Following on from sub-culture, I think we can see that these 3 groups within a hospital have their own distinctive identity (see what you think!). I’ll consider some of the implications in the next post.
Level 1 Surface manifestations
Medical: White coats, stethoscopes, ritualised ward rounds, fellowships of Royal Colleges, eminent personalities
Managerial: “civilian” clothes, plush offices remote from patient areas, separate hierarchy
Nursing: Uniforms, “hands-on” work, largely female, local training
Level 2 Values and beliefs
Medical: Personal contract between doctor and patient, clinical freedom, scientific basis for treatment, member of profession, not employee of Trust
Managerial: Loyalty to Trust, resources limited by centrally-controlled budgets, financial prudence, adherence to central policy
Nursing: Patient advocacy, care more than cure, nurturing, comfort, self-sacrifice, hygiene
Level 3 Basic assumptions
Medical: Hippocratic Oath, patient confidentiality, sanctity of life, responsibility to patient
Managerial: Responsibility to Trust/NHS for public money expenditure, health gain of population more important than individuals
Nursing: Primacy of the individual, patient dignity
By analysing the sub-cultures using Schein’s model, it may be possible to identify common themes within each. Appealing to common values may allow greater acceptance of change initiatives. Moreover, those parts of the change initiative which fit with a particular subgroup can be emphasised most for that situation. In other words, inasmuch as the senior management is a part of the culture, they may be able shape aspects of it to suit their agenda.
I’ll give some specifics in next posts!