Case : Organizational Culture: Life or Death

Anyone working for a company, a project, a joint venture, or in a group that’s been together even for a few months is working in a cultural system. Human beings can’t work around each other for very long without repetitive activities, strategies, and rituals appearing. How things are accomplished has a cultural rhythm and flow.

           Studies suggest that a key feature of employee success is how closely an individual’s work habits match the culture in which he or she is employed.

  Success in this research is defined as both productivity and longevity. A sound understanding of culture is important in making the best hiring, assignment, and retention decisions.

         In an interesting study involving hospitals, success has a life and death aspect. The rapid, efficient, and top-quality treatment of heart attacks is important and crucial for survival. A research study in the Yale School of Medicine journal, Circulation: Journal of the American Heart Association, points out the role that culture plays in survival.

    Eleven hospitals consistently delivered therapy to restore blood flow to heart attack patients in 90 minutes or less. The researchers studied how staff at these hospitals, including Yale–New Haven Hospital, regularly delivered such speedy treatment, which can save lives.

            The authors write that many of the nation’s hospitals do not respond as quickly as national guidelines suggest, even though speed is important in restoring blood flow to reduce the amount of damage to heart muscle. Faster “door-to-balloon” time—time elapsed from a patient’s arrival to treatment with angioplasty—translates into better survival and less disability.

  The researchers visited each of the 11 hospitals and conducted extensive interviews with staff—from the top administrators to technical support staff— and identified a set of common themes.

       “We found that success involved much more than skilled individual doctors and nurses,” said lead author Elizabeth Bradley, associate professor in the Department of Epidemiology and Public Health at Yale. “What distinguished these hospitals was how well they were organized, how teams functioned together, how the culture rewarded quality improvement and how they dealt with setbacks.”

         Bradley added, “The themes also reflect the ability of the top performing hospitals to pursue simultaneously contrasting approaches and balance the tensions between them. For example, having standardized protocol but retaining flexibility to refine them continuously, or having intense and individualized data feedback but a no-blame culture. The ability to balance these paradoxes may be a critical aspect of bouncing back from the speed bumps in the process of improvement.”

  “All of these top hospitals share eight common characteristics that drive their ability to deliver fast, effective treatment to patients with ST-elevation acute myocardial infarction (STEMI),” said senior author Harlan M. Krumholz, M.D., the Harold H. Hines, Jr., Professor of Medicine. “This study has direct and important information for hospitals around the country.”

               Each of the hospitals had explicit commitment to reduce delays throughout the process; senior management support for quality improvement efforts; innovative protocols and flexibility in refining those protocols; collaborative teams across nursing, cardiology and emergency services,; real-time data feedback to measure success; and an organizational culture that made hospitals resilient to setback.


1. What values appear to be driving the doctors and nurses in the hospitals to treat heart attack patients?

2. Why must a person’s work habits match the team culture in the hospitals depicted above?

3. What types of events could change or alter the strong team culture in the hospitals depicted above?

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