AN ASSESSMENT OF THE IMPACT OF ORGANIZATIONAL CULTURE ON HEALTHCARE TEAM COLLABORATION IN NIGERIA

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Each organisation worldwide possesses unique distinguishing features and values that form its culture, similar to how individuals have their own distinct personalities. Organisations possess shared values and beliefs that serve as a guiding framework for their members, delineating the organization's structure and authority (Williams et al., 2023). The groups within organisations strongly adhere to these implicit rules and regulations, norms, customs, values, and beliefs that define the behaviour of organisation members and their expected responses to the internal and external environment of the organisation (Kreitner & Kinicki, 2018). The leadership, values, shared history, and traditions of an organisation serve to socially unite its members, fostering their dedication and loyalty to the organization's aims, ultimately leading to good performance.

According to Liu (2023), Organisational culture is the collective set of values, beliefs, norms, and practices that influence how individuals behave in an organisation. It is an essential aspect that impacts communication patterns, decision-making processes, and the overall work environment. In the healthcare sector, a favourable organisational culture can promote collaboration, mitigate tensions, and improve the effectiveness of service provision. In contrast, a detrimental or incongruous culture can result in ineffective communication, diminished job contentment, and ultimately, degraded quality of care for patients (Liu, 2022).  According to De Boom (2023), organisational culture has a significant impact on the way teams interact, communicate, and collaborate. A pleasant and unified culture in healthcare settings can bolster team efficiency, enhance patient care, and elevate work satisfaction among personnel. In contrast, a culture that is hostile or fragmented can result in communication failures, decreased collaboration, and ultimately, inferior patient outcomes (De Boom, 2023: Liu, 2022).

Organisational culture is commonly seen as a prerequisite for effective teamwork inside an organisation. Organisational culture refers to the collective values, beliefs, and perceptions that employees hold within a company. It serves as the cohesive force that binds an organisation together (Johnson, 2019). Schein (2017) defined organisational culture as the collective unconscious assumptions and ideas shared by members of an organisation. The organisational culture is influenced by key factors such as mission, strategy, structure, leadership, and human resource practices (Strasser et al., 2019). An organisation with a robust culture facilitates employees in achieving their objectives and duties while ensuring job satisfaction (Green, 2018). Organisational culture plays a significant role in shaping behaviour and performance in the workplace, as well as impacting teamwork and treatment outcomes (Strasser et al., 2019). Prior research mostly examines the influence of organisational culture on the implementation of interventions, quality improvement, patient safety, or performance. Some studies also concentrate solely on specific professional groups, such as nurses (Mansell, 2017). 

 Furthermore, these investigations were carried either in acute care facilities or long-term care facilities. The study conducted by Strasser et al. (2019) is the only one that has been carried out in the interprofessional rehabilitation environment. It was confirmed that the functioning of a team varies greatly based on the prevailing organisational culture. Teams that had a more personal and dynamic organisational culture, as opposed to those that were more bureaucratic and formal, achieved the highest scores in team functioning (Strasser et al., 2019). Collaboration among professionals from different disciplines is a crucial aspect of the comprehensive chronic care strategy (Betancourt et al., 2020). According to Junio et al. (2019), a partnership is described as a participative, collaborative, and coordinated approach to shared decision-making around health and social issues including patients. Körner and Wirtz (2019) delineate the fundamental aspects of client-centered interprofessional teamwork as communication, cooperation, coordination, respect, and work climate. 

Moreover, collaboration in the field of healthcare can be classified into two types: interprofessional and multiprofessional team approaches (Salisu et al., 2019). The two approaches vary in terms of organisation, leadership, communication, and decision-making. The interprofessional strategy yields superior outcomes in terms of teamwork and more staff satisfaction compared to the multiprofessional approach (Corbett, 2017). Multiprofessional cooperation refers to a collaborative approach where many disciplines or professions operate independently, each with their own specific treatment objectives. The physician assesses and assigns the treatment alternatives to other healthcare providers in a predominantly one-way, but occasionally two-way, interaction process among the professionals. On the other hand, the interprofessional approach is characterised by increased interaction and active participation, whereby healthcare professionals collaborate to establish a shared treatment objective and modify their discipline-specific goals accordingly. The physician engages in a collaborative decision-making process with other healthcare professionals and coordinates therapy through interprofessional team meetings (Wei et al., 2020). 

Multiple studies have demonstrated the impact of interprofessional cooperation on outcome measures at the client, staff, and organisational levels: At the individual level, effective cooperation is associated with increased satisfaction and acceptance of treatment, enhanced treatment quality, improved patient safety, and better clinical results (Mathieu, 2019; Bosch, 2019; Hartnell, 2017; Clarke, 2020). Studies have indicated that at the staff level, there are several positive outcomes associated with job satisfaction, including enhanced well-being, improved mental health, a more favourable team climate, and increased team efficiency (Aiken, 2020; Chang, 2019; Robbins, 2021). At the organisational level, the presence of effective cooperation is linked to financial savings, increased employee retention, and decreased turnover (Hartnell, 2017; Clarke, 2020). 

