Editorial - Vol 5, No 4: Managing "Cultural" Differences in Health Services

This edition of Healthcare Review – Online^TM considers the broad concept of "culture" in relation to health services management and the management of change in the health sector.

The many differences between clinical professionals and managers can have disruptive implications for health care organisations. These differences are essentially cultural in nature, arising from the different practices common to each occupational group.

Papers in this edition consider different approaches directed at managing these cultural differences.

In the paper titled "Bridging Cultural Differences Between Professionals and Managers", Barbara Simpson and Matthew O’Brien, The University of Auckland, and Bob Large, Auckland District Health Board, consider dialogue as a tool for bridging between cultures. They note that such bridging requires more than mere negotiation and compromise and is likely to involve transformation, of underlying assumptions within each group as preparation for building common ground from which to communicate.

Simpson et al. introduce personal construct psychology as a practical means of implementing dialogue. They report the findings of a workshop involving senior managers and clinical directors where participants found that by elaborating their differences using personal construct psychology, they were then better able to explore their commonalities, thus, providing a foundation for ongoing dialogue.

In their paper titled "Action Learning Groups and Cultural Change in Hospitals", Dean Phelan and Gregory R Birchall, Partners in the TopWheel HR Company, Australia, focus on cultural change. They outline how action learning groups can be used as a foundation within hospitals or any organisation to help to facilitate change.

The paper highlights the importance of the organisation’s leadership being of one mind about the operating beliefs, values and edge that are required for organisational "success" - a "common strategy viewpoint". It describes the potential for action learning groups to enable and encourage all organisational members to understand, engage and emotionally "buy into" the strategy viewpoint, and to develop and implement changes to business processes, behaviours and ultimately the culture of the organisation.

In the paper "Involving Clinicians in Management - A Challenge of Perspective", Professor Peter Spurgeon highlights the fact that many conflicts of managerial and medical cultures and perspectives remain to be resolved.

Spurgeon explores various theories on how best to integrate managerial and medical perspectives into health management. He references the UK example where the growth of managerialism within the public sector and the emerging role of managers empowered to enforce government policy have brought to a head inherent tensions between doctors and managers.

This edition on cultural differences in health service management supplements the series on "Leadership in Health" that included editions on "Achieving Leadership and Quality Health Services in the UK" (October/November 2000), "The Role of Clinical Leadership in New Zealand" (March 1999), and "A UK Perspective on Clinical Leadership" (February 2000).

Readers may also wish to note that an edition in April 2000 presented the proceedings from the Clinical Governance in Healthcare forum held in Auckland, New Zealand, on 4 April 2000 "Clinical Governance in Healthcare". This edition examined the concept and experience of clinical governance with the objective of more fully defining the concept and its relevance to New Zealand in terms of quality care and professional practice.