Organizational culture in hospitals: issues in measurement

It is still not clear that organizational culture in hospitals is linked to patient or provider outcomes. However, measurement of organizational culture in nursing units within hospitals and for entire hospitals is common. Two instruments frequently used to measure hospital culture or work group culture within hospitals are the Organizational Culture Inventory (OCI) (Cooke & Lafferty, 1987) and the Nursing Unit Cultural Assessment Tool (NUCAT-2) (Coeling & Simms, 1993a). The purpose of this paper is to review selected empirical studies of organizational and work group culture in hospitals and critique these two measurement instruments. The paper discusses the issues of unit of analysis/aggregation bias and sample size when using these two instruments. It was concluded that OCI has been widely used in many types of organizations and has substantial data supporting the reliability and validity. However, the instrument does not always capture variation in nursing units. The NUCAT-2 has less reliability and validity data but researchers have reported wide variation among units. Individual items can be selected for use from the NUCAT-2 and it is less expensive to use than the OCI.