Embedding of organisational culture change programs in healthcare
The factors that influence
Organisation-wide culture change programs (OWCCP) are a mechanism in healthcare that assists the workforce to embed safe patient care and improved patient and staff outcomes. However, there is considerable variability in sustaining the quality and safety outcomes achieved from OWCCP. Evidence on how OWCCP can be embedded, and ultimately sustained, is difficult to accurately assess. This is due to the challenges involved in defining the focus and impacts of OWCCP in complex systems like healthcare. A further challenge is that research into OWCCP primarily focuses on implementing and/or sustaining change programs or initiatives, rather than embedding these programs into everyday business.
Additional research is required to better understand the mechanisms and effects of embedding an OWCCP on a large scale in healthcare. More detailed knowledge about these mechanisms will support the development of frameworks or models that include the embedding phase of OWCCP. This is a current gap in models or frameworks that support OWCCP. Strategies that address this gap can ultimately support successful OWCCP and improved patient and staff outcomes in complex healthcare organisations.
The objectives of our scoping review were to (1) identify the factors that influence embedding OWCCP in healthcare at an organisational (macro) and facility (meso) level, and (2) explore the scope and limitations of embedding OWCCP in the healthcare research literature.
Searches were conducted in six empirical databases and three grey databases from January 2013 to March 2024. Data from the full text articles were extracted and reported according to the SQUIRE 2.0 guidelines. Factors that influence embedding were then inductively coded, interpreted and grouped into categories.
The scoping review started with 7,922 studies that were screened, with 17 studies included in the final review. Ten key factors emerged as influencing the embedding of OWCCP in healthcare. These were based on three key groups: process, people and the program itself. The ten factors included (1) measurement, monitoring, and outcomes; (2) integrating the change program into business processes and systems; (3) education and training; (4) supportive leadership; (5) shared and defined accountability; (6) stakeholder engagement (7) resources to support the change; (8) alignment with organisational culture; (9) adaptable change program(s); and (10) alignment with the external environment.
The findings from our study can be used to guide and support the embedding of OWCCP in healthcare. The identification of ten key factors that influence embedding of OWCCP highlights the need for a model that can better inform change management in healthcare. Such a model would provide a practical tool for change management leaders and assist with the planning and sustaining of OWCCP in healthcare organisations. The review also identified important gaps in the knowledge base of embedding OWCCP in healthcare, including a need for future studies to clearly define what embedding OWCCP entails, and investigate how the different differing populations, settings, systems and processes influence the embedding of OWCCP.
Natalie Wilson
Director, Transforming Your Experience,
South Western Sydney Local Health District
NSW Australia
New South Wales, Australia
The protocol is available in JBI Evidence Implementation:
Wilson, Natalie; Eljiz, Kathy; Hogden, Anne; Greenfield, David
JBI Evid Implement. 2025 Feb 14. doi: 10.1097/XEB.0000000000000494