ORGANIZATION CULTURE IN FORTIS HEALTH CARE

QUESTION

ORGANISATIONAL CULTURE IN HEALTHCARE ORGANISATION IN INDIA.

these are the comments my prof. gave me so please make sure u edit accordingly and with precision

1)     Requirements. If you are preparing the text for the journal, you need to follow their manuscript preparation requirements very precisely.

2)     Summary. It should have a conclusion. The short one (2-3 sentences) but it should be.

3)     Introduction. The first paragraph of your introduction should be moved to the end of introduction chapter. Your Introduction should start with motivating/explaining the importance of organizational culture. Why it is important? Why editor should accept your paper? Why anyone should be interested to read it. My recommendation would be – to divide your introduction in two parts. The first will be one page introduction, in which you will describe the importance of it, role etc. Look to similar papers for examples of introduction. Also you can read one of mine‘s paper and you will see what I mean (see attached file). The second you can call „defining organizational culture“and put all definitions classifications etc in it. The last chapter starting „Healthcare Sector is one of the fastest growing sectors in India. Privatization of the sector has resulted in private sector owning 80%“ is a little bit „out of context“. I am not saying that it is bad. However, it is not clearly related with your previous paragraph. The paragraph about definition and classification of organizational culture is good.

4)     Chapters Constituents and Structure of Organizational Culture in Healthcare Organizations in India, Government Healthcare Organizations, and Private Healthcare Organizations are written based on one reference. Moreover, these chapters have statements, which are not grounded with any studies or references. Based on what you are saying, „Physicians are more empowered than the nurses to suggest any changes in the management processes. These healthcare organizations are highly competitive as they are run with profit-motives. Hence, higher emphasis is given on masculine cultural dimensions like competitiveness and assertiveness“? I am not saying that it is not true, but this sentence is very ambitious and (as you are writing paper) we have to be very careful with such statements. All your paper is full of statements, which are not based on literature.

5)     Chapter „Impact of Organizational Culture on Performance of Healthcare Organizations in India“. The title of your chapter argues, that you will discuss about organizational culture in India. However, you are presenting studies / works from US and other parts of the world. It is not OK, if your title conflicts with the text. So either you change your title, or you discuss only about studies from India.

6)     Chapter „Role of Leadership in Managing Organizational Culture in Health Care Organizations“. I would say, you should discuss more in this issue.

7)     Chapter „Study of a Healthcare Organization in India: Fortis Health Care“. Normally we are not allowed to rewrite results from other studies. I mean, that you allocate one chapter (1.5 pages) for presenting the results from one study. It is not common practice.

8)     Conclusions are ok.

 SOLUTION

Organizational Culture inHealthcare Organizations in India

Abstract

This research is a literature review of existing empirical studies to find the relationship between organizational culture and performance of healthcare organizations in India. The objectives of this paper are to understand a) the constituents and structure of Organizational culture in the healthcare organizations in India b) examine the impact of Organizational culture on performance of healthcare organizations in India and c) the role of leadership in managing Organizational culture. Organizational Culture refers to the system of shared values, beliefs and behaviors considered valid by the members of the organization. Organizational Culture of Healthcare Organizations can be best understood by looking at their vision and mission statements, organizational structure, and performance management and reward systems. Hofstede’s four cultural dimensions are used for understanding the cultures existing in Government and Private sector hospitals in India. The second part of the research focuses on understanding the impact of organizational culture on organizational performance. It is found that culture influences work-attitudes of employees. Job-satisfaction, productivity and efficiency are positively correlated to organizational culture. The third part of the research focuses on role of leadership in the management of organizational culture, Study of literature shows that an organization’s culture can be developed and transformed through effective leadership strategies. Leadership influences work-attitudes of employees. The paper concludes with the study of Fortis Healthcare’s organizational culture and its impact on Fortis’s performance.

Key words: Organizational Culture, Organizational Structure, Healthcare Organizations, Healthcare Performance, Leadership.

