Journal of Applied Research in Intellectual Disabilities 2003, 16, 279284

Investigating Organizational Culture: A Comparison of a `High'- and a `Low'-Performing Residential Unit for People with Intellectual Disabilities
Elizabeth Gillett and Biza Stenfert-Kroesey
y

Psychological Services, Coventry Primary Care Trust, Sage Ward, Gulson Hospital, Gulson Road, Coventry CV1 2HR, UK, School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK

Accepted for publication 25 June 2003

Background This pilot study investigates organizational culture in small community-based residential services for people with intellectual disabilities, one of the under-researched determinants of staff behaviour and performance. Staff performance is of primary importance in the provision of quality services. Materials and methods Two matched residential units were assessed using COMPASS: A Multi-Perspective Evaluation of Quality in Home Life, and identied as `high' and `low' performing. The organizational culture of the units was assessed using the Organizational Culture Inventory in order to investigate any associations.

Results The unit with better quality outcomes demonstrated a more positive organizational culture overall, with statistically signicant lower scores on three negatively inuential cultural styles, namely, oppositional, competitive and perfectionistic. Conclusions There may well be a meaningful relationship between organizational culture and quality outcomes, although the nature of this relationship is far from clear. The continuation of investigations into organizational culture is encouraged. Keywords: organizational culture, quality of life, residential services, staff performance

Introduction
When developing quality services for people with intellectual disabilities, staff performance has a primary role (e.g. Rice & Rosen 1991; Hatton & Emerson 1995). Hastings et al. (1995) developed a framework representing factors that determine the behaviour of staff and highlighted several under-researched variables, including `organizational culture', an area of interest in organizational research. Organizational culture has been dened as `how things are done around here'. It is what is typical of the organization, the habits, the prevailing attitudes, the grown up pattern of accepted and expected behaviour. Drennan (1992). Organizational culture has captured the attention of academics and practitioners in varying disciplines because of its potentially profound inuence on organizational
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performance. Some authors (e.g. Petty et al. 1995; Schein 1996) have described how culture can affect performance by inuencing managerial and workforce behaviour. Studies of organizational culture have focused mainly on business environments. However, a number of studies have applied it to clinical settings such as residential treatment centres for children (Sawyer & Woodlock 1995) and healthcare environments (Klingle et al. 1995). White et al. (2003) highlighted that certain organizational cultures can increase the users' vulnerability to abuse, whilst Hatton et al. (1997, 1999a,b) stated that organizational culture is an important feature of intellectual disability services as it is associated with staff outcomes such as work satisfaction, turnover and reported stress. They suggest that it can have an inuence in either buffering against or exacerbating the effects of stressful environmental factors. Hatton et al. (1997) reported that 30% of staff working in intellectual disability services self-report high levels of stress, and as several aspects of organizations

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inuence stress, it is important to understand these factors alongside aspects such as the characteristics of users. High levels of stress are implicated in poor staff performance (e.g. observed interactions; Rose et al. 1998) and other behaviours with negative consequences, such as absenteeism and turnover (Hatton et al. 1997). Clinical implications resulting from these behaviours include decreased quality of life (Felce 1996), reduced continuity of care and decreasing workforce skills and experience (Baumeister & Zaharia 1986). Quality of life is often proposed as the ultimate criterion for the assessment of service effectiveness (Perry & Felce 1995) and an important goal of services (e.g. Dagnan et al. 1996); therefore, a quality of life measure is a useful way of quantifying the overall outcome of staff's performance. Despite this common goal, studies have consistently shown substantial variation in quality within service models (e.g. Hatton et al. 1995) and that houses managed by the same organization vary in their ability to achieve specic levels of performance (Hewson & Walker 1992). Organizational culture may be a factor that helps explain some of these ndings. However, Hatton et al. (1999b) recognize that there is not an empirically established link between organizational culture and service quality as so little research has been undertaken in this area. This pilot study aims to explore associations between organizational culture and quality outcomes in community residential services for people with intellectual disabilities. Accordingly, this study investigates whether demographically comparable residential units with identied differences in users' quality of life differ on a measure of organizational culture. It was hypothesized that the residential unit with a higher quality of life for the users would have a signicantly more positive organizational culture.

These units were selected on the basis of similar structures, resourcing and demographics (see Table 1) with a clearly identied differential in the delivery of targeted goals of the service as measured by a quality of life instrument.

