledge and educate others?

- 20 70 10 - -

Total Percentage – 400% 0 190 190 20 0 0

Total Percentage – 100% 0 47.5 47.5 5 0 0

Municipal Hospitals

Table V.f. Percentage Variation of Private Hospital Employees’ Openness Within the Staff

QuestionsCannot

Comment%

Strongly Agree

%

Agree%

Somewhat Agree

%

Disagree%

Strongly Disagree

%

Is the staff openly informative to others about what work they are doing?

- 28 60 12 - -

Does the staff strive to maintain confidentiality whenever required and are not very particular about matters?

35 40 25 - - -

Does the staff generally trust their colleagues and not doubt anyone?

2 4 90 4 - -

Is the staff open to share knowledge and educate others?

- 30 60 5 5 -

Total Percentage – 400% 37 102 235 21 5 0

Total Percentage – 100% 9.25 25.5 58.75 5.25 1.25 0

Private Hospitals

Openness within the Staff51 | P a g e

Majority of the employees in municipal hospitals are seen to be compatible with their fellow

employees and none of them are seen to have any sort of resentment between one another.

Figure V.c. Municipal Hospital Employees’ Openness Within the Staff

The employees in private hospitals also are seen to be compatible with their peers. But in

comparison to the municipal hospital employees (47%), a lesser percentage (26%) strongly

agrees to their openness level.

Figure V.d. Private Hospital Employees’ Openness Within the Staff

52 | P a g e

V.3. Involvement in Social Activities within the Organization: The

percentages reveal the employees and organization’s social conduct.

Table V.g. Percentage Variation of Municipal Hospital Employees’ Involvement in Social

Activities within the Organization

QuestionsCannot

Comment%

Strongly Agree

%

Agree%

Somewhat Agree

%

Disagree%

Strongly Disagree

%

Does the staff treat their colleagues as friends?

- 60 40 - - -

Does the staff make it a point to organise social & cultural events?

- - - 20 70 10

Does the staff prefer going together for meals?

- - 10 - - 90

Does the hospital management have respectful attitude towards their ex-employees?

45 - 12 18 - 25

Total Percentage – 400% 45 60 62 38 70 125

Total Percentage – 100% 11.25 15 15.5 9.5 17.5 31.25

Municipal Hospitals

Table V.h. Percentage Variation of Private Hospital Employees’ Involvement in Social

Activities within the Organization

QuestionsCannot

Comment%

Strongly Agree

%

Agree%

Somewhat Agree

%

Disagree%

Strongly Disagree

%

Does the staff treat their colleagues as friends?

- 65.5 10 24.5 - -

Does the staff make it a point to organise social & cultural events?

- - 35 32.5 17.5 15

Does the staff prefer going together for meals?

- - 9 49 11 31

Does the hospital management have respectful attitude towards their ex-employees?

2 30 68 - - -

Total Percentage – 400% 2 95.5 122 106 28.5 46

Total Percentage – 100% 0.5 23.875 30.5 26.5 7.125 11.5

Private Hospitals

53 | P a g e

Involvement in Social Activities within the Organization

Majority of the employees at municipal hospitals (31%) disagree with any occurrences of

social activities being conducted within their organization. Only 30% of the employees

agree on them being interactive socially.

Figure V.e. Municipal Hospital Employees’ Involvement in Social Activities within the Organization

64% of the employees in private hospitals have agreed to engage in social interactions;

whereas 19% of the employees disagree to any occurrences of social engagements within the

organization.

Figure V.f. Private Hospital Employees’ Involvement in Social Activities within the Organization

54 | P a g e

V.4. Performance – Orientation of the Employees:

Table V.i. Percentage Variation of Municipal Hospital Employees’ Performance Orientation

QuestionsCannot

Comment%

Strongly Agree

%

Agree%

Somewhat Agree

%

Disagree%

Strongly Disagree

%

Is the hospital staff particular and serious in achieving their targets?

- 58 42 - - -

Is the hospital staff particular about quality and infection control?

- - 62 18 15 5

Does hospital staff have service oriented attitude towards patients as well as sensitive towards patient's requirement?

5 - 50 18 15 12

Are hospital's rules & regulations followed strictly by the staff?

- 70 25 - - 5

Does hospital staff maintain good interdepartmental relationship and respect their superiors and peers?

- - 75 15 10 -

Do the employees seek to team oriented approach for overcoming outcomes?

- 8 70 22 - -

Total Percentage – 600% 5 136 324 73 40 22

Total Percentage – 100% 0.83 22.675 54 12.165 6.66 3.67

Municipal Hospitals

Table V.j. Percentage Variation of Private Hospital Employees’ Performance Orientation

QuestionsCannot

Comment%

Strongly Agree

%

Agree%

Somewhat Agree

%

Disagree%

Strongly Disagree

%

Is the hospital staff particular and serious in achieving their targets?

- 25 75 - - -

Is the hospital staff particular about quality and infection control?

- 75 25 - - -

Does hospital staff have service oriented attitude towards patients as well as sensitive towards patient's requirement?

- 30 70 - - -

Are hospital's rules & regulations followed strictly by the staff?

- - 80 15 5 -

Does hospital staff maintain good interdepartmental relationship and respect their superiors and peers?

- - 90 10 - -

Do the employees seek to team oriented approach for overcoming outcomes?

