Organizational Culture Change in a Texas Hospital

Coustasse-Hencke, Alberto, MD, MBA, MPH, Organizational Culture Change in a Texas Hospital. Doctor of Public Health (Health Behavior), June 2004, 329 pp., 11 tables, 8 illustrations, bibliography, 198 titles. The purpose of this research was to analyze a Balanced Scorecard (BSC) approach in a Texas hospital with a main focus in Patient Satisfaction (PS), and to measure organizational change and its impact on PS. This dissertation also applied a "Shared Vision" of the organization as the central process in bringing forth the knowledge shared by members of the community hospital who were both subjects and research participants. The development of the framework for analysis was influenced by theories of organizational change, epistemology and philosophy of science, and included approaches to social inquiry in cybernetics, organizational behavior, learning organization, complex systems and the BSC. While the framework has a vast theoretical foundation it has not been subject to an in situ test of on-going organizational change system. The research employed primary and secondary data sources, combined quantitative and qualitative methods for an embedded longitudinal single case study, and utilized a triangulation of methods for analysis. The quantitative study utilized survey analysis and 18 measurements from the organization and used PS as the basic measurement for the study. The qualitative study used two different sets of Interviews, one for the Board and Vice President's level, and other one for all employees. Participant observation was used and archival data were collected to provide a better understanding of the organizational culture and the context in which change was taking place. Conclusions from the first iteration cycle included: an increase in PS; one subculture within the hospital had shared vision and acted as a Learning Organization; management was conducted by "silos"; and there was lack of feedback between organizational levels of the hospital, especially in financial management, with organizational dysfunctionality in reacting and adapting to the environment.