Article
Organizational Culture and Individual
Values in Greek Public Hospitals:
A Competing Values Approach
Journal of Health Management
17(2) 119–137
© 2015 Indian Institute of
Health Management Research
SAGE Publications
sagepub.in/home.nav
DOI: 10.1177/0972063415575785
http://jhm.sagepub.com
Nikolaos Kapetaneas1
Catherine Kastanioti2
Athina Lazakidou1
Panayotis Prezerakos1
Abstract
Purpose: The values are particularly important in the research of organizational culture and the person–organization (P–O) fit. This article tries to identify the culture dimensions that exist within public
procurement in Greek public hospitals, based on employee characteristics.
Design/methodology/approach: We have used exploratory factor analysis for the evaluation of
multidimensional structure of organizational culture profile (OCP) scale. Then, we investigated the
extent to which the OCP, with 54 items, that constitutes eight factors in the causative analysis of factors can be incorporated into the Quinn and Cameron theory of competitive values framework (CVF).
In order to investigate this subject, we have developed a non-standard multidimensional scaling (MDS)
that imposes the OCP on the solution space with the permutation test that evaluates the cohesion of
engagements, which represents MDS and then we have extended our work to test our results by using
structural equations modelling (AMOS).
Findings: Internal consistency of all components was moderate to strong (a = 0.61 until 0.89). We
realized that the OCP can be incorporated in the CVF, in a way the four quadrants which emerged have
been formulated in four types of organizational culture.
Research limitations/implications: The results have implied that the P–O fit can be assessed simply
by the congruence of the person’s and the organization’s positions, measuring organizational culture in
a way that is consistent with the CVF.
Practical implications: We believe that our preliminary study can serve as an audit tool for
managers and policy makers as well as a guide for recruitment of new employees in health care
sector.
1
2
Faculty of Nursing, University of Peloponesse, Sparta, Greece.
Associate Professor, Technological Educational Institute of Peloponnese, Kalamata, Greece.
Corresponding author:
Nikolaos Kapetaneas, Faculty of Nursing, University of Peloponesse, Sparta, 23100, Greece.
Email: [email protected]
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Journal of Health Management 17(2)
Originality/value: This research fills the gap between organizational culture and the P–O fit in procurement offices in Greek public hospitals.
Keywords
Person–organization fit, organizational culture, competing values model, hospitals, Greece
Introduction
The sustained interest in organizational culture throughout literature has confirmed that elements of core
values and assumptions are often at the root of organizational systems and structures. Denison and
Mishra (1995) argue that in order to understand or change an organization, a researcher must first examine the linkages between personal values and the structure of the organization. Schein (1996) supported
that culture is one of the more powerful and constant forces that functions in the organizations; however,
organizational culture has been interpreted in many ways, depending each time on the researcher’s point
of view (Schultz & Hatch 1996). If the organizational culture significance is important, then one should
determine common characteristics including cultural strength, types of organizational culture and the
relation between personal values and organizational culture (Schwartz et al. 2001).
Research Question
First, we investigate the extent to which the organizational culture profile (OCP) using five-point Likerttype scale will differ from the original OCP using Q-sort method and second, the extent to which the items
of OCP can be mapped on two bipolar dimensions established theoretically in Cameron and Queen (1999)
organizational culture theory of competitive values framework (CVF).To address this issue, we developed
a non-standard method of multidimensional scaling (MDS) which imposes an OCP-based axial regionality
onto the solution space and afterwards we performed a confirmatory factor analysis to support the theory.
Organizational Culture
Defining Organizational Culture
Organizational culture has been established as the social glue that keeps the organization together; however, the ‘values’ are the means that influence the way in which the members of an organization think,
feel and behave (Cameron 2008). Studies have shown that organizational culture consists of observable
and measurable characteristics of culture such as values, behavioural norms and assumptions implemented by the organizational members (Denison 1996). According to Schein (1984), culture exists at
three levels of abstraction which are the assumptions, values and artefacts. In line with the previous
authors, Goll and Zeits (1991) stated that in order to understand the organizational culture, one should
deal mostly with ‘major beliefs and values’.
Furthermore, the organizational culture is a pattern of beliefs and expectations which are shared by
the organization’s members (Schwartz & Boehnke 2004). More specifically, it is a pattern of shared
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Kapetaneas et al.
basic assumptions which teach new members the correct way to perceive, think and feel in order to avoid
any resistance when external adjustments and their internal integration need to be implemented in the
organization (Schein 1992). According to Cameron and Quinn (1999), organizational culture is perceived as taken-for-granted values, collective memories, underlying assumptions, expectations and definitions that exist within the organization. The elements of the organizational culture range from
fundamental assumptions to norms, symbols, rituals and other cultural activities through the values and
rules of conduct in organizational behaviours.