- 8 70 22 - -

Total Percentage – 600% 0 138 410 47 5 0

Total Percentage – 100% 0 23 68.33 7.83 0.84 0

Private Hospitals

55 | P a g e

Performance – Orientation of the Employees

Majority of the employees (77%) at municipal hospitals are seen to be compatible with their

assigned work, thus enabling them in enhancing their performance. A majority abide to the

rules and regulations put forth by the management.

Figure V.g. Municipal Hospital Employees’ Performance Orientation

The majority of the employees (91%) in private hospitals are also seen to have a higher

performance orientation, thus enabling them in performing well at the assigned tasks. All of

the employees strongly disagree with the hospital staff performing poorly.

Figure V.h. Private Hospital Employees’ Performance Orientation

56 | P a g e

V.5. New Recruits: The percentages reveal the attitudes of the hospital employees

towards new staff. The percentage was brought down from 300% to 100% for easy

interpretation of the collected data.

Table V.k. Percentage Variation of Municipal Hospital Employees’ Perception to New Recruits

QuestionsCannot

Comment%

Strongly Agree

%

Agree%

Somewhat Agree

%

Disagree%

Strongly Disagree

%

Does the hospital staff facilitate socialisation with the new recruits?

- 100 - - - -

Are new approaches by the new recruits criticized?

- - - - 40 60

Is the staff particular that new recruits should accept and practice the hospital tradition?

- 70 30 - - -

Total Percentage – 300% 0 170 30 0 40 60

Total Percentage – 100% 0 56.67 10 0 13.33 20

Municipal Hospitals

Table V.l. Percentage Variation of Private Hospital Employees’ Perception to New Recruits

QuestionsCannot

Comment%

Strongly Agree

%

Agree%

Somewhat Agree

%

Disagree%

Strongly Disagree

%

Does the hospital staff facilitate socialisation with the new recruits?

- 100 - - - -

Are new approaches by the new recruits criticized?

3.75 3.75 - 7.5 - 85

Is the staff particular that new recruits should accept and practice the hospital tradition?

- 90 10 - - -

Total Percentage – 300% 3.75 193.75 10 7.5 0 85

Total Percentage – 100% 1.25 64.58 3.33 2.5 0 28.34

Private Hospitals

57 | P a g e

New Recruits

Majority of the employees (67%) in municipal hospitals are seen to be compatible and

friendly towards their new employees. They show positive attitudes towards them in

blending with the hospital culture.

Figure V.i. Municipal Hospital Employees’ Perception to New Recruits

Majority of the hospital staff (68%) at private hospitals are also seen to be compatible with

the newly recruited employees. But 28% of the hospital staffs are seen to completely

disagree in portraying positive attitudes towards the new recruits.

Figure V.j. Private Hospital Employees’ Perception to New Recruits

58 | P a g e

V.6. Employee’s judgement towards their Hospital: The percentages describe

the level of bonding the hospital employees have towards their organization. The percentage

was brought down from 500% to 100% for easy interpretation of the collected data.

Table V.m. Percentage Variation of Municipal Hospital Employees’ judgement towards their Hospital

QuestionsCannot

Comment%

Strongly Agree

%

Agree%

Somewhat Agree

%

Disagree%

Strongly Disagree

%

Does the staff look for a long term association?

- 100 - - - -

Is the hospital staff loyal to the hospital? - - 90 10 - -

Are the employees proud about working for the hospital?

- 70 10 20 - -

Does the staff feel that they are overburdened with work?

- 90 - - 10 -

Does the staff seek help from the union to solve their issues with the management?

- 80 10 3 7 -

Total Percentage – 500% 0 340 110 33 17 0

Total Percentage – 100% 0 68 22 6.6 3.4 0

Municipal Hospitals

Table V.n. Percentage Variation of Private Hospital Employees’ judgement towards their Hospital

QuestionsCannot

Comment%

Strongly Agree

%

Agree%

Somewhat Agree

%

Disagree%

Strongly Disagree

%

Does the staff look for a long term association?

- 100 - - - -

Is the hospital staff loyal to the hospital? - - 85 15 - -

Are the employees proud about working for the hospital?

- 75 5 20 - -

Does the staff feel that they are overburdened with work?

10 30 60 - - -

Does the staff seek help from the union to solve their issues with the management?

- - 50 40 10 -

Total Percentage – 500% 10 205 200 75 10 0

Total Percentage – 100% 2 41 40 15 2 0

Private Hospitals

59 | P a g e

Employee’s judgement towards their Hospital

Majority of the hospital employees (90%) in municipal hospitals show their loyalty and

reveal a strong bondage towards their organizations. Only 3 % of the staff shows a negative

attitude towards their hospital.

Figure V.k. Municipal Hospital Employees’ judgement towards their Hospital

Majority of the hospital employees (81%) at private hospitals are also seen to have a close

bondage towards their organizations and express loyalty. Only a minority of the employees

(2%) did not show a positive attitude towards their hospital.

Figure V.l. Private Hospital Employees’ judgement towards their Hospital

60 | P a g e

V.7. Hierarchy Structure in Hospitals: The percentages indicate the level of

hierarchy followed in each of the hospitals.

Table V.o. Percentage Variation of Municipal Hospital Employees’ Hierarchy Structure in Hospitals

QuestionsCannot

Comment%

Strongly Agree

%

Agree%

Somewhat Agree

%

Disagree%

Strongly Disagree

%

Does hospital management strictly follow hierarchy structure?

