THE RELATIONSHIP BETWEEN ORGANISATIONAL CULTURE AND EMPLOYEE ENGAGEMENT IN PRIVATE HOSPITALS

How to cite this paper: Ashley, N., & Brijball Parumasur, S. (2024). The relationship between organisational culture and employee engagement in private hospitals. Corporate Governance and Organizational Behavior Review, 8 (1), 68 – 82.


INTRODUCTION
The study investigates the relationship between organisational culture and employee engagement in private hospitals in Ghana.Organisational culture has become one of the prevailing concepts in management for over a decade now.Zhong et al. (2016) observed that the construct of organisational culture has received extensive recognition as a way to apprehend human systems.The culture of an organisation is usually passed on from employees who have served long in the organisation to new employees (Zhou, 2017).The differences in culture across companies make it nearly impossible to accomplish a universal and acceptable culture.Nevertheless, despite differences in the definition and measurement, culture is an important topic that regulates how a worker fits into an organisational setting.An organisation with a well-developed culture spends less money solving its problems as compared to a poorly developed one.In this current business era, organisational culture is an influential tool that depicts various facets of a firm.
Employee engagement is also another significant issue in management theory and practice.The notion of employee engagement was drawn from the field of health psychology and originates from work done by Maslow on employee motivation (Dlamini, 2018).Employee engagement has also existed for some years now, but the numerous methods and diverse conceptualisations have subdued the progress of a suitable measure that effectively describes the concept (Kuok & Taormina, 2017).Developing countries, such as Ghana, experience poor service in healthcare and this has predominantly been ascribed to the marginal engagement of workers in the healthcare sector.In this light, employee engagement, which has become highly acknowledged as a crucial topic in management studies, is significant, as healthcare employees are indicted of absenteeism, lackadaisical attitudes towards work, precipitate delivery of healthcare services and poor attitude towards clients.Due to the needs of business practices, most firms in Western countries are conducting continuous studies on organisational culture and employee engagement among employers and workers.
Previous studies found the relationships between organisational culture and employee engagement as the main dimensions without considering the relationship between the sub-dimensions of the variables (Abdullahi et al., 2021; Brenyah & Obuobisa-Darko, 2017; Naidoo & Martins, 2014).Additionally, in the Ghanaian context, there are few studies regarding the relationship between organisational culture and employee engagement, especially in the healthcare sector.This study aims to close these gaps by providing empirical evidence to address the relationship between organisational culture (involvement, consistency, adaptability, and mission) and employee engagement (vigour, absorption, and dedication) and provide guidelines for enhancing organisational culture and employee engagement among healthcare employees in Ghana.Additionally, the study aims to measure the perception of organisational culture and the level of employee engagement among employees of private hospitals in Ghana.Thus, the research objectives of this study are: • to examine the perceptions of the organisational culture of healthcare employees; • to investigate the level of employee engagement of healthcare employees; • to evaluate the relationship between organisational culture and employee engagement of healthcare employees; • to investigate the intercorrelations between the sub-dimensions of organisational culture (involvement, consistency, adaptability, mission) and employee engagement (vigour, absorption, dedication) respectively; • to examine the managerial perceptions of organisational culture and employee engagement in private hospitals.
The structure of the paper is as follows.Section 1 provides an introduction and background to the study.Section 2 presents a brief discussion of relevant literature.Section 3 explains the methodology adopted to conduct the empirical study on the relationship between organisational culture and employee engagement.Section 4 describes the findings of the study and Section 5 discusses the results.Section 6 provides conclusions and recommendations for enhancing organisational culture and employee engagement.

Defining employee engagement
According to Parent and Lovelace (2018), employee engagement is the positive connection, enthusiasm, and energy of a worker toward his or her job.Employee engagement refers to a passionate state or a set of responses that employees exhibit when executing job-related responsibilities, which leads to better performance (Hairapetian, 2020).Burnett and Lisk (2019) are of the view that when workers turn out to be highly engaged, they become more involved, identify with their jobs, and energetically shape their workplace.Additionally, Ashley (2018) is of the view that engaged workers cultivate a vigorous sense of belonging to their firm and are known for their willingness to endeavor to do more than what is required in their basic roles.According to Kumar and Pansari (2016), employee engagement is an employee's opinions, attitudes, and conduct towards their job-related duties that predetermine the employee's level of work satisfaction and increase performance.

