Original Research

How to change organisational culture: Action research in a South African public sector primary care facility

Robert Mash, Angela De Sa, Maria Christodoulou
African Journal of Primary Health Care & Family Medicine | Vol 8, No 1 | a1184 | DOI: https://doi.org/10.4102/phcfm.v8i1.1184 | © 2016 Robert Mash, Angela De Sa, Maria Christodoulou | This work is licensed under CC Attribution 4.0
Submitted: 18 March 2016 | Published: 31 August 2016

About the author(s)

Robert Mash, Division of Family Medicine and Primary Care, Stellenbosch University, South Africa
Angela De Sa, Division of Family Medicine, University of Cape Town and Western Cape Department of Health, District Health Services, South Africa
Maria Christodoulou, Division of Family Medicine and Primary Care, Stellenbosch University, South Africa


Background: Organisational culture is a key factor in both patient and staff experience of the healthcare services. Patient satisfaction, staff engagement and performance are related to this experience. The department of health in the Western Cape espouses a values-based culture characterised by caring, competence, accountability, integrity, responsiveness and respect. However, transformation of the existing culture is required to achieve this vision.
Aim: To explore how to transform the organisational culture in line with the desired values.
Setting: Retreat Community Health Centre, Cape Town, South Africa.
Methods: Participatory action research with the leadership engaged with action and reflection over a period of 18 months. Change in the organisational culture was measured at baseline and after 18 months by means of a cultural values assessment (CVA) survey. The three key leaders at the health centre also completed a 360-degree leadership values assessment (LVA) and had 6 months of coaching.
Results: Cultural entropy was reduced from 33 to 13% indicating significant transformation of organisational culture. The key driver of this transformation was change in the leadership style and functioning. Retreat health centre shifted from a culture that emphasised hierarchy, authority, command and control to one that established a greater sense of cohesion, shared vision, open communication, appreciation, respect, fairness and accountability.
Conclusion: Transformation of organisational culture was possible through a participatory process that focused on the leadership style, communication and building relationships by means of CVA and feedback, 360-degree LVA, feedback and coaching and action learning in a co-operative inquiry group.


organizational culture; organizational change; primary care; leadership; health services research


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