- 20 70 - 10 -

Is decision making centralized? 15 85 - - - -

Do all communications compulsory occur in written format?

- 40 45 5 10 -

Are all inter-departmental communications dealt via the departmental heads?

- 70 30 - - -

Is the hospital system dependent? - - 100 - - -

Is the hospital dependent on people? - 20 80 - - -

Total Percentage – 600% 15 235 325 5 20 0

Total Percentage – 100% 2.5 39.2 54.2 0.8 3.3 0

Municipal Hospitals

Table V.p. Percentage Variation of Private Hospital Employees’ Hierarchy Structure in Hospitals

QuestionsCannot

Comment%

Strongly Agree

%

Agree%

Somewhat Agree

%

Disagree%

Strongly Disagree

%

Does hospital management strictly follow hierarchy structure?

- 90 10 - - -

Is decision making centralized? - 55 30 15 - -

Do all communications compulsory occur in written format?

- 25 37.5 37.5 - -

Are all inter-departmental communications dealt via the departmental heads?

- 90 10 - - -

Is the hospital system dependent? - 90 10 - - -

Is the hospital dependent on people? - 30 70 - - -

Total Percentage – 600% 0 380 167.5 52.5 0 0

Total Percentage – 100% 0 63.33 27.92 8.75 0 0

Private Hospitals

61 | P a g e

Hierarchy Structure in Hospitals

A strong hierarchical structure exists in municipal hospitals. Majority of the hospital

employees (93%) agreed that their hospital management controls the activities that take

place within the organizations.

Figure V.m. Municipal Hospital Employees’ Hierarchy Structure in Hospitals

Private hospitals are also seen to inculcate a hierarchical culture. The majority of the

hospital employees (91%) agreed that their decision making was carried out by their

superiors.

Figure V.n. Private Hospital Employees’ Hierarchy Structure in Hospitals

62 | P a g e

V.8. Code of Conduct: The percentages describe the level of code of conduct the

organizations follow. The percentage was converted from 300% to 100% for easy interpretation

of the obtained data.

Table V.q. Percentage Variation of Municipal Hospital Employees’ Code of Conduct

QuestionsCannot

Comment%

Strongly Agree

%

Agree%

Somewhat Agree

%

Disagree%

Strongly Disagree

%

Is the organization particular about the employees’ wardrobe tidiness?

- - - 12 70 18

Is there a code of conduct for the hospital staff?

- - - - 30 70

Does the hospital have a protocol for interacting with visitors (telephone or live greetings)?

- - - - - 100

Total Percentage – 300% 0 0 0 12 100 188

Total Percentage – 100% 0 0 0 4 3.33 62.67

Municipal Hospitals

Table V.r. Percentage Variation of Private Hospital Employees’ Code of Conduct

QuestionsCannot

Comment%

Strongly Agree

%

Agree%

Somewhat Agree

%

Disagree%

Strongly Disagree

%

Is the organization particular about the employees’ wardrobe tidiness?

- 55 40 - 5 -

Is there a code of conduct for the hospital staff?

5 - 90 5 - -

Does the hospital have a protocol for interacting with visitors(telephone or live greetings)?

45 40 5 10 - -

Total Percentage – 300% 50 95 135 15 5 0

Total Percentage – 100% 16.67 31.67 45 5 1.66 0

Private Hospitals

63 | P a g e

Code of Conduct

Majority of the hospital employees (94%) disagree to any code of conduct followed by the

hospital management in municipal hospitals. Almost none of the hospital employees agree

to any conduct codes that require to be pursued.

Figure V.o. Municipal Hospital Employees’ Code of Conduct

Instead private hospitals are seen to have a code of conduct that requires to be followed by

the employees. Majority of the hospital employees (71%) agree that the management has

applied a code of conduct that has to be obeyed upon.

Figure V.p. Private Hospital Employees’ Code of Conduct

64 | P a g e

Chapter VI - DISCUSSION

Employee’s Perception towards the Management

The municipal hospitals as per the study shows that 50 % of the staff agreed to the fact they

were provided training and imparted the same knowledge towards work, but the remaining

50 % staff comprising of labour employees denied the provision of training which is

attributed to the fact that they did not need much of technical training as compared to the

non-labour staff.

Staff at private hospitals showed that 90% of its employees agreed that they have been

imparted the required knowledge to work with. A difference in opinion exits for clerical

staff who commented that training was not required for them except in special situations like

new software instalment by the organization or introduction of new technology.

Comparing the percentages describes that private hospitals are more compelled on training

their employees prior to assigning them to tasks.

60% of the staff at municipal hospitals agreed that the hospitals provided them with the

resources whenever required. Employees from various cadres have shown mixed reactions

depending upon their perception towards management. Enhanced disagreement regarding

this aspect was seen with paramedical and senior medical staff.

All the employees at the private hospitals accept that they have been provided with the

necessary resources required for their effective functioning. This proves that the

management attends to the employees to help them in fulfilling their targets thus making

them task-oriented as compared to the employees at the municipal hospitals where the

management does not stress on inculcating the similar culture.

65 | P a g e

60% of the employees at municipal hospitals feel to an extent their organizations are

disciplined but the remaining 40 % of the employees feel that the discipline principle does

not exist within their organizations. Such principles are not practised and hence this aspect

requires immediate attention since an organization without discipline would result in

extensive conflicts and disagreement.

