Reference no: EM132902198
Cultures At Work: The Case of Home Care Service Geoffrey Bloor and Patrick Dawson (pp. 583 - 586)
The case of Home Care Service (HCS) in Australia provides a practical illustration of the increasing importance of professional subcultures in a growing number of organizations. The case of HCS is particularly illuminating as it provides an empirical example of the coexistence of a number of different "cultures" (referred to as subcultures) within a single organization. Home Care Service (HCS) was established in the early 1970s, as a result of societal and particularly hospital staff concerns about the care of the elderly. Its history, the vision of its founder and early members, professional expectations and its link with the central metropolitan hospital, all serve to influence local attitudes and perceptions. Certain patterns of behavior and operational practice combine with prescriptive regulatory rules and legitimated authority relationships in shaping cultural change at work. These patterns sustain an ideational cultural system that places a high premium on the provision of professional services to geriatric clients. Currently, the primary cultural system supports a medically dominated operating system which is integrated with general medical services provided at the major metropolitan hospital.
An examination of the values held by HCS staff reveals the existence of a number of subcultures. The dominant subcultural value system is that of the medical staff, who hold a particularly influential position within the organization's power structure. For example, although allied health professionals are nominally case managers, geriatricians who work part-time at HCS and at the major metropolitan hospital randomly review their decisions. This practice was established early in the history of the organization by the founding Medical Director and was justified on the basis of the need to maintain high standards of services that do not promote client dependency. This is an example of a founder/leader's values being translated into practices for organizational members who might not hold the same values (Hofstede et al., 1990). A major part of the ideology of the medical authority is the need to maintain high standards of professional practice and, in particular, to make accurate professional assessments and diagnoses of patients' conditions before deciding what services to provide to meet their needs. In practice, this usually results in the provision of services that support the care plans of general medical practitioners and hospital medical staff. Medical dominance is further reinforced by the provision of private offices for geriatricians, while other professionals (with the exception of senior staff), have their desks grouped in local government teams in a large open office. The geriatricians also speak of "my team" (much to the annoyance of other staff), and insist that team meetings are held on days when they are available, even if some part-time allied health professionals are not.
Despite some resentment of the working practices associated with the "enhancing subculture" of geriatricians (in amplifying the assumptions, values and beliefs of the primary hospital culture), staff do not challenge the status quo. Junior staff rarely speak at meetings and allied health chiefs will frequently defer to the wishes of the geriatricians, despite inconsistencies in decision-making. Although the medical staff dispute claims that they dominate, they place great emphasis on maintaining work practices that support medical authority. Furthermore, one of the reasons given for a recent increase in the number of geriatricians was the need to review more of the allied health staff's work.
The physiotherapists and occupational therapists form what Martin and Siehl (1983) call "orthogonal subcultures;" that is, they accept the basic assumptions of the primary cultural system regarding the need for high standards of professional practice but also hold some that are unique and in conflict with those of the dominant medical subculture (see also, Ott, 1989, p. 46).
This group are the most concerned of all the allied health professions with the image of their profession. They are also relatively young professions and place their major emphasis on developing and maintaining "hands-on" skills. However, much of the therapeutic work done in HCS is routine (that is, once assessments are completed and programs established the work is generally done by paramedical aides), and, hence, therapists typically regard HCS as a stepping stone to other positions (usually in hospitals), which results in a relatively high turnover of staff. Consequently, whilst many therapists are not happy with their relative powerlessness, they are disinclined to speak out against the dominant subculture as they generally do not see themselves staying in HCS for very long.
In contrast, social workers are more outspoken. Whilst they also value high professional standards and have a commitment to client rehabilitation (and, in this sense, share the core values of the organization), they interpret these concepts in different ways to the other professional groups. For example, their code of ethics includes a strong commitment to client self-determination and they are therefore more inclined to accept clients' own assessments of their needs. Moreover, this group tends to encourage clients to be assertive about what they want (although they may over time attempt to get clients to gain a more realistic perspective if necessary). As such, they generally advocate on behalf of clients even in the face of medical authority dissension. They also serve as an important source of innovative proposals and are often willing to deal with complex situations that other professionals do not wish to tackle. In this way, social workers can be seen to lie somewhere between an orthogonal and counter-culture and represent a type of "dissenting subculture" within the existing service philosophy for home care provision (see Bloor & Dawson, 1994). In other words, while they are not directly opposed to a culture of healthcare, their philosophy of home care service provision is often at odds with other professional groups and the dominant medical subculture. They, therefore, represent a dissenting professional subculture in holding an alternative pattern of shared values and practices which have the potential to replace the current medical service philosophy and become the new dominant (and enhancing) subculture. However, while this illustrates the possibility of shifting subcultural positioning within the primary cultural system, this is unlikely to occur in practice as there is minimal subcultural conflict because clients will generally request the treatment that doctors recommend.
