Implementing person-centered care in a general medical clinic: cultural barriers and driving forces

Public healthcare organisations in Sweden have been described as strongly hierarchical and coherent organisations [1]. To bring about control, generalized care models have been developed to handle hospital clinics and primary care sites [2]. This paper examines the preparedness to change in hospital settings. The purpose of the present study was to reveal barriers to the introduction of person-centred care (PCC). Organisational culture and resistance to change on hospital ward and clinical level and was based on the 2 concepts of “organisational culture” and “resistance to change”. These 2 concepts were measured by questionnaires based on theories of organisational culture and resistance to change. The concept of organisational culture is based on the Competing Values Framework [3-5]. The model is developed on the idea that organisational culture consists of opposite values [6]. They are: a) Human Relations (HR); b) Open Systems (OS); c) Rational Goal (RG) and d) Internal Processes (IP). HR is characterised by flexibility, cohesion, trust and belongingness. OS indicates extrovert outgoing organisational characteristics. It is assessed by benchmarking, experiment and the ability to run projects independently. RG favours planning, goal setting and economy in order to improve effectiveness and efficiency. It is characterised by competitive behaviour with an emphasis on winning. An IP organisation seeks stability and continuity by maintaining control, routines, rules and hierarchies [7]. Oreg [8] has identified the following 4 sources of resistance to change: a) routine seeking (RS); b) emotional reaction to imposed change (ER); c) short-term focus (SF) and d) cognitive rigidity (CR). These dimensions are based on 7 studies and represent a 4-facet structure of resistance to change [8]. RS corresponds to a reluctance to withdraw from old habits. Organisational members prefer to act within a well-defined and familiar framework. In the ER dimension, change is a stressor. Individuals with a high ER score suffer from a lack of resilience and are reluctant to participate in change processes. The SF focus identifies an individual’s ability to adjust to new situations. A high score can indicate a resistance to change, because it involves more work in the short-term. CR corresponds to dogmatism. Dogmatic individuals resist change because of rigidity and a closed mindset.