90% of the employees at private hospitals on the other hand feel that their organisations

have inculcated strong principles which are bound by their employees; else action would be

taken for not abiding to their regulations. This shows that private hospitals engulf a

hierarchical type of culture within their organizations.

50% of the employees at municipal hospitals state that their management considers their

suggestions and attends to their complaints; whereas the remaining 50% belonging to the

labour group disagree to their suggestions being considered. This proves that in municipal

hospitals, the management gives preferences to only educationally qualified staff thereby

bringing about partiality.

75% of private hospital employees agree to their management attending to their complaints

as well as considering their suggestions. The remaining 20 % who consisted of Class IV

employees disagree to the fact that their management is considerate towards their

suggestions. As followed in municipal hospitals, private hospitals are also noticed to be

partial towards well qualified staff.

All the employees at municipal hospitals feel that the promotions are not allocated as per the

performance of the personnel. Whereas at private hospitals mixed responses was obtained

from the employees. 44% agreed that the promotions were given diligently according to

personnel’s performance. But 47% employees disagreed to their management being fair in

allotting promotions according to their performance and 9% could not comment on such a

question.

66 | P a g e

This shows that partiality exists in both types of organizations when dealing with handing

out promotions. Such culture should not be entertained since it de-motivates the employees

on working hard, thereby reducing their performance towards their assigned tasks.

It was observed that employees at both types of organisations feel that their hospitals give

first preference to its patients thus showing utmost care for them. The organizations being

hospitals have to focus primarily on their customers and since both types of organizations

achieve their target, it proves that both types are task oriented. This type of culture hence

creates a positive attitude in employees since they achieve greater patient satisfaction. As

said earlier, patient satisfaction automatically has an influence on employee satisfaction,

thereby helping in enhancing their performance.

75% of the employees at the municipal hospitals feel that their organizations do not respond

to patient’s feedback. But since the municipal hospitals are seen to put their patients first,

their recommendations and suggestions should be acknowledged. Only then would they

approve on patient satisfaction. This shows that the suggestions put forth by patients are not

delivered to the management due to the hierarchical culture of the organization; the

employees are seen to be restricted from voicing their opinion.

Whereas 85% of the employees at private hospitals have agreed that their organizations

respond to patient’s feedback. In fact certain organizations provide feedback forms to be

filled by patients and this is controlled directly by management. Hence even though a

hierarchical culture exists in these organizations, the management does take into

consideration the patient’s recommendations since it would help benefit their organization in

the future.

67 | P a g e

The study shows municipal hospitals have a high expenditure and not much emphasis is

given for cost containment. 70% of the employees at municipal hospitals have disagreed to

their organizations on controlling cost. This is observed since these municipal hospitals are

under the authority of the government and hence all their financial transactions are managed

by the government itself.

All the employees at the private hospitals on the other hand agree to their organizations

taking steps to cut cost as well as using proper techniques to manage the usage of the

resources (money). Since private organizations have to manage all their financial

transactions themselves, they solely are responsible to keep track of their finances.

Openness within the Staff

All the employees at the municipal hospitals are open towards one another regarding the

work they do. This shows that the municipal hospital employees are very interactive and are

able to confront their peers or higher management whenever required. Thus hospital

management encourages their subordinates to voice themselves when work related issues

arise.

Majority of the employees at private hospitals also agree on interacting with their co-

workers to discuss work related issues. But unlike the employees at the municipal hospitals,

12% of them agree to their interactive levels to an extent. This shows that certain staffs are

not comfortable in discussing all their work issues since they perceive their solutions to be

accurate.

Municipal hospital employees agree on a whole that confidentiality is maintained whenever

required. This shows that the company policy has enforced a regulation that strictly requires

to be followed and abiding to this rule by maintaining patient’s confidential information

helps gain the patient’s trust thereby enhancing their growth.

68 | P a g e

Whereas in private hospitals, 65% of the employees agree that they keep the patient’s

confidentiality whenever necessary. But the remaining 35% could not comment regarding

this issue stating that either their management has not conveyed to them in regard to patient

confidentiality or the employees have not interpreted it. This could lead to vital information

of patients being conveyed across to employees leading to the patients feeling embarrassed

and hence would not trust the hospital again. This is turn would automatically affect the

hospital’s growth.

The entire staff at the municipal hospitals is seen to trust their peer group as well as their

superiors. No significant issues regarding doubts have been observed amongst any of the

employees. This proves an existence of a trustworthy environment where in all the

employees can put their faith in each other without giving a second thought.

In private hospitals it is seen that 98% of the employees also trust their co-workers as well as

their superiors thereby enhancing trustworthiness within the organization. This will thereby

enact on the patients, developing their trust towards both types of organizations in the

process. This hence enhances the reputation of the organizations making them competitive.

All the employees at the municipal hospitals agree on sharing their knowledge with either

new employees or existing co-workers thereby aiding in enhancing their information

regarding work or the values and norms at the hospitals, thus helping them enhance their job

performance which will gradually increase the organization’s communication as well as

their growth.

95% of the employees at private hospitals are also seen to share their knowledge with their

co-workers or their subordinates. This thus helps in enhancing the communication within

the organization. This describes inculcating of a democratic form of culture where the

employee’s views are considered.

69 | P a g e

The remaining 5% of the staff refuse to educate others since they feel a competition lies and

each one of them are concerned about their self growth. Such issues would inhibit the

organization from growing and it may result in conflicts and hence should be avoided.