Introduction

The paper on ‘Organizational Culture of Healthcare Organizations in India’ is a literature review of existing empirical studies to find the relationship between organizational culture and performance of healthcare organizations in India. The objectives of this paper are to understand a) the constituents and structure of Organizational culture in the healthcare organizations in India b) examine the impact of Organizational culture on performance of healthcare organizations in India and c) the role of leadership in managing Organizational culture. This has been accomplished through a comprehensive study of existing literature and surveying various healthcare organizations operating in India.

Culture is an integral part of human lives, and manifests in different forms such as national culture, regional culture, organizational culture, department culture and so on. Emile Durkheim, often described as the classical social theorist of culture ^I, defined culture as an emergent web of representations which embodied the values, beliefs and symbolic systems of a natural collectivity ^II.According to Durkheim, culture is a manifestation of social bindings and human beings’ collective efforts to deal with the complexities and uncertainties of life ^II.It can be further described as a system of shared values, beliefs and behaviors considered valid by the members of the organization and taught to the newer members in the organization as the correct way to think, feel and behave ^III.

Edgar Schein divides organizational culture into three levels: Artifacts, Espoused Values and Basic Underlying Assumptions ^III. In other words, Culture is manifested in the form of artifacts, mindset and behavior. The various artifacts through which an organizational culture can be observed are mission and vision statements of the organization, logo, dress code, arrangement of furniture, language used, work-hour flexibility, reward structure, performance evaluation processes and so on. Sometimes, stories about the history of the organization are passed on through generations of employees and are a source of great pride for the organization. Norms followed in an organization give an idea about its culture too. Specific rituals and ceremonies distinguish cultures of different organizations.

Hofstede’s analysis of national cultures can be applied to organization culture as well. Accordingly, there are four dimensions of culture: power-distance, uncertainty avoidance, individualism versus collectivism and masculinity versus femininity^IV. Power distance refers to the degree of equality in the organization as perceived by an employee lower in the hierarchy. Higher power distance indicates that inequalities exist between different classes of employees. Uncertainty avoidance describes the level of acceptance for uncertainty and ambiguity within the organization. The dimension of individualism/collectivism denotes the degree to which the organization emphasizes on individual/collective achievement. Masculinity versus femininity denotes which are the predominant values of the system. While masculine organizational cultures are denoted by competitive and assertive value systems, feminine organizational cultures have focus on relationships and quality of life. The Hofstede’s model of cultural dimensions will be used in the subsequent sections to understand the organizational culture of healthcare organizations in India and abroad.

The role of culture is important in assessing an organization’s performance. Culture generates a commitment to something larger than the individual self-interest. Employee performance attributes like productivity, job satisfaction and motivation have been found to be positively correlated to organizational culture^V. Organizational culture has impact on various aspects of the Organization including strategy, management practices, employee behavior, organizational structure, policies, processes and procedures.Organizational culture has been classified as two types: strong and weak culture. Although, a strong culture shows tremendous unity at the workplace, and commitment to the principles of the organization, strong cultures have been shown to be associated with high inertia to change. Strong culture may lead to failure of the organization if the employees stick to their existing beliefs and methodologies at the face of change. But organizations with strong culture also see high levels of commitment from employees and low employee turnover.

Understanding the organizational culture and evaluating its impact on the organization are crucial for the management to improve the performance outcomes of the organization, along with helping them to decide strategies for the future.

Healthcare Sector is one of the fastest growing sectors in India. Privatization of the sector has resulted in private sector owning 80% of the healthcare market in India^VI. With many super-specialty hospitals in operation, affordable costs of treatment and a vast base of experienced and skilled doctors, Indian Healthcare sector has developed a lot in the last few years. Medical Tourism in India is at present a million dollar business. Overseas patients come to India because of the low costs of treatment (treatment costs in India are approximately 30-70% lower than that of US) and availability of skilled doctors^VI. While the private hospitals are mostly a part of the urban India, Government provides healthcare services throughout the country extending from the national level to the village level. Effort has been made in this paper to understand and capture the Organizational cultures of both private sector and Government hospitals, and analyze how it impacts their performance.

