The effect of organizational culture in health services on employee flourishing

1 Introduction

Organizations desire to move towards their goals with employees who have collective consciousness. Achieving goals in corporate life is defined by effectiveness. Moreover, the primary resource in achieving effectiveness is employees. Culture has an important role in maximizing the value of human capital, which is regarded as the main source of organizational effectiveness [1, 2].

Culture refers to a relatively stable set of beliefs, values and behaviors that are widely adopted by a society [3]. Schein defines culture as a part of the characteristic of groups and the accumulation of learning that the group has acquired throughout history [1]. He also emphasizes as an important part of this definition the necessity of transferring this accumulation to new group members. Hofstede and his colleagues stated that although the definitions of culture are different from each other, when the concept is evaluated in terms of the organization, some features are at the focus of the subject [4]. Accordingly, organizational culture structure has characteristics such as being holistic, having a historical basis, being related to anthropological concepts, being socially structured, being temperate and being forced to be altered. Leithy stated that culture is to organizations what personality is to individuals. Cultural characteristics distinguish organizations from others in terms of beliefs, values, styles and relationships [5].

The phenomenon of culture is one of the main interests of organizational behavior studies [6]. While the interest in organizational behavior coincided with the interest in the management of organizations, in this developmental process, sociological and anthropological perspectives were benefited from in addition to psychology. In this process, managers have had the opportunity to shape the concept of “culture” with beliefs, values, norms, ideology and management styles [1]. In general, by examining definitions of culture, managers need to anticipate or grasp the general trend in employee behavior and thinking because definitions of culture are primarily concerned with the way employees behave or think. Culture has a significant impact on getting new employees to adopt the correct acknowledged way of behaving and ensuring the sustainability of organizational life. In short, managers utilize culture to control and direct employee behavior [7]. In particular, the binding role of culture is at the forefront in preventing conflict and tension environments that may prevent organizational development [8].

Petty and his colleagues consider culture for organizations from two perspectives; the first one considers culture as a means of determining organizational strategy, developing it, evaluating the progress made, and defining the products and services of the organization. The second perspective is related to the symbols, rituals and myths related to the subconscious that circulate among members [9]. Organizational culture is the model of fundamental assumptions that a certain group invents, discovers, or develops as it learns to cope with the problems of external adaptation and internal integration, which functions well enough to be considered valid and therefore to be learned [10]. Abu-Jarad et al. stated that organizational culture is related to the unique quality models and style of doing business that members engage in [11].

Organizational culture is a phenomenon that can be managed. Managing organizational culture can be hampered by the multiplicity and complexity of subcultures, conflicting political interests, poor timing and lack of communication [12]. Nevertheless, every obstacle is influenced by the dominant general culture of the organization. Organizational culture is also a determinant of economic activity. In addition to this, it is also affected by the outcome of economic activities [13]. A strong organizational culture is constructed through consistent beliefs, values, assumptions and behaviors adopted by the majority of members. In particular, it is assumed that a strong cultural structure provides many benefits to organizations because it supports motivation, commitment, solidarity and homogeneity [14]. For these reasons, managers today cannot exhibit unconscious and random behavior in the formation and development of corporate culture. On the contrary, they have to behave systematically in order to unite under a common cultural framework in the organization.

Managers want to give vision to their employees in organizational environments with defined goals [15]. Vision mediates the shaping of culture. A generally accepted healthy organizational culture is an important condition for the long-term stable successful functioning of the organization. It is important for the organization to share the understanding and interpretation of culture, to create a complex of healthy attitudes and values, to develop strategies for combining personality and organizational cultures, and to ensure the compatibility of organizational culture with universal human values [16]. Flourishing is a universal basic human right.