Involvement in Social Activities within the Organization

Employees at municipal hospitals are seen to be friendly with their colleagues during work

hours. This creates an environment where each employee does not fear from approaching

their co-worker regarding any issue. This shows that a group type of culture has been

developed to an extent amongst the employees and this is usually noticed among employees

of the same cadre.

Majority of the employees at private hospitals also agree in treating their staff as friends

whereas the remaining agreed to an extent. This shows that certain employees are not very

comfortable in treating all of their employees as friends, thus revealing that the hierarchical

nature is dominating over the culture at the organizations. The employees placed at higher

management are seen not to mix around with their subordinates as they feel that it may

lower the respect their subordinates give to them.

Staffs at municipal hospitals absolutely disagree to the fact that their organization holds any

social events for the employees. Only 20% of the staff at certain municipal organizations

agree to an extent regarding conducting of cultural occasions. This describes a rational type

of culture that has been inculcated within the organization, focussing their employees on

only achieving their targets. This creates a very monotonous environment tending to initiate

a dull attitude within the employees.

70 | P a g e

67% of employees at private hospitals agree to their organization’s conducting social

gatherings or events. But since 33% of the employees have disagreed to any occurrence of

social events, showing that the practice of cultural events is not common in the whole

organisation but rather practiced by certain groups of the same cadre amongst themselves.

Percentage status shows 90% of employees at municipal hospitals having completely

disagreed to dining outdoors which proves that their organizations work round the clock,

hence cannot afford employees of same cadre go outdoors for meals at the same time. The

remaining 10% of staff that agreed to dining outdoors do so only after their shifts.

58% of the employees at private hospitals are seen to manage time and meal outdoors with

their co-workers, whereas the remaining 42% disagree to dining with their peers since they

cannot manage to avail any personal time during their shifts. This shows that the

organizations are very persuasive on reaching their targets, pushing employees to cut their

personal time to achieve them.

Hospital management at municipal hospitals are not seen to be respectful towards their ex-

employees since 25% of the staff disagreed when questioned regarding giving respect and

45% did not comment on this issue. This shows that either the employees are not aware of

the attitudes of the hospital management or just portraying an ignorant attitude towards the

question.

Whereas 98% of the employees at private hospitals are seen to agree that their organization’s

management show respect towards the past employees. This creates a strong bond between

employees and their management thus enhancing a greater companionship level. Only 2%

of the employees could not comment regarding this issue thus displaying their ignorance

towards the management.

71 | P a g e

Performance – Orientation of the Employees

All the employees at municipal and private hospitals are seen to be focussed on achieving

their targets. This shows that their management has inculcated a rational type of culture

which determines that the organizations are task oriented. Employees from both types of

organisations feel that they are highly motivated on achieving their assigned targets. This

shows that both types of organizations are seen to enforce and motivate their staff towards

achieving the targeted goals. Certain organizations put forth deadlines for completion of the

tasks; hence since the employees are time bound on a certain activity, they are determined

on completing it.

Employees from different cadres are seen to have different opinions towards their

organization’s Infection Control. 30% of the employees are seen to completely disagree

with the fact that their organization considers controlling infection and maintaining quality.

Such situations may bring up threat alerts during inspections and hence the organization

should maintain their quality.

Private hospitals are seen to have an absolute control over any outbreak of infection and do

keep a check on their quality. This aspect has been confirmed by their respective employees

who approve that their management keeps on a constant check on their organization’s

quality. This type of environment should be maintained since the organization would be

prepared for sudden inspections.

A majority of the employees comprising of 68% of the staff agree to them being sensitive

towards patient care. 27% of the employees disagree and the remaining 5% cannot

comment regarding this issue. This shows that the employees that disagree or cannot

comment do not handle patients directly. This proves all employees are not trained on how

to handle patients.

72 | P a g e

Whereas at private hospitals, all of the employees whether directly or indirectly associated

with patients are seen to be sensitive to patient care and attend to them whenever required.

This tends to increase patient compliance within the organization, thus helping in the growth

of the hospital.

95% of employees in both types of organizations are seen to abide to the rules and

regulations put forth by the organization. This proves that their organization stress that their

rules have to be followed, without which strict actions would be taken. This shows that the

organizations impose a hierarchical nature to an extent. A fear has been built within the

employees regarding that any action would be taken against them if they did not abide to

their rules. Only 5% of the employees disagree to the staff strictly abiding to the rules. This

shows that a small percentage of employees have observed certain personnel disobeying the

imposed regulations.

Interdepartmental relationships as well as seniority respect is seen to be maintained

positively by 90% of the employees in municipal hospitals and 100% in private hospitals.

This reflects an adaptation of a group culture, thereby increasing communication skills. The

bond between employees of different departments is seen to increase thereby helping one

another during patient related issues. 10% of the employees at municipal hospitals are seen

not to be interactive with other departments showing that either a certain cadre or certain

employees prefer being by themselves. Such an environment can bring about disputes and

should be looked out for.

All the employees at both organizations use a team oriented approach to resolve issues. Thus

co-workers are seen to approach their peers in case of any issue. This shows that

employees’ respect for one another grows, helping each other in times of need. Inculcating

of a team oriented approach shows the presence of a group culture.