Some researchers state the cultural strength is based on the consistency of perceptions of the company’s values (Gordon & DiTimaso 1992) and others believe that organizational culture exists when the
members of one unit or an organization have shared common values (Weiner 1988). In addition, sufficient evidence shows that an organization achieves its objectives when it manages to attract, maintain
and motivate the employees in order to embrace the same values and beliefs and share the same objectives and priorities (Bellou 2009; Kristof 1996). The organizational culture concerning the central values
requires the determination of breadth of relative values and afterwards their estimate for which values
they can be viable to organization and how they can be shared (Saffold 1988). Additional research for the
purpose of the P–O fit has spent a large part of the attention to organizational culture because it has
directed ‘culture’ as total cognitions which are common to the members of the social unit or the organization. Central to these cognitions are basic values which are supposed to guide the individual behaviour
(Bilsky & Jehn 2002; Chatman 1991; O’Reilly et al. 1991).
Therefore, we hypothesized that:
H1:The factor structure of the original OCP using Likert-type scale for a sample of procurement
employees in public hospitals in Greece will differ from the original OCP factor structure.
H2:The intercorrelations of the OCP items can be represented in a two-dimensional MDS representation that strictly satisfies the CVF; the fit of this representation is marginally better than the fit for
an exploratory factor analysis.
H3:The factor analysis will identify innovation as a discrete dimension of the OCP, and possibly
could be an important organizational culture trait adopting new procurement procedure.
Measuring Organizational Culture
Typological versus Dimensional Approaches
There are two main approaches to measure organizational culture: the first adopts a typological approach
in which the assessment results are one or more ‘types’ of organizational culture and the second one is
the dimensional approach.
One model of the typological approach suggested that there are four types of organizational culture
and each is reflected in the structure of an organization and its set of systems. First, ‘people orientation’
reflects perceptible support, collaboration, the respect between organizational members. Second, an
‘innovation’ type implies general openness to change, and the tendency to experiment and take risks in
order to meet new challenges. Third, ‘control’ is another important element. It focuses on the level of
formal work, procedures, the existence of rules and the importance of the hierarchy. This element is similar to the ‘bureaucratic’ dimension prevalent in some structures. Finally, ‘results/outcome orientation’ is
another core dimension that measures the level of productivity or performance expected inside an organization (Delobbe et al. 2002).
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The dimensional approach establishes a profile approach in the model that does not try to categorize
organizational culture, but instead tries to identify its key characteristics. Once they have been identified,
they can be compared to the culture that the organization wants to operate and any suitable changes can
be planned. Dimensional approaches aim to evaluate the presence and the relative force of cultural
dimensions (Ashkanasy et al. 2000), and the majority of these approaches they take predefine dimensions (Delobbe et al. 2002). However, more frequent means address roughly nine dimensions.
Briefly, while typological approaches are categorized in predetermined organizational culture types
(Mannion et al. 2005), dimensional approaches explore probably the nature and the degree to which each
cultural dimension is present in an organization, in order to maintain any competences as well as changes
in management strategies (Ramirez et al. 2013).
Organizational Culture Profile Survey Instrument
Various measures of organizational culture have been developed. The OCP proposed by O’Reilly et al.
(1991) is one of the most widely cited survey instruments in the organizational culture literature
(Marchand et al. 2013). Based on an examination of 18 culture measures which was published between
1975 and 1992, Ashkanasy, Broadfoot and Falkus (2000, cf. Sarros 2005) reported that the OCP was one
of the only few instruments to provide details with regard to reliability and validity measuring culture
profile of organizations. In addition (Tobias et al. 2009), it was reported that after this approach, OCP
(O’Reilly et al. 1991) has higher degree of robustness in measuring attitudes and subjective opinions.
One approach is that culture of an organization can be evaluated by examining these values that are
important for the individual perception or identity, as well as reflecting and being relative to the central
values of an organization. We decided to investigate OCP (O’Reilly et al. 1991) because it constitutes
one of the more important instruments measuring organizational culture (Agle & Caldwell 1999; Borg
et al. 2009; Cable & Judge 1997; Howard 1998; Marchand et al. 2013; Sarros 2005). This tool may also
be useful in the evaluation of organizations in need of changing culture, distinction of subcultures and
evaluating the ability to introduce and implement a new processes design. Borg et al. (2009) reported that
O’Reilly, Chatman and Caldwell (1991) developed the OCP following a quantitative comparison profile
approach by evaluating the P–O fit in terms of organizational culture.
