Organizational Culture Paper

Organizational Culture Paper

Organizational culture (OC) is essential in determining quality improvement initiatives’ trajectories. According to Mannion & Davies (2018), OC represents shared feelings, ways of thinking, and behaviors unique to institutions. Often, a distinct organizational culture entails three primary levels of manifestations; visible elements, shared ways of thinking, and the underlying firmly-held assumptions. Mannion & Davies (2018) argue that the visible aspects of culture include the mechanisms of distributing services and roles, the facility’s physical layout, pathways for care delivery, accepted dress code, reward systems, and staffing practices. In the same breath, shared thinking entails values and beliefs that justify organizational activities and sustain the visible manifestations of organizational culture. Finally, the deeply-rooted assumptions encompass all underpinnings of daily practice, including norms, beliefs, and perceptions. The three aspects of organizational culture determine how organizations implement quality improvement initiatives and explain the sources of resistance to change. This paper elaborates on the effects of organizational culture on quality improvement by using the case of a Veteran Administration organization.

The Quality Improvement Initiative for Veteran Administration

As a family nurse practitioner in a veteran administration organization, I have witnessed scenarios of communication breakdowns and fragmented service coordination that have resulted in undesired consequences such as care delays, compromised patient safety, and patient dissatisfaction. One of the priority areas of a quality improvement initiative is the institution’s emergency department. In this sense, it is vital to implement interventions that promote effective interpersonal communication between healthcare professionals in the emergency department to improve care delivery patterns and cultivate a safety culture. Communication breakdowns have often delayed patient transport and service coordination across organizational units. When implementing the quality improvement initiative to improve communication and care coordination, it is essential to perceive interpersonal communication as a product of an organizational culture that requires a change to guarantee quality care delivery to veterans.

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The State of Cultural/Organizational Readiness for Quality Improvement

Although the organization grapples with communication breakdowns, especially when dealing with patients requiring emergency services, it is fully prepared for quality improvement initiatives to address these challenges. According to Miake-Lye et al. (2020), assessing the institution’s preparedness to change is possible by considering elements of the “inner and outer settings,” including structural characteristics, leadership, networks and communication, culture, and the implementation climate. In the same breath, elements of the outer setting include aligning resources with quality improvement initiatives, understanding patient needs, and inter-organizational collaboration that influences quality improvement initiatives.

In terms of inner and outer settings, the employees are aware of organizational core values supporting the mission and vision statements. Also, they have the autonomy and freedom to influence decisions and integrate creativity into the overall institutional activities for promoting care quality and patient safety. In the same breath, the organization’s leadership supports the tenets of consensus decision-making, including respect for opinion diversity, collaboration, and removing silos and territories that compromise interprofessional and interprofessional collaboration. Undoubtedly, these factors can facilitate motivation and cultivate the desire to participate in quality improvement initiatives for improving communication and care delivery patterns. Consequently, it is valid to contend that the organization is culturally prepared for the quality improvement initiative.

Is the organizational culture present for quality improvement?

A supportive organizational culture is undoubtedly present for quality improvement despite the breakdown in communication patterns between healthcare professionals across departments. One aspect that signifies the presence of a supportive culture is the elimination of information silos and territories that compromise information sharing and knowledge transfer among employees. According to Bucata & Rizescu (2017), effective communication in healthcare should consider various conditions, including simplifying the channels of sharing information, fluency and assurance of reversibility of communication, and flexibility and adaptability of communication systems. Secondly, employees understand organizational core values and have the autonomy to contribute to organizational decisions. These considerations signify the presence of a supportive organizational culture that can facilitate quality improvement.

Organizational Leadership Strategies that Support Quality Improvement, Positive Patient Experiences, and Healthcare Quality

Despite the challenge of communication breakdown, organizational leaders embrace transformational leadership to bolster employee motivation, awareness, and willingness to participate in quality improvement initiatives. The tenets of transformational leadership manifest through interpersonal collaboration, valuing employees’ opinions and diversities, upholding employee autonomy, and eliminating information silos. Further, Khan et al. (2020) contend that transformational leadership has four primary components: individualized influence, intellectual stimulation, individualized consideration, and inspirational motivation. These aspects are vital in facilitating creativity, enhancing confidence, and facilitating interpersonal communication and communication.