Barriers to employee engagement
While the majority of the literature has focused on the drivers of engagement, there is also a growing emphasis on identifying the barriers to engagement among employees.According to Kang and Sung (2017), poor communication is a barrier to engagement.The lack of effective communication thus impacts employee engagement adversely (Moletsane, 2017).Therefore, a lack of good communication leads to insufficient engagement (Schroeder & Modaff, 2018).Furthermore, Lockwood (2007) is of the view that bureaucratic behaviors in organisations and being overwhelmed with work significantly serve as barriers to the engagement of employees and make them more susceptible to stress.In addition, Mullarkey et al. (2011) believe that the lack of trust employees have in management is an antecedent to disengagement among employees.A further barrier to employee engagement is a lack of resources (Garbacz et al., 2018).When employees do not have the proper equipment and resources, they become frustrated, disengaged, and reduce productivity.

Defining organisational culture
Culture as a term was devised from the German word "kultur" in the 18th century to depict achievements in civilisation (Atiku, 2014).According to Lee et al. (2016), organisational culture is the set of beliefs, values, and ideologies that serve as the basis for a company's management style and practices, as well as the conduct that highlights such fundamental principles.Al Saifi (2015) is also of the view that organisational culture is a powerful, inferred, and usually, insentient energy that controls the conduct of individuals and the manner in which they identify things, their values, and the way they think.Kuronzwi (2019) believes that every organisation has a culture, but most firms pay less attention to it, which may influence the organisation's output.Quinn et al. (2020) opine that the culture of an organisation refers to a communal understanding apprehended by employees that differentiates one company from another.The culture of a firm permeates every significant aspect of the firm since it shapes the behavior and management structure.

Sources of organisational culture
Szydło and Grześ-Bukłaho (2020) are of the view that organisational culture springs from diverse sources, with one main source being the beliefs of the founders.Founders usually introduce a plan and direction for the organisation at an early stage of the company and usually have a significant influence on how the organisation functions.According to Chatman and O'Reilly (2016), founders may enact their individual experiences and cultural history on their workers as well as associates within the company.According to Gao (2017), the source of organisational culture also includes learning from experienced colleagues as well as new employees and managers.Küçükoğlu and Adigüzel (2019) posit that learning experiences originate from the societal trends of the business environment.Also, organisational structure is another source of organisational culture.The organisational structure refers to how an organisation is structured as well as how power and authority to make decisions are disseminated in an organisation (Nwachukwu & Chladkova, 2019).

Importance of organisational culture in the healthcare sector
According to Nightingale (2018), organisational culture is a major factor that forms a safe healthcare system and, hence, needs a culture of learning and openness where employees voice their opinions and concerns.Having a common culture in an organisation enhances unity among workers and helps them understand each other better.In the healthcare context, organisational culture provides a framework and a set of values to form, implement, and assess the delivery of quality services and care to patients and employees.Hence, organisational culture is a significant phenomenon since it can support or impede the performance of an organisation.Most staff in the healthcare industry spend an average of 37 hours a week in hospitals in Ghana, and hence, this needs to be an experience that is favorable to the employees' health, mind, and body.Furthermore, a workplace that has a good organisational culture is driven by purpose, and employees have clear expectations.Brenyah and Obuobisa-Darko (2017) acclaim that organisational culture inspires and encourages workers to be engaged in their duties at the firm and connect with other employees.