The initial publication of this instrument was a Q-sort technique which required people to categorize
54 value items into nine ordered scaled categories, depending on how much the characteristics of an
organization or the value preferences of a specific individual were to be assessed and categories ranged
from most to least (O’Reilly et al. 1991). OCP was modified further by developing a Likert-type scale in
order to facilitate the completion of the instrument by the respondents without the need of the researcher
facilitating the study as is required in Q-sort method (Block 1978). In this modified version, respondents
were called to complete the statement ‘To what extent is your organization recognized for its...’ in relation to each of the 54 OCP value items and using a five-point Likert-type scale where 1 = not at all, 2 =
minimally, 3 = moderately, 4 = considerably and 5 = very much (Sarros, 2005). O’Reilly et al. (1991)
reported that eight factors result from the correlations of OCP items. These factors were labelled as: (1)
innovation and risk taking, (2) attention to detail, (3) orientation towards outcomes or results, (4) aggressiveness and competitiveness, (5) supportiveness, (6) emphasis on growth and rewards, (7) collaboration
and team orientation and (8) decisiveness, with a reported average reliability coefficient for the OCP of
0.88, while Vandenberghe’s (1999) study established an average reliability of 0.86 using the same instrument. In addition, in Bellou’s study (2008), Cronbach’s a coefficient ranged from .63 to .84. Sarros
(2005), using a short version of the OCP with 26 items instead of the original with 54 and Likert-type
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Kapetaneas et al.
scale, found seven factors that emerged from confirmatory factor analysis for a large Australian sample,
which were labelled as: competitiveness, social responsibility, supportiveness, innovation, emphasis on
rewards, performance orientation and stability with Cronbach’s a coefficient range for each factor from
.66 to .87. The OCP as mentioned before contains 54 value written statements that appear as general
descriptors of individual and organizational values (O’Reilly et al. 1991) and the participants were asked
to sort the 54 value statements from least to most characteristic of their organization.
It has been suggested that studies using OCP should carry out further validation. Vandenberghe (1999)
proposed that more analysis of the OCP cultural dimensions is warranted. Howard (1994) also suggested
that the reliability of all OCP dimensions requires further investigation and Sarros (2005) in his personal
correspondence with the researchers, both Cable (personal communication, 29 July, 1999) and
Vandenberghe (1999), confirmed the need to examine the structure of the OCP in more detail.
Researchers have generated many culture dimensions over the past few decades (Denison 1996;
Howard 1998; Cooke & Rousseau 1988; Zammuto & O’Connor 1992) in which general resemblances
exist between dimensions; however, it is important to establish a firm framework of culture dimensions
that can characterize organizational culture.
Competing Values Framework
The initial work for the CVF began as an effort to identify an organization’s culture and its relationship
to organizational efficiency. Based on Quinn and Rohrbaugh (1983) attempt, they tried to analyze previous research by Campel et al. (1974) in which 39 indicators were presented as a comprehensive set of all
possible measures for organizational effectiveness.
Using multidimensional scaling from those 39 indicators, two major dimensions emerged that organized them into four main clusters. On the first dimension (flexibility-control), at one end characteristics
focus on flexibility, discretion and dynamism while on the other end focus is on stability, order and control. The second dimension differentiates a focus at one end on an internal orientation, integration and
unity while at the other end the focus concentrates on an external orientation, differentiation and rivalry
(internal–external), (Cameron 2008; Cameron & Quinn 1999). Together, these two dimensions form four
quadrants, each representing what people value about an organization’s culture, what they define as
good, correct and appropriate, how information is shared and communicated, what are the fundamental
human needs, and which are the core values that shape decisions and taking action (Cameron 2008;
Cameron & Ettington 1988; Mitroff 1983). Figure 1 illustrates the relationship of these two dimensions
to one another along with the resulting four quadrants.
The characteristics of each culture type are summarized as follows (Cameron & Quinn 1999):
1. Clan or group or human relations culture type is internally oriented and is reinforced by a flexible
organizational structure. This type of culture supports employee participation, cooperation, teamwork, fulfilling work through human resource development, participation, employee involvement
and open communications. Consequently, organizations value affiliation, membership and support while expecting to increase the outcomes of employee morale, satisfaction and commitment
(Cameron & Ettington 1988).
2. Hierarchy or control or internal process culture type is internally oriented and is supported by
an organizational structure driven by control mechanisms. It focuses on the level of work formalization, the existence of rules and procedures and the importance of the hierarchy. Procedures
govern what people do. A core assumption in hierarchical cultures is control, stability, rules and
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Flexibility
Human Relations Model:
Open Systems Model:
• Flexibility
• Growth
• Innovation
• Creativity
• Teamwork
• Participation
• Empowerment
• Concern for ideas
Internal
External
Internal Process Model:
Rational Goal Model:
• Centralization, control
• Routinization, formalization
• Stability, continuity, order
• Predictable performance outcomes
• Task focus
• Goal clarity
• Efficiency
• Performance
Control
Figure 1. The Competing Values Framework of Organizational Effectiveness
Source: Kalliath (1999).
regulations. As a result, hierarchical cultures are hypothesized to value precise communication,
reutilization, formalization and consistency (Quinn & Kimberly 1984). Behaviours that result
from these values include conformity and predictability.
