| Course | DNP 713 Analysis of Organizational Cultures in Healthcare |
|---|---|
| Module | Module 8 |
| Paper type | Organizational culture synthesis paper |
| Length | About 927 words, 6 pages |
| Format | APA 7 student paper |
| School | Arizona State University |
| Program | Doctor of Nursing Practice |
| Updated | October 2026 |
Free sample paper for DNP 713 Module 8
From Silence to Speaking Up: A Model for Changing Patient Safety Culture on a Progressive Care Unit
Student Name
Edson College of Nursing and Health Innovation, Arizona State University
DNP 713: Analysis of Organizational Cultures in Healthcare
Instructor Name
Month Day, Year
From Silence to Speaking Up: A Model for Changing Patient Safety Culture on a Progressive Care Unit
The Area of Culture and Why It Matters
Rapid responses on our progressive care unit are called late, and nurses tell us in surveys that they hold back concerns. Culture is not a soft concern: across most of the studies in one systematic review, better cultures went with better results for patients (Braithwaite et al., 2017). The target of change is not a policy but an assumption: that speaking up about a "feeling" will be dismissed or punished.
Diagnosis
Artifacts from my photo diary, a public fall counter, a high nurses' station and a hallway of physician portraits, suggest hierarchy and a blame-sensitive approach to safety. Interviews showed that the same artifacts carry different meanings for day and night staff. Our Safety Attitudes Questionnaire results were lowest for teamwork climate, a domain that captures whether staff feel able to raise problems (Sexton et al., 2006). In the terms of Schein's levels, the espoused value is "safety first," while the working assumption is "do not bother the doctor unless you are sure" (Schein & Schein, 2017).
The diagnosis also drew on the course's view that artifacts and values interact over time. Hatch (1993) describes culture as a cycle in which assumptions show up in values, values are made real in artifacts, and artifacts are read as symbols that feed back into what people assume. On our unit, the fall counter shows that cycle at work: leaders put it up to celebrate safety, but some nurses read it as a scoreboard that marks whoever was on duty when a patient fell. The same object strengthens a fear of blame that leaders did not intend. Any model for change therefore has to work on meanings, not only on objects.
The Model
The four stages are sequenced on purpose. Surfacing comes first because a hidden assumption cannot be argued with, and staff need to hear leaders say it aloud before they will believe anything has changed. Signals come second because new artifacts give staff a low-risk way to try the new behavior: marking a worry on a board is easier than calling a physician at three in the morning. Success stories come third because, in Gagliardi's account, values grow out of experiences people share in which a behavior paid off, and a single well-told story of an early call that saved a patient may do more than a year of reminders. Stabilizing comes last, when orientation, recognition and the annual survey start treating speaking up as part of who the unit is.
| Stage | What changes | Theory behind it | Leader actions | Measure |
|---|---|---|---|---|
| 1. Surface | The assumption is named openly | Schein: assumptions must be made visible before they can change | Share survey results and photo meanings at staff meetings; ask what makes speaking up hard | Attendance; themes from discussions |
| 2. Signal | New artifacts carry new meanings | Hatch: artifacts are interpreted and can feed back into values | Huddle hub with a "worry" column; leaders thank every concern raised | Worry marks per week |
| 3. Succeed | Speaking up is seen to work | Gagliardi: values form through shared experiences of success | Share stories where early concern saved a patient; recognize the nurse | Time from warning score to rapid response |
| 4. Stabilize | The new norm becomes taken for granted | Gagliardi: incremental change broadens values while keeping identity | Link speaking up to the unit's identity as a caring team; include in orientation | Annual teamwork climate score |
Why Incremental Change
Gagliardi (1986) warns that cultures protect their identity and absorb many changes without altering underlying assumptions. A sudden mandate to escalate concerns could produce apparent change: more calls documented, the same fear underneath. The model instead links speaking up to something the unit already values, caring for its patients, so the change broadens identity rather than threatening it.
The Leader's Role
Psychological safety, the shared belief that interpersonal risk is safe, predicts whether teams learn from errors (Edmondson, 1999). Leaders build it through their responses. The most important action in the model is the first time a nurse raises a concern that proves unnecessary: if the leader thanks her, the culture learns one thing; if the leader sighs, it learns another.
Challenges in Model Building
Culture models risk treating culture as a machine with levers. Cultures are also fragmented rather than uniform, and the photo diary already showed day and night staff reading the same artifacts differently, so the night shift may need its own version of stage 2. The measures also capture climate more readily than assumptions, so focus groups at stage 4 will ask whether staff now believe speaking up is normal.