73 | P a g e

This brings out positive attitudes within the employees since they perceive that each one’s

inputs are voiced and considered by management. This environment usually resolves issues

much quicker in comparison to a management that solely resolves them.

New Recruits

All employees at both types of hospitals seem to accept new recruits very willingly and aid

them in their orientation within the organisation. Their socialization with the new

employees is seen to be very interactive, thus making the new staff feel comfortable in the

organization. This will thus help the new employees to learn and draw level to the values

and norms that the organizations have induced thereby accustoming themselves to the

culture and acknowledging the rules and regulations put forth by the existing employees

much quicker. The interactive skills helps the new employees clear their doubts on work

related issues when communicated to their co-workers.

100% of the employees at municipal hospitals disagree on criticizing the inputs or

suggestions put forth by the new employees. This shows that the interactive levels as well

as the respect are justified equally to all the co-workers. This will thus help inculcate a

positive attitude within the new employees, hence enhancing their work performance.

Employees at private hospitals agree to an 85% extent that they do consider the suggestions

put forth by the new employees. But 12% of the staff does not agree on considering the

inputs by the new staff and instead criticize their approaches. Such an environment may de-

motivate the new employees thus lowering their work performance. Hence care should be

taken while communicating such issues with new staff.

Employees at private and municipal hospitals compulsory seek that the newly recruited staff

abide to the culture of the respective hospitals, since the management needs to preserve the

environment of the organization.

74 | P a g e

They encourage the new staff to adapt to the present customs and adopt the values and

norms that the organization imposes. This proves that an antagonistic form of culture also is

in play within both types of organizations. This is preferred so that all the employees in that

particular organization think alike and work in a similar manner, thereby diminishing any

performance differences. This would thus help increase the growth of the organization since

all the staffs are in uniformity with one another.

Employee’s judgement towards their Hospital

Employees from both types of organizations are seen to seek a long term bond with their

hospital. This shows that the employees have developed a likeness and built a comfort zone

within the hospital and its surroundings. They are seen to be very compatible with their co-

workers and their management. They seem to have adjusted very well with their interactive

skills. It is surprisingly noticed that even after disagreeing with the kind of performance

appraisal being distributed; employees at municipal hospitals want to be associated with

their organisation. This shows that the employees see themselves having a lasting tenure

with the hospital.

All the employees at municipal and private hospitals are seen to be loyal to their

organization; but 10% and 15% of the employees at municipal and private hospitals

respectively have agreed to their loyalty levels only to an extent. This may create a concern

for that hospital since these employees are most likely to end up being disloyal to the

organization. These situations may arise if those employees feel they are being ignored and

feel restricted from voicing their opinions. Hence care should be taken with such staff to

make them feel their need within the organization.

75 | P a g e

Both private and municipal hospital’s employees agree to be proud to work for their

organization. This shows that they obtain what they expect from the organization and they

also visualise the hospital’s growth to be respectful.

The staffs are pleased to see their organization achieving their targets and this creates a

positive impact on the employee’s attitudes towards their organization. The employees are

proud that their organization is patient compliant thereby boosting the hospital’s growth.

Employees of all cadres at the municipal hospitals are seen to be overburdened with work.

This shows that the cultures at the municipal hospitals have adopted a task-oriented culture

and the organizations are compelled on achieving their targets on time. Thereby the

employees feel a time constraint exists in completing the assigned tasks. Such a strenuous

impact should not be put onto the culture, since the employees may get overstressed

resulting in work related errors.

90% of the staff at private hospitals feel that they have been overloaded with work. Since

10% of the employees cannot comment on such an issue, it shows that the work is not

proportionately divided among the personnel. Their management is responsible for such

issues. Such situations can arise conflicts and disputes which are not healthy for the

organizations. These issues should be resolved quickly.

Union seems to play a very important role in solving employee related issues since on an

average 90% of the staff from both types of organizations have agreed on involving the

management in resolving their problems. This shows that the organizations have inculcated

a form of group culture where the employees are able to approach the management. This

would help develop a very comfortable environment aiding the employees to be reachable to

the union. Only a minority of the employees disagree on this issue since they either prefer

solely solving their problems or have developed a fear towards approaching their union.

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Hierarchy Structure in Hospitals

A hierarchy form of culture is seen to be predominant in both types of hospitals as

commented by majority of the employees. This shows that only top management is in

control of decision-making and does not consider the staff’s opinion. In this type of

structure it is observed that all types of announcements are formally communicated either

via e-mails or notices. Since hospital management enforces this hierarchical form,

physicians will be seen to given most preference and thus would expect maximum respect

from the remaining staff thus expecting management to consider their suggestions and

opinions with priority. This type of structure could create insecurity for the other staffs

since they feel their inputs are not considered.

Employees of all cadres from both types of hospitals are seen to uptake a centralised form of

decision making. This confirms the presence of a hierarchical culture which is followed to

an extent at the hospitals. This proves that the employees do not have a say during the

decision making process. This type of structure can de-motivate the employees making

them insecure about their importance within their organization. 15% of the employees at

municipal hospitals could not comment regarding this issue. This shows that either they are

ignorant of the decision making process or prefer not to interfere in such matters.

All private hospitals have been found to communicate formally in a written format. These

types of organizations are seen to uptake a more of a hierarchical culture where all

announcements are conveyed via notices or emails or noted down communications. In this

type of structure, certain employees may not feel comfortable in communicating certain

personal issues to management. Such cases should only include verbal confrontations and

hence communications via written format may arise concerns for some staff.