In Nigeria, as well as in numerous other nations, the provision of healthcare depends significantly on the efficient cooperation of different specialists, such as physicians, nurses, chemists, and administrative personnel. The efficacy of patient treatment is greatly impacted by the level of collaboration and synergy within these heterogeneous teams. Yet, the efficacy of this partnership is frequently influenced by the underlying organisational culture within healthcare organisations. The healthcare system in Nigeria has various obstacles, such as insufficient finance, substandard infrastructure, and a scarcity of proficient personnel. These issues are frequently exacerbated by cultural variables that impact the functioning of healthcare teams. Factors such as hierarchical hierarchies, divergent professional philosophies, and ethnic diversity might have an impact on collaboration within healthcare teams. Hence, it is crucial to comprehend the influence of organisational culture on team collaboration in order to identify effective strategies for enhancing healthcare delivery in the country. Therefore, the necessity for this investigation arises.

1.2 Statement of the problem

Efficient cooperation among healthcare teams is crucial for providing exceptional patient care. Healthcare institutions in Nigeria frequently encounter obstacles that impede teamwork, including limited resources, excessive workloads, and a varied workforce. Although these elements have been extensively studied, the impact of organisational culture on team collaboration has been relatively overlooked.

Organisational culture has a significant impact on the manner in which healthcare professionals engage with one another, exchange information, reach decisions, and address problems. An environment that fosters support can enhance transparent communication, confidence, and reciprocal regard, resulting in enhanced teamwork and enhanced patient results. Conversely, a culture that promotes isolated groups, strict hierarchies, or competitive relationships among professionals can hinder collaboration, leading to inefficiencies, mistakes, and less than ideal healthcare. An organisational culture that promotes the formation of isolated groups, imposes strict hierarchical divisions, or encourages competition amongst professionals can greatly impede teamwork (Bertrand et al., 2019). This type of culture can result in inefficiencies, mistakes, and less than optimal patient care. Organisational silos arise when different departments or teams operate independently, hindering the exchange of information and collaborative endeavours. The absence of integration can lead to fragmented care and heightened risk of errors. Weaver et al. (2017) conducted a study which revealed that working environments in healthcare settings that are divided into separate departments are linked to decreased collaboration and inferior patient outcomes.

Furthermore, an inflexible hierarchical framework might impede the flow of communication and hinder the process of making decisions. Reluctance of team members to express themselves or share information because of perceived power dynamics might result in insufficient information exchange and suboptimal decision-making (Lam, 2023). The study conducted by McFadden et al. (2018) emphasises that hierarchical cultures within healthcare environments can have adverse effects on both team collaboration and patient safety. Lami (2019) argues that cultures that promote or accept professional rivalries can generate conflict and impede teamwork. Professional rivalries can result in a dearth of collaboration, diminished morale, and heightened stress levels. A study conducted by Gittell et al. (2019) discovered that the presence of competitive or antagonistic interactions among healthcare workers might have a negative impact on both team performance and patient care.

Although organisational culture is significant, there is a scarcity of research on its influence on healthcare team collaboration in the Nigerian context. Healthcare facilities in Nigeria function within intricate cultural contexts marked by varied ethnicities, distinct professional hierarchies, and differing work ethics (Aniedi et al., (2024)). The impact of these cultural factors on teamwork dynamics is substantial, yet there is a lack of research on this topic in current literature. The objective of this study is to investigate the impact of organisational culture on healthcare team collaboration in Nigeria, with the aim of addressing the existing knowledge vacuum in this area. Insufficient comprehension of this correlation can hinder the effectiveness of endeavours to enhance teamwork and, subsequently, the delivery of healthcare. This study seeks to address this deficiency by evaluating the influence of organisational culture on collaboration across healthcare teams in Nigeria.

Objectives of the study

The primary objective of this study is to critically assess the Impact of Organizational Culture on Healthcare Team Collaboration in Nigeria. Specific objectives of this study are to:

To identify the elements of organizational culture within Nigerian healthcare institutions.

To assess how cultural factors, hinder effective collaboration within healthcare teams in Nigerian healthcare institutions

To evaluate how organizational culture and team collaboration influence patient care and outcomes in Nigerian healthcare institutions

To examine the role of communication practices and hierarchical structures in shaping team interactions and collaboration in Nigerian healthcare institutions

To develop strategies that can be used to implement cultural changes and improve team collaboration and patient outcomes in Nigerian healthcare institutions

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

How do various elements of organizational culture influence team collaboration in Nigerian healthcare institutions?

What are the specific cultural factors that hinder or facilitate effective teamwork in these settings?

How do organizational culture and team collaboration influence patient care and outcomes in Nigerian healthcare institutions?