Flourishing is the meaning of life, evoking wellness, productivity, development and resilience [17]. Flourishing is a component of feeling well and functioning effectively. It is based on self-report and is therefore a subjective measure of flourishing [18]. Flourishing is not about immediate circumstances and their consequences, but rather should be considered as a concept that encompasses mental and physical health, happiness and life satisfaction, meaning and purpose in life, virtue, and social relationships, especially within the family [19]. In this sense, flourishing is a higher concept that can be evaluated with the all aspects of an individual’s life beyond psychological flourishing [20]. Flourishing has many benefits for employees in working life where social relations are intense.

Employees would like to fulfill the requirements of their profession in work environments where they feel peaceful. Employers, on the other hand, want to proceed with employees who will support the peace of the working environment. It is a proven fact that flourishing benefits the welfare of all sides within the boundaries of the organizational structure [21]. It is assumed that employees and their organizations are in a social exchange relationship to create value in the same work environment. When one party is perceived to have made a positive contribution to the other, the beneficiary feels gratitude for the positive gain that they received as a result of the exchange and endeavors to reciprocate [22]. Even the dissemination of this state of gratitude in the organization is sufficient for institutions to carry out well-being-enhancing activities. Flourishing is a well-being-related concept that summarizes the psychology of a successful employee who benefits from a safe and supportive workplace in organizational structures, engages in a satisfying job and takes pleasure in it [23].

Human flourishing refers to a much broader condition that includes mental and physical health, but also happiness and life satisfaction, meaning and purpose, character and virtue, and social relationships. It is observed that organizational life strives to provide environments with better mental and physical health [20]. Flourishing in working life occurs at the intersection point where the individual is satisfied with their work, has a sense of effectiveness in their work and a healthy balance is established between work and private life [24]. It is recognized that flourishing employees have improved work performance, clarity in communication between team members, improvements in workplace outputs, and increased commitment to the organization [25].

Nowadays, changes in social and demographic life have led to structural changes in family and work life. The individual has to assume many roles that require different obligations and responsibilities in both work and family life [26]. It is believed that the flourishing of the person who is expected to maintain all these roles successfully will benefit both the person themselves and all stakeholders with whom they are in a relation.

Flourishing is more valuable from a holistic perspective. At the heart of every social community are the individuals who constitute it. Social flourishing is established by the flourishing of the members. Social flourishing has a value beyond the aggregation of individual flourishing. Individual subjective flourishing is a constitutive component of social flourishing. Any society in which individual members cannot develop is characterized as undeveloped [27]. Societies in flourishing realize their development through harmony among their components.

Redelinghuys et al. argue that since there is a strong relationship between positive organizational practices and employee flourishing, it is necessary to assess the current state of organizational culture and the impact on employees [28]. Improving organizational culture for this purpose will lead to an increase in employee flourishing and performance.

Considering the general literature, it is observed that there are few studies focusing on subjective flourishing measurement where life satisfaction and happiness are at the forefront [29]. Although there is a belief that there is a link between organizational culture and employee flourishing, it can be stated that there is a limited number of studies to determine the interaction of organizational culture characteristics with the concept of flourishing. To overcome this deficiency, this study was conducted to examine the impact of organizational culture on employee flourishing. Since organizational culture is a set of deep-rooted values and beliefs shared by the employees of a particular organization and contributes positively to employee flourishing by directing managers’ decision-making and organizing activities for the better, it was thought that organizational culture would have an impact on flourishing and the title of the study was determined as “examining the effect of organizational culture on employee flourishing in health services” [7]. This article examines the effect of organizational culture perceptions of healthcare workers employed in a university hospital on their flourishing, and the concept of flourishing is considered as an outcome concept, not as a predictor.

2 Materials and methods

3 Results

Table 1, which presents the socio-demographic characteristics of the participants, displays that the majority of the participants are female (77.9%). Among the respondents, “26–35” (61.2%) for age, “married” (58.2%) for marital status, and “bachelor’s degree” (69.9%) for educational status were found to be the largest share group. Most of the participants have been in the profession for “1–5 years” (38.8%). Considering the time spent in their current organizations, “1–5 years” (61.5%) is the largest group. The 25 health workers who participated in the research stated that they worked as managers (8.4%).

