The Practicability of Competing Value Framework as a Stride towards Public Service Delivery Improvement in the Health Sector.

• Author: Ojogiwa, Oluwaseun Temitope

1. Introduction

   Health defines the worth of a nation's human capital, labor force and is a critical factor for the growth and development of the economy (Bamidele and Okafor, 2021; Abimbola, 2020). The significance of healthcare in the economy cannot be overstated, as the nation's first wealth is its health. The growth and productivity of a nation are largely dependent on the health of the populace, which is measured by the health sector's performance. Therefore, the government must be willing to invest resources in the enhancement of the health sector (Abimbola, 2020). Quality issues in the healthcare sector have been raised in developed countries like the United Kingdom (UK) and the United States of America (USA) and have propelled the prioritization of quality improvement as a key policy subject (Davies, Nutley and Mannion, 2000). Prominently, the health sector in developing countries is commonly beset by glitches of poor access, poor financing, and poor maintenance among others. These challenges are considered as not mere weaknesses but a system-deficiency that affects service delivery and the general performance of the health sector. More so, the challenges are identified as barriers to the attainment of the United Nations (UN) health-related Sustainable Development Goals (SDGs) (Mbau and Gilson, 2018; Aregbeshola, 2019). Unfortunately, there are lags in the development and maintenance of the Nigerian health sector, which have resulted in the underperformance of the management of the sector. The sector has experienced abandonment, especially with regard to financial desertion and hoary health equipment that has crippled the progressive capabilities of the health system and the quality of services provided (Abimbola, 2020).

   From a discussion of the achievement of quality health care, organizational change is noted as a requirement to attain quality improvement in health care (Aregbeshola, 2019). However, the organizational change could be managed when the culture in which excellence can flourish is built. In essence, structural reorganization should be implemented alongside cultural change to transform the health system. Therefore, to achieve a strategic and successful transformation of the health sector, it is important to emphasize a cultural transformation promotable by the assessment of the nature and characteristics of the organization's culture to identify the attributes that support good performance and service delivery. In addition, there must be expectations from a proposed cultural change to confirm the prospect of improved performance in the health sector (Davies, Nutley and Mannion, 2000).

   According to Mbau and Gilson (2018), limited gains have been realized from several attempted reforms of the health sector and the focus has shifted to the intangible aspects of the organization that have a greater impact on the outcome of the sector. Hence, organizational culture is considered to have the potential of influencing how proposed reforms accomplished the intended outcome. Although literature has confirmed the influence of organizational culture on organizational performance, there are insufficient empirical data on the cultural diagnosis for the undertaking of a cultural transformation. Therefore, more empirical studies are required on the relationship between organizational culture and the improvement of the health system particularly in developing countries to unearth the understanding of the potential of organizational cultural diagnosis to influence a positive transformation in public sectors (Davies, Nutley and Mannion, 2000). Anning-Dorson, Christian and Nyamekye (2020) highlighted that excellent service delivery sprouts from an organization's culture as the alignment of the organization's service delivery orientation and its culture provides the strategic and essential tool for the development of its effectiveness.

   In view of the significance of the cultural assessment of an organization as an influence on the organizational transformation, this study aimed to assess the organizational culture of the Kwara State public health sector in Nigeria using the psychometric tool of the Organizational Culture Assessment Instrument (OCAI). The OCAI was employed to understand the current and preferred culture of the organization to leverage how change can be implemented successfully in order to achieve improved performance. This next section provides the delineation of the concept of organizational cultural change.

