Haute Culture: how open culture breaks through old-fashioned work patterns in healthcare
Old-fashioned work patterns in healthcare can possibly be improved through shared leadership, according to research by health scientist Romana Malik.
Healthcare-related scandals worldwide make it painfully clear how a toxic organizational culture can seriously undermine patient safety and the well-being of healthcare professionals. In the Netherlands, such abuses also came to light in various hospitals where, among other things, there was intimidation, concealed medical (fatal) incidents and a culture of fear. These cases illustrate how hierarchy, a culture of accountability and a lack of psychological safety can lead to harmful outcomes. Despite the increasing attention for promoting a so-called ‘open culture’—in which healthcare professionals can express their concerns without fear of repercussions—the concretization and implementation of this concept remained extremely complex. Malik's research focuses on analyzing the concept of open culture, its relationship with patient safety, the crucial role of good leadership and interprofessional collaboration and the well-being of healthcare providers in realizing sustainable and meaningful cultural change within healthcare.
Investigating organizational culture in healthcare is complex, partly due to the limitations of existing measurement instruments in capturing intangible aspects. Quantitative methods provide valuable data, but often do not reveal the underlying assumptions. Qualitative and alternative approaches provide more depth, but encounter significant obstacles in environments with a culture of fear. It is therefore not only important to develop new methods to recognize non-open cultures, but also to take preventive and proactive measures that actively support the promotion of an open culture. It must be recognized that the individual perception of professionals about their contribution to an open culture does not necessarily correspond to the broader organizational reality. In the pursuit of culture change, psychological safety should therefore not be seen as an exclusive goal; the focus should be on the implementation of an open culture, which includes psychological safety, while the reverse is not self-evident. Our research shows that an approach such as ‘shared governance’ or shared leadership—in which interprofessional collaboration and learning are central, diversity is embraced and decision-making takes place jointly—can potentially be successful in promoting an open culture, if applied consistently. A given that is unfortunately often lacking in practice.
Malik's findings have important implications for healthcare organizations, healthcare professionals and policy makers. They emphasize that leadership in an open culture is not only based on knowledge or status, but on sharing these skills with integrity, openness and equality. This contributes to a work environment in which well-being is central, every perspective is valued, and diversity is seen as an opportunity. This approach is applicable to healthcare institutions or departments that struggle with work patterns that are no longer appropriate in the current context. Promoting interprofessional working and learning through a strategy such as shared leadership can play a crucial role in this. The results are relevant in view of recent scandals, also in healthcare, such as at UMC Utrecht, where a culture of fear led to the underreporting of fatal errors. By opting for an open culture, Malik and her colleagues hope to overcome epistemic injustice and improve care. In the long term, this could lead to a healthier work environment and better care for patients.
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