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Chapter Two Literature Review

2.1. Introduction
It has been predicted that the world population will expand with shrinking of economic activity and larger proportion of living elderly people (Bloom, 2005). Fastest increase has been noted for ‘oldest old’ with 85 years or more age, which is projected by quadruple with 5% of the population of the UK by 2033 (Dini et al., 2008). Wide ranged consequences related to ageing society for the social care, health and housing, with technological solutions for the selected ‘problem’ are implied already. People having long-term conditions can increase the instance of life-threatening events being managed better. More emphasis is about local services as well as tools which are patient-centred and can meet demand. However, there are many physicians who can remain reluctant in order to accept change added by lack of education through the emergence the field as well as the way it affects patients. Current article describes newer care models, comprising the electronic devices at homes of older adults dwelling in community.

2.2. Small and medium Size Enterprises (SMEs): A Concept

‘The World Bank Review on Small Business Activities establishes the commitment of the World Back Group to the development of the small and medium enterprise (SME) sector as a core element in its strategy to foster economic growth, employment and poverty alleviation.’ (Ayyagri, Beck, and Demirguc-Kunt, 2007. P. 415)
In the past 20 years, scholars witnessed an explosion in the research into the role of the small and medium sized enterprises (SMEs) within the global context which has resulted in a significant amount of academic literature and thinking (Parker, 2000). There is also an increasing recognition of the key role that SMEs play in domestic and global economy. According to (Ibeh, 2000) It has been noticed that the research in this area has been stimulated by growing debates on globalization and its effects on the rising of SMEs and last but not the least entrepreneurial response required by business to cater and deal with the increasing competition. It is very important to understand the meaning and history of SMEs before we take our discussion any further. As the interest in SMEs has been increasing, many scholars have been interested to find a clear definition for SMEs. However, literature proves that this term has various definitions varying from country to country and based on the sources reporting SME statistics (Ayyagri, Beck, and Demirguc-Kunt, 2007).
“The category of micro, small and medium-sized enterprises (SMEs) is made up of enterprises which employ less than 250 persons and which have an annual turnover not exceeding 50 million euro, and/or an annual balance sheet total not exceeding 43 million euro”. (EC, 2003, P.39)
Medium, small and micro-sized enterprises (SMEs) play a very important and central role in the European Economy. These SMEs are major sources of innovation, employment and entrepreneurial skills. If we talk about the enlarged European union of 25 countries, there are about 23 million SMEs that provide employment to about 75 million people which represent 99% of the total enterprises. However the SMEs often meet with the market imperfections. They frequently have difficulty in obtaining capital or credit, particularly during the phase of start-up. They are restricted in terms of the amount of resources they have and thus these restrictions on resources often lead to the lack of innovation and access to new technologies. Thus the support for Small medium and micro sized enterprises is one of the most important priorities of the European Commission’s for economic growth, creation of jobs and social cohesion (European Commission, 2007).

2.2.1. Importance of a European SME definition
Despite their size, Small and Medium Sized enterprises offer more job than large business and are the drivers of innovation and development (Teng, Bhatia, and Anwar, 2011). For example research reveals that SMEs in the USA ‘spend almost twice as much of their R&D dollars in fundamental research compared to the large firms’ (Yeung and Chew, 2001. P. 433). Parker (2000) also pointed out that governments are getting more interested in small businesses and their support for SMEs is increasing especially in wealthy countries, as it is believed that SMEs are exceptionally innovative and contribute to high quality employment. Some researchers suggest that SMEs are more flexible and responsive to their consumers’ needs.

The new SME definition introduces three different types of enterprises. Each corresponds to a type of relation which an enterprise may have with each other. The difference or distinction is necessary in order to establish a clear image of an enterprise’s economic situation and to exclude those that are not genuine SMEs. In most of the cases, SMEs are generally autonomous as they are either completely independent or have one or more minority partnerships (i.e. each less that 25%) with the other enterprise. If the holding rises or increases to no more than 50%, this relationship is classifies as partner enterprises. If the holding crosses the 50% mark, in such cases the enterprise would be classifies as a linked enterprise. Depending on the category in which your enterprise fits, you may have to include data from one or more other enterprises when calculating your own data. The result of the calculation will allow you to check whether you comply with the staff headcount and financial thresholds set by the definition. Enterprises coming above these lose their SME status (EC, 2007).
The first step to qualify as an SME is to be considered as an enterprise. According to the new definition, an enterprise is ‘any entity engaged in an economic activity, irrespective of its legal form’. The wording is not new. It reflects the terminology used by the European Court of Justice in its decisions. (EC, 2007)
As the table below, the category of micro, small and medium-sized enterprises consists of enterprises which employ less than 250 persons and which have either an annual turnover not exceeding 50 million euro, or an annual balance sheet total not exceeding 43 million euro. Within this category: Small enterprises are defined as enterprises which employ fewer than 50 persons and whose annual turnover or annual balance sheet total does not exceed 10 million euro. Micro enterprises are defined as enterprises which employ fewer than 10 persons and whose annual turnover or annual balance sheet total does not exceed 2 million euro (European Commission, 2007).

2.2.2. Importance of SMEs and their key role
The importance of Small and Medium Enterprises (SMEs) and Micro Firms in both national and international context is undoubtedly of higher relevance. In a large number of countries the percentage of micro and small firms is extremely high, e.g. 98% in Portugal. These firms are important not only on what concerns to its representation for economic analyses but also for the countries’ economies and the implications that it brings to the society. These firms have an important role on many aspects, such as employment, taxes or innovation that, most of times, is regarded as something on the responsibility of large firms or research centres. In “The Theory of
Economic Development” Shumpeter (1934) emphasizes the role of entrepreneur, as a prime cause of economic development, being this development achieved through innovation. Taking into consideration this thesis one can say that if the entrepreneur has an important role for development, this role is achieved through the “institution” that he/she represents: the Firm.

Nowadays most of the World Economies are facing some economic problems, it is said that we are in a recession period, however a few years ago Audretsch (2000) was saying: “the last decade has seen a re-emergence of competitiveness, innovation activity and job generation in the United States. Not only was the economic turnaround largely unanticipated by many scholars and members of the community policy, but what was even more surprising than the resurgence itself was the primary source – small firms.” If this was the reality some years ago it must be valid for the new crisis that the world is facing today.

In the theatre of development the role played by SMEs and micro firms is very important, not only because they are defined as the engine of economic growth, but mainly because they are the largest percentage of firms in the economic activity. “Industry and its impact on economic and social development and the environment have been at the centre of the debate on sustainable development since the term ‘sustainable development’ was brought into common use by the Brundtland Commission in 1987.

There is now a consensus among policy makers that in order to achieve sustainable development, Governments and non-state actors need to make greater efforts to integrate economic, social and environmental goals into industry policy and decision making” (United Nations, 1998). Six years after this conclusion, it seems that the word industry must be understood not only as the manufacturer sector, but the economic activity that includes industry and services. Once again we are talking mostly about SMEs.

Related with SMEs, nowadays we find a very common word that is Entrepreneurship. “As means of generating jobs and raising incomes, increasing rates of enterprise creation is an almost universal concern among local authorities. Along with efforts to attract investment, stimulating entrepreneurship is one of the two pillars of most local and regional development strategies” (OECDa, 2003).

The past twenty years have seen many researchers analysing the function enacted by the small and medium sized enterprises (SMEs) in the international reference which has led to profusion in scholastic literature and theories. It is crucial to comprehend the description and history of SMEs prior to discussing the topic further.
In the European Economy, a crucial and fundamental function is enacted by medium, small and micro-sized enterprises (SMEs). Such SMEs are crucial sources of creativity, employment and entrepreneurial abilities. However, SMEs frequently face several issues. They have issues in getting credit or raising capital, especially during their set-up period. The limitations of resources frequently result in limitations of creativity and access to novel technologies. Hence the support for SMEs is one of the significant priorities for the European Commission to ensure economic development, job creation and social cohesion.
Despite being small in size, SMEs provide more jobs compared to larger trades and are often the drivers for creativity and development. It is also indicated that governments are showing more interest in SMEs even in wealthy nations as SMEs appear to be very creative and appear to provide high quality employment. A few analysts also recommend that SMEs are more adaptable and reactive to the requirements of their clients.
A new SME definition introduces three varied kinds of firms. Each definition is similar to a kind of association which a form may share with another. In majority of the instances, SMES are usually autonomous or are partner firms or linked firms. Firms which surpass the staff headcount or financial limits as per definitions lose their SME status. A firm may either be micro, small or medium-sized enterprise based on number of people employed, annual turnover, or the annual balance sheet total.
In several nations, the proportion of micro and small firms is very high. These enterprises enact a crucial function in several facets including employment, taxes or innovation.