3. Adhocracy or create or rational goal process culture type is externally oriented and is supported
by a flexible organizational structure. This type of organizational culture indicates general openness to change and to take risks. Hence, adhocracy organizations value growth, stimulation, variety and autonomy (Quinn & Kimberly 1984). Behaviours that emerged from these values include
risk taking, creativity and adaptability. Consequently, these means are predicted to cultivate innovation and cutting-edge output (Denison & Mishra 1995).
4. Market or compete or open systems culture type is externally oriented and is reinforced by an
organizational structure focus in control mechanisms that measure the level of productivity or
performance expected inside an organization (Delobbe et al. 2002) The primary belief in market
cultures is that clear goals and contingent rewards motivate employees to aggressively perform
and meet organization’s goals. Therefore, market organizations value communication, competence and achievement. Behaviours associated with these values include planning, task focus,
centralized decision making and articulation of clear goals.
Moreover, Howard (1998) declared that CVF represents a valid framework because it fulfils the three
critical questions that are related with the analysis of organizational culture: (i) it determines a descriptive content of organizational culture, (ii) it identifies dimensions where resemblances and differences
between cultures can be evaluated and (iii) it indicates the tools and the techniques for organizational
analysis which allow measurement and representation of culture.
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Kapetaneas et al.
What is notable with regard to these dimensions is that they represent opposite or competing values.
Each one highlights a core value that is opposite from the value on the other end of the chain that is to
say flexibility versus stability, internal versus external. The dimensions, consequently, produce quadrants that are also contradictory or competing on the diagonal (Cameron 2008). In conclusion, the CVF
proposes that culture types consist of a combination of focus and structure of the organization have
unique sets of attitudes, values, beliefs and assumptions that affect the attention and effort to achieve
separate organizational ends in a way in which the organizational culture is described and experienced
by individuals. In other words, it is consistent with the dimensions of the CVF (Mason & Mitroff 1973;
Mitroff & Kilmann 1975). Therefore, primarily, evaluating organizational culture is to identify aspects
of the organizational culture that reflect individuals core values and assumptions (Sarros, 2005).
A Theory-based MDS Approach
Using MDS, the main objective is to determine the dimensions that influence behaviour, which may not
have been immediately obvious from the data, consequently with general overview of the relationship
between variables (Woosley et al. 2004). In essence, MDS provides a visual representation of
dissimilarities (or similarities) among objects, cases or, more broadly, observations (Davison 1983). In
other words, the technique is trying to find the structure in a set of measurements which exist in distances
assigned to specific locations in a spatial configuration (Giguère 2006). Also, it can be used to investigate
and discover the characteristics of unknown social and psychological structures, but also to confirm a
priori assumption for these structures by identifying major grouping characteristics (Borg & Groenen
2005; Jaworska & Chupetlovska Anastasova 2009). In this form, the points that are most closely linked
to spatial map represent similar objects while those who are further aside represent dissimilar. The
emerged dimensions extracted from the spatial configuration of the data are considered to reflect the
hidden structures, or the important relations, within it (Ding 2006; Young & Hamer 1987). The rationale
for this approach is the theory that assigns each latent variable to the proposed model structures of
values, also referred to as ‘weak confirmatory factor analysis’ (Bilsky & Jehn 2002), in such a way that
it supports the theory that the unobservable variables of the OCP can be imposed on the MDS
configuration in a way that it represents the theory of CVF (Cameron & Quinn 1999) and provides an
explicit, theoretically grounded hypothesis about the structure of the values (Borg & Groenen 2005).
This analytical procedure also has been successfully applied as a confirmatory approach in theory of
values in a number of studies (Bilsky & Schwartz 1994; Elizur et al. 1991; Howard 1998; Schwartz &
Boehnke 2004).
Data Analysis and Results
Sample and Procedure
In Greece, there are 133 public hospitals, organized in seven administrative health regions including a
national authority for procurement called the Health Procurement Committee. This study took place in
102 public hospitals, 6 administrative health districts and the Health Procurement Committee. A questionnaire, together with a cover letter and a reply envelope mailed to the employees of procurement
offices of each hospital. After 3 weeks, a reminder telephone call was made.
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Data Analysis and Results
Statistical Analysis
Continuous variables are presented with mean ± standard deviation (SD). Qualitative variables are presented with absolute and relative frequencies. First, exploratory factor analysis (EFA) was carried out on the
54 items to evaluate construct validity, disclose underlying structures and reduce the number of variables.
Principal component analysis (PCA) was chosen as an extraction method using varimax rotation. Kaiser–
Meyer–Olkin (KMO) procedure for measuring sample adequacy was applied. The cut-off point for factor
loadings was 0.50 and for eigenvalues it was 1.00. The internal consistency of subscales was analyzed with
Cronbach’s a. Subscales with reliabilities equal to or greater than 0.70 were considered acceptable.
