Work Culture


Work culture is an organizational management concept that deals with the attitudes, beliefs, and perceptions of employees relative to the institution's principles and practices. In the healthcare setting, work culture determines how medical, nursing, ancillary staff, and other professionals work together to achieve organizational goals, whether they work in clinics, hospitals, health centers, or other health institutions.

Major components of the work culture as it applies in healthcare practice include the statement of its mission and vision, institutional policies, work procedures, and organizational rules. Additionally, the current state of organizational development is an essential element for every healthcare setting as it determines the organization's maturity, which could directly influence the work culture as a whole. Considering these basic elements, every organization member, from healthcare managers to staff, expects a strong work culture to maximize potential in serving patients. A positive work culture is geared towards progressive improvement for the individual staff and the organization, while a negative work culture fosters disintegration, loss of cooperation, and collaboration among staff. Thus, this results in regressing organizational value and overall performance. With this, work culture must be assessed and improved in every health organization as it significantly impacts healthcare staff, leaders and managers, the organization itself, and, more importantly, patient outcomes in terms of health.

Issues of Concern

The following factors have been described as associated with the work culture of specific healthcare organizations, dichotomized into positive and negative work cultures. Positive work cultures must be continually enhanced while learnings from negative work cultures must be sought and applied so as not to cause further problems.[1] 

Positive Work Culture

Good leadership behavior is essential in maintaining the team's relationship to create a work culture that brings significant positive organizational change. Leaders who can scan the situation and the needs of the individual staff a necessary skill to identify and bridge possible gaps in work implementation. Aligning the members to the organization's direction sets the work's tone for every member. When each staff at every level of the organization becomes fully aware of the situation, it becomes more natural for the leaders to mobilize the whole team and delegate appropriate tasks to carry out individual functions. Lastly, a leader who can inspire his colleagues in the organization develops a positive work culture for all. Emphasis on these essential roles must be well taught to healthcare managers since every organization or team is unique. When members of the organization have established a harmonious relationship with its leaders, and vice versa, performance and satisfaction at work are enhanced.[2][3]

Aside from leadership abilities, management skills require emphasis for all persons tasked to manage a unit, a section, a department, or the administrative body of any healthcare organization. Managers must be skilled in developing plans for the organization, organizing staff, and attending to employees' needs at work. They should be able to have control of the organization, especially regarding the implementation of its mandate as a whole. Furthermore, managers who constantly monitor the progress of work implementation and evaluate the organizational impact of its work on patients always have a more accurate view of the status of any healthcare institution. Managers and leaders can be different, but real leaders who strongly influence a positive work culture consistently demonstrate both skills. No employee could ever be more motivated and empowered to do the work when there are elements of trust and supportive supervision of one's performance and welfare.[4]

Another critical aspect that mediates the positive culture at work is the value of teamwork. Teamwork is the union of individual members to achieve a specific goal. Every healthcare organization, just like other business entities, usually conducts activities that enhance teamwork in the organization. Regular team-building activities can help with the primary goal of uniting the members and not for rest and recreation. Healthcare managers should be able to develop strategies that engage the participation of all members, which would soon break barriers to a good relationship at work.[5][6] When improving teamwork, 2 central relationships are involved: 1 between individual members and 1 between managers and staff. Additionally, teamwork in healthcare settings should not include only healthcare professionals but also all other staff (ancillary services, administrative services, and the like) that are part of the organization. Successful teams sustain a positive work culture.[7][8]

Negative Work Culture

Excessive and prolonged stress among healthcare staff leads to burnout.[9] Hospitals, medical centers, and other health institutions are known to be demanding in terms of work. Work shifts among staff are in place; however, they cannot cope with the demands required by each unit or department, especially in government and large private healthcare institutions. When these burnouts continue to inflict on our healthcare teams who provide direct patient care and services, it negatively impacts the quality of care they provide. Individual patients themselves can feel these changes. Recommendations may include formulating strategies that determine the source of the stress and the application of interventions that aid in minimizing, if not eliminating, stress and burnout in healthcare settings.

Another aspect related to the negative culture at work is absenteeism.[10] Due to the accumulation of stress at work, healthcare staff tend to lose satisfaction in performing their tasks, and whistling in absence from work reduces productivity for the organization and limits the quality of services they provide. Aside from work demands, the staff sees going to work as a burden when they feel dissatisfied with leadership and experience blame, confusion, discrimination, and incivility among colleagues.[11]

As leaders and managers of a healthcare organization, these concerns must receive proper attention rather than just focusing on increasing work output and profit. Leadership must remember that all healthcare staff, encompassing administrators, doctors, nurses, laboratory staff, pharmacists, technicians, hospital engineers, clerks, housekeeping service personnel, and other parts of the workforce, are the essential resources of the healthcare system. Applying strategies that work out a solution to sustain and continuously improve the positive work culture should always be a priority.