The function enacted by SMEs and micro enterprises is crucial for advancement not only because they are the engines of economic development, but chiefly as they are the biggest ratio of enterprises in the economic actions. There is agreement between policy makers that to attain sustainable development, it is crucial to make additional endeavours to combine the financial, social and environmental aims in the industrial policy and decision making.
Another term commonly linked to SMEs is Entrepreneurship. In addition to endeavours to attract investment, motivating entrepreneurship is one of the two pillars of majority of the domestic and regional advancement policies.

2.3. Assistive Technology Industry

According to ICF, the United Nations (UN) system offers the definition for assistive products as well as technology as product, tool, instrument, technology or equipment designed or adapted with the aim to develop individual functions with disability (WHO, 2002). CRPD implied assistive technology under plural aspects that just exemplified these kinds of products as well as technologies. Further assistive devices can be noted by Braille, mobility aids and augmentative along with alternative (means, modes and formats) of communication that is again defined in terms (Article 2). Current paper considers assistive technology as the umbrella term for further research.
Definition of ICF is about the general technology, as for instance the generalised technology or customised under universally recognised design, which is not part of assistive technology. CRPD universal design never excludes assistive technology (Article 2).
As an ICF facilitator assistive technologies is an environmental factor that remains external to every individual. Moreover, International Organization for Standardization (ISO) has classified technologies as per standard ISO 9999 (ISO 2007), and is also accepted by WHO as a relative to International Classifications along with conversion between ISO 9999 and the respective ICF classes as developed (ISO 2008). Therefore, UN system for both these classifications is the base to comprehend breadth of notable assistive technologies. However, benefits led by such structures and functions are subject to imply assistive technologies offering enough support to various aspects of the life. There is the impact on positive socioeconomic aspects. Assistive technologies is significant towards accessing education, added by academic productivity (Beijen, Mylanus, and Snik 2007; Parette and Peterson-Karlan 2007). As a successful strategy to accumulate job tasks, the mode of assistive technologies contribute towards positive results in employment domain and is critical for the removal of employment related barriers and to offer advantages to the productivity as well as self-esteem of the user (Roulstone 1998; Langton and Ramseur 2001; Chan et al. 2006; Yeager et al. 2006). Moreover, assistive technologies are important for the maintenance of health and mind (Veehof et al. 2006; Johnson et al. 2007).
Though assistive technologies comprise of potentialities to increase quality, participation of life, the success is beyond guarantee and thus must be looked beyond technology as well as user’s physical features; preferences, demands and expectations to be met (Brown-Triolo 2001; Scherer 2005).
According to recent report, home care quality in the UK is relevantly poor in such a way that it contravenes to the patients’ human rights.1 moreover various reasons are noted for low quality; where services never are customised to meet sensory impairment/disability cases, services never gets counted as flexible under diversified instances, patients attain little-to-no control about the care that is to be delivered, and care-workers face hurdles in managing time for all the patients.
Assisted living technology (or the ALT) can handle these issues through the process of helping patient towards the process of managing own care. It can reduce pressure over care workers and give respective care recipients enough control over different kinds of care as receive and delivered. Through the system of home reminder ALT can deliver messages as well as notifications to determined user in order to assist them in the process of managing determined conditions, lifestyle and environment. These kinds of notifications can remind about appointments, medicine and meal timings, running taps, instances of unlocked windows and even the needs for grocery. It can also assist in promoting healthy mode of social behaviour like calling friends and relatives.
Sensory impairments are common patients for care and should get considered for effective care. Application of home reminder is the way by which ALTs can have multimodal interaction with effective solution. Multimodal interaction is communication under multiple channels of sensory parts and allows impairments to attain interactions with non-impaired channels (like replacing an alarm by flashing light). To activate a home reminder system, it is about delivering notifications within different modalities.
The passage of the Technology-Related Assistance for Individuals with Disabilities Act (Tech Act) in 1988 was a turning point as attention increased on the role that assistive technology (AT) can have to improve the life of people with disabilities, and improving their functional needs (Alper, and Raharinirina, 2006). According to Wallace et al, (1995) Tech Act of 1988 contributed to public awareness of the curtail role that using assistive technology can play in daily life of people with disabilities. These authors pointed out that the Tech AT was amended in 1994, focused more on AT for individuals in different environments and contexts such as work, school and in community settings. On the other hand, the high cost of residential or nursing homes and the desire to be at home rather than hospital environment, had led to an increasing interest in assistive technology (Doughty et al, 2007).
‘Assistive technology includes any item that is used to maintain or improve functional capabilities. It can include items such as jar openers for individuals struggling to remove a lid from a stubborn container; pencil grip; alarm signaling devices; large dialers on the telephone; prompting devices for individuals with memory impairments, screen readers for computers; and environmental control systems that open and close doors and drapes, raise and lower beds, or operate electronic devices. Assistive technology includes both low and high tech solutions’ (Bodine, 2003. P.33).
‘Assistive technology is a tool used by someone with a disability to perform everyday tasks such as getting dressed, moving around or controlling their environment, learning, working or engaging in recreational activities.’ (Alper, and Raharinirina, 2006. P. 47)
‘Assistive technology has been defined by the European Commission’s Technological Initiative for Disabled and Elderly persons (TIDE, 1992) as the total of technologies provided directly to elderly and/or disabled people, to enable them to live more independent lives and become integrated in all the activities of their communities, preferably outside of institutional care’ (Young, and Sandhu, 1995, P.183). These authors believe that there is a difference between assistive aids such as adapted eating utensils and assistive technology. Assistive technology market is massive and broad, providing thousands of products for individuals, elderly or disabled. This market is dominated by SMEs. It is believed that this market will grow and the demand for assistive technology will increase as users will get familiar with AT and European population will grow older. (Young, and Sandhu, 1995). According to Doughty et al, ( 2007) European Community has the largest market for assistive technology products in the world, USA, Canada and Japan are in the second, third and the fourth place. Reports in 1995 show that assistive technology users will be about 32 million European in 2020. The vast number of AT users emphasizes the importance of the market and competitive environment particularly for SMEs. Furthermore, the current trend suggests that by 2020 one of four people in community population will be sixty or older.
The assistive technology industry includes businesses that provide products, devices, procedures, and services which have been designed to help daily living, work, communication, mobility, and independence of individuals with disabilities or elderly (Fels, and Gredeon, 2011). Business in this industry usually belong to one of the five industry grouping related to different disabilities such as physical, cognitive, sensory, or communication (Bauer, 2003). He also pointed out that in US this market is dominated by small enterprises and a very few larger companies supporting assistive technology market. Stone, (2003) believes that assistive technology industry which is mostly small businesses has significant barriers such as limited resources and high cost which are unique to AT market. As a result success of an AT enterprise is a challenge. In order to help the entrepreneurial who seek to provide assistive technology to those in need, it is important to recognize the potential barriers they might deal with.

According to ICF, the United Nations (UN) system provides the definition for assistive products in addition to technology as product, tool, instrument, technology or equipment designed or adapted with the objective to create individual functions with disability (WHO, 2002).
As an ICF facilitator assistive technologies is an environmental aspect that is extrinsic to every person. Assistive technologies are crucial to evaluate education, complemented by academic productivity. Though assistive technologies include the possibility to enhance quality, participation of life, the success surpasses guarantee and needs to be looked beyond technology in addition to a user’s physical features; preferences, demands and anticipations to be fulfilled.

Assisted living technology can handle with several problems through the process of helping patient towards the process of managing own care. It can lower stress over care workers and provide care recipients enough control over varied types of care as receive and delivered. Usage of home reminder is the technique by way how ALTs can have multimodal interaction with successful solution. To activate a home reminder system, it is related to providing notifications within varied modalities.
The passage of the Technology-Related Assistance for Individuals with Disabilities Act (Tech Act) in 1988 was a turning point as attention increased on the role that assistive technology (AT) can have to improve the life of people with disabilities, and improving their functional needs (Alper, and Raharinirina, 2006).
‘Assistive technology comprises of any article that is employed to maintain or enhance operational abilities. Assistive technology comprises of both low and high tech solutions. Assistive technology market is massive and broad, offering thousands of products for individuals, elderly or disabled. This market is dominated by SMEs. European Community has the largest market for assistive technology products in the world, followed by USA, Canada and Japan
The assistive technology industry comprises of businesses that provide products, devices, procedures, and services which have been designed to help daily living, work, communication, mobility, and independence of individuals with disabilities or elderly.

