1Quality Improvement in Clinical Education Research Center, Education Developmental Center, Shiraz University of Medical Sciences, Iran
2Center for Educational Research in Medical Sciences, Iran University of Medical Sciences , Tehran, Iran
Background: Hospitals and health care centers, like any other organizations, have some common norms and beliefs known as organizational culture. Organizational culture plays key roles in organizations and have impressive impacts on nurses’ performances. This study aimed to investigate the relationship between organizational culture and education of nursing staff employed in educational hospitals based on Denison Model and DREEM. Methods: This study is a descriptive, analytical survey conducted in 2015. The Target population of the present consisted of educational hospital’s nurses and paramedics. 200 nurses and paramedics have been selected using a random systematic method. Using a standard questionnaire of Denison and Dream which were validated and reliable, data were gathered. To analyze data, SPSS software version 16and T-test, ANOVA, regression, were used. Results: DREEM organizational culture questionnaire consisted of four dimensions. Percentage adjustment accounted for dimensions of organizational culture; mission (78.9%), later involvement (13.2%) and adaptability (4%) are as mentioned. Finally, the dimensions of organizational culture have managed to 96.1% of educational environment which demonstrated a significant positive correlation between these two variables (P <0.01). Conclusions: The organizational culture of S-Faghihi hospital (one of the educational hospitals affiliated to Shiraz University of Medical Sciences) showed a better situation than a Namazee Educational Hospital. Organizational culture as a decisive excellence factor in hospitals’ teaching improved the educational environment and ultimately improved student learning and educational consequences such as productivity and health of the patient.
The organizational culture as a collection of shared values and rules affects the behavior and thoughts of members working at organizations which can be considered as a starting point for mobility or an obstacle to organizational advance. The organizational culture is one of the fundamental aspects of the organizational culture changes in organizations (1). The Denison model based on scientific theories and findings was used to investigate the organizational culture in the teaching hospitals. This model was presented in 2000 by Prof (2). Denison consisting four dimensions of job involvement, consistency, adaptability and mission. Each dimension has an indicator that job involvement is measured by three indicators of Empowering, Team-building, Developing capabilities as an exception (3).
_ Compatibility: Results derived from review of articles highlight that the most effective organizations were stable, integrated and the employees’ behavior were derived from fundamental values. This compatibility is checked by three indicators: Fundamental values, Agreement, Coordination and Integration (4).
_ Adaptability: It seems to be difficult to make changes in organizations where are well integrated. This feature is examined by three indicators: Creating Change, Customer orientation, Organizational Learning (5,6).
_ Mission: It probably could be stated that the most important feature in organizational culture is a mission which is measured by three indicators: Orientation and strategic direction, Aims and objectives, Outlook (7).
Zhang. et.al (2015) assessed the connection between culture and organizational performance in six government agencies and came to the conclusion that this relationship is highly dependent on internal process, stable financial performance, and adaptability to the improvement in learning and organizational missions with client agents (8).
In a study conducted by Saadati et.al (2015) under the goal of assessing organizational culture (in hospital) based on the pattern of Denison on 194 staff of hospitals in Mashhad and Nishabur with at least 2 years of work experience, concluded that the dominant culture of these hospitals is based on missions. In order to improve their organizational culture, it was recommended that hospital managers do effort to reach the collaborative culture.
One of the other related concepts of the organizational culture is the atmosphere in where corporation occurred. The atmosphere is a mental tool to understand the dynamics of an organization. Atmosphere or organizational environment measures the amount of meeting the demands of people in the organization (9). One of the measuring quantification patterns of the training environment was offered by Rough in 1997at the University of Dundee in Scotland, named DREEM which is used to diagnose curriculum problems and the effectiveness of the change in education and compare the real environment with the desirable one (10).
The educational atmosphere questionnaire (DREEM) consists of five areas:
Perception of students from learning, perceptions of students from teachers, students' perceptions of their academic ability, perception of students of the educational atmosphere and students’ understanding of social conditions of education (11).
Educational institutions use different tools to assess their activities. In this study, the perspective of nurses working at… University of Medical Sciences was assessed by using DREEM pattern as a diagnostic tool (12). Pim Paryon et.al (2011), conducted the study to evaluate nurses’ opinions in the educational environment and its relationship to academic achievement where the appropriate educational atmosphere has been reported using DREEM (13).