Members of these various professional groups seek to control their organizational destinies. They can do by drawing on their particular skills and codes to demonstrate that they have particular areas of knowledge and expertise which the others lack, thus; legitimating their domination over certain aspects of the organization's work. Hence, codes of ethics, the belief in the client's right to self-determination, knowledge of how to perform particular therapies, can all assume an ideological significance in arguments aimed at controlling the organizational destinies of different individuals and groups. Rawson et al. (1980, p. 6) have similarly noted that professions frequently articulate and draw on discrete elements of their professional mantle to justify their areas of control. In the case of HCS, the fact that clients must have chronic diseases or physical disabilities to be eligible for assistance is one of the major factors in legitimating the dominance of tee medical profession over the other health professionals.
In addition to these three professional subcultures, there exist two other major organizational subcultures or "occupational communities" (van Maanen & Barley, 1984, p. 287). These comprise the administrative staff, who form an orthogonal subculture in supporting the core values of the dominant culture, and the paramedical aides (PMAs), who form a 'deferential subculture' in deferring to health professionals, especially the medical profession (see Bloor and Dawson, 1994). The organizational culture serves to reinforce this position through the maintenance of a mythology that professional staff "put PMAs down." which has served to make PMAs more remote and further reinforces the belief that they are "lesser" team members. On the other hand, paramedical aides often resort to 'atrocity stories' (Dingwall, 1977; Stimson & Webb, 1975) as a means of defending their group against what they perceive to be excessive claims of superiority by others in the organization.
Counter-culture and enhancing and orthogonal subcultures have been identified elsewhere (Rose, 1988; Siehl & Martin, 1984); whereas the other two types of subcultures, dissenting, and deferential, represent Bloor and Dawson's (1994) identification of further subcultural groupings (as illustrated in the case of HCS). Each of these subcultures shape the primary organizational culture in a number of different ways. The enhancing and deferential subcultures are both compatible with the organizational culture; with the latter it is through deference, and with the former it is through unquestioning support and advocacy of the "rightness" of the core assumptions, values and beliefs. In the case of dissenting subcultures, these were shown to challenge the existing dominant subculture and offer an alternative set of operating practices and values within the primary cultural system of home-care provision. Finally, the more common orthogonal subculture was shown to act as a midway point between the enhancing and dissenting subcultures, and facilitate the development of new proposals and the redefinition of common elements without radically questioning the dominance of the medical subculture.
The case of HCS demonstrates how there are often a number of "cultures" that co-exist in large organizations and that these interact and influence each other in shaping a more general "culture" of the organization. We refer to these as 'subcultures' and, in this case, as these are also influenced by external professional affiliation of the various groups that constitute HCS, we refer to them as "professional subcultures." HCS usefully illustrates how the element of professional culture is central to understanding why certain subcultures can sustain themselves in potentially alien cultural environments. At its simplest, professional subcultures are often stronger than other groupings within an organization in the sense of having extra-organizational associations and peers to aid them in shaping new cultures and codes of conduct, and resisting the imposition of other cultural values and practices. In other words, professional cultures that reside outside of organizations are central to sustaining professional subcultures within organizations. Thus, whilst professional subcultures conflict, coincide and interlock, they each have the potential to redirect and shape organizations (see Alvesson & Sveningsson, 2016).
Questions
1. How many subcultures co-exist within Home Care Service, and how do they compare and contrast?
2. How useful is Bloor and Dawson's characterization of the different types of subcultures in this case?
3. Is there an organizational culture? What is it, and how does it differ from the professional subcultures that exist within HCS?
4. How is it possible to manage cultural change in such an organization? What are the problems and issues that you are likely to encounter?
5. Consider and discuss Alvesson and Sveningsson's (2008, p. 39) claim that, "the concept of culture is often used to refer to top management beliefs of organizational culture (ideas of a specific culture can often be seen as a senior management subculture) that marginalize the (sometimes contrasting) meaning creation of other groups in an organization."
6. Discuss how this case might have been rewritten if the authors had adopted a fragmentary or integration perspective.