2.4. Tele-healthcare and its importance

Efficacy trials with high-profile in the domain of telehealth (here, remote medical monitoring/treatment of people in their own homes) and telecare (representing remote support services like alarms/fall detectors) are noted in reference to the technical interventions as in ‘work’ and policymakers tried to implement the same ‘at scale’ (Greenhalgh, Procter,Wherton, Sugarhood, & Shaw, 2012). However, this kind of enthusiasm is subject to reflect pro-innovation with a biased as well as misplaced modernist ideological dream (EFORTT Research Team, 2012; Greenhalgh et al., 2012). As a matter of fact, assisted living science is still in its infancy. Formerly, home computing was assumed to be computers that can be used at home for the same tasks as they were utilised in the e-filing process, aggregating, calculating, and etc., in office. Former computers concentrated over the home market that laid emphasis on the way these tasks are in the modern home. After some years, people started to use home computers for doing things that were traditionally considered to be done at home (like playing games, music and socialising) by the digitally-enabled provisions. It is then that the home computing attained a greater ‘at scale’ (Dourish & Bell, 2011).
Technology related to assist living stays parallel in current society. Current solutions considered self-management meant for illness at home as a matter to occur as it is in medical management being in hospital by means of generating, assessing and further manipulating measures of the objective related to health status (as in the data of biometric and behavioural results), which can lead to ‘informational representation’ for the patient to monitor, prompt and treat through the means of remote health as well as social care providers. As against this the telehealth delivery and telecare might need to get assessed in comparison to the traditional approaches and in relation with living with determined chronic illness, added by the considerations that are the way these activities as well as practices can get digitally enabled.
People consider technologisation of health as well as social care as the way to reflect growth of determined rationalist logic within the late modernity approach. The mode of rationality gets distinguished through formal as well as instrumental feature that has the abstraction attained from concrete instances with importance over means (efficiency related to the process of accomplishing task) instead of ends (‘rightness’ related to the task is noted in itself) (Sayer, 2011). For Sayer, this stands in contrasts to instrumental rationality having phronesis (practical reason), featured with concrete, practical, embodied and above all tacit based character; that concentrates on ends instead of means (especially if ends remain desirable and relevantly ethical and justified); and lay emphasis on human relationships along with the context of ‘what matters to people’. Literature about the telehealth as well as telecare, is subject to frame abstracted, selected rationalist language in the process of collecting data, transmission and processing data. It overlooks self-management related to illness that is not part of data processing. Instead, there are moral and practical selections (personal and socio-cultural) as per situation. In case of serious illness, we yearn towards human contact; need someone having symbolic power for witnessing our sufferings and share responsibility for making decisions that can withstand grave consequences (Schei, 2006). Empirical derivations of this research have been deliberately designed to decentre technologies as well as place as matters to people related to this research.

2.4.1. Telecare
Telecare definition used for this research is by Barlow et al., as ‘the use of communications technology to provide health and social care directly to the user (patient). This excludes the exchange of information solely between professionals, generally for diagnosis or referral’ (Barlow et al., 2007). Thus, telecare is a professional tool to deliver support to respective people and must be employed for being user-centred service, complementing instead of replacing current models of care.

Most of the elderly people prefer to be in their own homes and 35% living in care homes are potentially supported at home by telecare (Department of Health, 2005). The first country having official fee schedule meant for telecare, is Norway. It also is about reimbursable services by the National Health Service, 1996 (Hotsis et al., 2008). In case of England, Department of Health selected telecare and initiated £ 80 million over preventative technology in 2006, for nationalised basis for eligible people since 2010
(Department of health , 2002). For this association, ‘telecare is as much about the philosophy of dignity and independence as it is about equipment and services’ and its benefits are:
_ Reducing ‘unnecessary’ admissions in hospital that is cost savings;
_Increasing quality of lifestyle by giving enough independence as well as self-management;
_ Reducing caregiver burden;
_ Reducing falls;
_Reducing pressure of workforce for health care and social services;
_ Developing integrated module of health and social services, with primary and secondary care, modes of voluntary as well as private care providers;
_ Increased accessibility to various community palliative-care services for those who wish to die at home.

The major development of assistive technology, supported by innovation in ICT, new materials and technologies, provided customers with the opportunity to stay at home instead of hospital or care houses, and receive cheaper care. Electronically enhanced ‘assistive technology’ ,equipment for helping people carry out everyday activities, in conjunction with physical adaptations to the home are likely to be of more widespread benefit (Barlow, and Venables, 2004. P. 796). Regarding the relevant literature, the increasing number of potential customers and the unique complex market of assistive technology, emphasizes the importance of innovation as a major element for SMEs in this industry. However, studies show that there are various obstacles to innovation and SMEs challenge the unique barriers of assistive technology (Barlow, and Venables, 2004).
Considering the above discussion, SMEs are dominant in assistive technology industry, this is a fast growing market especially in European countries, various modern technologies namely tele-health and tele-care are more of interest for patient and provide them with cheaper care.

2.4.2. SMEs and Tele-Healthcare / Assistive Technology (AT) industry
SMEs active in assistive technology experience a different entrepreneurial climate. Many AT firms are really small and produce just a few products. Some of them start-off family business and some run by people who suffered from disabilities. However, the number of users of AT can be really high as there about 600 million people suffering from any disabilities around the world (Alper, and Raharinirina, 2006). According to Alper, and Raharinirina, (2006), technology has great potential for improving the capabilities of people who deal with any sort of disabilities. However, it seems that there are a number of barriers which hamper the flow of success into the SMEs of AT industry. According to Koch, (2006. P.566): ‘Increased demand of healthcare due to an increased number of elderly and changed life styles leading to an increase in chronic diseases, Demand for increased accessibility of care outside hospitals, moving health services into the patient’s own homes, Need for increased efficiency, individualization and equity of quality-oriented healthcare with limited financial resources,
Difficulties of recruiting and retaining personnel in the healthcare services in general and in home and elderly care in particular,’ Turns home healthcare into one of the fastest growing areas of assistive technology. Koch, (2006) also added that to decrease costs; there is a shift from hospital care to more advanced home healthcare. On the other hand, increasing development in new technology contributes to enhancing life of elder people and disabled. Electronic sensors, video monitoring, remote health monitoring, door monitors, bed alarms, pressure mates, smoke and heat alarms can improve patients’ security, safety and the ability to cope at home (Miskelly, 2001).
Assisted living science is still in early stages. The telehealth delivery and telecare may require to be evaluated in contrast to the comparative techniques and in context with living with ascertained chronic illness, added by the considerations that are the way these activities as well as practices can get digitally enabled. The mode of rationality gets distinguished through formal as well as instrumental feature that has the abstraction attained from concrete instances with importance over means instead of ends. In case of serious illness, we desire human interaction; we require somebody having mbolic power for witnessing our sufferings and share responsibility for making decisions that can withstand serious results
Telecare refers to employment of communications technology to offer health and social are directly to the user (patient). Norway was the first nation to provide an official fee schedule meant for telecare. In England, the Department of Health commenced £ 80 million over preventative technology in 2006, for nationalised basis for eligible people since 2010. The chief advancement of assistive technology, backed by innovation in ICT, new materials and technologies, offered clients the chance to stay at home rather than the hospital or care houses and obtain cheaper care. Several researches indicated that there were different impediments to innovation and SMEs challenge the unique barriers of assistive technology. SMEs are dominant in assistive technology industry; this is a rapid growing market particularly in Europe.

SMEs active in assistive technology experience a varied entrepreneurial setting. Several AT enterprises are small and generate limited goods. However, the number of users of AT are large as around 600 million people suffer from some disability across the globe. There are several impediments that halt the flow of success into the SMEs of AT industry.

