How Do Public Service Professionals Behave in Risky Situations? The Importance of Organizational Culture

• Author: Emily Rose Tangsgaard
• Published date: 01 September 2021
• Date: 01 September 2021
• DOI: http://doi.org/10.1177/02750740211010348
• Subject Matter: Articles

https://doi.org/10.1177/02750740211010348

American Review of Public Administration

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DOI: 10.1177/02750740211010348

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Article

Introduction

Many situations in public service delivery are characterized

by uncertainty about the potential negative consequences

following decisions. These risky situations make the behav-

ior of frontline professionals important, because they make

many decisions where they rely on discretion. Take the case

of a fragile heart patient. The clinical guidelines may advise

to conduct a certain procedure on the patient. However, this

procedure could trigger complications to the patient, who

also suffers from kidney failure. The decision, which is based

on an assessment of the patient’s overall condition, can either

turn out good, bad, or somewhere in between. The procedure

may improve the patient’s heart condition, but it may also

lead to an overall health deterioration. This is a risky situa-

tion because there is uncertainty about the likelihood of neg-

ative consequences following the decision. Often, there are

no evidently right or wrong answers to the challenges faced

in public service delivery, and the professionals rely on dis-

cretion (Lipsky, 2010; Tummers, 2013). The behavior of

frontline professionals is of particular importance in risky

situations since decisions can lead to unintended, negative

consequences to the service recipients.

Risk is present in public service delivery. From prospect

theory, we know that risk perception affects subsequent

behavior (Kahneman & Tversky, 1979), but we lack knowl-

edge of how organizational culture matters to risk perception

and behavior in risky situations (Sitkin & Pablo, 1992).

Based on these premises, the core argument explored in this

study is that organizational culture matters to how risky situ-

ations are perceived and acted upon in organizations that

deliver public services. Behavior is understood as frontline

professionals’ assessment of and decision on how to approach

a given decision in risky situations.

1Aarhus University, Denmark

Corresponding Author:

Emily Rose Tangsgaard, Crown Prince Frederik Center for Public

Leadership, Department of Political Science, Aarhus University, Bartholins

Allé 7, 8000 Aarhus, Denmark.

Email: ertc@ps.au.dk

How Do Public Service Professionals

Behave in Risky Situations?

The Importance of

Organizational Culture

Emily Rose Tangsgaard1

Abstract

Many situations in public service delivery are characterized by uncertainty about the potential negative consequences following

decisions. These risky situations make the behavior of frontline professionals particularly important. But what shapes the

risk perception and subsequent behavior of frontline professionals in risky situations? This article explores the idea that

organizational culture provides part of the answer. To examine this, a comprehensive qualitative study with participant

observations and interviews at five public hospital wards was conducted. The findings demonstrate the importance of

organizational culture on risk perception and behavior in risky situations. Basic cultural assumptions related to professional

discussion, administering medicine, grading of adverse events, and prioritizing follow-up activities matter to behavior in risky

situations. In organizational cultures with high levels of trust and dialogue about decision-making, the health professionals rely

on each other and ask for second opinions, when making decisions in risky situations. Conversely, in organizational cultures

with little trust and professional discussion, the health professionals are less likely to ask for second opinions and follow up

on risky situations, which increases the possibility of unintended, negative consequences. In this way, organizational culture

can be a driver of risk-reducing and risk-seeking behavior among frontline professionals.

Keywords

organizational culture, behavior, risky situations, risk perception, frontline professionals, interviews, participant observations

2021, Vol. 51(7) 492–508

Current knowledge about frontline professionals is

formed by Michael Lipsky (2010), whose work has had a

revival in recent years with renewed scholarly attention.

Previous research in this field has studied discretion and its

consequences in public service delivery (e.g., Baviskar &

Winter, 2017; Evans & Harris, 2004; Harrits & Møller, 2014;

Jensen, 2018; Lavee & Strier, 2019). However, what shapes

the behavior of frontline professionals is somewhat over-

looked, which is the main contribution of this article.