Afterwards, confirmatory factor analysis (CFA) with maximum likelihood procedure was used to
examine the pattern of relationships between the first-order factors and the four types of culture as second-order factors. Also, the model with the addition of two types (external and internal) of culture as the
higher levels of the model was also tested. For all models, independence of error terms was specified. A
number of approaches were used to assess the fit of the CFA models, including the comparative fit index
(CFI), the goodness-of-fit index (GFI), the c2 goodness-of-fit test and the root mean square error of
approximation (RMSEA) (Mueller, 2000). There are a variety of guidelines for interpreting the fit of a
specific model based on these indices. CFI and GFI indices can range from 0 to 1 with higher values
indicating a better fit of the model and recommended cut-off is 0.90 or better (Hu & Bentler 1999). The
CFI is recommended as the incremental index of choice as it takes into account the sample size when
comparing the hypothesized model with the independence model while avoiding problems found with
other indices, thus in the current study, CFI is encouraged as the basic index for a good fit (Bentler 1992).
RMSEA values of less than 0.05 indicate a good fit and values as high as 0.08 indicate a reasonable fit
(Hu & Bentler 1999). Also, a non-significant chi square statistic indicates a good fit, but chi square is
usually sensitive to sample sizes and usually significant for large sample sizes as ours (Mueller, 2000).
It has been proposed that c2/df values less than three indicate a good fit (Hu & Bentler 1999). The intercorrelations (Pearson’s r) between the culture dimensions were also computed. Correlation coefficient
between 0.1 and 0.3 is considered low, between 0.31 and 0.5 moderate and over 0.5 high. P values
reported are two-tailed. Statistical significant level was set at .05 and analysis was conducted using SPSS
18.0 and AMOS (SPSS, Chicago, IL, USA) statistical software.
Results
Sample Characteristics
Sample consisted of 402 participants (25.6 per cent men and 74.4 per cent women) (Table 1). Most participants (45.8 per cent) aged from 25 to 44 years and 25.6 per cent aged from 45 to 54 years. Almost half
of the responders (46.3 per cent) had a university degree and 13.4 per cent had an MSc or a PhD degree.
Of the subjects, 69.2 per cent had more than 11 years of previous employment and the mean number of
years at the current working position was 12.1 (SD = 9.3). The majority of the participants (82.3 per cent)
had previous working experience, mainly in the private sector (72.8 per cent).
Factor Analysis
A PCA was conducted on the 54 items with orthogonal rotation (varimax). The KMO measure verified
the sampling adequacy for the analysis, KMO = .924 (‘superb’ according to Hutcheson and Sofroniou
1999, cf. Field, 2009). Bartlett’s test of sphericity c² (1431) = 10,509.97, p < .001, indicated that
correlations between items were sufficiently large for PCA. An initial analysis was run and 11 components
had eigenvalues over 1. The Scree plot was slightly ambiguous and showed inflexions that would justify
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Kapetaneas et al.
Table 1. Sample Characteristics
%
N
Sex
Men
103
25.6
Women
299
74.4
Age (years)
18–24
1
0.2
25–34
64
15.9
35–44
184
45.8
45–54
143
35.6
10
2.5
Lyceum
162
40.3
Technological institute/university
186
46.3
54
13.4
8
2.0
3–10
116
28.9
11–20
131
32.6
147
36.6
+55
Educational years
MSc, PhD
Years of previous employment
<3
>20
Years at current working position, mean (SD)
12.1±9.3
Previous working experience
No
71
17.7
Yes
331
82.3
Private sector
241
72.8
Public sector
66
19.9
Freelancer
24
7.3
Previous working experience at:
Source: Authors’ own.
retaining eight components. Given the fact that from the produced data, we observed that three components
had only three items each and low Cronbach’s a produceing inadequate models were removed (Sarros
2005), and eight components were retained in the final analysis (Table 2). Finally the items 5, 9, 15, 16,
17, 24, 25, 26, 32, 33, 39, 45, 46, 48 and 53 were not included in the eight factors.
The eight factors were orientation towards outcomes or results, emphasis on growth and rewards,
emphasis on attention to detail, stability and maintaining the status quo, being innovative, decisiveness,
collaboration and team orientation and supportiveness. Our results show that their value taxonomy is
essentially the same as that proposed by O’Reilly et al. (1991); however, one deviation should be noted:
‘Aggressiveness and competitiveness’ as identified by O’Reilly et al. is now represented by the component called ‘stability and maintain the status quo’.
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Table 2. Factor Loadings from the Results of Exploratory Factor Analysis of the 54-Item Questionnaire
Orientation Emphasis Emphasis Stability and
Toward on Growth
on
Maintained
Collaboration
Outcomes
and
Attention the Status
Being
and Team
or Results Rewards to Detail
Quo
Innovative Decisiveness Orientation Supportiveness
Item 51
.690
Item 52
.637
Item 47
.623
Item 50
.600
Item 40
.573
Item 43
.571
Item 42
.566
Item 44
.564
Item 54
.552
Item 49
.547
Item 36
.749
Item 35
.712
Item 37
.669
Item 38
.656
Item 34
.538
Item 13
.752
Item 14
.719
Item 11
.685
Item 12
.624
Item 2
.783
Item 1
.777
Item 3
.693
Item 4
.660
Item 7
.778
Item 8
.766
Item 10
.599
Item 6
.581
Item 29
.590
Item 28
.563
Item 31
.538
Item 27
.535
Item 30
.507
Item 19
.677
(Table 2 Continued)
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Kapetaneas et al.