2.5. SMEs’ Success & Failure and importance of Organisational culture

Research on Small and Medium Sized Enterprises (SMEs) has grown drastically during the last few years as a huge number of businesses around the world are SMEs and they have significant impact on the economy of the countries. ‘There is a broad consensus that a vibrant SME sector is one of the principal driving forces in the development of a market economy. SMEs stimulate private ownership and entrepreneurial skills, are flexible and can adapt quickly to changing market demand and supply situations, generate employment, help diversify economic activity, and make a significant contribution to exports and trade.’ (UNECE, 2003. P.291). The contribution of SMEs in economy of nations emphasizes the importance of focusing on the studies about possible ways which can improve business, however, success in Small and Medium Enterprises is one of the subjects on which few comprehensive and in-depth studies have been conducted (Ramana, Aryasri, and Nagayya, 2008).
Few researchers such as Bhide, (2000), Miner,(1990) conducted studies to explore entrepreneurial success. Laresen et al, (2006) suggest that successful businesses satisfy customer’s need through offering high quality services and products. He believes that in business life, success is a concept in management, although it is not always clearly defined. Success and failure may be considered as measure of good or poor management. In business literature success usually is associated with firm’s financial performance. However, Foley and Green, (1989) believe that there is no clear definition of success in international business and studies have interpreted firm’s success in many ways. According to Mathew (2010), ‘firm performance refers to the firm’s success in the market’, while ‘success in general, relates to the achievement of goals and objectives in whatever sector of human life.’ He believes that success has two important dimensions: financial vs. other success and short term success vs. long term success. Some researchers believe that success can has different forms such as survival, sale growth, profit, number of employed, reputation. Lussier (1995) identified ‘Lussier model” which is success versus failure prediction model. In this model 15 factors which can contribute to the firm’s success and failure were introduced. These factor are adequacy of start-up capital, record keeping and financial control, industry experience, management experience, business planning, availability of professional advisor, education of owner, quality of staff, product/service timing, economic timing, age of business owner, existence of business partners, business-owning parents, minority business owner, and marketing skills. Ghosh et al (2001. P.209) also defined key success factors (KSFs) as factors which are essential for excellent performance of the company and critical success factors (CSFs) as those factors that are needed for survival of the firm. According to Lussier, and Pfeifer, (2001. P. 232) a business has to make at least industry-average profit for the previous three years to be considered successful and failure is defined as not having made a profit in the previous three years. With respect to psychological and behavioural trait, Frese, Brantjes, and Hoorn, (2002), Hodgkinson (2001), and Olson, and Bokor, (1995) found that the ability to carry on strategic planning is related to firm’s success. A few researchers found out that some psychological attributes such as innovative orientation, a drive for independence, attitude towards risk, and a competitive nature are related to success ( Frese, Brantjes, and Hoorn, 2002; Koop, De Reu, and Frese, 2000; Dess, Lumpkin, and Govin, 1997; Covin, and Slevin, 1989).In contrast to psychological traits, some factors such as training, managerial skills, and environmental situations can be easily developed. Numerous studies have been focusing on the managerial skills and environmental conditions which impact firm’s success (Lussier, 1995). In a survey in 2003, Vientnamese SMEs introduced ‘friendliness toward customers’ as the main success factor and ‘A good product at a good price’ as the second (Benzing, Chu, and Bove, 2005), while Romanian SMEs selected ‘friendliness to customers’, ‘A reputation for honesty’, and ‘good customer service’, as the top three success factors (Benzing, Chu, and Bove, 2005). Neshamba (2000), studied Kenyan SMEs and found that manager’s previous experience, considering the needs of customers, hard work, and access to capital were crucial success factors. Chu, Benzing, and McGee, (2007), also considered hard work as the major success factor in Kenya. Ibrahim and Goodwin (1986) studied variables contributing to SME’s success in Canada and USA and introduced four success factor based on their findings. They are entrepreneurial values, managerial skills, interpersonal skills, and environmental characteristics. The existing literature shows that researchers do not agree on the variables contributing to success in SMEs. Most of studies focused on a set of variables such as the managerial skills, training of entrepreneurs, psychological and personality of owner managers, and external environment (Benzing, Chu, and Kara, 2009).
It is a fact that only 50 percent of small firms survive more than three years from initial set up (Watson, 2003). Although business failure happens to all companies, small or large, small firms are in a higher threat as they don’t have the financial supports large companies usually possess. Business failure can have different reasons related to owners, management, action made by other businesses, customers, or supplier. Therefore it is essential to recognize the entire possible factor which might lead to failure (Ropega, 2011). Many studies have examined the perceived causes of small and medium enterprise (SME) failure. These studies have generally been based on the opinions of one or more of the following three groups: failed owner/managers (Fredland, and Morris, 1976; Smallbone, 1990; Hall, and Young, 1991; Hall, 1992; Gaskill, and Van Auken, 1993); non-failed owner/managers (Fredland, and Morris, 1976; Chaganti, and Chaganti, 1983); or third parties such as liquidators or official receivers (Hall, and Young, 1991; Lowe, McKenna, and Tibbits, 1991; Hall, 1992). The motivation for most of these studies is best described by Abdelsamad, and Kindling, (1978, p.24) who stated that ‘Although failures cannot be completely avoided in a free enterprise system, the failure rate could be reduced if some of its causes are recognized and preventive action is taken’. A similar view was expressed by Larson, and Clute, (1979, p.36) who stated that ‘One realistic approach would be to identify failure symptoms before the business failed. In fact, if deficiencies can be diagnosed early enough, managerial assistance can be given and failure may be averted’. Even though not all failed firms end in bankruptcy, ‘most business failures result in heavy personal loss for the entrepreneur’ (Bannock, 1981, p.35). These personal losses include: financial losses ‘from the disposal of remaining stocks of merchandise, adapting equipment to other uses, and finding employment for labor in other enterprises’ (Hutchinson, Hutchinson, and Newcomer 1938, p.497); and the degradation and disappointment suffered by the owner and the owner’s family (Berryman, 1983, p.47). Two primary causes of SME failure appear to be a lack of appropriate management skills and inadequate capital. Said, and Hughey,(1977, p.37) argued that ‘75 percent of these failures could be avoided if the proper help is available and accepted’. Reynolds, (1987, p.239) found that a major factor related to small firm survival was the amount of attention given to financial matters. Duchesneau, and Gartner, (1990, p.309) reported that ‘Successful firms spent more time planning at start-up, were more likely to have used professional advice and had greater amounts of capital at start-up’. Similarly, Potts, (1977, p.93) found that ‘successful companies rely more heavily on accountants’ information and advice than do unsuccessful companies’. In addition, Kent, (1994) found that the financial performance of a group of A somewhat contrary view is expressed by Fredland, and Morris, (1976, p.7). They argued that in ‘A full employment economy and assuming capital markets operate with reasonable efficiency) a business failure indicates a previous misallocation of resources. They also noted that such an underutilised. Similar sentiments were expressed by Storey, (1989, p.178).

2.5.1. Culture
The word culture has different meanings from the roots of ‘tilling the soil’ to the really western usage of ‘to be civilized’ or ‘cultured’ which is often used in the arts and music (Bareger, 2007). Hofstede(1991) named this traditional definition ‘culture one’. According to Jahoda (2012), culture has been polysemous for long time. ‘For centuries it meant producing or developing something, such as “the culture of barley” or “the culture of arts”, and it is still employed in this sense as in “culture of bacteria” (P.289). He believes that only in 18th century France the single word ‘culture’ began to be use and to associate with the meaning of training or refinement of mind and rapidly extended ‘to refer to the qualities of an educated person’ (P.290).
Anthropologist and sociologists such as Kluckhohn defines culture in terms of patterns. According to Kluckhohn (1951) ‘culture consists in patterned ways of thinking, feeling and reacting, acquired and transmitted mainly by symbols, constituting the distinctive achievements of human groups, including their embodiments in artifacts; the essential core of culture consists of traditional ( i.e., historically derived and selected) ideas and especially their attached values’ (P.86).
Schein (2004) endeavoured to define culture formally. He argued that ‘culture is a pattern of shared basic assumptions that was learnt by a group as it solved its problems of external adaptation and internal integration, that has worked well enough to be considered valid and, therefore , to be taught to new members as the correct way to perceive, think, and feel in relation to those problems’. Deal and Kennedy (1982, p.4) defined culture as ‘the integrated patterns of human behaviour that includes thought, speech, action and artifacts, and depends on man’s capacity for learning and transmitting knowledge to succeeding generations.’ Kotter and Heskett (1992. P.4) introduced another definition of culture. They believed that ‘the totality of socially transmitted behaviour patterns, arts, beliefs, institutions, and all other products of human work and thought characteristics of a community or population.’ Geert Hofstede, an expert on cross-cultural differences and management, defined culture as ‘the collective programming of the mind which distinguishes the members of one human group from another’. In another definition of culture comes from sociologists Zvi Namenwirth and Robbert Weber,(1987) they see culture as a system of ideas and argue that these ideas constitute a design for living. Dodor, and Rana, (2007), believed that the concept ‘culture’ has been defined very well, despite its complexity in literature. As it was mentioned earlier, a culture can be expressed on different layers.