Constituents and Structure of Organizational Culture in Healthcare Organizations in India

Organizational Culture of Healthcare Organizations can be best understood by looking at their vision and mission statements, organizational structure, their leadership and management styles, and performance management and reward systems.Hofstede’s cultural dimensions^IV can prove useful for analyzing the Organizational Culture of Healthcare institutions. The Organizational Culture also depends on the psychological aspects of the work of hospital employees, like emotional and physical stress, type of patients, social support system etc. The culture is different for the private sector and Government organizations due to different organizational structures, different goals and different management styles. Organizational Culture components and structure for both the private sector and Government healthcare organizations are described below. The discussion on organizational culture of Government and private sector healthcare organizations are based on study through visits to these hospitals and observing the day-to-day functioning.

Government Healthcare Organizations

The healthcare services provided by the Government extend from national level to village level. At the central level there is the Union Ministry of Health and Family Welfare, followed by various state level, regional level, and district level and community level healthcare centers^VII.

The Government Healthcare Organizations are run with a no-profit motive. These organizations are characterized by a hierarchical structure. The employees have job security, along with benefits like accommodation facilities. Moreover, the Government healthcare organizations generally have pay-for-experience compensation systems. The performance measurement systems use traditional methods, mostly assessment by the immediate supervisor.

Using Hofstede’s cultural dimensions ^IV the culture of Government Healthcare Organizations can be easily described. Government healthcare employees perceive the existence of the large power gaps between the superiors and subordinates. Thus, the culture is more segmented than unified in terms of power. Government healthcare employees are more set in their ways, with low levels of change-acceptance and change-management. Thus, this culture scores low on the uncertainty avoidance dimension. Government healthcare organizations have more feminine characteristics with low-importance on competitiveness and high-importance on personal attributes. The absence of pay-for-performance reward structures promotes a collectivist work culture in these organizations.

Private Healthcare Organizations

Private Healthcare Organizations run with a profit-motive. These organizations are characterized by higher efficiency systems and processes, use of modern technology and systems for operations, and competitiveness. The Organizational Structure commonly found in the private healthcare organizations is hierarchical. Employees are performance driven. Most of these organizations have high treatment costs as compared to Government healthcare organizations. Accordingly, they aim to provide better services through state-of-the art infrastructure, better food facilities, more personal care through higher value of nurse-patient ratio etc.

The organizational culture varies with different private organizations. However, some common characteristics do exist, which can be explained through Hofstede’s cultural dimensions ^IV.There is existence of power-gaps in the organization, with the management and leadership essentially in control of decision taking and change management processes. Physicians are more empowered than the nurses to suggest any changes in the management processes. These healthcare organizations are highly competitive as they are run with profit-motives. Hence, higher emphasis is given on masculine cultural dimensions like competitiveness and assertiveness. Pay-for-performance reward structures encourage individualistic culture rather than collectivist culture. The management’s focus is on sustaining in the competitive healthcare industry, and hence, they frequently change strategies. The employees, thus, are more open to changes and are adaptable. Thus, there exists a culture of lower uncertainty avoidance.

Some Common Cultural Characteristics of Healthcare Organizations

Healthcare Organizations in general have a demanding work environment. The nurses and physicians, in particular, have a hectic job-life, with a weak social-support system in the hospitals. Many a times, high emotional turmoil is faced by nurses and physicians involved with patients nearing their ends. Physicians and nurses working in surgical departments and ICUs also deal with stress. Nurses, especially, face with stress of balancing work-home life. This stressful work environment requires for a social support system, which however is not well-developed in Indian Healthcare Organizations.

Physicians and nurses have been found to favor a culture of internal focus, stability and control ^VIII. Physicians and nurses also indicated that they had a low level of personal involvement in their organizations, with both of these groups perceiving the organizational structure to be hierarchical ^VIII. However, they have high preference for clan culture and least performance for hierarchical culture ^VIII. Moreover, nurses perceive the existence of high power-distance in the organization and believe they have less possibility to propose changes in management activities ^VIII.