Table 2 presents the mean and standard deviation results of the scales and their sub-dimensions. The mean score of the participants on the Denison Organizational Culture scale is 2.92±0.765 and the mean score of the New Flourishing index is 74.19±22.888.

Table 3 presents the correlation values between organizational culture and flourishing perceptions of healthcare workers. Accordingly, it was determined that there was a moderate positive relationship between organizational culture and flourishing of healthcare professionals (r = 0.479; p < 0.01). There is a significant and positive relationship between the flourishing sub-dimensions of organizational culture such as happiness and life satisfaction (r = 0.450; p < 0.01), mental and physical health (r = 0.439; p < 0.01), purpose and meaning of life (r = 0.464; p < 0.01), personality and virtue (r = 0.452; p < 0.01), close social relationships (r = 0.497; p < 0.01), financial and material status (r = 0.316; p < 0.01). There are significant and moderate positive relationships between flourishing and the sub-dimensions of organizational culture such as participation culture (r = 0.492; p < 0.01), consistency culture (r = 0.458; p < 0.01), adaption culture (r = 0.383; p < 0.01) and vision culture (r = 0.433; p < 0.01).

Table 4 data indicate that there is a significant relationship between organizational culture and flourishing (F = 88.229; p = 0.000, p < 0.05). It was determined that organizational culture alone explained 22.6% of flourishing (Adjusted R² = 0.226). It is observed that a one unit increase in organizational culture has a positive contribution of 14.327 to flourishing.

Table 5 demonstrates that the relationship between organizational culture sub-dimensions and flourishing is significant (F = 25.975; p = 0.000, p < 0.05). These four sub-dimensions explain 25.1% of flourishing (Adjusted R² = 0.251). When the results of t-values regarding the significance of regression coefficients are analyzed, it is observed that only participation culture has a significant effect on flourishing (p = 0.000; p < 0.05). Consistency (p = 0.184, p > 0.05), Adaptation (p = 0.152, p > 0.05) and Vision (p = 0.116, p > 0.05) cultures have no effect. It is observed that flourishing is affected with a positive force of 9.715 for a one unit increase in Participation culture.

It is recognized that positive workplace activities increase the satisfaction levels of employees and this has an impact on the overall life [35]. In this study, it was found that the level of flourishing of health workers increased as the organizational culture increased. A similar result was obtained in a study conducted by Singh et al. in the banking sector [36]. Redelinghuys et al. also detected a positive relationship between organizational culture and flourishing in a study conducted in the education sector [28]. In a study conducted with nurses, a positive relationship was found between organizational culture and flourishing, albeit at a low level. Paz et al. explained the relationship between quality of life, culture and flourishing [37]. He stated that organizational cultures have a good mediating power, especially increasing the explanatory power on flourishing. Tawfik et al. stated that organizational factors positively affect flourishing, which is an important component [38]. The results of the current study and similar studies suggest that positive contributions to the development of organizational culture in institutions where healthcare professionals are employed increase employee flourishing.

In this study, it was found that organizational culture explained 22.6% of the flourishing level of health workers. The results of another study conducted in the education sector indicate that there is a strong positive correlation between organizational culture and organizational flourishing and 59.2% of the variance in organizational flourishing can be explained by organizational culture [39]. In a study conducted by Sim et al. in a university hospital in Korea, as a result of the regression analysis in which ‘relationship-oriented organizational culture’ and ‘awareness of violence in the hospital’ were independent variables and ‘psychological flourishing’ was the dependent variable, it was reported that relationship-oriented organizational culture and awareness of violence in the hospital had an effect of 17.3% on psychological flourishing [40]. Another result was reflected in the result of the study conducted by Jung et al. Accordingly, organizational culture had a significant effect on subjective flourishing in the organization and was found to explain 28.4% of this effect [41]. These results indicate that the development of organizational culture will result in higher flourishing

