Along with the Alternative Culture and Advocacy Culture in health care, these two organizational cultures play a major role in determining how complexities (and other VUCA-Plus conditions) are interpreted and made meaningful (social complexity perspectives), while offering contradictory ideas and instituting polices and actions that make the system that much more complex (mathematical complexity perspective).
Together with turbulence, contradiction rages uncontrolled and often uncontrollable when these six cultures are fully in operation. While we will be devoted an entire set of essays to these six cultures, we provide a brief review of the way in which anxiety builds organizational culture and the way in which each of these cultures operates. This brief review provides a glimpse into how health care leadership is being challenged by the diverse perspectives and operations that attend each of these cultures.
Culture and Anxiety: Culture provides a container. It establishes roles, rules, attitudes, behaviors and practices. In terms of the illness experience it describes ways for people to begin feeling safer after they have experienced themselves as vulnerable, unsure or threatened. Many people, for instance, feel comfortable and comforted when they place themselves in the hands of a physician. The patient can depend on the physician’s allegiance to the Hippocratic oath and the pledge to do no harm. Culture places boundaries around the illness experience. It provides predictability.
Culture says that when you take on the sick role you are not alone. There are specific people to see. There are tests to be performed. There is assurance that you are a long way from dying. Culture provides meaning. In some parts of the world illness and injury are expected to be an opportunity for transcendence and personal growth. In North America and many other technologically dominated societies it is something to be endured and gotten past as soon as possible. We know that the illness or injury will soon pass or heal, because he has faith in medical technology. In all these ways, culture helps to manage anxiety.
Psychologists tell us that when we become anxious, we tend to regress to a more primitive state of mind and feeling. We become more like we were as children. In particular, we are likely to become dependent, and look forward to being taken care of by a person who in certain respects is superior to us. This anxiety and resulting dependency often serve us well. Our anxiety encourages us to seek help. It provides an incentive for us to turn to other people, to rely on their expertise or at least their caring attitude, and to recognize our own need for change.
Yet, anxiety is also a source of major problems regarding health care. Anxiety not only keeps people from addressing major health-related problems in their lives, this emotional state also contributes to the wounding of healers and blocks the fundamental changes required in our contemporary health care delivery systems. As we come to understand the nature and effect of anxiety in health care, we will begin to unravel many of the Gordian knots associated with our current health care crisis.