Lack of flexibility at the job place is another challenge for the healthcare organizations. Maintaining a work-life balance is tough for the hospital staff with shift duties assigned to them.Female hospital staffs, including nurses and receptionists, have to manage night-time shifts, along with taking care of their family. This gives rise to the need for support at workplace and from the family. Many a times, the family of the female staffs are not supportive of their working night shifts. Turmoil at home with lack of a social support system at workplace does not provide a healthy work climate for the female employees of the hospital.

Jobs related to intensive-patient care have high attrition rates, especially in the private sector health care organizations. This problem is not limited to India only. Continence care in nursing homes is one such area which sees high attrition rates across the world^IX.

An example to show how the organizational culture of an organization can be identified by looking at the artifacts, and mindset and behavior of the employees of the organization is given below:

Apollo hospitals are one of the largest healthcare organizations operating in India and Asia, with their businesses ranging from hospitals to pharmacies and consultancies. This organization has total employee strength of 30,640. The Company’s vision statement is “to touch a billion lives” and its mission statement is “to bring healthcare standards within the reach of every individual…committed to the achievement and maintenance of excellence in education, research and healthcare for the benefit of humanity”.This vision and mission statement shows that the organizational culture of this organization is more leaned towards innovation and competition. The inclusion of education and research in its mission statement shows that Apollo hospital is promoting an innovative and knowledge-oriented work culture. The vision to touch billion lives basically indicates the management is emphasizing on being competitive. On analyzing the artifacts and business processes of Apollo Hospitals, it is found that most of the processes are computerized, again leading towards technology innovation- and competition-oriented organizational culture.The doctors and nurses are provided with customized training programs. This provides a sense of involvement to the doctors and nurses and encourages them to develop themselves, helping the organization build a culture focusing on education and innovation.

Impact of Organizational Culture on Performance of Healthcare Organizations in India

The notion that organizational culture has an impact on the performance of healthcare organizations is based on certain assumptions: a) healthcare organizations have identifiable cultures b) culture is related to performance c) culture can be modified to have an impact on performance and d) this alteration will provide a worthwhile return on investment ^X. It has been established in the previous section that healthcare organizations, be it Government or private sector, have cultures specific to their organizations. There is also evidence for the second assumption. Research in management areas has established that there exist links between culture and performance^{XI XII}. A wide range of studies in the area of culture and change have shown that organization culture is susceptible to change and changes in organizational culture may generate minor, major or dysfunctional effects on the organizational performance ^XIII.  These researches are mainly concentrated on the non-healthcare organizations. Russell Mannion and his companions have done extensive literature review to link these research results to healthcare organizations as well ^X. Thereby, it can be concluded that healthcare organizations have cultures, which can be impacted by procedural or structural changes, and thus affecting the performance of the organizations.

Organizational Culture of a health care organization has been shown to influence the performance of the organizations on many aspects: human resource management, service to patients, and economic performance ^XIV. Various success stories of achievement of organizational excellence by transforming organizational culture exist in the literature. One such story is that of Baptist Hospital in Florida. It started with the CEO of the hospital constructing a vision for the hospital to make it the best health care organization of America. Priority was changed to relationships between employees and patients ^XV. These changes enabled the hospital to become number one in patient service quality which has been acknowledged in different surveys and by the prestigious Baldrige Group.

Organizational Culture has been shown to impact job-satisfaction and motivation of employees ^V. A healthy organizational culture can work wonders on job-satisfaction of employees. This can be illustrated by the example of Griffin Hospital in Connecticut. This organization approached the problem of high attrition rate and lower employee motivation by bringing about a change in the organizational culture ^XVI. The leadership changed the hierarchical organizational structure to convert it into a caring culture. Nursing turnover decreased significantly and patient satisfaction increased.