Link between organisational culture on employee engagement
Numerous studies found a relationship between organisational culture and employee engagement (Brenyah & Obuobisa-Darko, 2017; Dasgupta & Dey, 2021; Kwakye, 2018; Tannady et al., 2019).The link between organisational culture and employee engagement can be elucidated from the viewpoint of social exchange theory.When workers are guided by the culture of a firm, it helps them to have a good rapport with their colleagues within the firm, where they have the necessary support and are likely to perform well, be devoted, and be engaged (Brenyah & Obuobisa-Darko, 2017).According to Pepra-Mensah and Kyeremeh (2018), organisational culture is likely to persuade employees to be engaged since it is a strong driver of employee behaviour.
The following hypotheses have been proposed in light of the study's goals: H10: There is no significant relationship between organisational culture and employee engagement.
H1: There is a significant relationship between organisational culture and employee engagement.H20: There are no significant intercorrelations among the sub-dimension of organisational culture (involvement, consistency, adaptability, and mission) and employee engagement (vigour, absorption, and dedication), respectively.
Referring to the objectives and hypothesis of the study a conceptual framework was developed to investigate the relationship between the variables as stated above.
Figure 1 displays the conceptual framework that guided the study in understanding the relationship between organisational culture and employee engagement.The dependent variable for this study is employee engagement (with its subdimensions of vigour, absorption, and dedication).Sun and Bunchapattanasakda (2019) opine that engagement is a positive, fulfilling and work-related mindset that is categorised by vigour, absorption and dedication.The authors believe that these three sub-dimensions of engagement are closely connected.Additionally, the independent variable is organisational culture (with the sub-dimensions of involvement, consistency, adaptability and mission).This study is guided by the Denison's (1990) organisational culture model in investigating organisational culture.Presently, employers in private and public organisations are conscious and concerned about the significance of organisational culture and employee engagement in their firms and hence more research should be undertaken in this field.

Research approach
This study utilised a case study approach, underpinned by exploratory and descriptive approaches.The study selected a case study method of research since it produces a comprehensive, multifaceted understanding and exploration of a research problem in a practical setting.This research objective could also be achieved by adopting an analytical approach as it quantifies a relationship between diverse factors or phenomena.

Study population and sample
The population in this study refers to the total group of workers in the selected private hospitals in Accra, Ghana.The population for the study was about 260 employees.The population consisted of all the employees from the 3 selected private hospitals in Accra.A sample size of 155 was considered adequate for the quantitative study based on Sekaran and Bougie's (2016) population-tosample size table.Additionally, in regard to the qualitative study, a sample of 15 participants consisting of hospital administrators, medical doctors, and directors at the hospitals were invited for the interviews.The aptness of the organisational culture questionnaire was examined using Kaiser-Meyer-Olkin (KMO) measure as sampling adequacy (0.854) and sphericity (630; 0.000), and the aptness of the employee engagement questionnaire was found as sampling adequacy (0.905) and sphericity (136; 0.000), which indicated that the questionnaires were appropriate and significant.The sample size was further described in terms of age, gender, tenure, and marital status.The majority of the participants fall between the ages of 26-35 years old (40.1%), with male participants (54.1%), a tenure of 0-5 years (41.1%), and most of the participants being married (48.4%).

Measuring instrument
Data was collected using closed-ended questionnaires that were designed for employees and distributed at the hospitals.The questionnaires for employees were divided into 3 sections.Section A was designed to collect biographical data (age, tenure, gender, marital status) on employees and was measured on a nominal scale with pre-coded categories.Furthermore, Section B consisted of items relating to organisational culture with an adjusted version of the Denison's (1990) organisational culture survey.Furthermore, there are 9 items measuring each dimension (involvement, consistency, adaptability, and mission), making a total of 36 items for assessing organisational culture.Section C is comprised of questions relating to employee engagement with an adjusted version of the Utrecht Work Engagement Scale (UWES) designed by Schaufeli et al. (2002).The UWES measures employee engagement and its key dimensions, namely, vigour, absorption, and dedication.There are 6 questions each for vigour and absorption, as well as 5 questions for dedication, making a total of 17 questions for measuring employee engagement.A five-point Likert scale was used for both Sections B and C, permitting respondents to select the response that fits their view.A Likert scale ranging from 1 ("strongly disagree") to 5 ("strongly agree") was utilised in this study.In addition, the Likert scale organises items in varieties that cover the entire variety of possible responses in terms of levels of agreement/disagreement (Rahi, 2017).Also, preceding data collection, a pilot study was done to evaluate the feasibility and to assess if the items adequately capture the objectives of the study (Creswell, 2014).The researcher randomly distributed questionnaires to 3 hospital administrators and 3 nurses (1 from each hospital) for the pilot study.Pilot testing was done to evaluate the entire questionnaire under real survey conditions.
In this study, semi-structured interviews were used to gather information from participants.The semi-structured interviews included participants such as hospital administrators, medical doctors, and hospital directors.With this type of interview, the researcher is permitted to ask the participants an identical set of questions in the same order.This form of the interview was selected since it is easy and fast to conduct (McGrath et al., 2019).The semistructured interviews focused on three sections.Section A relates to the respondent's biographical data (age, gender, tenure, and marital status).Section B comprised 3 questions relating to the organisational culture of employees at the workplace, and was focused on an adjusted version of the Denison's (1990) organisational culture survey.Lastly, Section D comprised 3 questions relating to employee engagement and utilised the UWES.Also, the qualitative data used thematic analysis to interpret the semistructured interviews.

