Introduction

Within healthcare organizations different functions are performed, which can have an impact on the behavior, attitudes, and performance of each of its members, as well as the level of care they provide that can be associated with the direct treatment and quality of care, as well as the interaction between colleagues and their relationship with multidisciplinary teams that will influence their behavior, attitudes, and perceptions that will generate a work environment, thus, forming and reinforcing the organizational culture, so that some authors comment that the structure of an organization is associated with the organizational performance of the institution ¹.

In other words, if workers in an organization do not clearly know the culture of their work organization, they are not aware of its relevance for the success of the institution ². Additionally, it also implies that workers assume responsibility and commitments to the adversities they face in their organizations and this is reflected in some characteristics where it implies an interaction between what is expected from the organization and what is generated internally, because the user seeks efficiency, quality, and dynamism in the processes of care, which in turn, is related to the functions and tasks assigned to the personnel, their involvement in openness to learning and their adaptation to changes, which can motivate them to be creative and encourage innovation in order to reach the objectives and goals of the institution ³.

Likewise, if an adequate culture is encouraged within the organization, it can significantly achieve the satisfaction of workers and users ⁴. In healthcare institutions, organizational culture is a reference for the quality of the care services provided. The mission established in these organizations is clearly defined and understood by all the actors; however, within the administrative processes, the prioritization of some indicators may not always be the same for all members, influencing the perception of the organizational culture within the organization. If this culture is strong, it will result in the entire healthcare team having a solid culture, which can result in quality medical care ⁵. Moreover, integrating all workers supports their participation in decision making, assuming a responsibility that will influence their performance within the organization ⁶. It is important to reflect that in recent decades in the companies there has been a growing interest in the organizational culture, job satisfaction, and performance, due to the impact on production and the quality of the services provided by the different organizations ⁷. However, in public health institutions the importance of evaluating these conditions is not present, so there is no opportunity to identify the work environment in this kind of organizations and, as a result, that it can be related to the quality of care they provide ⁸. Although nursing professionals are an essential part of the healthcare team, their perception of organizational culture, job satisfaction and performance can generate a strong empowerment among professionals, thus, developing an environment of commitment, understanding and collaboration that will strengthen their performance ⁹. Therefore, the objective of this study was to determine the relationship between organizational culture, job satisfaction, and performance in health care workers.

Methodology

This correlational, cross-sectional, and analytical study was conducted in the period ranging from October to November 2019, in workers of first level of health care in Querétaro, Mexico, with a population of 340 employees; a simple random probability sampling was made, leaving a sample of 125 participants, consisting of 48 nurses, 32 doctors, 22 dentists, and 23 administrative personnel. The selection criteria included that they have worked in the organization for more than one year; that they were present at the time of the survey; and that they signed the informed consent form. The exclusion criteria took into account those who did not sign the informed consent form, those who decided to withdraw halfway through the study, and those who did not complete the questionnaires properly.

The survey to record the data that represented the variables of study consisted of: a) Questionnaire of social and working data as well as health data of workers; the questionnaire included 25 items. b) Denison Organizational Culture Survey (DOCS) instrument, adapted by Bonavia ¹⁰, to measure organizational culture, which consists of 60 items; this instrument evaluates four dimensions: involvement, consistency, adaptability, and mission, with a likert-type response, ranging from 1=totally disagree to 5=totally agree, evaluating organizational culture in a low, medium, and high range, with Cronbach's Alpha of 0.97 ^10,11. c) Motivation and job satisfaction test by Garcia ¹², consisting of 35 items, which evaluates three dimensions such as motivation, satisfaction, and sense of position and hierarchy, with a likert-type response, ranging from 1= totally disagree to 5= totally agree, classifying job satisfaction in a low, medium, and high level, with Cronbach's Alpha of 0. 97 ¹². d) Job performance questionnaire by Núñez ⁽¹³⁾, consisting of 33 items, with five dimensions such as results orientation, quality, interpersonal relationships, initiative, and teamwork, Likert-type scale, ranging from 1=never to 5=always. With a range to assess job performance with a score of 33 to 76 (low), 77 to 120 (regular), and 121 to 165 (optimal), with Cronbach's Alpha of 0.87 ¹³. Statistical analysis of the social and working data was performed with frequencies and measures of central tendency. The Komogorov-Simirnov test showed normality of the data, and due to this, Pearson's R correlation was performed between the variables. The data were processed with the statistical package for social sciences (SPSS version 25).

The study was registered with the research committee: 001/FEN-IND-DIP-09-EA and Bioethics: ENF-010-2021-ESP of the School of Nursing. It was conducted under informed consent and voluntary participation of the personnel, under the regulations of the General Health Law on Health Research, title two, chapter one, article 17, where it is determined that it was a study with minimal risk ¹⁴.

Results

In terms of sociodemographic characteristics, 69% were women and 31% were men; the average age was 40.0 years (± 5.3) in a range of 35 to 50 years; regarding marital status, 55% were married and 43% were single. In terms of schooling, 55% reported having a bachelor's degree, 23% technical level, 11% high school, and 10% master's degree. In relation to the years worked from their first job to their current one, 33% reported having between 1 and 10 years; regarding seniority within the organization, 51% reported having less than 10 years (Table 1).

Moreover, 72% of the workers reported that they did not have another job and 28% said that did have another job; these included private offices and public governmental institutions. Respondents mentioned that they did not change shifts. The average number of hours worked per week was 40 (±5.0). Regarding the evaluation of the organizational culture, the dimensions of involvement (58%), consistency (71%), adaptability (67%), and mission (55%) were evaluated at a medium level (Table 2).