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90% of the staff at municipal hospitals are seen to agree with all their communications being

dealt with in written format. Hence a hierarchical form of culture has been adopted to an

extent. 10% of staff who disagree to this issue, confirm that verbal communications are also

used as a form of communication in certain municipal hospitals. Certain staff like labour

staff may not be able to communicate in written form due to their limited literate knowledge.

Hence verbal communications would encourage the employees’ voice out certain issues that

cannot be conveyed in written format.

Staffs from both types of organizations agree to any inter-departmental issues being dealt

only via their department heads. This conveys that both types of hospitals have adopted a

form of hierarchical culture where they do not discuss issues with their subordinates. Only

departmental heads are seen to converse with each other when issues arise. Such a culture

may decrease the motivation level amongst the employees since they feel that they are not

included in issues of high priority thus leading to reduced work performance. Hence care

should be taken regarding such issues as it may give rise to disputes.

All employees from both types of organizations have commented that their hospitals are

dependent on systems, without which it would not function. This shows that the staffs are

well aware of their hospital surroundings and their functioning. Hence constant check of

systems is required to ensure that they are calibrated.

Employees at both types of organizations agree that their hospitals would not function

without personnel in it thus specifying that their organizations are people dependent.

Hospitals are organizations where their patients require the presence of personnel to comfort

them and be reachable to their needs. This shows that the employees are well aware of their

tasks and attend to it whenever required.

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Code of Conduct

Majority of the employees at municipal hospitals disagree that their organizations are

particular about their wardrobe tidiness. The staff have not agreed to their organizations

containing a code of conduct that requires to be followed by them. According to the

employees, no protocol exists in training the staff regarding standard communication to

visitors or patients. This shows that municipal hospitals do not have any ethics code that

they should be maintained. This could arise in patient non-compliance. Municipal hospitals

are seen to be least bothered about their public relationship. This is observed since their

management is handled by the Government which is seen to be taken lightly.

Private hospitals on the other hand are observed to run absolutely in contradiction to

municipal hospitals in the aspect of their code of conduct. Since the private hospitals run by

themselves, they are very much concerned about their public relations to build their image.

Hence in order to gain maximum patient compliance, the private hospitals are observed to be

very strict regarding the employees’ tidiness in their clothes wear. They expect this since

they have put forth a code of conduct that requires to be followed by all staff. Half of the

employees agree to their organizations consisting of protocols on interactions with visitors.

45% of the employees could not comment on this issue proving that they are not in direct

contact with the patients or visitors and hence not aware of such protocols. Hence to

maintain a good public relation with their patients, private hospitals compel their staffs to

follow their code of conduct.

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Chapter VII - CONCLUSION

At municipal hospitals the study shows that labour staff suggestions are considered in the

hospitals. They being the major part of the organisation cannot be neglected. They need to

be given appropriate attention and their views regarding minor decisions like planning their

work, shift timings, leave plans are usually considered. The labour staff should be involved

in trainings provided as per their type of work. This would help them grow serious about

the assigned tasks making them feel more responsible thus aiding in enhancing their

performance.

Municipal organisations cannot function without their employees since increasing employee

satisfaction would thereby increase the quality shown of their work. Thus promotions

should be considered for employees on basis of their performance level and not on partiality.

This enhances their motivation driving them for the betterment of their organization.

Being municipal hospitals, it is assumed that the staffs at the hospitals are overburdened due

to insufficient resources (inadequate material, employees, money) or increased work (mass

disasters or epidemics). However this research goes in contradiction to this assumption,

since their provided resources are handled by proper resource management and training.

Though the management at municipal hospitals cater too much of their services to patients,

the cleanliness of the premises are at times overlooked which could be a cause of increased

hospital acquired diseases.

As the study states that municipal organisations depend on their seniors for decision making,

the results are usually delayed for key decisions since people are being more dependable on

one another. If municipal hospitals become more role oriented than their performance

orientated, it would enhance their public relations and would involve them in a better

decision making process.

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In private hospitals as well, the main core of all their organisations are the labour staffs.

Hence more importance should be given to their suggestions and recommendations. This

will help motivate them thus giving them confidence that their suggestions are being

considered. It will also help motivate them on their work performance since a feeling of

them needed in the organization exists.

As it has been observed in that in private organisations, the work pattern is more

interdependent and hence employees’ togetherness is considered much important. Indians

are usually seen to share more amongst their own culture. Since India is filled with people

of variety of cultures from various states, hosting of cultural events will ensure employee

participation and will also help create a bond among those employees of different cultures.

The results of this study confirm that private organisations function smoothly, however the

performance evaluation is seen to be determined on the basis of seniority and not by the

performance itself. If a system is developed which evaluates an individual on the basis of

his or her performance, then this will thus help motivate each individual to perform well

which in turn will lead to a better organization.

The report states that private as well as municipal hospitals do not cultivate a single type of

culture, but a mixture of cultures. It is mostly observed that in both types of organisations,

hierarchical culture is seen to be predominating over the other culture forms.

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Chapter VIII - LIMITATIONS

Limitations of this survey:

1. The data obtained from the employees at the hospitals might be inaccurate since this

study is based on one’s perception towards their organization, but a possibility that

their perception can change over time exists.