Measures COMPASS: a multi-perspective evaluation of quality in home life

COMPASS (Cragg & Look 1992) measures the extent to which the lifestyles of people with intellectual disabilities using residential services are consistent with the principles of normalization (Wolfensberger & Glenn 1975). The areas assessed are the `Five Accomplishments' (O'Brien & Lyle 1987), activity and competence, access to the community, making and maintaining relationships, dignity and status, and choice and decision making. It also encompasses individuality (Blunden et al. 1987). COMPASS has good inter-rater reliability, good internal reliability and an easily interpretable factor structure, with the scores converted into percentages of total possible score (Dagnan et al. 1994).

Organizational Cultural Inventory

The Organizational Cultural Inventory (OCI; Cooke & Lafferty 1989) presents 120 statements, which describe behaviours and `personal styles' that are implicitly required of members of organizations. The respondent reads each statement and indicates on a ve-point Likert scale the extent to which people at work are expected to behave in that way. The scores are plotted onto a circumplex that converts the raw scores into percentiles, and the culture is categorized into a constructive (C), passivedefensive (PD) or aggressive-defensive (AD) cultural style. Xenikou & Furnham (1996) compared the four most established measures of organizational culture (Rousseau 1990) and reported the OCI as the most internally reliable. Cooke & Szumal (1993) found it a reliable and valid tool for assessing organizational norms and expectations.

Method Design
This pilot cross-sectional study compared staff groups from two residential units with analogous resourcing, structures and demographics on a measure of organizational culture.

Procedure
Following an initial selection of residential units on the basis of an area manager's judgement of the `best' and the `worst' performing units in their area, a global COMPASS prole was completed for each unit to formally operationalize `high' and `low' performance. These global COMPASS proles were derived by completing section 1 (interviews with users and staff) separately for each of

Participants
The participants were the staff groups from two residential units (n 7 and 8, respectively), each comprising two community houses managed as one unit, in the same provincial town, operated by a voluntary organization.

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Table 1 Demographic information and COMPASS scores (as a percentage of possible total score) for the `high'-performing (A) and `low'performing (B) staff groups Staff group A (high) Number of houses in unit Total number of residents Number of residents with full-time supervisory needs Number of residents with semi-independent living skills Sex of residents Age of residents Total number of staff Number of senior staff Number of full-time/part-time staff Age of staff Average number of years working in unit Sex of staff Activity score (COMPASS) % Access score (COMPASS) % Relationships score (COMPASS) % Dignity score (COMPASS) % Choice score (COMPASS) % Individuality score (COMPASS) % 2 8 4 4 F4 M4 40 (mean) 11 (SD) 9 (n 7) 2 FT 3 PT 6 40 (mean) 8 (SD) 3 F6 M3 88 95 70 90 77 89 Staff group B (low) 2 7 4 3 F3 M4 49 (mean) 7 (SD) 9 (n 8) 2 FT 2 PT 7 42 (mean) 12 (SD) 4 F6 M3 63 81 39 56 41 58

the two houses within each unit. Section 2 (observations) and section 3 (subjective opinion of assessor) were then completed to cover both the houses within each unit. During individual meetings between the rst author and staff members, the OCI was introduced and completed per instructions. These meetings always occurred in a quiet and condential room with no interruptions. The individual OCI scores for staff within the same unit were combined to create a global prole by calculating the mean average.

It can be seen that there is a signicant difference (P < 0.01) in the AD cultural style, with staff group B (low performing) showing signicantly elevated levels of this undesirable style in comparison to staff group A (high performing). Furthermore, three of the four individual styles making up the AD cultural style also showed signicant differences in the same direction (P < 0.05), these being oppositional, competitive and perfectionistic. No further statistically signicant ndings emerged.

Results
The global prole OCI scores of staff groups A and B highlight that staff group A scores consistently better than staff group B, with higher (or equal) scores for each of the C styles, and lower scores for each of the PD and AD styles (see Table 2). In order to establish whether the two units' culture signicantly differed, MannWhitney U-tests compared the three OCI overall cultural styles along with the 12 individual style scores (see Table 2).

