Understanding the Role of Organizational Culture in Organizational Change
Culture--the patterns of values, norms, beliefs, and perceptions that are often the drivers of organizational members' thinking and behavior--is recognized as an important influence on the success of organizational change. This dissertation is a collective case study of four primary care practices implementing the Patient-Centered Medical Home--an organizational change initiative that promotes the ideals of accessible, comprehensive, coordinated, patient-centered care--to examine the relationship between culture and organizational change. Chapter 1 presents the background and motivation for this research. Chapter 2 reviews the prior research and establishes the new contribution of this dissertation.Chapter 3 describes the data and methods utilized in this research. Data collection occurred over two rounds: round 1 occurred after the unofficial starting point of PCMH implementation, and round 2 was collected eight months later. Key informant interviews and surveys conducted during both data collection rounds directly and indirectly assessed organizational members' perceptions of culture and experiences during PCMH implementation. Reports summarizing each practice's PCMH implementation further characterized each practice's change efforts and progress. Development of each case utilized a mixed methods strategy known as concurrent embedded strategy in which interviews were the principal data source and were triangulated with the surveys and reports. Organizational culture has a complex, reciprocal relationship with change that is not clearly understood. To contribute to filling this knowledge gap, Chapter Four presents the results of this research. While some practices made greater progress implementing PCMH than others, none of the practices completely achieved the PCMH ideals. The relationship between the practices and their overarching health system drove integral parts of the PCMH implementation process in all practices. Differing leadership styles, decision-making norms, practice member relationships, organizational-centeredness, and patient-centeredness had varying relationships with the PCMH implementation progress in the practices. Additionally, the challenges of PCMH implementation were related to slight changes in practice culture, including an increased focus on fostering cooperative relationships among practice members, greater adaptability, and exacerbated the disconnect between the health system and practices. The last chapter provides the conclusion to this dissertation. First, it reviews the research aims and summarizes the results. Then, it presents the four main limitations of this study. Finally, it discusses future research opportunities. Further research is needed to understand the utility of the NCQA PCMH recognition program; how to actualize the PCMH model; and the nuances of the relationship between culture and change in varying contexts.