(Table 2 Continued)
Orientation Emphasis Emphasis Stability and
Toward on Growth
on
Maintained
Collaboration
Attention the Status
Outcomes
and
Being
and Team
or Results Rewards to Detail
Quo
Innovative Decisiveness Orientation Supportiveness
Item 20
.669
Item 18
.529
Item 23
.730
Item 22
.564
Item 21
.537
Item 41
.502
Source: Authors’ own.
Table 3. Correlation Coefficients between the Culture Dimensions
Orientation Emphasis Emphasis Stability and
Toward on Growth
on
Maintained
Collaboration
Outcomes
and
Attention the Status
Being
and Team
or Results Rewards to Detail
Quo
Innovative Decisiveness Orientation
Emphasis on growth
and rewards
0.61
Emphasis on attention
to detail
0.48
0.41
Stability and maintained
the status quo
0.45
0.29
0.36
Being innovative
0.29
0.30
0.24
0.36
Decisiveness
0.72
0.57
0.50
0.45
0.32
Collaboration and
team orientation
0.58
0.41
0.40
0.43
0.25
0.50
Supportiveness
0.33
0.34
0.29
0.26
0.21
0.26
0.26
Source: Authors’ own.
Note: All correlations were significant at p < 0.001
Correlation between Culture Dimensions
Correlation coefficients between the culture dimensions are shown in Table 3. All correlations were
significant and ranged from 0.21 to 0.72, and 67.8 per cent of the correlations were moderate to high
indicating moderate to strong relationships between the various aspects of culture.
Results on MDS
Our descriptive attempt to map the eight OCP-scale scores in multidimensional space resulted in a
parsimonious two-dimensional configuration that seems intuitively reasonable. An overall MDS was
performed based on the intercorrelations of the eight OCP scores calculated by the factor analysis. First,
we assess the structure of the eight components by representing their intercorrelations as distances in a
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Journal of Health Management 17(2)
Derived Stimulus Configuration
Euclidean Distance Model
2
F6
Decisiveness
Dimension 2
1
0
Orientation
toward outcomes
F1
or results
F5
Innovation
F2
F8
EasygoingnessSupportiveness
Emphasis on
growth and
rewards
–1
F4
Stability and
maintained
the status
quo
F3
Attention to
detail
F7 Collaboration and
team orientation
–2
–1,5
–1,0
–0,5
0,0
0,5
Dimension 1
1,0
1,5
Figure 2: Two-dimensional MDS of the Eight OCP-Scale Scores
Source: Authors’ own.
two-dimensional ordinal MDS space (Figure 2). We then divide this space in a way that four regions
emerge, each one containing only points with the same ‘Type’ of organizational culture according to
CVF. In other words, we seek an optimal mapping of the correlations into distances of an MDS space
that can be divided into four distinct regions, according to CVF theory
The distinct four regions have emerged (Figure 2) as point F1 is located in the upper right region,
namely according to CVF ‘Market’ type of culture, points F5 and F6 are located in the upper left region,
namely ‘Adhocracy’ type of culture, points F2, F7 and F8 are located in the low left region namely ‘Clan’
type of culture and points F3 and F4 are located in the lower right region namely ‘Hierarchy’ type of
culture.
The results indicate that the composite factors’ reliability coefficients exceed the 0.80 Cronbach’s a
coefficients for all factors; 0.89 for market (equals with the component F1, since in this quadrant only
one component is mapped), 0.81 for adhocracy, 0.82 for hierarchy and 0.81 for clan. Internal consistency reliabilities demonstrated uniformly positive support for the convergent validity of the items comprising the eight measures. Results from the non-metric MDS scaling, confirm the conceptual model of 4
organizational culture types and clearly support the theoretical model of Competitive Values
Framework.
Our structural analyses from OCP data values achieved using ALSCAL and MDS with a factor of
stress coefficient (form 1) (Kruskal 1964). We analyzed the matrices of Pearson correlation
coefficients between the eight items with ordinal MDS (defaults for ties and iteration criteria: stress
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Kapetaneas et al.
convergence = 0.0001, minimum stress = 0.0001, maximum iterations = 100), using the starting
configuration described before.
The fit indices of the respective model did not point to any problematic solution. Scaling resulted in
a stress coefficient (form 1) S = .13073 (reciprocal square root (RSQ) = .8785), which is appropriate (cf.
Bilsky et al. 2011; Borg & Groenen 2005) for this type of analysis.
Figure 2 summarizes the results of the MDS, which clearly supports our interpretation.