Culture and Human Resource Management are interrelated. While human resource practices like recruitment styles, compensation and reward structures, performance management systems, and socialization events help in creation and maintenance of the culture of an organization, organizational culture also has impact on human resource practices like ensuring motivation and job-satisfaction among employees for better productivity, employee retention, creation of positive employment image for prospective employees and effective team-work systems.

Research pertaining to impact of organizational culture on performance of healthcare organizations in India is not well developed. However, there are similarities between the healthcare organizations’ cultures, and the basic assumptions remain the same. Hence, inferences from the research done on foreign healthcare organizations can be applied to the Indian Healthcare Organizations as well.

One such success story in the Indian healthcare scenario is that of Sri SatyaSai Hospital in Puttaparty, Andhra Pradesh. This health care organization is different from other health care organizations in many ways. Its unique culture arises from a caring culture, driven by the belief of ‘Seva’. World-renowned doctors come to serve in the hospital free of cost, just to get happiness from doing service to mankind. The quality of service of this organization is considered one of the best in the world, with free treatments given in super-specialty areas. The success of this organization in service quality and high involvement of doctors and nurses is an example of how organizational culture impact organizational performance.

Hierarchical organizational culture has been negatively associated with satisfaction with managerial decisions ^XVII.Research shows that organizational culture not only impacts work attitudes, but also has impact on organizational climate ^XVIII. Organizational Climate depicts global representation of one’s organization, and influences employee’s behavior and attitude at workplace ^XIX. It includes perceptions of employee regarding work environment and tasks. Constructive culture is required for positive organizational climate which will improve the work attitudes of employees for better performance of healthcare organizations. Some of the essential cultural characteristics that will have positive impact on the performance of the healthcare organizations are: people orientation, team orientation, and an open attitude towards change and innovation ^XX. However, transforming culture is not an easy task. Cultural change strategies may be targeted at first order or second order change ^XXI. Strategies covering structural, process and contextual dimensions are required for successful cultural transformation ^XXII.

Role of Leadership in Managing Organizational Culture in Health Care Organizations

An effective leader is one who leads the way towards the vision of the organization by ensuring employee involvement and satisfaction in the process. Health care environment calls for a supportive leader who is empathetic and responsive to the employees and preserves the power status within the hospital system ^V. Leadership can influence the organization climate, thereby influencing the workplace attitudes of the employees. Leadership behavior has been shown to be positively correlated with job satisfaction ^V.

Leaders need to be dynamic and far-sighted. In today’s dynamic and unpredictable world, leaders need to set direction, create motivation and commitment among employees, partners and stake holders, while continuing to provide high-quality patient care ^XXIII.  Healthcare Organizations of the present day world face as much challenges in their operations as do the banking organizations. Healthcare Organizations’ success depends on their ability to attract and retain highly-qualified and experienced doctors and nurses. Healthcare Organizations are affected by changing Government policies regarding safety and environment, rapid technological obsolescence of existing facilities and medical equipment, and competition from existing and new players in the market. This requires an effective leadership and management team in place to ensure the smooth-running of the organization. The various challenges faced by the employees of the healthcare organizations have to be handled by the leadership. Leaders in the healthcare industry need to be empathetic to the hospital staff. At the same time, the leadership needs to be aware of the changing rules of game of the industry. An efficient leader for a healthcare organization is one who can motivate the employees of the organization, provide them with a positive work environment, and lead the organization towards its vision.

Research shows that healthcare organizations are yet to develop themselves in the leadership arena. The key findings of a CCL study in the area of leadership in healthcare organizations are: a) top-priority for leadership development in healthcare sector is to enhance skills for leading teams b) provide current and future leaders with cross-organizational experiences and c) emphasize on qualities like adapting to change ^XXIII.

As said by Peter Drucker, “Management is about doing things right; whereas Leadership is doing the right things”. A poll held in 2003 showed that 90 of 180 healthcare executives believed that healthcare as a profession drives away potential leaders from the industry^XXIV.Moreover, it is being predicted that there will be a 15 percent drop in the leadership pool of the healthcare industry over the next few years ^XXIV. Thus, there is a need to develop leadership qualities among the executives of the healthcare industry, as well as attract leaders from outside the industry.

