Developing a Framework for Understanding Organizational Culture in Healthcare Organizations from a Complex Adaptive Systems Perspective

Most conceptual models of organizations, including the dominant frameworks for understanding and assessing organizational culture, rely on a mechanistic view of organizational dynamics. Although popular, the mechanistic view is inherently simplistic and fails to address the complexity of contemporary organizations (Boan & Funderburk, 2003; Clancy, 2007; Clancy, 2007; McDaniel & Driebe, 2001; Plsek & Greenhalgh, 2001; Rowe & Hogarth, 2005; Seel, 2000, Seel, 2005). This research project attempted to provide a more comprehensive conceptual tool through developing and assessing a framework based on the key properties of the complex adaptive systems perspective. The new Complex Adaptive Systems – Organizational Culture (CAS-OC) Framework developed in this research was then assessed with relation to use in health care organizations. This framework was developed through a mixed methods research design consisting of three phases. Phase one involved a systematic scoping review of the organizational culture and complex adaptive systems literature. The review of the organizational culture literature resulted in identification and screening of 12,154 peer-reviewed articles and 1,660 grey literature documents. A total of 215 documents met the inclusion criteria and were reviewed resulting in identification of 14 definitions, 26 frameworks and 123 components of organizational culture. The review of the complex adaptive systems literature resulted in confirmation of the five key properties of complex adaptive systems discussed in the literature. Phase two involved a Delphi study conducted with international organizational culture experts. These experts identified 68 components of organizational culture. Based on their conceptual similarity, these components were combined into 17 factors of organizational culture. The results from phases one and two were added to the newly confirmed list of key properties of complex adaptive systems to inform development of the new CAS-OC Framework. Phase three was the assessment phase. The new CAS-OC Framework was presented to professionals in Alberta healthcare organizations for review and assessment as a potential tool. Their assessment confirmed the categories and components already incorporated in the framework and identified 10 additional components they wanted to see included in the framework. These additional components were examined and incorporated into the new framework if they were not already included. Overall, the assessment participants concluded that the framework was feasible, appropriate, meaningful and effective for use in healthcare organizations in Alberta, specifically Primary Care Networks in Alberta. This research contributed to the body of knowledge in four areas. First, this research examined organizational culture using a phased, mixed method approach. Second, this research confirmed the key properties of complex adaptive systems theory discussed in the complexity literature. Third, this research introduced a complex adaptive systems–based definition and framework for understanding organizational culture in Alberta health care organizations to the current body of knowledge. Finally, this research assessed the Feasibility, Appropriateness, Meaningfulness, and Effectiveness of the CAS-OC Framework from a usability perspective. The research concluded with recommendations for future research

Multiple Session Masked Priming: Individual differences in orthographic neighbourhood effects

Multiple Session Masked Priming was used to investigate differences between individuals in the fine-tuning of their lexical representations. The form-priming effects were determined separately for each of the 50 participants, from the patterning of masked priming effects over three neighbourhood (N) levels. At each N level, primes varied in their orthographic similarity to the target- Identity, One-Letter-Different and All-Letters-Different. An analysis of the pooled data showed patterns of masked priming consistent with other group studies, but considered separately, an array of individual differences in the tuning of lexical representations was observed. Inconsistent findings and conflicting evidence characterise much of the word recognition literature, and have lead to a plethora of theories on many aspects of word recognition. One explanation for the conflicting evidence regarding theories of word recognition, is the possibility that it reflects individual differences. The problem here lies in the fact that support for one model or another has generally been drawn from standard group studies, where outcomes are averaged over the sample of participants. Averaged outcomes may show what is generally true for that sample, but fail to capture the critical variations between individuals. In order to study individual differences a task must be found that will provide reliable data concerning the processing capacities of each participant. There are two issues here. First, the task used must reflect the automatic processes of lexical access, and second, the task must generate sufficient data on each participant to enable stable conclusions to be drawn about their individual performance; that is, we need to be able to generate reliable individual profiles of lexical processing. Although there is some debate (e.g. Bodner & Masson

A concurrent examination of neurocognitive and language impairments in schizophrenia thought disorder

Formal thought disorder (FTD) in schizophrenia has been associated with both cognitive and language impairments. However, there is still considerable debate regarding the degree to which each contributes to FTD. This study had two aims: (i) to examine which cognitive impairments are related to FTD and, (ii) to explore if FTD has any language-specific symptoms. 57 schizophrenia/schizoaffective patients and 48 healthy controls completed the MATRICS battery and D-KEFS Stroop task assessing general neurocognition and inhibition, as well as three language tasks assessing word identification (lexical recognition), synonym identification (lexical semantics) and sentence meanings (syntax). PANSS FTD ratings were used. Cognitive assessment results revealed FTD patients performed worse than non-FTD patients on measures of semantic and executive processing (p<.05), with both groups poorer than controls (p<.01). This supports indications of concurrent semantic and executive dysfunction, and suggests that a combination of both may relate to manifest FTD. Language assessment results revealed impairments in FTD compared to non-FTD patients and controls in the recognition of homophones (but not antonyms) and sentence comprehension (syntax). Lexical recognition of words (without semantic manipulation) was not impaired in schizophrenia patients generally compared to controls. This supports language processing impairments at both the single word and sentence levels in FTD. Significant correlations were observed between positive FTD symptoms and syntactic problems (p<.001). Stepwise regressions revealed that syntactic errors predicted 10% of the variance (p=.008) in positive TD severity, after controlling for semantic and executive deficits and lexical semantic processing. This provides evidence that a language-specific impairment of syntactic comprehension is present in schizophrenia, and exacerbated in FTD. Overall, this study supports current cognitive and language theories of impairment in FTD, with evidence for concurrence of executive, semantic and syntactic dysfunction

Characterising receptive language processing in schizophrenia using word and sentence tasks

Introduction. Language dysfunction is proposed to relate to the speech disturbances in schizophrenia, which are more commonly referred to as formal thought disorder (FTD). Presently, language production deficits in schizophrenia are better characterised than language comprehension difficulties. This study thus aimed to examine three aspects of language comprehension in schizophrenia: (1) the role of lexical processing, (2) meaning attribution for words and sentences, and (3) the relationship between comprehension and production. Methods. Fifty-seven schizophrenia/schizoaffective disorder patients and 48 healthy controls completed a clinical assessment and three language tasks assessing word recognition, synonym identification, and sentence comprehension. Poorer patient performance was expected on the latter two tasks. Results. Recognition of word form was not impaired in schizophrenia, indicating intact lexical processing. Whereas single-word synonym identification was not significantly impaired, there was a tendency to attribute word meanings based on phonological similarity with increasing FTD severity. Importantly, there was a significant sentence comprehension deficit for processing deep structure, which correlated with FTD severity. Conclusions. These findings established a receptive language deficit in schizophrenia at the syntactic level. There was also evidence for a relationship between some aspects of language comprehension and speech production/FTD. Apart from indicating language as another mechanism in FTD aetiology, the data also suggest that remediating language comprehension problems may be an avenue to pursue in alleviating FTD symptomatology