Cronbach’s a, descriptive statistics and item-total correlations of the culture items are shown in
Table 4. All the dimensions exceeded the minimum reliability standard of 0.70 except for supportiveness, indicating acceptable internal consistency. Cronbach’s a for the cultural dimensions was 0.89 for
orientation towards outcomes or results, 0.85 emphasis on growth and rewards, 0.80 for emphasis on
attention to detail, 0.83 for stability and maintained the status quo, 0.76 for being innovative, 0.84 for
decisiveness, 0.79 for collaboration and team orientation and 0.61 for supportiveness. Also, item-total
correlations exceeded 0.50 for all items.
Table 4. Cronbach’s a Coefficients, Item–Total Correlations and Descriptive Statistics for the Culture
Dimension and Culture Types
Culture
Type
Culture Dimension
Market
a=0.89
Item
Item–total
Correlation
Mean
SD
Orientation Toward Outcomes or Results
51
.690
4.24
.66
a=0.89
52
.637
4.15
.71
47
.623
4.26
.66
50
.600
4.22
.75
40
.573
4.14
.77
43
.571
4.43
.66
42
.566
4.15
.70
44
.564
4.12
.72
54
.552
4.57
.60
49
.547
3.93
.81
Clan
Emphasis on growth and rewards
36
.749
4.17
.95
a=0.81
a=0.85
35
.712
3.99
.87
37
.669
4.29
.81
38
.656
4.29
.84
34
.538
4.18
.75
Collaboration and team orientation
19
.677
4.47
.75
a=0.79
20
.669
4.46
.73
18
.529
4.16
.76
Supportiveness
23
.730
3.50
.94
a =0.61
22
.564
3.47
.92
21
.537
3.83
.78
41
.502
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3.73
.85
(Table 4 Continued)
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Journal of Health Management 17(2)
(Table 4 Continued)
Culture
Type
Culture Dimension
Hierarchy
Emphasis on attention to detail
13
.752
4.40
.67
a=0.80
14
.719
4.45
.62
11
.685
4.31
.67
a=0.82
Item
Item–total
Correlation
Mean
SD
12
.624
4.00
.70
Stability and maintained the status quo
2
.783
4.19
.64
a=0.83
1
.777
4.20
.70
3
.683
4.23
.70
4
.660
4.07
.71
Adhocracy
Innovation
7
.778
3.47
.91
a=0.81
a=0.76
8
.766
3.25
.96
10
.599
3.69
.89
6
.581
3.79
.92
Decisiveness
28
.563
4.30
.63
a=0.84
31
.538
4.31
.67
27
.535
4.16
.67
30
.507
4.39
.65
Source: Authors’ own.
CFA Results
CFA was first conducted using the culture survey items as observed variables and the eight indices as
first-order factors. Afterwards, CFA was conducted for second-order models including: (a) the four
types of culture (market culture, clan culture, hierarchy culture and adhocracy culture), (b) the two
types of culture (internal and external) and (c) both the aforementioned four and two types of culture
indicating that external side includes market culture and adhocracy and internal side includes clan
culture and hierarchy culture. Table 5 presents results from CFA analysis. The chi-square test of the
models was in all cases significant as expected, but the ratio c2/df was less than three. CFI was more
than 0.9 for all models indicating acceptable fit and RMSEA values were less than 0.08. In comparison
with the first-order model, all the second-order models indicated a better fit with greater values for
CFI and RMSEA less than 0.05. Comparing the three tested second-order models, the lowest fit indices were found for the model with the two types of culture (external and internal), while the model
with the four types of culture exhibited a slightly better fit with GFI, CFI and RMSEA equal to 0.857,
0.909 and 0.048, respectively.
The four quadrants represent a model focusing on the contradictions that occur as organizations try to
achieve internal integration and external adaptation (Hatch 1993; Schein 1990). All organizations express
each dimension to some degree; however, most organizations will emphasize some of these dimensions
more than others (Quinn & Cameron 1983; Zammuto & O’Connor 1992), according to the means of
effectiveness they want to achieve.
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Kapetaneas et al.
Table 5. Fit Indices Results from CFA for the Tested Models Concerning Culture Dimensions
c2 (df)
c2/(df)
P
GFI
CFI
RMSEA
First order
1,393.5
(671)
2.1
<0.001
0.848
0.900
0.052
Second order with four types of culture*
1,321.3
(693)
1.9
<0.001
0.857
0.909
0.048
Second order with two types of culture**
1,381.7
(688)
2.0
<0.001
0.849
0.902
0.050
Second order with both four and two types of culture
1,335.5
(682)
2.0
<0.001
0.855
0.908
0.049
Model
Source: Authors’ own.
Notes: *Market culture, clan culture, hierarchy culture, adhocracy culture.
