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When Staff Create the Organisational Culture

A Case Study in the Spanish Emergency Health Care System

Gonzalo Sánchez Gardey

Ingunn Hagen

Emergency units suffer from continuous overload because all types of users demand the service. The literature shows that in general, the percentage of non-urgent users varies from 20 per cent to 80 per cent, depending on the type of centre analysed, the research approach or the methodology. While some studies have analysed this phenomenon focusing on the users, the current research adopts a different perspective. In this article, we try to explain how the break-down in the emergency services affects the work that the staff do. Drawing on evidence obtained from a six-month ethnographic study in two Spanish public hospitals, we conclude that in this overloaded context, official definitions of emergencies and formal classification protocols are completely useless. Exploring the staff's perceptions about the users and the service itself we try to re-create the process by which the diverse health care workers informally re-define symbols, concepts and behaviour patterns, creating a specific internal culture that helps them cope with the complexity of the service and the excessive demand.

Journal of Health Management, Vol. 10, No. 2, 163-189 (2008)
DOI: 10.1177/097206340801000201


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