Denison argues that participation and coherence are internal factors in developing an effective organizational culture, while adaptability and vision are external factors. Engagement in particular has an important role in shaping organizational culture. Engagement culture, which includes transparent communication, employee-oriented leadership and strong interpersonal communication, has an important role in the formation of affective organizational commitment [8]. In this study, it was found that the flourishing level of health workers increased as the culture of participation increased. The most fundamental feature of participation culture is that it supports teamwork in organizations [42]. It is a proven fact that team-based work leads to collective flourishing of employees [43]. High levels of participation enable employees to have control over decisions, processes and results, and this power leads to an increase in flourishing [43, 44].

Organizational culture can affect employee performance, engagement and happiness [46]. In this study, it was found that happiness and life satisfaction of healthcare workers increased as organizational culture increased. In a study, it was found that as the person-organization fit increases, happiness also increases [47]. In another study, it was similarly found that happiness increased as the level of organizational support increased [48]. The results of this research are similar to the literature. Since the increase in person-organization fit enables employees to take a more active role in the organization and meet the expectations of the organization, it is thought that the happiness and life satisfaction of health workers increase.

Workplaces have an important role and responsibility in achieving social flourishing [49]. Organizational culture has an important role in the formation of corporate identity and shaping the organizational structure [50]. In this study, it was found that the level of close social relationships increased as the organizational culture of health workers increased. In a study, it was found that leader-member interaction increased as organizational culture increased [51]. In another study, it was found that emotional commitment increased as person-organization fit increased [52]. Increasing organizational culture is thought to increase the social relations of health workers by increasing leader-member interaction and emotional commitment.

In this study, it was found that the level of life purpose and meaning increased as the organizational culture of healthcare professionals increased. In a study similar to this research, it was found that as the level of support in organizations increases, employees’ life satisfaction increases [53]. In another study, it was determined that the quality of working life increased as organizational commitment increased [54]. The results of this research are similar to the literature. Increased support and commitment within the organization is thought to increase the quality of life as it increases the willingness for organizational roles, focusing on organizational goals and willingness to continue working.

5 Conclusion

This study reveals that the perception of organizational culture has an impact on flourishing; therefore, the positive development of organizational culture will contribute positively as well. Teamwork in the realization of workflows in institutions providing health services has become a necessity in today’s conditions. One of the basic conditions for the desired fulfillment of interdisciplinary and team-based health service delivery is the happiness and flourishing of health workers.

Uniting employees around the same values, supporting them to have organizational awareness, and giving them more responsibility should be the priority areas of organizations. All these activities should be transformed into routine workflows that are part of the organizational culture rather than being a privilege directed to employees. The results of this study provide important information for health institutions and all other organizations to prioritize investing in happiness and flourishing.

Healthcare is a field with unique characteristics. One of the unique features of this field is that healthcare workers have no tolerance for making mistakes. The tension created by this situation may be at a level to negatively affect the flourishing of healthcare workers. It is inevitable that an employee whose flourishing is negatively affected will negatively affect the productivity of the organization of which they are a member. The only way to get rid of this negative spiral is to be aware and make conscious efforts to increase flourishing. These efforts should also be made a cultural part of the organization.

Positive development in the organizational cultures of health service providers is for the benefit of the society as well as the employees. In order to maximize this benefit, initiatives related to the physical and mental flourishing of employees should be supported by organizations. It is recommended that organizations contribute to the flourishing of their employees in order to consolidate their legitimacy.

Ethical considerations

Ethics approval was granted by Social and Human Sciences Research Board of Başkent University (Date: 19.10.2022; Approval no. E-62310886-605.99-171302). Participants were informed and their verbal consent was obtained.

Informed consent

All participants provided informed consent prior to enrollment.