**External and internal side.
Discussion and Perspectives
The four quadrants represent a model focusing on the contradictions that occur as organizations try to
achieve internal integration and external adaptation (Hatch 1993; Schein 1992). All organizations
expresse each dimension to some degree; however, most organizations will emphasize some of these
dimensions more than others (Quinn & Cameron 1983; Zammuto & O’Connor 1992), according to the
means of effectiveness they want to achieve.
Outcome orientation (component 1), has features such as being results oriented, having a clear guiding philosophy, an emphasis on quality, being socially responsible, confronting conflict directly, working
in collaboration with others, fitting in, enthusiasm for the job, being highly organized and having a good
reputation are closely linked to competitiveness and productivity through a strong emphasis on external
positioning and control, characteristics close to market (compete) type culture, in terms of CVF. The
term market type culture according to CVF is not synonymous with marketing function or marketplace,
but rather it refers to organization which is oriented toward external environment instead of internal
affairs and it operates primarily through economic market mechanism and competitive dynamics.
Onto position which components such as ‘Supportiveness’ and ‘Easygoingness’ are located, resembling with characteristics of Clan (Collaborate) type of organizational culture. Supportiveness (stated by
O’Reilly et al. 1991) or easygoingness (stated by Chatman & Jehn 1994) (component eight) is mainly
contacted by items such as being easy going, informality, tolerance and developing friends at work
which are in line with CVF theory. In line to previous component, people orientation (component seven)
(stated by Chatman & Jehn, 1994) or team orientation and collaborative (stated by O’Reilly et al. 1991)
are mainly contacted by items such as fairness, respect for the individual’s right and being people oriented. The lower left region of the CVF resembles characteristics of clan type culture, completed by
emphasis on rewards (component two), which consists of items such as high pay for good performance,
opportunities for professional growth, security of employment, praise for good performance and having
high expectations for performance. All three components are in line with the clan (collaborate) type of
organizational culture with typical characteristics of teamwork, employee involvement programmes and
corporate commitment to employees. Basic assumptions in clan culture are that the environment can best
be managed through teamwork and a humane work environment.
The same applies to finding innovation (component five) which is located in the upper left region of
the CVF and resembles characteristics of adhocracy (create) type culture. Innovation is constructed by
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Journal of Health Management 17(2)
willingness to experiment, risk taking, autonomy and being quick to take advantage of opportunities. In
the same quarter, also decisiveness (component five) with items such as initiative taking, action orientation, achievement orientation, decisiveness and being reflective is in line with adhocracy type culture. It
is the organizational culture that is most responsive to a changing environment. Basic assumptions were
that innovation, preparing for the future and pioneering initiatives lead to success, and the major task of
management is to foster entrepreneurship, creativity and activity on the cutting edge.
Opposed to, lower right region, the last two components stability (maintaining the status quo) (component four) and detail orientation (component 3) make up the hierarchy (control) type of organizational
culture. Stability (maintaining the status quo) is constructed by adaptability, flexibility, stability and
predictability. Detailed orientation is made up of paying attention to detail, being precise, being rule
oriented and being analytical which are in line with basic characteristics of hierarchy type of culture.
This type is characterized by a formal and structure place to work. In addition, maintaining a smoothly
running organization is important and the long-term goal of the organization is stability, predictability
and efficiency. Formal rules and policies hold the organization together.
Our attempt to map the OCP results onto Cameron and Quinn (1999) CVF is consistent with findings
represented by Howard (1998). In his study of the validation of the Competitive Value Model, Howard
used the OCP instrument and his results with k =.12 and RSQ =.95, also support our interpretation.
Moreover, Bilsky and Jehn’s (2002) descriptive attempt to map the nine OCP-scale scores in multidimensional space also resulted in a two-dimensional configuration using a nonmetric MDS, with coefficient K = .15 and RSQ = .88, which seem in line with our results. From a methodological perspective, it
is interesting that the value scales of OCP data obtained from exploratory factor analysis fit reasonably
well into the confirmatory MDS structure.
Conclusions
We attempted to provide strong support for the use of the OCP scale for measuring organizational culture
in procurement offices in Greek public hospitals consistent with the CVF. This study, in line with previous
studies (Marchand et al. 2013; Sarros 2005; Zachariadou et al. 2013) showed that the modified OCP using
a Likert-scale is a reliable and valid tool in a more user-friendly approach to investigate organizational
culture in large samples. Moreover, we found that there is not one strong culture that characterizes employees in public hospitals. According to Nystrom (1993), the strength of an organization’s culture refers to the
degree of consensus among members about which values prevail and which dominate in importance. We
believe that our preliminary study can serve as an audit tool for managers and policy makers in the expected
new procurement processes of implementation in public hospitals in Greece. We expect managers and
policy makers can use this study in an effort to reduce cost and increase transparency and accountability.
Our findings can be also used as a guide for recruitment and selection of new employees in procurement
offices in public hospitals. This study is our first tentative step towards integrating findings. Since we conducted this study, we are working on a follow-up study in the area of P–O fit and outcome performance.
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