Snag et.al (2011) has done a cross-sectional analytic study at Golestan University of Medical Sciences with 148 medical students based on DREEM; it was demonstrated that the majority of students considered the educational atmosphere of the university was suitable. Male students had a more positive viewpoint in comparison with the female students, respectively (14).
One of the health policies is improving staff training to enhance the quality of health care and treatment. By right training, motivating and investment in human resources, good productivity can be achieved in the short period of time by employees (15). Due to the importance of organizational culture and employee training goals which are considered as the parts of Denison objectives in organizational culture, it is necessary to pay attention to the relationship between organizational culture and educational culture (16). Although the components of organizational culture and educational atmosphere in Iran have been studied in different organizations, there are limitations in health area. This study aimed to investigate the relationship between organizational culture and education of nurses in selected hospitals affiliated to Shiraz University of Medical Science.
This was a descriptive study conducted in 2014. The study environment was consisted of teaching hospitals at Shiraz University of Medical Sciences (Namazee and S-Faghihi Hospitals).
The target population of the study consisted of work teams through which 2200 samples were selected and divided into four groups of nursing, anesthesia, operating room and laboratory science and based on systematic random sampling.
In this study, 700 hospital nurses from S- Faghihi Hospital in collaboration with hospital officials and 1500 were selected from Namazee hospital.
The data were collected by standard questionnaires of “Denison organizational culture” and standard questionnaire of “educational atmosphere, DREEM”. DREEM questionnaire has two sections. The first section includes the demographic questions and the second section includes 43 questions related to nurses’ perception and expectations of teaching and learning environment of the teaching hospitals.
The maximum questions of teaching and learning in the DREEM environment questionnaire was 200 questions which scores range was different. Scores from zero to 50 means very poor, score range of 51 to 100 shows that the environment has a problem (bad) and a more positive attitude was defined by the score range of 101 to 150 and the score range of 15 to 200 means that the environment is excellent. Eight items of the questionnaire were negative options which were coded inversely.
A denison organizational culture questionnaire has 34questions and its goal is to assess the organizational culture of the hospital.
After approval of the proposal by Vice Chancellor for Research of University of Medical Sciences, and asking for permission from the authorities of the security units of Namazee and S-Faghihi Hospitals, the early stages of the implementation of the study were done. The nurses’ thoughts and comments about organizational culture and educational atmosphere after completing five 2-hour sessions of accreditation classes were collected through a questionnaire. At the beginning of the training program researcher explained the objectives of the research and the need to recruit participants in such a study. Validity of instruments is approved by expert in medical education and, Reliability of the data collection tool was approved by Cronbach's alpha coefficient data was obtained as 0.88 for Denison organizational culture and 0.91 for DREEM questionnaire .
The participated nurses in the study were assured that the questionnaires remain anonymous and all gathered information would be confidential. In general, type of factor analysis of this study is approved and according to the dimensions defined in the organizational culture, structure, the number of factors has been considered the same as each factor and component.
Data were analyzed by software SPSS.V.16. In descriptive statistic section, the characteristics of the participants and at the inferential statistics, the averages of each variable were calculated and compared using ANOVA, T-test, Regression.
This study aimed to investigate the relationship between organizational culture and educational atmosphere from the view points of the nurses working at two educational hospitals (S-Faghihi and Namazee).
According to the results derived from the study mean age of respondents was 48/31. The frequency distribution by gender was that 18.1 percent of respondents were male and 9/81 percent was women.
About the distribution of respondents based on employment status, study results indicate that 31.7 percent of respondents were formally employed, 1.26 percent of them were treaty, 6.27 and 6.14 percent of the employees worked by contracts. The variable frequency distribution of participants according to their occupational history of nursing prayers and Faghihi , results showed on 2.64 percent of respondents with a history of ten years , 7.21 percent and 1.12 percent between ten to twenty years more than twenty years had a history of occupational exposure.
In examining the hypothesis, Using linear regression analysis and command Step-Wise dimensions of organizational culture as independent variables and the dependent variable in the equation were as Educational Environment. Table 1 using a stepwise multiple regression equation to explain the dependent variable (Educational Environment) review. All aspects of organizational culture as independent variables were entered into the equation R2 values for each variable of one to four steps are:0.961,0.961,0.921,0.789. These values indicate that the input of each of the variables in this equation is how much each of the four stages have been added to the R2. As can be seen from these variables. Through them , 96.1 percent of the dependent variable to explain the educational environment.