Measures
In this study, factor analysis was used to evaluate the validity of the questionnaire.Additionally, a rotated component matrix was used in extracting factors; only items with loadings > 0.4 were considered for the study.In relation to the dimensions of organisational culture, four factors were derived from the factor loading matrix (see Table 1).Also, with regard to employee engagement, three factors were derived from the factor loading matrix (see Table 1).Additionally, Cronbach's coefficient alpha was also used to measure the reliability of the questionnaire (see Table 2).Cronbach's alpha was used to assess the reliability of the measuring instrument.Table 2 indicates that the coefficient alpha of organisational culture reflects a very high degree of interitem consistency (0.939), thereby indicating that the questionnaire was reliable.Additionally, the coefficient alpha of the dimensions of organisational culture ranges from moderate (0.758) to a high level (0.867), which indicates a high level of inter-item consistency.Also, Table 2 depicts that the alpha coefficient of employee engagement has a high degree of inter-item consistency (0.919).The coefficient alpha of the dimensions of engagement ranges from moderate (0.775) to high (0.877).

Administration of the measuring instrument
In this study, data was sent and received from the participants by sending the questionnaires via email.The absence of the researcher during the collection of data was in keeping with the imperative of social distancing during the period of the coronavirus pandemic, which was significant as it assisted in evading the likely threat and stress on the participants.

Statistical analysis
The quantitative data was measured using both descriptive and inferential statistics.The opinions of employees concerning organisational culture and employee engagement were evaluated by asking respondents to answer a survey on a 1-5 Likert scale.

