OC

The OC was assessed using CVF.15 CVF is one of the most frequently used methods to assess OC in health care and non-health care settings.10,16–18 “It was developed in response to the need for a broadly applicable model that would foster successful leadership, improve organizational effectiveness, and promote value creation.”15 It depicts the differences between OCs across two axes: structure and focus. The structure axis has two extremes: one emphasizes on flexibility, discretion, and dynamism and the other emphasizes on stability, order, and control. The focus axis also has two extremes: the first is internally orientated with a focus on integration, collaboration, and unity and the second extreme is externally orientated with a focus on differentiation and competition. The two axes classify the CVF into four quadrants (subcultures), namely clan/group, development, rational, and hierarchical culture.

Clan/group culture is described by high flexibility and internal focus. It emphasizes the values of cohesiveness, participation, collaboration, empowerment, human resources development, mentoring, and teamwork.

Developmental culture is described by high flexibility and external focus. This culture emphasizes mainly the adhocracy, creativity, risk taking, growth, and gaining new resources for the organization.

Rational culture is externally focused with an emphasis on control. This culture tends to focus on the values of competition, goal attainment, achievement, and productivity.

Hierarchical culture is internally focused with an emphasis on control. This culture focuses on the bureaucracy, uniformity, stability, predictability, internal efficiency, coordination, and strict rules and guidelines.

Generally, the organizations or subgroups within them are not characterized by one of these four cultures, but rather they have competing values, and therefore a less or more tendency toward one particular quadrant.15 The CVF questionnaire measures culture type through 20 items divided equally into five domains of OC, with four answer categories representing different archetypes. The five domains represent descriptions of clinic characteristics, leadership, cohesion, emphasis, and rewards. Within each domain, an ipsative scale is followed in which the respondents are asked to distribute 100 points “in rank order” between the four answer categories according to which answer best fits the current clinic. The mean score for each of the four cultural types was computed. The dominant culture type in both PHC-MoH and PHC-UNRWA was based on the highest average culture type score.