1. An assessment of organisational values, culture and performance in Cape Town’s primary care services
Bob Mash, Srini Govender, Arina Schlemmer, Family Medicine and Primary Care, Stellenbosch University
Angela De Sa, Abdul Isaacs, Family Medicine, University of Cape Town

2. Vision 2020: A value-based approach
“The department renders a large and complex service every day of the year and the clinical environment is often stressful. .. Staff attitudes are the common source of complaints. .. A key issue is how greater commitment and engagement from our staff can be promoted on a daily basis, moving towards a more client-centred service with a greater focus on quality improvement.”
Espoused organisational values:
Caring
Competence
Accountability
Integrity
Responsiveness
Respect

3. Aim and objectives
To evaluate how staff within the Metropolitan District Health Services of Cape Town perceive their values and organisational culture.
To measure:
Current personal values of staff,
Current organisational values
Desired future organisational values
To evaluate the alignment of personal, current and desired organisational values.

4. Methods Cultural values assessment (cross- sectional survey)
All staff at 5 community health centres in Cape Town Metropole
Validated CVA questionnaire
Analysis and report by Barrett’s Value Centre

5. Organisational values Organisational behaviour
Conceptual framework
Our people’s values
e.g. Empathy
Our peoples behaviour
e.g. Patient-centred consultation
Organisational values
e.g. Quality
Organisational behaviour
e.g. Quality improvement cycle
Patient experience
Health outcomes
Quality of care

6. The Barrett Seven Levels of Organisational Consciousness
Positive Focus / Excessive Focus
Resources and safety
Sufficient budget, equipment, employee health, safety. Control, corruption, greed
Relationships with colleagues and patients
Loyalty, open communication, patient experience, friendship. Manipulation, blame
High performance and quality of care
Systems, processes, quality, best practices, pride in performance. Bureaucracy, complacency
Continuous renewal and learning
Accountability, adaptability, empowerment, teamwork, goals orientation, personal growth
Building internal organisational community
Shared values, vision, commitment, integrity, trust, passion, creativity, openness, transparency
Making a difference to the local community
Collaboration, community involvement, partnerships
Staff fulfilment, coaching/mentoring, leadership dev
Service to population and nation
Social responsibility, future generations, long-term perspective, ethics, compassion, humility
Service
Making a Difference
Internal Cohesion
Transformation
Self-esteem
Relationship
Survival

7. Location of respondents (N=154)

8. Job category of respondents (N=154)

9. Personal values
Are people’s personal values congruent with the commitment in Vision 2020 to improving the patient’s experience?

10. Current organisational values
Are organisational values congruent with the commitment in Vision 2020 to improving quality of care?

11. C T S Department of Health (154) Personal Values
Current Culture Values
Desired Culture Values C T S
CTS =
Entropy = 2%
CTS =
Entropy = 36%
CTS =
Entropy = 2%
C = Common Good
T = Transformation
S = Self-Interest
Positive Values
Potentially Limiting Values
Values Distribution
Copyright 2011 Barrett Values Centre
December 2011

12. Entropy Risk Bands 10% or less: Prime: Healthy functioning
11% - 19%: Minor Issues: Requiring cultural and structural adjustments
20% - 29%: Significant Issues: Requiring cultural and structural transformation and leadership coaching
30% - 39%: Serious Issues: Requiring cultural and structural transformation, leadership mentoring/coaching, and leadership development
%: Critical Issues: Requiring cultural and structural transformation, selective changes in leadership, leadership mentoring/coaching, and leadership development
More than 50%: Cultural Crisis: For private sector or corporations, high risk of bankruptcy, takeover or implosion
The numbers come from experience.
We have seen examples or organisations with entropy over 50% who have not taken corrective action and failed.
We often see government departments or government funded organisations operating with large entropy scores and they can survive where commercial organisations would not because the government keeps pumping the money into an unhealthy system.
Some degree of Entropy (less than 10%) is helpful in that it drives continuous growth and change. Like the sand in an oyster that yields a pearl.

13. Future values
What are the desired values for the organisation in future?

14. Key findings
Staff are potentially aligned with the desire to improve patient experience and quality of care and have values congruent with this
The organisation invests a lot of energy in trying to improve quality and manage staff, but most of this is experienced negatively and is unproductive.
Staff experience of the organisation is currently incongruent with the values of Vision 2020 and their own personal values

15. Implications Transformation of the organisational culture is needed
Leadership mentoring/coaching and leadership development will be necessary
Family physicians are part of this leadership