Schein defines the level of culture as below:
Schein’s levels of culture

Source: Schein’s (2004): Organizational Culture and Leadership, 3rd Edition
Artifacts:
The surface is the level of artifacts which includes all phenomena that we can see, feel and hear when we encountered a new culture. This level also includes the group’s product, physical environment such as architecture, language, certain type of science and technology, arts, clothing, manners of address, gestures, non-verbal communication, emotional displays, national and religious rituals, ceremonies, and other sensible elements (Schein, 2004).
A significant point related to this level is that both are easy to be sensed and be felt and very difficult to encode them.
Schein gives a very good example of Egyptians and Mayans pyramids. They both built up the high pyramids which are quite similar in terms of architecture but very different meaning in each culture. In other words, in the visitor eyes, both look same while there are big different cultural descriptions and purposes behind these. As Guardian reports there are the oldest ‘tombs’ in Mayan’s pyramids while there are ‘temples’ in Egyptian’s pyramids.
One significant point which specially should be considered is the danger of trying to infer the assumptions from artifacts alone. The interpreter will inevitable to reflect of one’s own feeling about what is being seen. For instance when one sees an informal organization, interprets that as inefficiency if one’s own background is based on this assumption which informally means inefficient working or playing around. Differently, if one sees a very formal organization, maybe interprets that as a sign of lack of innovative capacity or bureaucracy based on his assumption of formality, (Schein, 2004).
Significantly the best way to achieve the best level of understanding for a certain culture can be living on that culture and observing the groups over the period of time. Also in this way it is much reliable to go through the ‘espoused beliefs and values’ as the second level of culture.
Espoused Beliefs and Values first of it is significant to consider what does value and belief mean? Hill (2007) cites that values form the bedrock of a culture and people argue, fight, and even die over values such as freedom and Browaeys and Price (2008) implies that ‘Values are what is considered important and unimportant, beautiful or not beautiful, right or wrong and sometimes value is something experienced inwardly and which is not up for discussion’.
Beliefs and values usually undergo the process of transformation to become ‘assumption’. In the first stage, a phenomenon becomes into a shared value or belief and ultimately over the period of time it goes into a shared assumption. Not all beliefs and values undergo such transformation, only those that can be empirically tested and evaluated and that continue to be a reliable solution for the group’s problems.
In case if the certain value or belief is not quite testable (or if it is less testable), the ‘social validation’ is the non-automatic possible way for transformation. By ‘social validation’ it meant that certain value or belief is confirmed by the shared social experience of a group. (Schein 2004)
For instance a certain culture cannot prove that its religion is more efficient and superior rather than other culture’s religion. In such a case like this, if the members and people of this culture reinforce each other’s beliefs and values after a while, they come to be taken for granted. And of course anyone who fails to accept such beliefs and values run the risk of ‘excommunication’ which means might be thrown out of the group. Apparently these values and beliefs are transformed into non-discussible assumption which is supported by articulated sets of beliefs, norms and operational rules of behaviour.

2.5.2. Dimensions of organizational culture

In the current scenario, amidst increasing competitiveness, the organisations are trying hard for sustainability (Fekete and Borcskei, 2001). The organisations are trying hard to get more innovative, creative and competitive ways to stay in the international market. Various factors are affecting the organisations. A very prominent factor influencing respective performance of the firm is the culture as maintained by the organisation (Peters & Waterman, 1982; Cameron & Quinn, 2006; Fekete 2011; Duke II & Edet, 2012; Saffold, 1988; Zheng et al., 2010). Since organisational culture is directly related to the individual consumer, there is the need to offer excessive attention to the same in selected secondary sources (Barney, 1986; Ojo, 2010; Oparanma, 2010). As per the theoretical derivations, idea of connecting organisational culture to organisational performance is a relevant approach (Ahmed, 1998; Cameron & Quinn, 2006; Peters & Waterman, 1982; Saffold, 1988; Zheng et al., 2010). Some empirical data are also considered about the connection of performance with the culture (Duke II & Edet, 2012; Marcoulides & Heck, 1993; Ogbonna & Haris, 2000).

There are many articles that are noted in context of the culture, very few are about the connection of it with organisational performance (Kim et al., 2004; Lim, 1995; Reichers & Schneider, 1990). Moreover, there are some reviews that mentioned about this issue with definition, yet the study design as well as measurement remains inconsistent tot he basic connection of performance with culture within an organisation (Kim et al., 2004; Lim, 1995; Reichers & Schneider, 1990).
No rigid definition can be considered for understanding organisational culture as a whole (Barney, 1986; Abu-Jarad et al., 2010). However, it has been defined from diversified perspectives. Determined literature reviews related to organisational culture, as led by Schneider et al., (2012) state, “there is not agreement on what culture is nor how it should be studied”. Schein (1990, p.111) still tried to clarify this aspect by stating organisational culture as, “a pattern of basic assumptions that a group has invented, discovered or developed in learning to cope with its problems of external adaptation and internal integration, and that have worked well enough to be considered valid, and therefore, to be taught to new members as the correct way to perceive, think, and feel in relation to those problems”. According to Kim et al., (2004, p. 341) it is, “the shared values and norms of the organization’s members”. Definition of organizational culture is “the shared, basic assumptions that an organization learns while coping with the environment and solving problems of external adaptation and internal integration that are taught to new members as the correct way to solve those problems” by Park et al. (2004). As per Armstrong (2006, p. 384) corporate or organisational culture is “the pattern of values, norms beliefs, attitudes and assumptions that may not have been articulated but shape the ways in which people in organizations behave and things get done.”

Abu-Jarad et al., (2010, p. 34) defined organisational culture as the way of affecting employees as well as outcomes of organisational initiatives. Organisational culture can affect behaviour of employees, learning approaches and developmental structure of the working groups (Bollinger & Smith, 2001; Saeed & Hassan, 2000) through innovation and creativity (Ahmed, 1998; Martins & Terblache, 2003; Martins & Martins, 2002; Mclean, 2005; Vincent et al., 2004), and further with knowledge management (McDermott & Tseng, 2010). Researches on organisational culture being connected to organisational performance remain extensive (Han et al., 1998; Kim et al., 2004; Oparanma, 2010; Saeed & Hassan, 2000; Tseng, 2010; Zain et al., 2009). However, the results are inconclusive (Scott et al., 2002; Abu-Jarad et al, 2010) as the definition, design and structure are connected to various problems and differences.

Studies are noted in context of mediating effects over other factors, like knowledge conversion (Tseng, 2010), management (Zheng et al., 2010), innovativeness (Han et al., 1998) with organisational performance and culture. Saffold (1988) stressed on interactive process, culture, and outcomes for investigating culture-performance connection. Thus, organizational culture is subject to affect performance by mediating factors (Tseng, 2010; Zheng et al., 2010)

Organizational culture is a novel attitude comprising of aspects like members having mutual perceptions and understanding. Initially, it was considered as a reasonable tool for controlling people and coordinating a business. Such organisations have officially noted vertical levels, hierarchical authorities, etc., but organization needs more features. An organization consists of friendly and flexible individual personality, with conservative/intimate features (Rabinz, 1996). For the staff, there is an acceptance towards determined behavioural pattern or so-called culture of organization.
Thus, organizational culture is the conceptual system for the organizational members with consensus making respective organization prominent from other organizations. On a specific note, this system has common concepts creating organisational value.
Mirkamali (2002) notes ‘organizational culture being dominant mode of behavioral pattern within the members of the organization with values, habits and beliefs of supported by people in majority. Definition of Stanley Davis is about shared values as well as beliefs adding meaning to organisational members and laying impact over organization-based performance and behavior, making decision/editing/planning of policies as well as strategies, job satisfaction and motivation, innovation and creativity, missions, goals and commitments of the respective organization. All such patterns, identify diversified elements that are responsible to unite culture and features of the organisation like individual mode of creativity, support of manager, dependency on enterprise with conflict phenomena, style of leadership offering critical understanding to the organizational culture.

