A tripartite dynamic is created. As pain increases, anxiety also increases for both the patient and those attending the patient. Culture is then created which helps to reduce the anxiety and provide comfort or reassurance if it is successful. As Edgar Schein (1992) has noted, the culture of an organization is the residue of the organization’s success in confronting varying conditions in the world. To the extent that a health care organization is adaptive in responding to and reducing pervasive anxiety associated with pain, then the existing culture of this organization will deepen and become increasingly resistant to challenge or change.
The pain also impacts directly on the culture. While health care professionals are often reluctant to address the troubling issues associated with the meaning of pain, they must eventually confront these issues, even if this confrontation requires, as in the 1990s movie The Doctor, that they confront their own pain and mortality. At the same time, patients are trying to make sense of the pain and try to find meaning in the attendant suffering.
Together the professionals and patients create additional cultural artifacts. These artifacts include stories, rituals, symbols, language, dress, and decoration of physical space, as well the rights, privileges and responsibilities associated with certain culturally based roles in the organization. These artifacts give further meaning to the pain and suffering, and to the work of health care professionals. Artifacts often cluster and form powerful, coherent images. We call these images the archetypes of health care. These archetypes become particularly powerful and persuasive under conditions of anxiety and pain.
Organizational Anxiety and the Six Cultures of Health Care: Health care organizations must always address the anxiety associated with current or potential pain illness, and injury—and, more generally, the fear of dependency and death. Health care organizations are successful in part, and perhaps in large part, because they can reduce anxiety, or at least provide a context for understanding the meaning or purpose of the pain and anxiety that is experienced by patients, clients, citizens and people working in health care.
Organizations have created or embraced cultures that help them address the pain and anxiety that inevitably accompanies the provision of health care. We identify six primary cultures that currently exist in North American health care systems, as well as many other health care systems in our world. These cultures influence the ways in which we interpret the nature and purpose of health care, as well as the ways in which we confront, reduce or find meaning and purpose in the pain and attendant anxiety associated with health care.