A First Ninety Days
In month one, the nurse manager and I will share the survey and photo diary findings at all three staff meetings, including one at 0700 for night staff, and record what staff say makes speaking up hard. In month two, the huddle hub and the worry column will go in, and the charge nurses will practice a single response to every concern: thank the nurse, act or explain, and close the loop before the end of the shift. In month three, the first stories will be told at huddles, and the time from early warning score to rapid response will be pulled from the record for the first comparison with baseline.
Conclusion
Changing a safety culture means changing what staff take for granted. This model connects the semester's theories into a sequence a unit leader can follow, with measures at each stage and honest limits.
References
Braithwaite, J., Herkes, J., Ludlow, K., Testa, L., & Lamprell, G. (2017). Association between organisational and workplace cultures, and patient outcomes: Systematic review. BMJ Open, 7(11), e017708. https://doi.org/10.1136/bmjopen-2017-017708
Edmondson, A. (1999). Psychological safety and learning behavior in work teams. Administrative Science Quarterly, 44(2), 350-383. https://doi.org/10.2307/2666999
Gagliardi, P. (1986). The creation and change of organizational cultures: A conceptual framework. Organization Studies, 7(2), 117-134. https://doi.org/10.1177/017084068600700203
Hatch, M. J. (1993). The dynamics of organizational culture. Academy of Management Review, 18(4), 657-693. https://doi.org/10.5465/amr.1993.9402210154
Schein, E. H., & Schein, P. (2017). Organizational culture and leadership (5th ed.). Wiley.
Sexton, J. B., Helmreich, R. L., Neilands, T. B., Rowan, K., Vella, K., Boyden, J., Roberts, P. R., & Thomas, E. J. (2006). The Safety Attitudes Questionnaire: Psychometric properties, benchmarking data, and emerging research. BMC Health Services Research, 6, 44. https://doi.org/10.1186/1472-6963-6-44
What the DNP 713 Module 8 instructions ask for
The posted syllabus grades the Organizational Culture Synthesis Paper at 60 points in Week 14, the lesson on challenges in model building, within Module 3, Creating an Organizational Model. You synthesize learnings from across the semester to describe how to create culture change in a specific area of your organization's culture, with examples such as patient safety, patient experience and a culture of inquiry. The final presentation that follows summarizes the model, so the paper is its written foundation. Expect to diagnose current culture, propose a model, connect it to course theories and instruments, and discuss challenges. Draw on your photo diary, mind maps and design work. Reread your photo diary, mind maps and design presentation before drafting; they supply most of the evidence for the diagnosis section.
Inside the DNP 713 Module 8 example
The paper names one area of culture and the specific assumption to change, then diagnoses the current culture using three kinds of evidence from earlier assignments: artifacts, interviews and survey results. The model is presented as a four-stage table, each stage tied to a theory, leader actions and a measure, which shows synthesis rather than a review of theories. A section explains why incremental change was chosen, and another describes the leader's role. A section on challenges in model building answers the week's topic directly. The conclusion restates the purpose in one sentence. The table format lets faculty check that every stage has a theory, an action and a measure, so gaps in the model are easy to see.
Reading the DNP 713 Module 8 grading rubric
Synthesis papers are generally graded on a clearly defined area of culture, an evidence-based diagnosis, an original model that integrates course theories, instruments and design, specific leader actions and measures, recognition of challenges and limitations, and scholarly writing. Drawing on your own earlier assignments as evidence is expected. A model with stages and measures is easier to evaluate than a narrative. Explaining why a type of change was chosen shows theoretical depth. Discussing subcultures and measurement limits shows critical thinking. A model a leader could actually use earns the most credit. Faculty also look for models that admit uncertainty, such as subcultures or measurement limits, rather than promising that culture will change on schedule.
DNP 713 Module 8 help: mistakes that cost marks
Papers often review each theory in turn and add a model at the end. Build the model first, then explain which theory supports each part. Another weakness is a target that is too broad, such as improving culture. Name one area and one assumption. Use data from your own organization. Include measures for every stage. For help with your culture change model and synthesis paper, send the desk your photo diary, mind maps and the prompt. Test the model by asking how it would handle the night shift or another subculture. Define the culture area narrowly enough that one leader could act on it within a year.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Arizona State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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DNP 713 Module 8 questions, answered
Where can I find a free DNP 713 Module 8 sample paper?
The culture synthesis paper above is complete: a four-stage model for building a speaking-up safety culture, with diagnosis, theory links, leader actions, measures and challenges.
How many points is the DNP 713 Synthesis Paper?
The Organizational Culture Synthesis Paper is worth 60 points.
What areas of culture can the DNP 713 synthesis paper address?
The syllabus gives examples such as patient safety, patient experience and a culture of inquiry.
Why use incremental culture change?
Cultures protect their identity, so changes linked to existing values are less likely to be absorbed without real change.
What evidence should a culture change model include?
A diagnosis from artifacts, interviews and survey data, plus measures for each stage of the model.