2. Theoretical framework

   2.1. The concept of organizational cultural change

   Reforms in the public sector are attempts to survive within the changing environment. While several public sector reforms and policy changes centered on accountability and transparency, employee performance have resulted in profuse failures (Wang et al., 2019). The failures have been blamed on the neglect of organizational culture, namely, the core values, ethics, mission, strategies and goals of the organization (Davies and Egbuchu, 2019). It is believed that an effective organizational change necessitates supported values, emotional intelligence and improved skills, among other things (Mierke and Williamson, 2017). Hence, the cultural assessment of an organization is not an option in recent unsettled times to evade organizational ineffectiveness and inefficiency. Moreover, a change motivated through the cultural perspective is held to guarantee anticipated results and fortify the sustainability of any proposed change (Alvesson and Sveningsson, 2015).

   Organizational culture is one of the most appropriate components of an organization, either public or private (Cera and Kusaku, 2020). The culture of an organization is insinuated to include the principles, assumptions, and approaches that influence its effective activities and business performance (Adekoya et al., 2019). Similarly, Schein (2010) describes culture as values, ways of thinking, unbiased and more noticeable parts of the organization. Organizational culture could improve an innovative strategy and simplify changes in an organization due to its attribute of shared values and purposes (Ahmady, Nikooravesh and Mehrpour, 2016). These definitions indicate that organizational culture has the capacity to reflect positively on the employees' attitude, perception, career satisfaction, ethical behavior, employee engagement, and work satisfaction, which all together when integrated would brace the organizational performance in the long term.

   Clearly, a thorough understanding of an organization's culture and its components is critical to achieving successful cultural transformation (Alvesson and Sveningsson, 2015). However, the implementation of desirable changes has been ineffective regardless of the efforts exerted in the process because the organizational culture is overlooked (Limwichitr, Broady-Preston and Ellis, 2015). Alvesson and Sveningsson (2015) affirmed the naive disregard of the potential value of organizational culture by ample literature on the subject matter. In addition, many organizations' cultures are merely catchphrases and unrealistic dreams without the profound insight into the itemized culture. This portrays the challenges involved in getting a grip on organizational culture. According to Janicijevic (2012), a good assessment and understanding of an organization's culture are capable of influencing the approach to initiate an applicable and effective change. Warrick, Milliman and Ferguson (2016) emphasized that culture influences the choice of change to be implemented in an organization and guides the management processes.

   From the foregoing discussions, the need for an organizational cultural assessment has been underscored with the acknowledgment of its benefits. In light of this, it is required for leaders to be cognizant of the organizational culture prior to effecting any change (Al-Haddad and Kotnour, 2015; Ojogiwa and Qwabe, 2021). Furthermore, diagnosing the culture of an organization could offer strategic interventions as prioritized (Slack and Singh, 2018). Besides, cultural change is considered the right strategy to realize a successful change and an effective performance in the public sector (Vargas and Negro, 2019). Therefore, the cultural analysis of an organization is proposed as a strategy for the management of an effective and sustainable change to survive in the contemporary world characterized by constant changes.

   Though the public sector is not much concerned about profit-making, several attempts had been made to improve its service delivery in the current changing world (Slack and Singh, 2018). The quality of the Nigerian healthcare system has been compromised through many challenges that have negatively affected service delivery (Muhammad, Abdulkareem and Chowdhury, 2017). Ojogiwa and Qwabe (2021) observed that efforts to tackle corruption have not appeared significant when the culture was not transformed. Organizational cultural change is a process of critically evaluating the culture of an organization; the process involves envisioning the organization's desired values and principles, implementing the ideal culture and reinforcing and sustaining the cultural changes within a period considered suitable by the organization (Intezari and McKenna, 2018). The next section highlights the framework of the study.

   2.2. The Competing Value Framework (CVF)

   This study is anchored on the Competing Value Framework (CVF), which was developed from the study of Quinn and Rohrbaugh (1981) to recognize the principles of effective organizations. The framework is validated based on empirical evidence as an extensively used framework for identifying and assessing the essential cultural dimensions of an organization (Cameron and Quinn, 2019). Four dominant organizational culture types were developed from the CVF on which the foundation of the OCAI is built (Sulkowski, 2014). They are Clan, Adhocracy, Hierarchy and Market...