Date of Award

January 2025

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Erika Linnander

Second Advisor

Leslie Curry

Abstract

Organizational culture is increasingly recognized as a fundamental determinant of operational performance and clinical outcomes in healthcare, particularly within high-acuity settings such as Intensive Care Units (ICUs). Despite a growing body of international literature affirming this relationship, there is a paucity of context-specific evidence on the role of organizational culture within ICUs in Australia and Aotearoa, New Zealand. This absence has constrained the capacity of health systems in these regions to design and implement culture change interventions tailored to local realities. In response to this gap, this thesis offers a conceptual framework that maps domains of organizational culture hypothesized to drive ICU operational performance and clinical outcomes. The methodology comprised two phases: (1) a literature review to contextualize findings within broader organizational theories and frameworks and (2) a secondary analysis of Leading ICUs for Transformation (LIFT) program deliverables to examine how ICU teams conceptualize cultural issues affecting operational performance and clinical outcomes. We identified six overarching domains of ICU organizational culture: leadership and governance; team dynamics; cultural competence and inclusivity; change readiness and innovation; workforce well-being and job satisfaction; and provider training and accountability. These domains represent theoretically grounded categories that are hypothesized to shape operational performance and clinical outcomes. Importantly, they are not discrete, but dynamically interconnected, reflecting a systems-based conceptualization of cultural influence. This thesis advances both scholarly discourse and practical application by articulating a cohesive, empirical model for cultural transformation in ICUs. It holds relevance for healthcare leaders, policymakers, and implementation scientists seeking to design initiatives that are both evidence-based and tailored to the cultural context. By recognizing culture as a hypothesized catalyst for and a reflection of quality improvement, this research lays the groundwork for future efforts aimed at fostering high-performing intensive care teams.

Comments

This is an Open Access Thesis.

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