Organizational culture is an essential aspect that consolidates visible and firmly-held assumptions, ways of thinking, beliefs, and organizational norms. These elements of organizational culture determine how organizations implement change and quality improvement initiatives. In this sense, our organization can leverage these aspects of organizational culture to support a quality improvement initiative for addressing communication breakdowns and practice gaps that compromise care quality. It will be possible to assess the organizational preparedness to implement a quality improvement initiative by evaluating the level of employee motivation, leadership commitment, resources alignment, and the implementation climate.


Bucăţa, G., & Rizescu, A. M. (2017). The role of communication in enhancing the work effectiveness of an organization. Land Forces Academy Review, 22(1), 49–57. researchgate.

Khan, H., Rehmat, M., Butt, T. H., Farooqi, S., & Asim, J. (2020). Impact of transformational leadership on work performance, burnout and social loafing: A mediation model. Future Business Journal, 6(1), 1–13. Springeropen.

Mannion, R., & Davies, H. (2018). Understanding organizational culture for healthcare quality improvement. BMJ, 363(363), k4907. BMJ.

Miake-Lye, I. M., Delevan, D. M., Ganz, D. A., Mittman, B. S., & Finley, E. P. (2020). Unpacking organizational readiness for change: an updated systematic review and content analysis of assessments. BMC Health Services Research, 20(1).



Assignment 1: Organizational Culture Assessment Tool
Your organization is ready to implement a quality improvement initiative; however, it is becoming increasingly clear that perhaps not everyone is on board with the proposal.
What could be contributing to this potential resistance? How might organizational culture impact or influence the ability to engage in quality improvement initiatives?

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Organizational culture is the shared way of thinking or feeling in a given organization. This culture creates the dynamic for a willingness to change and/or improve. For example, if an organizational culture is one in which change is welcomed to improve and all voices are encouraged to be shared, the implementation of a quality improvement initiative will likely be accepted and supported. However, if an organizational culture is one in which the acknowledgement of mistakes are penalized and only leadership voices are respected, the implementation of a quality improvement initiative may be met with hesitation and skepticism.
For this Assignment, you will consider the impact of cultural and organizational readiness as it relates to the implementation of quality improvement initiatives. You will consider the leadership strategies needed to support these measures and complete an Organizational Culture Assessment Tool.
To Prepare:
• Review the Learning Resources regarding the implementation of quality improvement initiatives.
• Consider what stakeholders must be present to implement these initiatives, and reflect on the leadership strategies needed for success in promoting quality improvement initiatives in healthcare organizations and nursing practice.
• Select a healthcare organization or nursing practice (with which you are familiar) to complete the Organizational Culture Assessment Tool.
The Assignment: (2–3 pages)
Complete the Organizational Culture Assessment Tool for the healthcare organization or nursing practice you selected. Then, address the following:
• What is the state of cultural/organizational readiness for quality improvement?
• Is the organizational culture present for quality improvement?
• What leadership strategies are present in the organization to support quality improvement, positive patient experiences, and healthcare quality?
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at All papers submitted must use this formatting.





I WORK FOR THE VETERANS ADMINISTRATION AS A FAMILY NURSE PRACTITIONER AND FEEL THAT THERE IS A HUGE PRACTICE GAP IN COMMUNICATION AMONG PROVIDERS THROUGHOUT THE ORGANIZATION. For example, today I had a patient that was to transfer to another long term facility for care. When the ambulance (EMS) arrived to transport, the appropriate paper work had not been completed by the transferring provider because he thought the social worker was completing it. Somewhere the information had not been communicated to the completing provider delaying the patient’s transport to another day. Communication on all levels is horrible in this setting. However, you can add your touch and senarios fitting for the assignment.



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