Discussion
These results suggest that two comparable residential units with differing service outcomes in terms of quality of life have shown signicant divergence in some aspects of organizational culture, that is, in the accepted and expected behaviours (Drennan 1992) in the workplace. Previous research suggests a range of factors impact quality of life, including: users' age (Jones et al. 1996); users' ability level (Perry & Felce 2003); service model (Hatton et al. 1995); unit size (Stancliffe 1997); operational policies, training oppor-

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Table 2 Means and signicance levels for staff groups A and B on the individual and overall cultural styles of the OCI Group A (high) Mean 153 35 33 44 42 91 21 27 26 18 76 19 20 14 22 Group B (low) Mean 138 35 30 36 34 117 29 34 33 22 101 23 27 18 30

Style Constructive () Achievement (11) Self actualizing (12) Humanistic encouraging (1) Affiliative (2) Passive-defensive () Approval (3) Conventional (4) Dependent (5) Avoidance (6) Aggressive-defensive () Oppositional (7) Power (8) Competitive (9) Perfectionistic (10)

P-value (one-tailed)

P < 0.05;

P < 0.01.

tunities and stafng levels (Fleming & Stenfert-Kroese 1990); and resources (Shah & Holmes 1987). However, the residential units in this study are very similar on all of these factors, as shown in Table 1, and are managed by the same area manager with similar budgets and targets. Therefore, the corresponding difference in organizational culture may help to explain the differences in the users' quality of life. The low-performing staff group B were found to have signicantly higher scores on the negatively inuential AD cultural style, and in three of the individual styles within this category, namely: oppositional (e.g. norms of confrontation and criticism); competitive (e.g. norms of win against others and compete rather than co-operate); and perfectionistic (e.g. norms of never making a mistake and setting unrealistically high goals). It is clear how elevated levels of these styles within a community home for people with intellectual disabilities could impact on quality outcomes and continuity of care for residential service users. The behavioural norms associated with these styles are in direct opposition to the principles of normalization and team working, which are perceived as being of paramount importance. These styles also reect a task rather than a person orientation, that is a primary concern for completion of tasks rather than of interpersonal relations and interactions (Cooke & Burack 1989). In addition to these directly related behavioural patterns impacting on clinical outcomes, AD styles are also negatively associated with positive organizational outcomes such as job satisfaction, employee well-being, role clarity

and motivation (Cooke & Hartmann 1989). In terms of well-being, staff stress is implicated as one of the many causal factors in absenteeism and turnover (Hatton et al. 1997), although no differences in turnover or absence gures were found between the two units in this study. Nevertheless, staff stress can be associated with poor performance in services for people with intellectual disabilities (e.g. Rose et al. 1998) and does vary within organizational boundaries and across sectors (Blumenthal et al. 1998). Because of the pilot nature of this study, several potential threats to validity were apparent, including minimal opportunities for statistical analyses of data and difculties accessing all of the staff employed by each unit. With regards to the choice of measures, COMPASS focuses on the extent to which users are leading socially valued roles without any reference to the person's preferences. This is opposed to Felce's (1997) model of quality of life that highlighted the importance of integrating objective and subjective indicators. A more recent review of quality of life (Hensel 2001) brings into question the validity of the concept because of its reliance on satisfaction as a subjective variable. She provides evidence that satisfaction is a stable psychological function over time and conditions, possibly related to disposition, which is maintained at a high level by a homeostatic or adaptive mechanism (e.g. Cummins 1995). It is suggested that quality of life measures should be abandoned as a means of judging services and therefore future larger scale research investigating organizational culture should consider the means by which they assess meaningful user outcomes.

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In terms of the use of the OCI, Klingle et al. (1995) suggested that as it does not address the users' perspective, its value as a generalizable measure of culture within clinical settings, particularly those serving the needs of full-time residents, is limited. In response, it has been stated that the OCI is not designed to measure user perceptions or outcomes, rather, it measures the operating culture of work organizations based on normative beliefs of organizational members; accordingly, the OCI is equally applicable to any workplace (Cooke, personal communication). Identifying alternative measures of organizational culture that include the user perspective may provide an interesting contrast for future research. The aim of this paper was to explore associations between organizational culture and quality outcomes in residential services for people with intellectual disabilities. Results suggest that there may well be a meaningful relationship, although the nature of this relationship is far from clear. These ndings support the continuation of investigations into organizational culture, with a focus on clinically as well as statistically signicant results, as a relatively small but constant difference may have a signicant impact in terms of service user and organizational outcomes. A comprehensive understanding of organizational factors alongside clinical ones will ultimately contribute to the design of an environment that will support both staff and users living optimum quality lifestyles.

Acknowledgements
We would like to thank all those that assisted with this project, especially the service users and staff of the two residential homes.

Correspondence
Any correspondence should be directed to Dr Elizabeth Gillett, Chartered Clinical Psychologist, Psychological Services, Coventry Primary Care Trust, Sage Ward, Gulson Hospital, Gulson Road, Coventry CV1 2HR, UK (Tel.: 44 24 76246270; fax: 44 24 76246269; e-mail: Liz.Gillett@ Coventrypct.nhs.uk).

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