How do communication practices and hierarchical structures affect team interactions and collaboration in Nigerian healthcare institutions?

What strategies can be implemented to enhance organizational culture and improve team collaboration in Nigerian healthcare institutions?

1.5 Research Hypotheses

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: Organizational culture and team collaboration have no significant influence on patient care and outcomes in Nigerian healthcare institutions.

Ha: Organizational culture and team collaboration have significant influence on patient care and outcomes in Nigerian healthcare institutions.

1.6 Significance of the study

The importance of this study resides in its capacity to enhance many facets of healthcare provision in Nigeria through the examination of the correlation between organisational culture and collaboration within healthcare teams. The project seeks to improve patient care quality, boost team performance, increase job satisfaction, inform policy and strategic planning, and contribute to academic and practical knowledge by offering insights and recommendations.

The study seeks to enhance teamwork among healthcare workers by examining the influence of organisational culture on team collaboration. Efficient teamwork is directly correlated with enhanced quality of patient care, as synchronised endeavours result in more precise diagnoses, prompt interventions, and comprehensive treatment strategies. The study presents empirical information on the impact of cultural influences on patient outcomes, which may be utilised to develop strategies that improve patient safety and the quality of care.

In addition, the research emphasises the particular cultural factors that either support or impede successful collaboration. Gaining insight into these factors aids in developing tactics to enhance team productivity and minimise inefficiencies in healthcare provision. The study investigates communication practices and hierarchical structures to identify and overcome typical obstacles that hinder successful team interaction. This research aims to enhance team dynamics and operational efficiency.

Moreover, an affirmative organisational culture that fosters trust, respect, and transparent communication can greatly augment job happiness among healthcare personnel. This can result in decreased burnout and turnover rates, which are crucial concerns in the Nigerian healthcare system. The study promotes a cooperative atmosphere, which enhances professional growth and contentment, leading to improved team spirit and productivity.

Moreover, the study offers useful insights for healthcare leaders and policymakers by pinpointing cultural obstacles and potential areas for enhancement. This information is vital for making well-informed decisions regarding organisational policies and practices. The study's findings can provide valuable recommendations for developing treatments that aim to enhance organisational culture, leading to improved team collaboration and healthcare outcomes.

Furthermore, the study fills a void in current research by specifically examining the environment of healthcare institutions in Nigeria. This research enhances the overall scholarly comprehension of the impact of organisational culture on team collaboration in various healthcare environments. The findings have practical consequences for healthcare managers and administrators, as they provide them with effective techniques to increase team dynamics and improve patient care through cultural upgrades.

1.7 Scope of the study

Broadly, this study focus is to critically assess the Impact of Organizational Culture on Healthcare Team Collaboration in Nigeria. Specifically, this study seeks identify the elements of organizational culture within Nigerian healthcare institutions, assess how cultural factors, hinder effective collaboration within healthcare teams within Nigerian healthcare institutions and evaluate how organizational culture and team collaboration influence patient care and outcomes in Nigerian healthcare institutions. 

Further, this study will focus on examining the role of communication practices and hierarchical structures in shaping team interactions and collaboration in Nigerian healthcare institutions and it also seeks to develop strategies that can be used to implement cultural changes and improve team collaboration and patient outcomes in Nigerian healthcare institutions.

 The study is carried out in Nigeria. 

1.8 Limitations of the study

Like any human undertaking, the researchers encountered numerous minor limitations during the examination. The primary constraint was the scarcity of comprehensive literature on the topic, resulting from the limited accessibility of data about an evaluation of the Influence of Organisational Culture on Healthcare Team Collaboration in Nigeria. Therefore, a substantial amount of time and effort was required to determine the suitable materials, books, or information and gather data. 

Moreover, this study is limited by its limited sample size and restricted geographical reach, concentrating exclusively on Nigeria. Hence, the generalizability of the findings in this study is limited, necessitating additional research. 

Furthermore, the researcher's limitations were mostly attributed to financial restraints, as they are a student without any means of money to support themselves. The expensive transportation fees at the research location presented a difficulty in covering the costs associated with transportation expenses.

In addition, the researcher encountered a time limitation as a result of the necessity to do this research while simultaneously meeting the requirements of attending lectures and engaging in other educational endeavors.

1.9 Definition of terms

Interdisciplinary teamwork: Interdisciplinary teamwork (also known as Professional collaboration) in healthcare refers to the collaborative approach where professionals from different disciplines work together to deliver comprehensive patient care.

Patient outcome: Patient outcomes are the results from care and treatments patients have received whilst in hospital, other clinical or care settings. They focus on meeting the physical, social, and emotional needs of patients from their own perspective to highlight what is important to them.

Organizational culture: Organizational culture is defined as the underlying beliefs, assumptions, values and ways of interacting that contribute to the unique social and psychological environment of an organization.