More and more researchers have shown interest in the idea of organizational culture in the last twenty years. The theme has been investigated by analysts through several theoretical pursuits, procedural tools, and descriptions of the notion also. There is immense discussion over basic matters of the theory and epistemology (Martin, 1992; Trice and Beyer, 1993). While a few consider the endeavours to gauge organizational cultures and their impacts on firms as extremely challenging e.g., Siehl and Martin, 1990; Martin, 1992; Alvesson, 1993), several researched commence on the presumption that culture is a calculable metric of firms (O’Reilly and Chatman, 1996). Such researches do not try to understand the meaning of varied institutional cultures or cultural forms as such, but instead, emphasise on their results for organisational conduct and procedures. The researches of the impacts of strong corporate cultures for performance of a firm, including the current study, fall under this convention. The researcher espouses O’Reilly and Chatman’s (1996: 160) description of organizational cultures “a set of mutual values (that describe what is crucial) and rules that describe suitable approaches and conducts of institutional members (how to feel and behave)” (for related descriptions, refer to Rousseau, 1990; Kotter and Heskett, 1992; Gordon and DiTomaso, 1992).
Furthermore, culture can be regarded to be strong if those rules and beliefs are extensively mutual and deeply held through the entire firm (O’Reilly and Chatman, 1996: 166; O’Reilly, 1989; Gordon and DiTomaso, 1992; Kotter and Heskett, 1992). This description of culture strength, opposed to a few others, necessitated no presumptions about which rules and beliefs may improve the performance of a firm (for instance., Ouchi, 1981; Deal and Kennedy, 1982; Denison, 1990). One of the crucial results of a strong corporate culture is that it enhances behavioural dependability across people in an organisation. Organisational culture describes a normative setting that acts as a source of reliable conduct in a firm. Thus, organisational culture can be regarded to be a social control technique (O’Reilly, 1989; O’Reilly and Chatman, 1996). Simultaneously, organisational culture builds the individual’s understandings of organisational proceedings and fundamental presumptions related to the institutional procedures. Schein (1991: 15) focused that organizational cultures “offer group members a technique of offering sense to their day to day lives, providing directions and norms for conducting themselves, and most significantly, lowering and limiting the nervousness of handling with an erratic and ambiguous surrounding.” A comprehensive consensus related to the fundamental presumptions and principles in the enterprise must enhance the behavioural dependability (Gordon and DiTomaso, 1992) and thus improve the performance of the firm, which is a task of the likely yield to the firm’s actions and its capability to execute those actions. The influence of reliability on performance is crucial, as enterprises with superb tactics (high possible yields) may perform badly if they fail to implement well, and enterprises that perform their procedures superbly may recompense for suboptimal tactics.

2.5.3. Types of organizational culture:
There are several organizational typologies and related dimensions such as Schein, Schwartz, Hofstede, O’Rielly, The Competing Values Framework. (Aktas, Cicek, and Kiyak, 2011) The Competing Values Framework (CVF) is one of “the most influential and extensively used models in organizational culture research” (Aktas, Cicek, and Kiyak, 2011. P.1561). Cameron and Quinn introduced the organizational culture framework based on a theoretical model called the Competing Values Framework (CVF) which has been one of the most successful models in the organizational culture area. (Aktas, Cicek, and Kiyak, 2011)This framework refers to “weather an organization has a predominant internal or external focus and weather it strives for flexibility and individuality or stability and control”. (Aktas, Cicek, and Kiyak, 2011 P.1561). This framework is based on six organizational culture dimensions and four dominant culture types including Clan, Adhocracy, Market, and Hierarchy.
The CVF model “explores the deep structures of organizational culture relating to compliance, motives, leadership, decision making, effectiveness, and organizational forms in the organization” (Quinn and Kimberly, 1984. P.298). Yeung, Brockbank, and Ulrich, (1991. P. 64) believe that “it has been shown that the CVF is both theoretically sound in integrating organizational culture to other organizational components and can be operationalized as a psychometrically sound instrument”. The characteristics of each type of culture are shown at the Figure.1

Figure. The Comparing Values of Framework of Organizational Effectiveness. Source: (Aktas, Cicek, and Kiyak, 2011)
The CVF shown in the above figure, has two axes each presents different value orientations (Denison and Spreitzer, 1991; McDermott and Stock, 2001). The vertical axis reflects the extent to which an organization focuses on change and stability. The horizontal axis refers to the extent to which an organization focuses on the internal organization and external environment. The two axes reflect four culture types. Cameron and Freeman (1991) mention these four organizational culture types as the “Clan”, the “Developmental” , the “Hierarchical” , and the “Rational” culture (Jocaobs et al, 2013). “The Clan culture identifies values that emphasize an internal, organic focus (‘do things together’), whereas the Rational culture identifies values that emphasize external, control focus (‘do things fast’). The Developmental culture identifies values that emphasize external, organic focus (‘do things first’) whereas the Hierarchical culture emphasize internal, control values (‘do things right’) (Jacobs et al, 2013. P. 118). Denison and Spreitzer, (1991) and McDermott, and Stock, (2001) named the four culture types as Group culture, Developmental culture, Rational culture, and Hierarchical culture. Researchers postulated that CVF’s four quadrants are ideals (McDermott and Stock, 2001; Henri, 2006; zu et al, 2010). Organizations often reflect just one culture type, more than presenting a combination of different culture types, although it might be that one certain type is more dominant (McDermot and Stock, 2001; Quinn and Spreitzer, 1991). Thus using the CVF to assess an organization’s culture, provide researchers with the opportunity to examine the relationship between different cultures (Zu et al, 2010). A number of studies have applied CVF to explore the organizational culture and performance (Jacobs et al, 2013; Zhen, Yuqiang, and Luning, 2012; Prajogo and McDermott, 2011; Gregory et al, 2009; Skerlavaj et al, 2007; Hunt et al, 2012;) organizational culture and organizational effectiveness (Faqir Sajjad et al, 2011; Aktas, Cicek, and Kiyak, 2011; Stock, McFadden, and Gowen, 2007; Hartnell, Ou, and Kinicki, 2011), and the link between organizational culture and innovation (Sanz-Valle et al, 2011; Acar and Acar, 2012 ). This research applies Competing Values Framework (CVF) which has previously been used to assess culture in healthcare and health area (Gifford et al, 2002; Goodman et al, 2001; Helfrich et al, 2007; Jones, DeBaca and Yarbrough, 1997; Meterko et al, 2004; Shortell et al, 2004; Strasser et al, 2002), and “it is perhaps the most popular approach to assessing culture where the interest is on relating culture to organizational performance” (Gregory et al, 2009.p. 673). Aktas, Cicek, ad Kiyak (2011. P. 1568) stated that “the contrasting values captured under CVF provide a strong reason for choosing this model of organizational culture over the others, such as Hofstede’s (1980) model or organizational culture profile developed by O’Reilly (1991)”.
Studies pertaining to SMEs have increased immensely in the past few years since several trades across the globe are SMEs and they have a crucial influence on the nation’s economies. SMEs drive both private ownership and entrepreneurial skills, are adaptable and can adjust to the changing market demand and supply scenarios, develop employment, assist to vary the economic actions and provide a crucial input to exports and trade. Different studies have focussed on varied aspects which influence the success of an enterprise. Business failure can be attributed to several causes either due to owners, management, action made by other businesses, customers, or supplier. Hence, it is crucial to identify the likely aspect that may result in failure. As per researches conducted failure of SMEs has been mainly due to three groups failed owner/managers, non-failed owner/managers or third parties such as liquidators or official receivers. The two main reasons for SME failure appear to be lack of suitable abilities and insufficient capital.
Culture formally refers to a pattern of shared basic assumptions that was learnt by a group as it solved its problems of external adaptation and internal integration that has worked well enough to be considered valid and, therefore, to be taught to new members as the correct way to perceive, think, and feel in relation to those problems. As per Schein, culture has different levels including:
Artifacts – Visible organizational structures and processes;
Espoused Beliefs and Values – Strategies, goals, and philosophies;
Underlying Assumptions – Unconscious, taken-for-granted beliefs, perceptions, and feelings;
There are different aspects that impact the organisational performance. Culture is a predominant one. Organisational culture can be regarded to be the shared values and norms of the organisation’s members. Organizational culture is a novel attitude including facets such as members having mutual perceptions and understanding. Thus, organizational culture is the conceptual system for the organizational members with consensus making respective organization prominent from other organizations.
Several analysts in the past two decades have begun to study organisational culture. While a few consider the endeavours to gauge organizational cultures and their impacts on firms as extremely challenging, several researched commence on the presumption that culture is a calculable metric of firms. One of the strong results of a strong corporate culture is that it enhances behavioural dependability across people in an organisation. Organisational culture describes a normative setting that acts as a source of reliable conduct in a firm. Thus, organisational culture can be regarded to be a social control technique.
There are varied organizational typologies and related dimensions such as Schein, Schwartz, Hofstede, O’Rielly, The Competing Values Framework. One of the most influential and widely employed prototypes in organisational culture research is The Competing Values Framework (CVF). This structure relies on six organizational culture dimensions and four dominant culture types including Clan, Adhocracy, Market, and Hierarchy.

