Organizational Culture and Social Networks in a Regional Health Cooperative

Thesis Abstract

This study investigates how organizational culture and social networks shape service delivery, collaboration, and staff well-being within a regional health cooperative operating across rural and semi-urban communities. Persistent challenges in care continuity, inter-professional coordination, and member engagement motivate the inquiry, with particular attention to how shared values, norms, and network structures influence decision-making, information flow, and adaptive capacity in a resource-constrained setting. The aim is to illuminate the mechanisms linking culture and networks to organizational performance and stakeholder satisfaction, and to generate actionable insights for governance and practice. The specific objectives are (1) to map the formal and informal social networks among clinicians, administrators, and community representatives; (2) to characterize the cooperative’s dominant cultural traits and subcultures using a mixed-methods approach; (3) to assess the relationship between network centrality, tie strength, and perceived information quality; (4) to examine how cultural attributes moderate the effect of networks on service coordination and patient outcomes; and (5) to develop a parsimonious conceptual model linking culture, networks, and performance outcomes to guide organizational development. A sequential mixed-method design is employed. The quantitative phase uses a cross-sectional survey of 220 employees spanning clinical and non-clinical roles, complemented by 40 governance stakeholders, to elicit perceptions of organizational culture (using the Competing Values Framework), communication quality, and coordination outcomes. Social network data are gathered through egocentric and whole-network measures, producing metrics such as degree centrality, betweenness, closeness, density, multiplexity, and tie strength. The qualitative phase comprises 40 in-depth interviews with physicians, nurses, allied health professionals, managers, and patient-representatives, plus six focus groups with front-line staff, aimed at capturing culturally grounded interpretations of work practices and network dynamics. Instruments are validated through pilot testing and expert review, with reliability checks (Cronbach’s alpha for scales) and content validity indices. Data analysis integrates social network analysis (SNA) and multilevel modelling, followed by thematic analysis of interview and focus group transcripts. Specifically, structural hole analysis and exponential random graph models (ERGMs) assess network configurations in relation to coordination outcomes. Multilevel regression examines how cultural typologies (hub-and-spoke versus clan-oriented cultures) at the team and organizational levels interact with network features to predict care continuity, staff turnover, and patient satisfaction. Key expected findings include (1) distinct sub-networks around clinical pathways and governance bodies, with central actors disproportionately influencing information dissemination; (2) a predominance of collaborative and humanistic cultural values alongside task-focused constraints in high-performing teams; (3) stronger ties and higher multiplexity associated with improved perceived information quality and coordination, especially where culture endorses open communication and psychological safety; (4) cultural moderating effects wherein clan-like cultures amplify the positive impact of dense networks on patient satisfaction, while hierarchical cultures dampen network benefits. The study anticipates identifying thresholds in network density beyond which marginal gains in coordination plateau, contingent on cultural support for knowledge sharing. Contributions to knowledge include advancing empirical understanding of how organizational culture and social networks co-determine health-cooperative performance in a regional setting, integrating SNA with contemporary cultural theory (e.g., normative and cultural-cognitive dimensions from the Competing Values Framework) and practical implications for governance, human resources, and service design. The findings will inform targeted leadership development, network-aware change interventions, and culturally attuned strategies to strengthen patient-centered care across distributed sites. The study concludes that fostering a culture of psychological safety and shared values, coupled with strategically cultivated networks that connect clinicians, administrators, and community representatives, enhances coordination and patient outcomes in regional health cooperatives. Recommendations include implementing formal network-building activities (mentoring, cross-functional teams), leadership development programs that model collaborative norms, measurement systems to monitor network health and cultural indicators, and policy adjustments to sustain integrative practices across sites. Further research is recommended to test the proposed model longitudinally and to explore cross-cooperative comparisons under varying regulatory and resource conditions.