Definition/Introduction

Work culture is a management concept that encompasses the attitudes, beliefs, and perceptions of the employer's principles and practices. Work culture determines how medical, nursing, ancillary staff, and adjacent professionals collaborate to achieve organizational goals in clinics, hospitals, health centers, or other health institutions. Organizational culture includes leadership and management behaviors, policies, standard practices, and perceived expectations within the workforce. These shared values and beliefs create an environment that is supportive or unsupportive.[1]

Significant components of work culture in health care include the mission and vision, institutional policies, work procedures, and organizational rules. The current perception of organizational development is essential for every healthcare setting to determine the organization's maturity, which could directly influence the work culture. Every organization member, from managers to staff, needs a strong work culture to maximize potential in serving patients. A positive work culture gears progressive improvement for the staff and the organization. In contrast, a toxic work culture fosters disintegration, loss of cooperation, and poor collaboration among staff. Work culture must be assessed and improved in every health organization to impact staff, managers, the organization, and, most importantly, patient outcomes. 

Issues of Concern

Positive Work Culture

Consistent and transparent leadership promotes a positive work culture. Positive leadership practices are the first step in building a positive organizational climate. A positive work culture involves continuous quality improvement, whereas lessons learned from a negative work culture are vital for mitigating further risk. Positive leadership is essential to create a work culture that brings positive organizational changes. Leaders must assess staff requirements to bridge possible gaps in work implementation. Leaders must also align the workforce with the organization's goals. This clarity minimizes confusion within the workforce and facilitates the delegation and mobilization of team members. A positive work culture promotes mutual trust between staff and leaders within the organization. When members of the organization establish harmony, it enhances job performance and satisfaction.[1][2][3][4]

Managers within the organization are equally important in fostering positive work cultures. They develop plans, assign staff responsibilities, and meet employees' needs. They should be able to control their respective units, especially regarding mandated job oversight. Furthermore, managers who monitor the progress of work implementation and assess the organizational impact of work on patients have a more accurate view of the status of any healthcare institution. Although leadership and management roles may differ, leaders who consistently promote a positive work culture demonstrate effective monitoring and evaluation practices.

Another critical aspect of mediating a positive culture at work is teamwork. Teamwork is the union of individual members to achieve a specific goal. Similar to other business entities, every healthcare organization typically conducts activities that enhance teamwork. Team-building activities can help unite individual members. Healthcare managers should develop strategies that engage the participation of all members, fostering positive relationships among them. When improving teamwork, 2 central relationships should be considered: 

• The relationship between individual members
• The relationship between managers and staff [5][6][7]

Successful teams include all workforce members to sustain a positive work culture.[8][9]

Negative Work Culture

A negative work culture instills stress and anxiety. Excessive and prolonged stress among healthcare staff leads to burnout. Hospitals, medical centers, and other health institutions are often filled with demanding and stressful situations due to the medical needs of their patients, which invites variability from day to day. Most employees attempt to cope with the demands of their work; however, this inevitably could lead to burnout for some. Some fields have higher rates of burnout compared to other fields. Continued stress in individuals experiencing burnout negatively impacts the quality of patient care.

The accumulation of stress at work causes healthcare staff to lose satisfaction in performing their tasks, leading to increased absenteeism. This absenteeism reduces productivity and limits the quality of services. A negative work culture promotes dissatisfaction with leadership and poor interprofessional relations, characterized by blame, discrimination, and incivility among colleagues. Corrective measures should be applied promptly when employees voice concerns regarding workload and stress. Strategies to find a solution to sustain and continuously improve employees' working conditions promote trust and build a positive work culture.[10][11][12] 

Clinical Significance

Work culture significantly impacts the quality of care and delivery of health services. A positive work culture strengthens the clinician-patient relationship, building patient trust and fostering staff confidence. Patients appreciate the healthcare team's efforts in providing care, regardless of positive or negative outcomes. When patients observe doctors and nurses satisfied with their work, their trust increases and promotes medical compliance. Patients are more likely to seek medical care at institutions where teamwork is evident among staff and where leadership is stable. Effective communication and unwavering commitment to teamwork are essential to a positive work culture. Adopting standardized tools of communication and behavior algorithms enhances teamwork and reduces the risk of adverse outcomes. A positive workplace culture correlates with improved mental health and happiness among employees, whereas a negative workplace culture correlates with depression, anxiety, and mental illness.[13][14][15]

The strategy implementation framework can be used to implement organizational interventions. Leaders who support a positive work culture can enforce interventions using the step-by-step approach described in this framework. The 4 groupings identified in the strategy implementation framework include strategic content, context, operational process, and outcome.

• Strategic content outlines the desired plan for organizational interventions. This content should include evidence that outlines the requirements of these interventions and the process of developing the proposed strategies, which should consist of literature references and internal organizational research. Internal organizational research is crucial for accepting the desired plans.

• The strategic context describes internal and external factors that affect the implementation of the desired plan. Factors that promote the adoption of proposed strategies and interventions should be emphasized, whereas factors that can negatively impact these strategies should be identified and addressed.

• The operational process encompasses specific implementation activities within organizations. These strategies are identified in the strategy content domain. This domain should outline the cost of these strategies in human capital, management systems, resources, and processes. If feasible, these costs should be weighed against the benefits of successful implementation.

• The outcome domain is a critical component of this framework. This domain allows the leaders to assess whether their strategies were effective and whether they achieved the desired change. The intended and unintended results should be measured and analyzed. Lessons learned and success achieved should be equally highlighted.[16]

A recent qualitative study identified 5 domains that impacted the work environment within a hospital department.

• A shared identity of development-focus among workers to promote a creative work environment.

• A focus on employee-driven change. Increasing employee participation improves the attitude and perception of workers, which, in turn, improves the integration of developmental strategies into the work environment.

• Identifying difficulties that hinder focus on development work. The study noted that clear communication for proposed changes and concise communication of the implementation process aid in successfully implementing development work.

• A high workload negatively impacts developmental strategies.

• Enlisting members outside the department to focus on development work improves the integration of these strategies.[17]

Nursing, Allied Health, and Interprofessional Team Interventions

Nurses have a crucial role in determining workplace culture in healthcare systems. Leaders and managers must ensure that nurses experience a positive organizational work culture. Two key aspects to achieve this goal include workload balance and minimizing fatigue. A high workload is among the most important factors promoting a negative work culture. High nursing workload also increases adverse outcomes for patients. Nurses can feel demoralized if they fail to meet patient care needs due to time constraints, workload imbalance, and managerial tasks. Organizational leadership must proactively prevent nursing burnout and decrease the risk of patient care errors. Situational, individualized, and team-based approaches should be incorporated to mitigate time pressures and care rationing during times of high workload. Proactive, transparent strategies can help balance nursing workloads, reduce tensions, and increase job satisfaction, shifting the organizational framework.[18] 

Emphasizing employee health to minimize fatigue improves employee performance and instills a sense of belonging and protection. Nursing leadership must implement shift-work strategies that ensure adequate rest periods between shifts and allow sufficient time to switch between day and night schedules. Improved sleep and alignment of circadian rhythms with work times reduce fatigue, improve workers' moods, and reduce patient care errors. Job satisfaction and retention increase, which inevitably builds a well-rooted positive work culture.[19]