Job satisfaction in its three dimensions, that is, motivation (98%), satisfaction and sense of position (96%), and hierarchy (84%) were rated as medium. In job performance, all dimensions were rated at high levels, with quality standing out with 96% and teamwork with 94%. However, although initiative was rated high, only 25% measured medium in this item.

The data association determined that there was a statistically significant and moderate relationship in three dimensions of the organizational culture and two dimensions regarding job performance; adaptability with interpersonal relationships and quality with p=0.01; consistency with quality and interpersonal relationships with p=0.01; mission with quality and interpersonal relationships with p=0.01.

Regarding job satisfaction in its satisfaction dimension, a statistically significant low relationship was seen with teamwork with p=0.05, and motivation with quality with p=0.05 (Table 3).

Discussion

The study reported that there was a moderate statistical relationship between some of the dimensions of organizational culture and job performance in primary health care workers. These results have identified how administrative factors within the public health system in Mexico are a determinant in the work performance of public employees ¹⁵. It is likely that during the performance of the functions that workers have as supervisors and the feedback they provide to workers help to strengthen their professional satisfaction and adaptability to the work environment ¹⁶.

A health institution whose organizational culture is strong will empower of all its members, where integration strategies will strengthen the performance of health professionals, and this is consistent with other research ^5,17, where reference is made to the way in which communication and adaptability will influence interpersonal relationships and quality of services within the organization, where the promotion of social integration among coworkers will strengthen positive relationships ¹⁸. In addition, consistency within the institution had a moderately significant statistical relationship with quality and interpersonal relationships, that is, the way in which it is integrated and the clarity regarding where the organization is headed, together with the definition of short, medium, and long term objectives, which will guide the quality of the service provided by its workers, and will also influence them to feel confident and be able to make decisions based on their skills and according to the guide of the organization ^19,20,21.

Regarding the association between job satisfaction and performance, a low statistically significant relationship was seen between the dimension of satisfaction and teamwork, i.e. the professional satisfaction of health care workers is not only comprised by their salary, benefits, and job security, but also by the effective integration and leadership strategies assumed by the administrative part, which will influence teamwork. This is in agreement with some research where it was reported that lack of motivation, leadership style, self-training, and professional growth have an impact on work performance ^7,9,22.

Added to this, assertive communication between team members and their superiors strengthens the interactions, in addition to be an important strategy for negotiation favoring the flow of information, shaping the positive relationships with their supervisors and the participation in decision making, thus, influencing work performance and causing workers to show initiative and motivation when performing their work ²³. A research carried out on service workers in Mexico ²⁴, where they evaluated the same variables, reported that the mission and vision of the organizational culture were high, related to motivation and satisfaction in the performance of their duties, because they reported having freedom to perform their tasks. This is not in line with the results obtained in this study, because the workers reported that they did not adapt and integrate to the institution, so they evaluated the organizational culture and satisfaction as medium, i.e. they do not feel confident with respect to the changes within the organization, as well as the lack of values, leadership, low communication of the institution's policies, lack of equality in the workload and poor management of the job profile, influencing their behavior when relating to their colleagues and the care they provide to patients.

With reference to job satisfaction, which is one of the fundamental elements within the organization, in health professionals it is of great importance because it is a determining and relevant factor for quality patient care, so the inquiry on this variable is an important indicator to improve the services offered, the fixed shift has a better job perception because it strengthens the integration with their work team and supervisors, also assertive communication within the work teams influences employee satisfaction ^22,25. Social recognition is of great importance for professionals who provide services, as well as the conditions in which they work which have to be adequate for their work performance ⁽²³; however, the results show that workers perceived that the hierarchical structure affects their job satisfaction either positively or negatively, as well as the commitment within the organizations, which is in line with findings of other authors ²⁶. Therefore, the importance of work in people's lives is probably the best explanation for the strong relationship between job dissatisfaction and life satisfaction ⁹.

Regarding job performance, health workers were evaluated at a high level in all dimensions; they considered that the quality of service they offer, the teamwork, the way they relate to each other, as well as the orientation in the achievement of goals, which are perceived as strengths in their professional practice. This is different from what has been reported in other studies in which the performance of health professionals was evaluated as low or moderate ^7,8,27; therefore, it can be considered that workers should have the necessary resources to be able to accomplish their assigned tasks and, therefore, be able to face adversities or situations that occur during the performance of their work, impacting the results within the established time, maintaining and promoting a good positive work environment and managing conflicts among colleagues ^22,28,29.

Among the limitations of the study, we identified those that are unrelated to the variables of the study, such as the participation of union representatives who used certain actions to politically convince their colleagues, at certain times showing indifference and insecurity when answering the questionnaires. The strengths of the study were the participation of a neutral multidisciplinary team that strengthened the process of applying the questionnaires, as well as the ease with which the management was able to carry out the study.

Conclusions

A moderate statistically significant relationship was seen between the dimensions of organizational culture and job satisfaction with the performance of workers at the first level of health care in Querétaro. Therefore, the adaptability and internal integration of workers can influence the way in which they relate and manage the quality of their professional performance and service, so that the administrators should integrate and communicate assertively the internal and external changes of the institution, so that workers can adapt to the new needs demanded by the organization; additionally, the promotion and creation of institutions with job stability will allow workers to have job security, which will reinforce the policies, mission, and vision of the institution. Likewise, recognizing the work of employees and stimulating the development of positive competencies, thus encouraging initiative in workers, teamwork can be strengthened, and achieve the expected objectives and goals.

Conflict of interest

The authors stated that there is no conflict of interest.

Financing

This work was financed by the researchers.