2.6. Assessment of Hospital Culture
The Denison model and Quinn and Rohrbaugh’s competing values framework (CVF) are the two conceptual structures that are frequently employed to evaluate the hospital culture. Mission, consistency, adaptability, and involvement are the four cultural attributes on which the Denison framework relies (Denison 1990). Mission specifies to a long-run aim for the firm; consistency shows the principles and systems that are the foundation of a strong culture; adaptability shows the capability to interpret the needs of the business surrounding into action; while involvement indicates developing human ability, ownership and accountability. Each of these attributes is typified by three sub-aspects. Different industries have employed the Denison prototype to evaluate culture (Hatch and Cunliffe 2006). The Quinn and Rohrbaugh’s CVF is frequently employed by researches related to the health services domain (Quinn and Rohrbaugh 1981). In the CVF, there are two groups of opposing principles. The first group is centralization and control over institutional procedures in contrast to decentralization and flexibility. The second if the firm is directed towards own intrinsic environment and procedures or the extrinsic environment and associations with extrinsic bodies (like regulators, vendors, rivals, associates and clients).

2.6.1. Different Perceptions of Hospital Culture

A subculture is a subgroup of a firm’s members who consider themselves to be a unique set in the firm and who regularly act depending on the shared comprehensions (Hatch and Cunliffe 2006). Subcultures may be formed in a hospital between employees sharing related attractions, those sharing professional, gendered, occupational characteristics, or between those who communicate more on account of sharing areas or machinery. For instance, in the U.S. hospitals, varied kinds of employees have varied viewpoints related to organisational patient safety climate (Thomas, Sexton, and Helmreich 2003; Hartmann et al. 2008; Singer et al. 2009), with senior managers having a more affirmative viewpoint compared to the frontline workers or supervisors (Singer ET al.2008).
Since Chinese managers, physicians, health technicians, nurses, and other employees have varied operations and work under varied settings, they indicate varied subcultures in a hospital with varied viewpoints of the institutional culture. Depending on the inferences made by Singer et al. (2008), the researchers recommend that the degree to which the employees communicate with the patients is a crucial aspect in ascertaining opinions related to organisational culture. The researchers hypothesise that the opinions related to organisational culture of the managers will vary from those of frontline workers who communicate directly with the patients.

2.6.2. Relationship between Hospital Culture and Hospital Performance
While it is agreed by managers and scholastic analysts that performance is impacted by organisational culture (Kreitner and Kinicki 2008), researches that prove a link between organisational culture and performance of the organisation have not provided uniform inferences (Damanpour 1992; Denison, Haaland, and Goelzer 2004; Kreitner and Kinicki 2008). In the domain of health care, researches have evaluates varied performance pointers like quality improvement activities, patient-care quality and efficiency, effectiveness of provider teams, health care provider job satisfaction, and patient satisfaction, making it tough to recognise uniform associations across varied researches (Coeling andWilcox 1988; Platonova et al. 2006; Williams et al. Konrad 2007; Zazzali et al. 2007). Furthermore, a large number of studies related to organisational culture of hospitals analysed the United States or other high-income nations. There is limited knowledge pertaining to hospital organisational culture in nations with varied socioeconomic and cultural settings (Helfrich et al. 2007).
The researchers study the association amongst the organisational culture and four kinds of performance pointers, which include crucial matters related to policy makers and the public in context to hospital conduct. The pointers comprise of resource use per patient (length of stay [LOS]), productivity in resource use (outpatient visits per physician per day [OVPPPD], bed days per physician per day [BDPPPD]), short-term profitability, patient satisfaction with medical care, and employee satisfaction.

A hospital whose culture focuses on social responsibility will accord more emphasis to the society interests over the interests of individual hospitals or patients. Public hospitals in China, for instance, have comparatively high occupancy rates (90.0 per cent in average in 2010) and comparatively long LOS (10.7 days in average in 2010) (Chinese Ministry of Health, 2011). And the opinion present is that capacity limitations restrain several individuals who need treatment from obtaining it. Hence, the idea of social responsibility in this setting may not be in social relevance on account of adverse impacts of shorter stays due to quality care, as LOS is strangely long China compared to other nations, the researchers believe that this kind of involuntary impact is doubtful.
The Denison model and Quinn and Rohrbaugh’s competing values framework (CVF) are the two conceptual structures are used to assess the hospital culture. Mission, consistency, adaptability, and involvement are the four cultural attributes on which the Denison framework depends. Each of these attributes is characterised by three sub-aspects. In the CVF, there are two groups of opposing principles. The first group is centralization and control over institutional procedures in contrast to decentralization and flexibility. The second if the firm is directed towards own intrinsic environment and procedures or the extrinsic environment and associations with extrinsic entities.

A subculture is a subgroup of a firm’s members who consider themselves to be a unique set in the firm and who regularly act depending on the shared comprehensions. Based on the comprehensions made by Singer et al. (2008), the researchers suggest that the degree to which the employees communicate with the patients is an important aspect in establishing opinions associated to organisational culture. The researchers hypothesise that the opinions related to organisational culture of the managers will differ from those of frontline workers who communicate directly with the patients. While it is agreed by managers and scholastic analysts that performance is impacted by organisational culture, researches that prove a link between organisational culture and performance of the organisation have not provided uniform inferences. There is limited knowledge pertaining to hospital organisational culture in nations with varied socioeconomic and cultural settings. The researchers study the association amongst the organisational culture and four kinds of performance pointers, which include crucial matters related to policy makers and the public in context to hospital conduct.
A hospital whose culture focuses on social responsibility will accord more emphasis to the society interests over the interests of individual hospitals or patients.

References:
• Beijen, J., E.A.M. Mylanus, and A.F.M. Snik. 2007. Education qualification levels and school careers of unilateral versus bilateral hearing aid users. Clinical Otolaryngology 32: 86–92.
• World Health Organization. 2002. International classification of functioning, disability and health (ICF). Geneva: World Health Organization.
• Parette, H.P., and G.R. Peterson-Karlan. 2007. Facilitating student achievement with assistive technology. Education and Training in Developmental Disabilities 42: 387–97.
• Yeager, P., H.S. Kaye, M. Reed, and T.M. Doe. 2006. Assistive technology and employment: Experiences of Californians with disabilities. Work 27: 333–44.
• Roulstone, A. 1998. Enabling technology: Disabled people, work and new technology. Buckingham: Open University Press.
• Langton, A.J., and H. Ramseur. 2001. Enhancing employment outcomes through job accommodation and asssitive technology resources and services. Journal of Vocational Rehabilitation 16: 27–37.
• Chan, F., G. Cheing, J.Y.C. Chan, D.A. Rosenthal, and J. Chronister. 2006. Predicting employment outcomes of rehabilitation clients with orthopedic disabilities: A CHAID analysis. Disability and Rehabilitation 28: 257–70.
• Brown-Triolo, D.L. 2001. Understanding the person behind the technology. In Assistive technology: Matching device and consumer for successful rehabilitation, ed. M.J. Scherer, 31–46. Washington, DC: American Psychological Association.
• Scherer, M.J. 2005. Living in the state of stuck: How assistive technology impacts the lives of people with disabilities. Brookline: Brookline Books.
• Veehof, M., E. Taal, J. Rasker, J. Lohmann, and M. van de Laar. 2006. Possession of assistive devices is related to improved psychological well-being in patients with rheumatic conditions. Journal of Rheumatology 33, no. 8: 1679–83.
• Johnson, K.L., B. Dudgeon, C. Kuehn, and W. Walker. 2007. Assistive technology use among adolescents and young adults with spina bifida. American Journal of Public Health 97: 330–6.
• Greenhalgh, T., Procter, R., Wherton, J., Sugarhood, P., & Shaw, S. (2012). The organising vision for telehealth and telecare: discourse analysis. BMJ Open, 2, e001574.

