T his paper uses case studies and survey data to explore the relationship between organizational culture and effectiveness. The results provide evidence for the existence of four cultural traits-involvement, consistency, adaptability, and mission-and indicate that these characteristics are positively related to perceptions of performance as well as to objective measures such as return on assets and sales growth. Organizational culture is found to be measurable and to be related to important organizational outcomes. AbstractThis paper develops a model of organizational culture and effectiveness based on four traits of organizational cultures; involvement, consistency, adaptability, and mission. These traits are examined through two linked studies: In the first, qualitative case studies of five firms are used to identify the traits and the nature of their linkage to effectiveness; In the second, a quantitative study provides an exploratory analysis of CEO perceptions of these four traits and their relation to subjective and objective measures of effectiveness in a sample of 764 organizations. The results show support for the predictive value of the traits, and help to illustrate the complementarity of qualitative and quantitative methods for studying organizational cultures.Two of the traits, involvement and adaptability, are indicators of flexibility, openness, and responsiveness, and were strong predictors of growth. The other two traits, consistency and mission, are indieators of integration, direction, and vision, and were better predictors of profitability. Each of the four traits were also significant predictors of other effectiveness criteria such as quality, employee satisfaction, and overall performance. The results also showed that the four traits were strong predictors of subjectively-rated effectiveness criteria for the total sample of firms, but were strong predictors of objective criteria such as return-on-assets and sales growth only for larger firms.This paper suggests that culture can be studied as an integral part of the adaptation process of organizations and that specific eulture traits may be useful predictors of performance and effectiveness. The paper also illustrates how qualitative case studies and inductive theory building can be combined with quantitative comparisons and theory-testing to make progress on specific aspects of organizational culture research. {Theory Building; Culture Effectiveness)

Despite the profound and pervasive importance of trust in medical settings, there is no commonly shared understanding of what trust means, and little is known about what difference trust actually makes, what factors affect trust, and how trust relates to other similar attitudes and behaviors. To address this gap in understanding, the emerging theoretical, empirical, and public policy literature on trust in physicians and in medical institutions is reviewed and synthesized. Based on this review and additional research and analysis, a formal definition and conceptual model of trust is presented, with a review of the extent to which this model has been confirmed by empirical studies. This conceptual and empirical understanding has significance for ethics, law, and public policy.

Researchers have posited a variety of behaviors that will occur within organizations faced with crisis. The threat-rigidity effect hypothesizes that in response to crisis, communication complexity is reduced, power and influence become centralized, and concern for efficiency increases, leading to conservation of resources and greater behavioral rigidity in organizations (Staw, Sandelands, & Dutton, 1981). Pfeffer (1978: 54) has also posited that "centralization is a likely outcome of organizational threats and crises, which provides a rationale for legitimately reasserting claims to centralized control." Individuals may also underestimate the extent to which their own behavior contributes negatively to an organizational crisis, thus reducing their flexibility of response (Kiesler & Sproull, 1982). Recent empirical research on crises and crisis-related phenomena supports these hypotheses and arguments. D'Aveni (1989) found that in comparison to surviving firms, bankrupt firms suffer from greater centralization of authority and rigid adherence to existing strategies. Moreover, when faced with an external crisis, managers of failing firms pay more attention to input resources such as creditors or suppliers and internal factors such as top managers and employees than do managers of surviving firms (D'Aveni & MacMillan, 1990). Research on organizational decline and downsizing, often involving organizations facing crisis, also provides supporting evidence. Cameron and his colleagues found several negative outcomes of firms that are declining: decreasing levels of slack resources, morale, trust, upward communication, and innovation; and increasing levels of conflict, centralization, and

Existing scales to measure trust in physicians have differing content and limited testing. To improve on these measures, a detailed conceptual model was constructed and a large item pool (n = 78) was generated following a detailed conceptual model and expert review. After pilot testing, the best-performing items were validated with a random national sample (n = 959) and a regional sample of HMO members (n =1,199). Various psychometric tests produced a 10-item unidimensional scale consistent with most aspects of the conceptual model. Compared with previous scales, the Wake Forest physician trust scale has a somewhat improved combination of internal consistency, variability, and discriminability. The scale is more strongly correlated with satisfaction, desire to remain with a physician, willingness to recommend to friends, and not seeking second opinions; it is less correlated with insurer trust, membership in managed care, and choice of physician. Correlations are equivalent with lack of disputes, length of relationship, and number of visits [corrected].

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