2. The number of questions put forth were too many which could have resulted in

participants getting restless in completing the questionnaire, thus altering their

subconscious perception from giving accurate answers.

3. Since limited timelines were given to the participants to fill the questionnaires, the

questions would have been answered in haste which would have resulted in varied

results.

Limitations of this study:

1. The number of participants approached was low due to shortage of time and hence

responses obtained are inadequate for defining the hospital’s organizational culture.

2. Due to lack of time only six hospitals in Mumbai could be approached, hence the

data obtained from the hospital staffs might not be completely substantial.

3. The reports generated did not determine the percentage of each type of culture

adopted at both private and municipal hospitals.

4. Psychologists were not approached for their feedback to gain their inputs on such

issues which would have given a better understanding of a hospital’s culture.

5. Equal number of participants from each cadre were not approached for the survey

which otherwise would give a better perception towards their hospital’s culture.

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Chapter IX - RECOMMENDATIONS/ FUTURE WORK

A better survey can be conducted on overall whereby all the hospitals in Mumbai,

Maharashtra should be covered to get a better perception of the organization’s culture from

the entire hospital staffs.

Before conducting surveys, psychologists should be approached to be briefed on the outlook

of a hospital’s culture and only then frame a precise questionnaire that would not take up

much of the participant’s time.

Equal number of participants from every cadre should be approached to obtain accurate

amount of data. This would help gain a better perception on the employees’ on an average.

Every organization should have a counsellor such that issues related to one’s personal or

work problem can be resolved helping employees focus better on their job, thus enhancing

their work performance.

Care should be taken as not to obtain any distortion in future research findings which could

result in vague or inaccurate results. Higher management could result in reporting

additional positive cultural values that may not be taken into effect in their system or may

under report of certain dysfunctional issues that occur. Hence such dimensions should be

avoided which could result in inaccuracy of the collected data.

Reports generated should include percentages of the types of cultures present to determine

the dominant culture that is usually inculcated within these organizations. Since we know

that a hospital culture usually comprises of a mixture of cultures, it is important to analyse

the core culture from which the other forms of cultures develop.

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APPENDIX

Assessment of Organizational Cultures at Municipal and Private Hospitals located in

Mumbai, Maharashtra

Hospital/Organization Name:

Your Role/Designation:

Answer each question by ticking them according to the following rating values:

5 --- Strongly Agree

4 --- Agree

3 --- Somewhat Agree

2 --- Disagree

1 --- Strongly Disagree

0 --- Cannot Comment

1. Employee’s Perception towards the Management

Sr. No. Questions 0 1 2 3 4 5

a)Is your hospital management keen towards staff knowledge and their enhancement?

b)Does hospital management provide adequate resources to the staff to function optimally?

c)Is hospital management principled and disciplined and do not hesitate to take action against the guilty?

d)Is your hospital management considerate regarding the suggestions/complaints of the staff?

e)Is the performance assessment practised genuinely and promotions given to deserved employees?

f)Does your hospital management put patient’s first?

g)Is your hospital management highly sensitive towards patient's feedback?

h)Is your hospital management highly conscious of the expenses and preach regarding cost containment?

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2. Openness within the Staff

Sr. No. Questions 0 1 2 3 4 5

a)Are you openly informative to others about what work you are doing?

b)Do you strive to maintain confidentiality whenever required and are not very particular about matters?

c)Do you generally trust your colleagues and not doubt anyone?

d)Are you open to share knowledge and educate others?

3. Involvement in Social Activities within the Organization

Sr. No.Questions

0 1 2 3 4 5

a)Do you treat your colleagues as friends?

b)Do you make it a point to organise social & cultural events?

c)Do you prefer going together for meals with your co-workers?

d)Do you think your hospital management has a respectful attitude towards the ex-employees?

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4. Performance – Orientation of the Employees

Sr. No. Questions 0 1 2 3 4 5

a)Are you particular and serious in achieving your targets?

b)Are you particular about quality and infection control?

c)Do you have a service oriented attitude towards patients as well as sensitive towards patient's requirement?

d)Do you follow hospital's rules & regulations strictly?

e)Do you maintain good interdepartmental relations and respect your superiors and peers?

f)Do your co-workers seek for a team oriented approach for overcoming outcomes?

5. New Recruits

Sr. No. Questions 0 1 2 3 4 5

a)Do you socialize with the new recruits?

b)Do you criticize approaches put forth by the new recruits?

c)Are you particular that new recruits accept and practice the hospital tradition?

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6. Employee’s judgement towards their Hospital

Sr. No.Questions 0 1 2 3 4 5

a)Do you look for a long term association with this hospital?

b)Are you loyal to your hospital?

c)Are you proud to work for this hospital?

d)Do you feel that you are overburdened with work?

e)Do you seek help from the union to solve your issues with the management?

7. Hierarchy Structure in Hospitals

Sr. No.Questions 0 1 2 3 4 5

a)Does your hospital management strictly follow hierarchy structure?

b)Is decision making centralized?

c)Do all your communications compulsory occur in written format?

d)Are all inter-departmental communications dealt via the departmental heads?

e)Is your hospital system dependent?

f)Is your hospital dependent on people?

8. Code of Conduct

Sr. No. Questions 0 1 2 3 4 5

a)Is your organization particular about the employees’ wardrobe tidiness?

b)Is there a code of conduct for the hospital staff?

c)Does your hospital have a protocol for interacting with visitors (telephone or live greetings)?

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