Organisational culture and its influence on physicians’ consultation style in Hong Kong

Chronic diseases are considered to be a global health system challenge, contributing to 60% of all deaths worldwide in 2005. There is a recognised need for patients with chronic diseases to make regular medication decisions with their GPs as an essential part of consultations. A growing body of evidence from the UK, the United States and China has suggested a link between GPs’ involvement of patients and information sharing in treatment decisions and improved communication and clinical performance. Charles and colleagues (1999) proposed a continuum of consultation models with increasing patient engagement, the one-way GP-dominant “paternalistic” style, the two-way “shared decision-making” (SDM) style, and the one-way patient-dominant “informed” style. These models illustrate various levels of involvement and knowledge sharing between GPs and patients in the treatment decision-making process. Yet, there is a lack of evidence to determine how organisational culture drives different consultation styles and improves decisional communication in Asian countries. Therefore, this qualitative study explored GPs and primary care managers’ perceptions of organisational culture within public and private healthcare organisations in Hong Kong, and how these perceptions influence GPs’ consultation style during medication consultations with patients with chronic diseases. Themes were generated from in-depth individual interviews with fourteen GPs and five primary care managers, based on two analytical frameworks, the Hofstede cultural dimension theory (2001/2011) and Hofstede’s multi-focus model of organisational culture (1990). Four themes concerning national culture, organisational culture, the system-, practice- and individual factors, as well as the financing and service level initiatives to drive cultural changes, were identified as influencing GPs’ consultation styles. The study highlighted that an engaging management style and customer-focused and mandatory learning cultures within healthcare organisations promoted greater use of two-way consultation styles by GPs during the consultation. In contrast, the study also found that authoritative, profit-driven and voluntary learning cultures within healthcare organisations promoted more one-way consultation styles, such as the paternalistic or informed styles. Thus, this study contributes to a better understanding of the positive and negative influences of national and organisational cultures on GPs’ practice of SDM with patients in discussions of chronic disease management across public and private healthcare organisations in an Eastern Asian country. Further research on the national culture of health care financing and patients’ influences on consultation styles is needed before the association between organisational culture and consultation style can be comprehensively understood