Monash Health Urology
Unit
Culture Review
Date: March 2017
Prepared by:
Judy North
m. 0428 052 225 | e. xxxx.xxxxx@xxxxxxxxxxxxxxx.xxx.xx
w. www.northconsulting.com.au
COMMERCIAL IN CONFIDENCE
Culture Review
Monash Health Urology Unit
Contents
Definition of Terms and Concepts ........................................................................................................... 2
Understanding Organisational Culture ................................................................................................ 2
Introduction ............................................................................................................................................ 4
Scope of the Review ............................................................................................................................ 4
The Current Operating Context of the MHUU ..................................................................................... 4
Methodology ........................................................................................................................................... 6
Emerging Themes .................................................................................................................................... 7
Overview ............................................................................................................................................. 7
Dysfunctional Dynamics across the Sites ............................................................................................. 7
Absence of Clear Governance Structures ............................................................................................ 9
Engagement and Commitment of VMOs........................................................................................... 11
Reputation of the MHUU .................................................................................................................. 12
Closing remarks ..................................................................................................................................... 14
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Definition of Terms and Concepts
The Monash Health Urology Unit (MHUU) Culture Review focused on exploring the prevailing culture
within the unit. This section of the report discusses some of the fundamental constructs and
theoretical bases that underpin the analysis of the MHUU’s culture.
Understanding Organisational Culture
The term ‘organisational culture’ has several different interpretations and it is important for the
purpose of this review to clarify how we define culture within the context of the review scope. The
review team focused on exploring the key behaviours and assumptions that underpin the culture at
MHUU. The review identified the current operating context for MHUU and accordingly, highlighted
the effective and ineffective cultural trends that were found to be predominant.
A Shared Pattern of Assumptions & Behaviours
A commonly accepted definition of organisational culture is:
“A pattern of shared basic assumptions that the group has learned as it solved its
problems of external adaptation and internal integration, 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” (p. 494, Schein, 2007).
In other words, culture refers to ‘the way things are done’ or the way work gets done. It is human
nature to repeat what has worked in the past. However, as cultural patterns emerge through
historical contexts, gradually there may come a time when the same patterns of behaviours become
ineffective and ill-suited to meet changing situational demands. This creates ‘legacy issues’ where
culture is defined by what was effective as opposed to what currently is effective.
Dimensions of Culture: What Lies Beneath?
Culture is a complex and dynamic construct which involves a consideration of the
“…deep structure of
organisations, which is rooted in the values, beliefs, and assumptions held by organisational members” (Denison, 1996). Culture is often manifested through a range of dimensions including:
Observable behaviour patterns: language, customs, traditions
Groups norms: standards and values that are abided by (often unspoken or implied)
Espoused values: published, publicly announced values
Leadership behaviours: what leaders value, prioritise and recognise
Formal philosophy: mission, vision and purpose
Embedded skills
Habits of thinking, acting, paradigms
Shared knowledge for socialisation
Shared meanings of the group
Metaphors or symbols.
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Some of these are readily observable aspects of an organisation. But more often than not, they are
elements that are below the surface and visible only through deeper examination of issues. For this
reason, culture is often visualised as an iceberg, where the visible aspects are just a part of a
necessary deeper understanding.
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Emerging Themes
Overview
This section of the report summarises the emerging themes that were identified through our
consultations with staff across the MHUU both at Casey Hospital and Moorabbin Hospital. The current
culture across the unit was observed as being highly factionalised across several dimensions,
including:
The geographical locations – Moorabbin Hospital versus Casey Hospital1 (sites)
The different leadership and management styles of the two sites
The Visiting Medical Officers (VMOs) - private practitioners versus those who work primarily
within the public healthcare system
The different levels of professional maturity (senior versus junior VMOs)
The different specialisations across specialisations across the two sites (uro-oncology and
extracorporeal lithotripsy services)
The VMOs versus the trainees – including residents, registrars and fellows2
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