We know that perception of risk affects how actors make

decisions and behave (Kahneman & Tversky, 1979). The

question is how risks are perceived and acted upon in organi-

zations that deliver public services and what shapes the per-

ception. As mentioned, the core argument of this article is

that organizational culture matters to how frontline profes-

sionals perceive risk and, therefore, how they behave in risky

situations. Yet, the importance of organizational culture in

relation to the behavior of frontline professionals in risky

situations requires illumination (e.g., Brehm & Gates, 1999;

Riccucci, 2005). The aim of this article is to do that by

answering the following question: How does organizational

culture matter to the behavior of frontline professionals in

risky situations?

The research question is studied in an explorative manner.

This entails an open approach to how organizational culture

matters to risk perception and subsequent behavior.

Organizational culture is a heavily theorized concept, and

here, the analytical framework proposed by Edgar Schein

(2017) is applied. The role of the theoretical framework is to

provide guidance in the data collection and analytical pro-

cess while leaving room to explore how organizational cul-

ture matters to the risk perception and behavior of frontline

professionals in risky situations (Collins & Stockton, 2018;

Yin, 2014).

The study examines the organizational culture and behav-

ior at five wards from three Danish public hospitals, building

on 30 interviews and 35 hr of observation. The health care

sector is a good case for studying the research question, as it

is a sector of high gains and high stakes in which health pro-

fessionals (HPs) handle patients with a range of conditions

and matters of life and death.

The findings suggest that organizational culture is impor-

tant for understanding the behavior of frontline professionals

in risky situations as it enables both risk-seeking and risk-

reducing behavior. For instance, basic cultural assumptions

related to discussing professional issues in risky situations

are at most wards sustained by high levels of trust, which

makes the HPs rely on each other and ask for second opin-

ions, when making decisions in risky situations. Conversely,

in organizational cultures with little trust, the HPs are less

likely to ask for second opinions and follow up on risky situ-

ations, which increases the possibility of unintended, nega-

tive consequences from risky situations. The findings do not

offer an exhaustive explanation to the behavior of HPs in

risky situations. This is the focus in the discussion of the

implications of the findings, which, among other things,

addresses how organizational culture can be impediment to

organizational learning.

The Role of Frontline Professionals and

Organizational Culture

The purpose of this article is to study the importance of orga-

nizational culture in relation to the behavior of frontline pro-

fessionals in risky situations. This link is not fully developed,

although many authors have hinted at how organizational

culture matters to subsequent behavior. Simon (1997) sug-

gests that it is necessary to study factors external to the indi-

vidual to understand the behavior in organizations. Sandfort

(2000) argues that attention should be directed at how social

processes and collective schema shape the behavior of front-

line professionals. Brehm and Gates (1999), Riccucci (2005),

and Oberfield (2010) all argue that organizational culture

matters and has implications for the behavior at the front-

lines. Sitkin and Pablo (1992) are the most specific when

they argue that perception of risk is filtered through the lens

of organizational culture. There is thus reason to believe that

organizational culture is important to understand the behav-

ior of frontline professionals in risky situations. First, the

theoretical framework provides insights into how we can

understand the behavior of frontline professionals, drawing

on the street-level bureaucracy literature and prospect theory.

This is followed by a definition and operationalization of

organizational culture.

Explaining the Behavior of Frontline Professionals

In his seminal work on street-level bureaucrats (SLBs),

Lipsky (2010) highlights two core characteristics that are

important when understanding the behavior of SLBs: inter-

action and discretion. SLBs are “public service workers who

interact directly with citizens in the course of their jobs, and

who have substantial discretion in the execution of their

work” (Lipsky, 2010, p. 3). The interaction refers to the fact

that SLBs have to respond to citizens and their needs and

preferences as part of their job. It could be a doctor interact-

ing with a patient in a case of treatment related to a diagnosis.

In many cases, there are no evidently right or wrong answers

to the problems encountered by SLBs (Lipsky, 2010). In

these situations, they rely on discretion—that is, the auton-

omy to decide what to do in a given situation. An example

could be decisions on what type of medicine to give a patient.

The concept of discretion implies that SLBs hold a substan-

tial amount of power over citizens’ lives.

There are many ideas regarding what shapes the behavior

of SLBs. Lipsky points to interaction and discretion but does

not draw much attention to how the professional background

of the SLBs is related to behavior (Evans, 2011; Harrits,

2019; Nothdurfter & Hermans, 2018). Elsewhere, profes-

sional background has been highlighted by scholars who

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Tangsgaard