• EFORTT Research Team. (2012). Ethical frameworks for telecare technologies for older people at home. Project 217787. Lancaster: University of Lancaster Accessed January 2013 on http://www.lancs.ac.uk/efortt.
• Dourish, P., & Bell, G. (2011). Divining a digital future: Mess and mythology in ubiquitous computing. Cambridge, MA: MIT Press.
• Sayer, A. (2011). Why things matter to people. Cambridge: Cambridge University Press.
• Schei, E. (2006). Doctoring as leadership: the power to heal. Perspectives in Biology and Medicine, 49(3), 393e406. http://dx.doi.org/10.1353/pbm.2006.0048.
• Bloom DE, Canning D. Global demographic change: Dimensions and economic significance 2005, http://www.globalhealth.harvard.edu/WorkingPapers.asp.
• Dini E, Goldring, S. Estimating the changing population of the ‘oldest old’. Pop Trends 2008;132:8–16.
• Martin S, Kelly G, Kernohan WG, McCreight B, Nugent C. Smart home technologies for health and social care support. The Cochrane Collaboration; 2009.
• World Health Organisation. Glossary of terms for community health care and services for older persons, 2004.
• Barlow J, Singh D, Bayer S, Curry R. A systematic review of the benefits of home telecare for frail elderly people and those with long-term conditions. J Telemed Telecare 2007;13:172–9.
• Department of Health. Older people and disability division. building telecare in England. London, 2005.
• Botsis T, Demiris G, Pedersen S, Hartvigsen G. Home telecare technologies for the elderly. J Telemed Telecare 2008;14:333–7.
• Department of health delivering 21st century IT support for the NHS. National Strategic Programme. London, 2002.
• Fekete H., Borcskei & E. (2011). Cultural Waves in Company Performance. Research Journal of Economics, Business And ICT, 3, 38-42.
• Cameron, K.S., & Quinn, R.,E. (1999). Diagnosing and Changing Organizational Culture. Reading, MA: Addison Wesley.
• Duke II, J., & Edet, G.H. (2012). Organizational Culture as a Determinant of Non-Governmental Organization Performance: Primer Evidence from Nigeria. International Business and Management, 4 (1), 66-75.
• Peters, T.J. & Waterman, R.H.(1982) . In Search of Excellence-lessons from Aermica’s best- Rrun Companies. Harper Collins Publishers, London.
• Saffold, G.S. (1998). Culture Traits, Strength and Organizational Performance: Moving beyond Strong Culture. The Academy of Management Review,13, 546-558.

• Barney, J.B. (1986). Organizational Culture: Can It Be a Source of Sustained Competitive Advantage?. The Academy of Management Review, 11(3), 656-665.
• Han, J.K., Kim, N., & Srivasta, R.K. (1998). Market Orientation and Organizational Performance: Is Innovation a Missing Link?, Journal of Marketing, 62 (4), 30-45.
• Abu-Jarad, I.S., Yusof, N.A,& Nikbin, D. (2010). A Review Paper on Organizational Culture and Organizational Performance. International Journal of Busines and Social Science, 1 (3), 26-46.
• Vincent L.H., Bharadwaj, S.G., & Challagalla, G.N. (2004). Does Innovation Mediate Firm Performance?: A Meta-Analysis of Determinants and Consequences of Organizational Innovation. Retrieved from http://smartech.gatech.edu/handle/1853/10731.
• Martins, E.C., & Terblanche, F. (2003). Building Organisational Culture that Stimulates Creativity And Innovation. European Journal of Innovation Management, 6 (1), 64 74.
• Ahmed, P.K. (1998). Culture and Climate for Innovation. European Journal of Innovation Management, 1(1), 30 43.
• Scott,T., Mannion, R., Davies, H., & Marshall, M. (2003). The Quantitative Measurement of Organizational Culture In Health Care: A Review of
• The Available Instruments. Health Serv Res. 38(3), 923-45.
• Saeed, M., &Hassan, M. (2000). Organisational Culture and Work Outcomes: Evidence from some Malaysian organisations. Malaysian
• Management Review, 35(2), 54-59.
• Zain, Z.M., Ihsak, R., &Ghani E., K. (2009). The Influence of Corporate Culture on Organisational Commitment: A Study on a Malaysian Listed
• Company, European Journal of Economics, Finance and Administrative Sciences,17, 17-25.
• Oparanma , A.O. (2010). The Organizational Culture and Corporate Performance in Nigeria. International Journal of African Studies ,3, 34-40.
• Kim, S., Lee J., &Yu K. (2004). Corporate culture and organizational performance. Journal of Managerial Psychology, 19 (4).340 359.
• Tseng, Shu-Mei. (2010).The correlation between organizational culture and knowledge conversion on corporate performance. Journal of Knowledge Management, 14 (2), 269-284.
• Zheng, W., Yang, B.,. & McLean, G. N. (2010). Linking Organizational Culture, Structure, Strategy and Organizational Effectiveness: Mediating Role Of Knowledge Management. Journal of Business Research, 63, 763 771.
• Mirkamali, 2002. Behavior and Relationships in the Organization and Management. Yastaroon Publication, Vol. 3.
Rabinz, A., 1996. Organization Theory. Safar Publication, Tehran.
• Denison, D. R. 1990. Corporate Culture and Organizational Effectiveness. New York: John Wiley & Sons.
• Hatch, M. J., and A. L. Cunliffe. 2006. Organizational Theory. New York: Oxford University Press.
• Quinn, R. E., and J. Rohrbaugh. 1981. “A Competing Values Approach to Organizational Effectiveness.” Public Productivity Review 5 (2): 122–40.
• Thomas, E. J., J. B. Sexton, and R. L. Helmreich. 2003. “Discrepant Attitudes about Teamwork among Critical Care Nurses and Physicians.” Critical Care Medicine 31 (3): 956–9.
• Singer, S. J., D. M. Gaba, A. Falwell, S. Lin, J. Hayes, and L. C. Baker. 2009. “Patient Safety Climate in 92 US Hospitals: Differences by Work Area and Discipline.” Medical Care 47 (1): 23–31.
• Hartmann, C. A., A. K. Rosen, M. Meterko, P. Shokeen, S. Zhao, S. Singer, A. Falwell, and D. M. Gaba. 2008. “An Overview of Patient Safety Climate in the VA.” Health Services Research 43 (4): 1263–84.
• Kreitner, R., and A. Kinicki. 2008. Organizational Behavior, 8th Edition. New York: McGraw- Hill/Irwin.
• Damanpour, F. 1992. “Book Review: Corporate Culture and Organizational Effectiveness.” Journal of Management 18: 175–6.
• Denison, D. R., S. Haaland, and P. Goelzer. 2004. “Corporate Culture and Organizational Effectiveness: Corporate Culture and Organizational Effectiveness: Is Asia Different from the Rest of the World?” Organizational Dynamics 33 (1): 98– 109.
• Coeling, H. V. E., and J. R. Wilcox. 1988. “Understanding Organizational Culture: A Key to Management Decision-Making.” JONA 18 (11): 16–23.
• Platonova, E. A., S. R. Hernandez, R. M. Shewchuk, and K. M. Leddy. 2006. “Study of the Relationship between Organizational Culture and Organizational Outcomes Using Hierarchical Linear Modeling Methodology.” Quality Management in Health Care 15 (3): 200–9
• Williams, E. S., L. B. Manwell, T. R. Konrad, and M. Linzer. 2007. “The Relationship of Organizational Culture, Stress, Satisfaction, and Burnout with Physician-Reported Error and Suboptimal Patient Care: Results from the MEMO Study.” Health Care Management Review 32 (3): 203–12.
• Zazzali, J. L., J. A. Alexander, S. M. Shortell, and L. R. Burns. 2007. “Organizational Culture and Physician Satisfaction with Dimensions of Group Practice.” Health Services Research 42 (3): 1150–76.
• Helfrich, C. D., Y. F. Li, D. C. Mohr, M. Meterko, and A. E. Sales. 2007. “Assessing an Organizational Culture Instrument Based on the CompetingValues Framework: Exploratory and Confirmatory Factor Analyses.” Implementation Science 2: 13, doi:10.1186/1748-5908-2-13.
• Chinese Ministry ofHealth. 2011. “2010 Statistical Bulletin of China’s Health Development” [accessed on June 30, 2011]. Available at http://www.moh.gov.cn/publicfiles/business/htmlfiles/mohwsbwstjxxzx/s7967/201104/51512.htm.

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