Leadership talent can be developed in healthcare organizations through five key steps ^XXIV:

a)Identification of key competencies for leadership b)effective job design c) giving priority on leadership recruitment, development and retention d) leadership training and development programs and e) continuous leadership assessment and performance management.

Some of the characteristics of highest performing leaders are: a strong character, strong technical knowledge, deep understanding of the industry, initiative-taking and driving for results, and strong at interpersonal skills. Character of a person is generally by birth. Leadership development programs should hence focus on building up the developable competencies like communication skills.

The leadership qualities can be developed through continuous leadership training and development programs. The success of these programs should also be assessed at regular intervals. Some of the expected direct results for the healthcare organization through the creation of effective leadership are excellent service, retention of employees, lower attrition and absenteeism, and increase in market share and revenues. Some other indirect measures for successful leadership are employee motivation and job satisfaction at the workplace. These success measures should be assessed continuously for measuring the effectiveness of the leadership development programs.

Study of a Healthcare Organization in India: Fortis Health Care

Fortis Healthcare Limited is one of the leading healthcare organizations in India. It currently operates 28 hospitals in the country with state-of-art facilities ^XXV. The vision of the company is “to create a world-class integrated healthcare delivery system in India, entailing the finest medical skills combined with compassionate care”. Fortis Healthcare has well-experienced doctors, nurses, technicians and management professionals as its employees.

The organizational culture of Fortis Healthcare can be analyzed through the human resource and management practices in the organization. The major goals of Fortis are to be world-class in quality and to be ahead of its competitors in terms of market share and innovations. Thus, the management strategies are competition-oriented, making the culture more competitive and open to change. The human resource policies are also in the same line. The compensation and rewards system is individual performance oriented. Compensation of physicians varies with seniority, reputation and specialty. Flexibility is another characteristic of this organization’s culture. Specialists work across the country depending on where their need arises. The organizational structure is hierarchical, with moderately decentralized decision making at operational levels.

The impact of Fortis’s culture on its performance can be examined through parameters like its market share, financial strengths, patient-service quality and employee turnover.

On the operational front, revenue in 2010-11 of the company was 1,483 crores of rupees, a growth of 58 per cent ^XXIV. Organic growth of the business was 28 percent ^XXVI. The market share of Fortis Group is expected to increase at a rate of 15-16% in the near future ^XXVI. The employee turnover rate has been constant over the years, with a turnover rate of 18% for employees below 30 years of age^XXVI.

The analysis of the culture and the performance parameters indicates that the organization culture is working well for the company. However, improvement needs to be done at human resources level to check the high turnover for the young employee base. Also, the company is yet to make a mark as exceptional quality service provider as mentioned in its vision statement. A closer look at the organizational culture will unlock the answers for the leadership as to how to lead the organization towards its vision.

Conclusion

The review of various literatures in the field of organizational culture and healthcare organizations resulted in understanding of organizational culture of the healthcare organizations in India. Similar to organizations in the corporate world, the healthcare organizations are also characterized by their cultures. The culture manifests in the form of artifacts, mindset and behavior. An organization’s culture can be understood by observing its organizational structure, human resource policies, and traditions at work place. Hofstede’s four cultural dimensions were used for understanding the cultures existing in Government and Private sector hospitals in India. The second part of the research focused on understanding the impact of organizational culture on organizational performance. It was found that culture influences work-attitudes of employees. Job-satisfaction, productivity and efficiency are positively correlated to organizational culture. An organization’s culture can be developed and transformed through effective leadership strategies. Leadership has been shown to influence work-attitudes of employees. Empathetic leadership is required in healthcare industry. With a deficiency in availability of effective leaders, and the rising challenge of outflowof leaders from the industry, leadership in healthcare organizations should be properly developed to ensure that the organizations are prepared to cope with the dynamic and competitive world.