Findings of quantitative study
The study aims to evaluate the perceptions of organisational culture (involvement, consistency, adaptability, and mission) and employee engagement (vigour, absorption, and dedication) in private hospitals in Ghana.Table 3 illustrates that the mean of the organisational culture (Mean = 3.665) reflects that the workers at the hospitals have positive perceptions of organisational culture.An in-depth analysis of the sub-dimensions of organisational culture further revealed that employees had a positive perception of adaptability (Mean = 3.747), followed by mission (Mean = 3.719), involvement (Mean = 3.620), and, finally, consistency (Mean = 3.549), which had the least yet above-average impact.Additionally, Table 3 also reflects that the employees display high levels of engagement (Mean = 3.883).
Upon in-depth analysis of the dimensions of employee engagement, the study concluded that employees have a very high level of dedication (Mean = 3.982), followed by vigour (Mean = 3.851), and finally, absorption (Mean = 3.826), with the least yet above-average influence.When compared against a maximum achievable score of 5, it is apparent that there is still room for improvement in terms of both variables.
The high mean score for organisational culture in this study implies that employees have positive perceptions of organisation culture.In relation to adaptability, the high mean scores imply that employees were very adaptable, which also enables them to work around challenges to find the best solution.This also infers that the employees believe that the hospitals encourage creativity among employees.Adapting to organisational change helps create adaptive techniques to meet the changing needs of the healthcare industry (Bizuneh, 2016).This enabled the hospitals to read the business environment and rapidly respond to current trends as well as anticipate imminent changes.This study also revealed that employees had high mean scores on mission, which implies that the strategic directions of the hospitals were clear to employees.Additionally, this infers that the employees believe that the hospitals have a long-term purpose and direction.A sense of mission permits an institution to form behavior by visualizing an anticipated imminent state.In terms of involvement, the high mean scores imply that employees acclimate quickly to the changing needs of the hospital and are believed to have a positive influence on the hospital.In addition, it also infers that employees felt encouraged to collaborate across diverse departments of the hospital.In light of consistency, the study also revealed positive perceptions.This implies that employees at the hospitals were very consistent in their principles and behaviors in accomplishing their duties.This dimension develops a mindset and a set of organisational values that make up an internal governance system founded on consensual support with its dos and don'ts (Bizuneh, 2016).
In relation to employee engagement, the study revealed high mean scores of engagement, which depict that employees in the hospitals had positive levels of engagement.In terms of dedication, the high mean scores imply that employees are enthused about the hospital and find their occupation full of meaning and purpose.Adamu (2020) found that employees believed that their work had a lot of meaning and purpose.In regards to vigour, the study also found high mean scores, which implies that employees are highly motivated at work, have strong mental fortitude, invest heavily in their work, and are persistent despite any obstacles.Tshionza et al. (2022) opine that healthcare employees who feel vigorous when doing their work help generate positive energy among employees, which impels them to go beyond any hindrances in their jobs.With regards to absorption, the study found high mean scores among employees, which implies that employees in the hospitals are very engrossed in their jobs.The study also indicated that employees forget everything else around them when they are working.Ashley (2018) added that workers who are engrossed in their jobs do not just get the work done; they do their very best to get the job done.
Table 4 illustrates that there is a significant relationship between organisational culture and employee engagement at the 1% significant level.Thus, the alternate hypothesis (H1) is accepted and the null hypothesis (H10) is rejected.Table 5 reflects that there are significant and direct relationships between involvement and consistency, adaptability, mission, vigour, absorption, and dedication, respectively, at the 1% significance level.Hence, the alternate hypothesis (H2) is accepted and the null hypothesis (H20) is rejected.This implies that an improvement in involvement is likely to have a snowball effect and thereby, enhance consistency, adaptability, mission, vigour, absorption, and dedication.This signifies that the employees' involvement was associated with consistency, adaptability, mission, vigour, absorption, and dedication in the private hospitals.Furthermore, there are significant, direct, and strong relationships between consistency and adaptability, mission, and vigour at the 1% significance level, respectively.Hence, the alternate hypothesis is accepted and the null hypothesis is rejected.This infers that an increase in consistency is likely to have a snowball effect and thus, enhance adaptability, mission, and vigour.This signifies that the employees' consistency was related to adaptability, mission, and vigour in the private hospitals.
Additionally, Table 5 indicates a significant and positive relationship between consistency, absorption, and dedication, respectively, at the 5% significance level.Hence, the alternate hypothesis is accepted and the null hypothesis is rejected.The results revealed that an increase in consistency will correspondingly increase the employees' absorption and dedication.
Table 5 reflects that there are significant, direct, and strong relationships between adaptability and mission, vigour, absorption, and dedication, respectively, at the 1% significance level.Hence, the alternate hypothesis is accepted and the null hypothesis is rejected.This finding revealed that an increase in adaptability will correspondingly increase mission, vigour, absorption, and dedication.The results portrayed that adaptability positively influenced absorption, mission, vigour, absorption, and dedication among employees at the hospitals.
Furthermore, there are significant and direct relationships between mission and vigour, absorption, and dedication at the 1% significance level, respectively.Therefore, the alternate hypothesis is accepted and the null hypothesis is rejected.This finding revealed that an increase in the mission will correspondingly increase vigour, absorption, and dedication.The results depicted that the mission positively influenced vigour, absorption, and dedication among employees at the hospitals.
Table 5 further indicates that there are significant and direct relationships between vigour and absorption, and dedication, respectively, at the 1% significance level.Hence, the alternate hypthesis is accepted and the null hypothesis is rejected.This finding revealed that an increase in vigour will correspondingly increase absorption and dedication.The results depicted that vigour positively influenced absorption and dedication among employees at the hospitals.
In addition, Table 5 depicts a significant and direct relationship between absorption and dedication at the 1% significance level.Hence, the alternate hypothesis is accepted and the null hypothesis is rejected.This outcome revealed that a unit increase in absorption will correspondingly increase dedication.The results depicted that absorption positively influenced dedication among employees at the hospitals.Thus, H2 may be accepted.

Results of qualitative study
As mentioned previously, 15 participants in managerial positions in the hospital agreed to take part in the semi-structured interviews, which resulted in a 100% response rate.The qualitative study was aimed at understanding how the management of the private hospitals perceive the organisational culture as well as employee engagement of their employees.The participants were probed on the issues about their perceptions of organisational culture and employee engagement at their hospitals.Some of the quotes that emerged from the interviews in support of the findings are as follows (see Tables 6 and 7).Table 6.Findings of organisational culture qualitative study (Part 1)

Questions Theme Responses
Do employees in this organisation work as a team?(Justify) Teamwork "Yes, running a hospital depends on the involvement of a number of departments from records, nurses, laboratory technicians and pharmacists.Hence, the employees work together and depend on each other for success" (P1)."Employees in the same department work as a team.However, when it comes to department to department jobs, there is lack of team work" (P4)."Yes, they work as a team which builds strong employee connections since the more workers work close to each other they also get to know each other very well which fosters togetherness" (P7).

