Exploring the nature of the relationship between organisational culture and organisational effectiveness within six New Zealand community-based pharmacies

Abstract

This study set out to explore the nature of the relationship between organisational culture (OC) and organisational effectiveness (OE) within six New Zealand community-based pharmacies. Internationally, community pharmacy is under pressure to integrate within the rest of primary care, and to ‘reprofessionalise’ through role extension via the provision of enhanced clinical services. A previous New Zealand organisational climate study identified that pharmacist attitudes and behaviours are barriers to implementing a policy-aligned vision. This climate study provided the impetus for the in-depth cultureeffectiveness study described here. Historically, management literature has adopted linear, causal, and unidirectional approaches to studying the relationship between OC and OE. Within the health sector, there has been movement away from this by informed and intellectually curious academics. They recognise the need for a deeper, richer understanding of the relationship between OC and OE and the notion of linearity is largely being replaced by one of patterns of culture and contingent relationships. This thesis describes conceptual research; a theory building exercise, in which OC is framed as socially constructed, and OE as multi-constituent, value-laden, and politically charged. The ontological assumptions are founded on social constructionism; the epistemological stance is interpretative. Concept mapping exercises were undertaken to inductively generate the OC and OE constructs as anchor points for discussion with all staff in six pharmacies; 47 interviews in total. A construct labelled Valued Outcomes (VO) emerged to supersede OE as the end-point in the discussion about the influence of OC on OE. In this study, OE manifest as technical performance, supported by cultural orientation toward procedure and process. The attainment of VO was contingent upon technical performance, but also upon the internal four-wall culture and co-production of OC with external actors. Both OC and VO reflected the duality of community pharmacy as retailer and as health care provider. OE influences OC in complex, non-linear, and recursive ways. Together, the contingent and recursive relationships support the idea of mutual constitution of OC and OE. In this study OC was dominant, and despite the development of OC and OE as separate constructs they emerged as overlapping and partially conflated. This study’s findings of complex, non-linear, and recursive interplays between OC and organisational outcomes further supports contemporary literature’s gradual movement away from direct causal relationships between OC and OE. The observation in this study, of conflation and mutual constitution, explains the difficulty seen in previous studies with conceptualising and operationalising both OC and OE as completely separate constructs. Emergence of the VO construct and the manifestation of OE as technical performance support the notion of construct identity, and in this thesis the argument is made for sound definition and conceptualisation of organisational constructs within future OC-OE studies. The observation of recursive relationships between OE and OC adds to existing health services research literature, with a call for its consideration in the design of future OC-OE studies. There are implications for future research, policy, and practice within the community pharmacy sector. Community pharmacy provides a rich context for the application of organisational theory, and this research provides a platform for future pharmacy-based health services research.