Clinical Significance

Whether positive or negative, work culture significantly impacts the quality of care and delivery of health services to patients.[12] A positive work culture always supports the healthcare professional-patient relationship. It builds patient trust and gains confidence among staff who provide patient care. It allows them to feel that other than the goal of working to cure their diseases, they receive care. When patients see doctors and nurses satisfied with their work and providing services, it enables them to follow instructions (eg, medication compliance). When they feel teamwork is active among staff and stable leadership exists from their managers, these patients may be more than willing to allow themselves to seek medical advice and treatment.



Prasanna Tadi


Sarosh Vaqar


9/18/2022 11:21:14 AM



Almost J, Wolff A, Mildon B, Price S, Godfrey C, Robinson S, Ross-White A, Mercado-Mallari S. Positive and negative behaviours in workplace relationships: a scoping review protocol. BMJ open. 2015 Feb 4:5(2):e007685. doi: 10.1136/bmjopen-2015-007685. Epub 2015 Feb 4     [PubMed PMID: 25652806]

Level 2 (mid-level) evidence


Tsai Y. Relationship between organizational culture, leadership behavior and job satisfaction. BMC health services research. 2011 May 14:11():98. doi: 10.1186/1472-6963-11-98. Epub 2011 May 14     [PubMed PMID: 21569537]


Sfantou DF, Laliotis A, Patelarou AE, Sifaki-Pistolla D, Matalliotakis M, Patelarou E. Importance of Leadership Style towards Quality of Care Measures in Healthcare Settings: A Systematic Review. Healthcare (Basel, Switzerland). 2017 Oct 14:5(4):. doi: 10.3390/healthcare5040073. Epub 2017 Oct 14     [PubMed PMID: 29036901]

Level 2 (mid-level) evidence


Kane-Urrabazo C, Management's role in shaping organizational culture. Journal of nursing management. 2006 Apr;     [PubMed PMID: 16600006]


Babiker A, El Husseini M, Al Nemri A, Al Frayh A, Al Juryyan N, Faki MO, Assiri A, Al Saadi M, Shaikh F, Al Zamil F. Health care professional development: Working as a team to improve patient care. Sudanese journal of paediatrics. 2014:14(2):9-16     [PubMed PMID: 27493399]


McEwan D, Ruissen GR, Eys MA, Zumbo BD, Beauchamp MR. The Effectiveness of Teamwork Training on Teamwork Behaviors and Team Performance: A Systematic Review and Meta-Analysis of Controlled Interventions. PloS one. 2017:12(1):e0169604. doi: 10.1371/journal.pone.0169604. Epub 2017 Jan 13     [PubMed PMID: 28085922]

Level 1 (high-level) evidence


Körner M, Wirtz MA, Bengel J, Göritz AS. Relationship of organizational culture, teamwork and job satisfaction in interprofessional teams. BMC health services research. 2015 Jun 23:15():243. doi: 10.1186/s12913-015-0888-y. Epub 2015 Jun 23     [PubMed PMID: 26099228]


André B,Sjøvold E, What characterizes the work culture at a hospital unit that successfully implements change - a correlation study. BMC health services research. 2017 Jul 14;     [PubMed PMID: 28705155]


Mijakoski D, Karadzinska-Bislimovska J, Basarovska V, Montgomery A, Panagopoulou E, Stoleski S, Minov J. Burnout, Engagement, and Organizational Culture: Differences between Physicians and Nurses. Open access Macedonian journal of medical sciences. 2015 Sep 15:3(3):506-13. doi: 10.3889/oamjms.2015.091. Epub 2015 Aug 12     [PubMed PMID: 27275279]


Mendoza Llanos R. [Job satisfaction and organizational culture as predictors of absenteeism]. Revista medica de Chile. 2015 Aug:143(8):1028-33. doi: 10.4067/S0034-98872015000800010. Epub     [PubMed PMID: 26436932]


Nkomazana O, Mash R, Phaladze N. Understanding the organisational culture of district health services: Mahalapye and Ngamiland health districts of Botswana. African journal of primary health care & family medicine. 2015 Nov 30:7(1):907. doi: 10.4102/phcfm.v7i1.907. Epub 2015 Nov 30     [PubMed PMID: 26842516]

Level 3 (low-level) evidence


Dodwad SS, Quality management in healthcare. Indian journal of public health. 2013 Jul-Sep     [PubMed PMID: 24125927]

Level 2 (mid-level) evidence