As a matter of fact, organizational factors play a highly essential role in the implementation and change of strategies, policies, and action plans in healthcare settings and determine their success. Thus, understanding and addressing organizational culture (OC) have become essential for achieving improved healthcare performance. This work aims to investigate the importance of OC for infection prevention and control (IPC) interventions, the theoretical basis of necessary cultural changes, and the role of leadership in them.
In general, no common definition may unite all aspects of OC in it. However, the most appropriate one was probably given by Shein, who stated that OC is “the pattern of basic assumptions that a given group has invented, discovered, or developed in learning to cope with its problems of external adaptation and internal integration, and that has worked well enough to be considered valid, and, therefore to be taught to new members as the correct way to perceive, think, and feel in relation to those problems” (De Bono et al., 2014, p. 2). Moreover, the collective mental programming on the basis of core values, rules, attributes, norms, and assumptions distinguishes the members of different organizations (Valmohammadi & Roshanzamir, 2015). As healthcare-associated infections currently remain one of the most substantial challenges to medical institutions, the efficient implementation of infection prevention and control (IPC) interventions helps to reduce infection-related incidents (De Bono et al., 2014). However, effective IPC heavily depends on multiple management systems’ interplay influenced by OC. In particular, the organization’s design and the arrangement of different jobs are the main components of culture that determine employee behavior. In turn, employee behavior impacts the prevention and control of infectious diseases.
Several theories related to cultural change are essential for implementing interventions that include the cultural adaptation theory, the self-efficacy theory, and the transformational theory of leadership. The first one describes cultural change as the generation of value in response to changing conditions. It explains the necessity for changes in OC in response to new challenges. The self-efficacy theory refers to employee behavior change and designates four modalities, including performance enactment on the basis of a person’s belief in his abilities, vicarious learning by watching others, verbal persuasion that modifies behavior, and emotional arousal (De Bono et al., 2014). Finally, the transformational leadership theory emphasizes leaders’ exclusive role in cultural change.
Although several leadership styles may be applied to cultural change, transformation leadership provides long-term effects. According to Willis et al. (2014), in organizational culture change, “alignment refers to the connection between transformational vision and action through a range of activities performed by those at multiple levels of a system” (p. 9). Thus, competent leaders considerably influence their subordinates, forming their perceptions and behavioral patterns. First of all, they articulate a new vision of OC enhancing people’s motivation and self-control (Fischer, 2016). In other words, in transformational leadership, employees are united by a particular mission where they are responsible for outcomes. In relation to the implementation of IPC, hand hygiene may be regarded as the basic measure. Thus, instead of total control, a leader articulates the importance of hand hygiene for disease prevention and motivates employees to follow prescriptions. In this case, healthcare providers realize their responsibility for the success of interventions.