References

1. Emirbayer, M. (1996) Useful Durkheim. Sociological Theory, 14: 109-130.
2. Durkheim, E. (1933) The Division of Labor in Society. Free Press.
3. Schein, E. H. (1985) Organizational Culture and Leadership. San Francisco: Jossey-Bass.
4. Hofstede, G. (1983) National Cultures in Four Dimensions A Research-Based Theory of Cultural Differences Among Nations. International Studies of Management & Organization, 13(1-2): 46-74.
5. Tsai, Y. (2011) Relationship between Organizational Culture, Leadership Behavior and Job Satisfaction. BMC Health Services Research, 11:98.
6.  Medical Tourism Corporation. Medical Tourism in India. Viewed on 21 May 2012 at http://www.medicaltourismco.com/india-hospitals/medical-tourism-india.php
7. Vaz, L. S.  ed. Bhalwar, R. Organization of Health Care in India. inTextbook of Public Health and Community Medicine. Department of Community Medicine (AFMC) and WHO
8. Savic, B. S. and Pagon, M. (2008) Relationship Between Nurses and Physicians in Terms of Organizational Culture: Who is Responsible for Subordination of Nurses?.Croat Med J., 49: 334-43.
9. Lyons, S. S. (2010) How Do People Make Continence Care Happen? An Analysis of Organizational Culture in Two Nursing Homes. The Gerontologist, 50(3): 327-339.
10. Mannion, R., Davies, H. T. O. and Marshall, M. N. (2005) Cultures for Performance in Health Care. Open University Press.
11. Ouchi, W. G. and Wilkins, A. L. (1985) Organizational Culture. Annual Review of Sociology, 11: 457-483.
12. Denison, D. R. (1990) Corporate Culture and Organizational Effectiveness. Wiley.
13. Hawkins, P. (1997) Organizational Culture: Sailing Between Evangelism and Complexity. Human Relations, 50(4): 417-440.
14. Kotter, J. and Heskett, J. (1992) Corporate Culture and Leadership. New York: The Free Press.
15. Reeder, L. (2002) Beyond Patient and Employee Satisfaction to Loyalty. Healthcare, Leadership and Management Report, 10(5): 1-9.
16. Freedman, D. H. (1999) Intensive Care. Inc, 21: 72-79.
17. Zazzali, J. L., Alexander, J. A., Shortell, S. M. and Burns, L. R. (2007) Organizational Culture and Physician Satisfaction with Dimensions of Group Practice. Health Serv Res, 42(3): 1150-1176.
18. Aarons, G. A. and Sawitzky, A. C. (2006) Organizational Climate Partially Mediates the Effect of Culture on Work Attitudes and Staff Turnover in Mental Health Services. Adm Policy Ment Health, 33(3): 289-301.
19. Pritchard RD, Karasick BW. (1973) The effects of organizational climate on managerial job performance and job satisfaction. Organizational Behavior & Human Decision Processes, 9(1):126–146
20. Davies, H. T. O., Nutley, S. M. and Mannion, R. (2000). Organizational Culture and Quality of Healthcare. Quality in Health Care, 9: 111-119.
21. Scott, T., Mannion, R., Davies, H. and Marshall, M. (2003) The Quantitative Assessment of Organizational Culture. Health Serv Res.
22. Scott, T., Mannion, R., Davies, H. and Marshall, M. (2003) Implementing Culture Change in Health Care: Theory and Practice. Int J Qual Health Care, 15(2): 111-118.
23. Center for Creative Leadership (2010) Addressing the Leadership Gap in Healthcare.
24. Wells, W. and Hejna, W.  (2009) Developing Leadership Talent in Healthcare Organizations: there are five key areas in which healthcare organizations can better foster the development of strong leaders among their employees.  Viewed on 21 May 2012 at http://findarticles.com/p/articles/mi_m3257/is_1_63/ai_n31297918/
25. Fortis Healthcare India. Viewed on 21 May 2012 at http://www.fortishealthcare.com/#
26. Fortis Healthcare Annual Report

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