The role of dominant culture type in aligning organizational performance with system-level goals

New Public Management theories and policies have pressured healthcare organizations toward structural, rather than cultural, changes to improve performance. However, in the pluralistic and complex settings of healthcare organizations, senior managers play a key role in setting the strategic direction and often lead organizations toward ambiguous and conflicting goals. From this view, senior management team culture might influence organizational performance. This study has two aims: to test whether and how senior management team culture influences performance and to investigate whether a specific culture type is most effective in fostering better organizational performance in a Beveridge-type health system. We assess senior management culture through the Competing Values Framework and use multivariate regression analysis to test the relationship between dominant culture type and two different measures of organizational performance: attractiveness and annual net income. In all, 529 senior managers from 59 healthcare organizations responded (53% response rate). The results show that dominant rational and hierarchical culture types are associated with better performance: the former is associated with higher attractiveness, and the latter, with better financial results. Enhancing a specific performance dimension might require a cultural change rather than a structural change. From this perspective, general directors and senior managers should be appointed according to the best match between the culture and the primary organizational goals. Organizations and policy makers should tactically use the training of top managers and leading health professionals to reinforce or shape leadership aptitudes consistent with an organizational culture that supports the expected performance.