The presence of a strong and appropriate organizational culture has become essential for an organization to function effectively and

efficiently in the modern era. Organizational culture is the consciously or subconsciously accepted and followed way of life or manner of performing day-to-day activities in an organization. It plays an important role in determining and controlling employee behavior at workplace. The core values, assumptions, norms, procedures, etc. that are followed in an organization constitute its culture. These are more often than not, accepted and followed throughout the organization, without much deviation. However, the presence of individuals from various social cultures and backgrounds in an organization, may lend a slight variation to the beliefs and ideologies of the organizational members. This difference results in the formation of subcultures within organizations. The presence of subcultures may be advantageous to an organization as the deviations from the norm may throw up alternatives to existing practices, which are often useful to the organization in adapting to changes in the external environment. Such adaptability is essential for the organization to survive. However, if the differences in ideologies go beyond a desirable level, they may have a negative effect on the organization and undermine it. The strength of an organizational culture depends on the sharedness and intensity of the core values of the organization. A strong culture tends to enhance employee commitment and loyalty towards the organization. Organizational cultures have been classified into four major types - market culture, adhocracy, clan culture and hierarchical culture. Organizational culture deals with the internalization of the core values and norms. If the organizational culture is well internalized, it can replace the formalization of rules and procedures in an organization. The difference between the two lies in the fact that, while formalization deals with the standardization of jobs and involves documentation of accepted values and norms, a strong organizational culture can achieve a certain amount of uniformity in work processes without documentation being required. Organizational culture plays a variety of roles in strengthening bonds between the members of an organization. The boundary-defining role of organizational culture implies that it helps to draw distinctions between one organization and another. It also creates a sense of identity and belongingness among the employees of the organization. Organization culture synergizes the efforts of organizational members towards the achievement of the common objectives of the organization. It also maintains the stability of the social system in the organization by minimizing individual differences between employees. Organizational culture is determined largely by the values, assumptions and personal traits of the founders. These values lay the foundation for the organizational culture, which is then accepted and followed throughout the organization. Culture in organizations is also learnt by its members through artifacts like stories, legends, rituals and material symbols. Stories pertaining to significant events in the company's history, the rituals of the organization, and even material symbols such as the physical layout of the organization, serve to transmit the core values of the organization. Language, which refers to the commonly used terminology, jargon and acronyms unique to a particular organization, also helps in the permeation of organizational culture.

Change in organizational culture is sometimes inevitable as the organization needs to adapt to changes in the environment. However, the highly complex and pervasive nature of organizational culture makes it difficult to push through any change in its culture. As members of the organization internalize the core values over a period of time, attempts to change it often invite enormous resistance from employees. Nevertheless, a well thought out action plan, with a change agent to assist in its implementation, can result in the successful transformation of an outdated organizational culture, to one which is more aligned to the external environment. Next Chapter

Introduction
Organizational culture has been a buzzword in Corporate America for the past 20 years, ever since managers began to realize that an organization's dominant philosophy and values could determine its success and be a competitive advantage. However, the health care industry has lagged in its understanding of how to develop effective organizational cultures. This knowledge lag is unfortunate since an effective organizational culture is crucial in health care organizations that face issues such as complex managed health care structures, competitive labor markets, and declining levels of patient satisfaction. What Is Organizational Culture? Organizational culture refers to a shared value system derived over time that guides members as they solve problems, adapt to the external environment, and manage relationships (Schein, 1992). Organizational culture explains how an organization's members do things to succeed, as well as how their behaviors can contribute to a group's failure. In other words, organizational culture serves as a cognitive map for members so they can understand what is valued in their organization, and how to direct their behaviors accordingly. The culture of a health care organization can powerfully influence its ability to manage human resources and serve patients, and ultimately has a strong impact on its economic performance (Kotter & Heskett, 1992). Constructive organizational cultures that enhance both employee satisfaction and patient satisfaction consist of work environments where members have positive colleague interactions and approach tasks in a manner that helps them to attain high-order personal satisfaction and meet organizational goals (Cooke & Rousseau, 1988). In other words, health care organizations that typify constructive cultures put people first by encouraging positive interpersonal relationships, but also they value self-actualization and employees who are achievement oriented. For example, when Baptist Hospital in Pensacola, Florida crafted a vision to become "the best healthcare system in America," the chief executive officer began by revamping the hospital's organizational culture. The cognitive map or driving force for this culture transformation was based on empowerment, as communicated through Baptist Hospital's mission, values, and patient

service philosophy (Reeder, 2002). Constructive relationships between patients and employees became the top priority. Because of these cultural changes, the hospital was acknowledged for its patient service quality by the prestigious Baldrige group and received high patient satisfaction ratings on the Press, Garney & Associates' survey, all while generating substantial cost savings. Similarly, when Griffin Hospital in Derby, Connecticut transformed itself from a bureaucratic culture to a caring culture, patient satisfaction soared 96%, nursing turnover decreased, and the hospital was in a better strategic position to compete against neighboring hospitals (Freedman, 1999). This transformation of Griffin's culture entailed creating a work environment where nurses were empowered to develop ways to cater to their patients' needs.