Understanding the role of organizational culture of healthcare facilities in Public Private Partnerships: A critical perspective study.

In these times, as the world emerges from a pandemic that devastated economies and restructured the priority of health, discussions of healthcare reform constitute a significant part of the management arena and greater political discourse. The pre-pandemic emphasis on Universal Health Coverage has received newfound scholarly interest. Public Private Partnerships (PPP) are broadly viewed as one of the main vehicles to achieve these ideals within pragmatic timeframes, especially in emerging and developing countries. Aligning the goals of these two sectors – especially in healthcare and at the micro-level - proves challenging at the point of patient care, where sometimes opposing views on what constitutes “better care” find their expression. This dissertation aims to provide a framework for understanding organizational culture within healthcare institutions, via an organizational science and management perspective, to further the understanding of compatibility across the PPP aisle. To reach these aims, the present dissertation consists of four main chapters reporting the four studies conducted. Each of these will be presented in the general introduction chapter, where we will explain the imperatives that led to the realization of the dissertation and the rationale of the management perspective within the context of organizational culture. Although the concept of organizational culture is examined largely in the healthcare sector, universally applicable business and organizational concepts are explored which could prove useful to other sectors. Chapter 1 explores the team-level attributes to organizational culture, as the functional unit of the healthcare system. In this contribution, an experimental pre- and post-test empirical design aims to put forward an instrument to measure psychological safety and demonstrate the significant effect of interventions on this construct. This contribution further demonstrates the association between psychological safety, team learning, and team performance. Additional qualitative data was analyzed to unpack the subjective experience of team members during the intervention. As multi-disciplinary teams are the means through which healthcare users experience the service, this contribution provides valuable insights into areas where management inventions can have a palpable impact on the quality of care provision to patients. Chapter 2 presents a grounded theory approach to understanding individual-level perspectives in environments with high levels of uncertainty. Factors that constitute a resilient organizational culture are examined at a high-functioning manufacturing plant during the National lockdowns in South Africa. Resilience at this organization is investigated at the dynamic capabilities and micro foundational level and reveals novel insights of possible strategic management interest. Chapter 3 uses a teaching case study methodology to capture the proactive design of a hospital culture using systematic problem-solving and LEAN-based methodologies. Focused ethnography is used to analyze the change management process and follow the experience of the facility during their emergency response to a natural disaster. The teaching case is designed at various levels of learning and multiple levels of analysis. This contribution demonstrates the importance of curated organizational culture during events of this nature. The value of an intensive learning culture is framed within the absorptive capacity of the facility and its members, and used to explain how this facility was able to be innovative during the period of disruption. Chapter 4 arrives at the strategic level of organizational culture. Here a systematic literature review methodology is used to investigate the influence of language and language policy on the organizational culture of health organizations during emergency responses. The makeshift hospitals of Huoshenshan and Leishenshan in Wuhan China is used to represent the highly volatile environment, and an extreme expression of language control compared to Western health facilities. The findings from this contribution demonstrate the effect of language policy on service design and quality of response. The last part of the dissertation will present the narrative results. Given the interdisciplinary and pluralistic nature of the research, the dissertation will narratively propose an initial understanding of what constitutes an organizational culture through a management perspective.