Table 1: stepwise multiple regression equation to explain the dependent variable
Added value to R2
Participate in the
According to the Beta values (Table 2) and the level of significance is obvious that all variables entered into the regression, the dependent variable is a positive and significant correlation. T test shows that the beta coefficients for the variables, at least 95 % significance level.
Table 2: The variables of the equation for the relationship between organizational culture and education
Significant levels T
Participate in the
The second research question was based on whether the male and female nurses there are significant differences in organizational culture? Due to the significant level can be stated 0.218 of the organizational culture there is no significant difference between male and female nurses (Table 3).
Table 3: The results of T test to compare the organizational culture By gender Nurses
Number of samples
Degrees of Freedom
The research questions of this study was Is the organizational culture of nursing between prayer and Faghihi there is a significant difference ?
According to t -test was found The average score Hospital nurses S-F… (X =3.61 ) and hospital nurse prayer (X =3.43 ) that a significant level (P=0.002) . It can be stated between the organizational culture of nursing S-Faghihi prayer and there is a significant difference (Table 4).
Table 4: The results of T test to compare the organizational cultureIn terms of hospital service
Number of Samples
Degrees of freedom
The research questions of this study did atmosphere between nurse education there are significant differences in terms of their academic status? Referring to the results of this table can be stated that significant differences exist between the atmosphere, nursing education in terms of educational status (Table 5).
Table 5: Descriptive statistics atmosphere of nurses In terms of educational status
Table 6: ANOVA to evaluate differences in the educational environment of nursesAccording to their academic status
Sum of squares
Degrees of freedom
The results demonstrate that the most important dimension of organizational culture (participating in the work, consistency, adaptability and mission) are appropriate forecast for the variable of educational environment criterion. According to the results, it was shown that all variables assessed by regression had a positive correlation with the dependent variable. In the teaching hospitals of Shiraz University of Medical Sciences, the dimension of participating in the work has the highest score, and the dimensions of the mission and flexibility and adaptability had the lowest points, respectively in order to predict the educational atmosphere of S-Faghihi and Namazee hospitals. Organizational culture is the predictor of educational atmosphere with its positive and negative effects on the educational process. By improving the corporate culture, we can achieve the appropriate learning atmosphere to train different groups of Medical Sciences along with staff.
There have not been any researches conducted on the prediction of educational atmosphere by organizational culture in Iran, till now. But in the study of Barazandehet et.al in 2012, the stepwise regression analysis indicated that the dimensions of the educational environment predict the dimensions of the performance of the organization in the areas of management, vision and customer satisfaction. The results of this study emphasized that the promotion in corporate culture can improve a learning environment for students, interns and nurses and have focused on advancing the goals of clinical education programs.
Institutions where can benefit from the findings of this study are as follows:
Teaching hospitals of Shiraz University of Medical Sciences (to improve current quality)
Education Development Center
School of Management
The presence of nurses in both groups, was the limitation of the present study. In order to have a better collaboration, both questionnaires were distributed simultaneously. Another limitation of the study was the low number of training sessions due to interference with the working hours of nurses, could not be more meetings cooperation of the two questionnaires completed relatively weak, some nurses had other limitations.
Considering the results of this study, the following recommendations are provided: In order to improve the corporate culture in teaching hospitals, we can take measures such as: staff training, culturing in order to value the education, managers' efforts to promote the culture of the hospital to the corporate culture. What’s more, to promote the educational atmosphere in hospitals, measures such as improving interpersonal and inter-organizational relationships, respect for the rights of the staff and students, optimization of services, efforts to address educational deficiencies, and proper training of staff can be done.
This study shows that there is a significant and positive relationship between the organizational culture and educational atmosphere and the educational atmosphere can be predicted by the organizational culture. So, teaching and learning in university hospitals can be improved by the advancement of corporate culture.
The present study assessed the small group of nurses and paramedics, so it is recommended that another study considering a larger group at educational hospital would be performed. Also authors would like to encourage other willing researchers to assess the relationship between educational context, organizational culture and job commitment to see whether they influence each other or not.
The researchers would like to thank all research participants of medical sciences university's (nurses) who have contributed to the study. The authors would also like to thank the education development center of Shiraz University of Medical Sciences for cooperation in this study.
Research committee approval and financial support:
The present article was extracted from the thesis written by Samira Sheibanian and was financially supported by Shiraz University of Medical Sciences (Grant No. 93 - 6746).
Conflict of interest: The authors declared no conflict of interest.
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