Communication
"Yes, employees do.We inspire them to freely communicate among themselves which enables them to work as a team" (P3)."Yes, we encourage clear and frequent communication among employees which helps them to work as a team" (P9).

Productivity
"Yes, working together as a team enables the workers to increase work efficiency" (P8)."Yes, working as a team makes employees in the hospital achieve their task successfully" (P10).
Does the hospital have an ethical code that guides the attitude of employees and tells right from wrong?(Justify)

Conducts and principles
"Yes, the hospital works with professional ethics from the nursing and midwifery council.These bodies provide strict ethical codes and morals to be guided by health professional in the country" (P1)."Yes, it does.The hospital is governed by some ethical codes of conduct as well as some principles for all employees to abide by.It also serves as a guide for employees for the right thing to be done" (P3)."Yes, this makes things to be comfortable in working the environment as they know that discipline is a huge factor and improves professionalism" (P7).
Training "Yes, the hospital provides the training sessions on the ethical procedures and attitude they need to portray to handle employees well" (P4)."Yes, the employees are trained on how to handle to patients who might want to cause trouble intentionally" (P6)."Yes, the employees are trained on how to handle to patients who might want to cause trouble intentionally" (P11).

Morals and values
"Yes, without a code of ethics an organisation cannot operate successfully and be in sync.We therefore have a moral duty that binds us to know what is right from wrong" (P9)."Yes, it serves as a valuable reference in helping the workers to locate vital documents and other resources related to moral and values of the hospital" (P15).Performance "Yes, we are committed to helping the society at large.The hospital is a haven for employees and this helps them work in an environment that brings out the full potential" (P3)."Yes, since the workers understand and buy into the vision of the hospital they enjoy their work, perform better, and drives the success of hospital" (P5)."Yes, the vision of the hospital provides clear goals for workers and improves their performance at work" (P8).

Sense of belongingness
"The vision statement of the organisation helps create inspiration and sense of belonging for employees as they help them track their progress against the stated goals" (P9)."Yes, there is a sense of belonging from staff to clients which creates a conducive environment for participation at all levels of care" (P11)."Yes, it creates a sense of belonging and inspires employees to attain the objectives of the hospital" (P14).
The organisational culture of a firm is a vital element in terms of the behavior of employees, mainly in trying to better comprehend the background of the firm as well as the employees within them.The culture of an organisation is shaped not only by basic supposition but by a specific pattern.
Additionally, Wagner and Hollenbeck (2020) maintained that culture shapes employees' behavior by helping them make sense of their environment.The culture of an organisation helps as a basis of a common meaning that describes why things occur in the manner which they do.

Questions Theme Responses
Do you feel your employees feel strong and vigorous in accomplishing their duties?(Justify) Motivation "Yes, workers keep performing well in their duties since they believe their hard work will be accepted by leadership which can lead to them been rewarded" (P3)."Yes, they do, employees show great enthusiasm and motivated which reflects in their reporting time to work" (P5)."Yes, employees in this hospital have shown resilience in completing task when things get though since they are rewarded for their good work" (P11).

Productivity
"Yes, employee's complaints are of key importance, since they are internal customers.Employees are therefore given all they will need to enhance better delivery of their service" (P6)."Employees know the reason why their job exists, above all just knowing how to do their jobs.This allows them to come up with new suggestions and ideas to improve their tasks" (P8)."Yes, employees are put much effort in their jobs tasks throughout the day can show higher levels of productivity over workers who only perform work tasks when customers or clients are in the vicinity" (P10).
Do you feel your employees are wholly immersed in their work?(Justify) Recognition "Yes, employees are entirely immersed in the way that they do at their various work departments.Since they are given much recognition for a job well-done" (P1)."Yes, employees are immersed in their jobs since they are given recognition at the hospital" (P2)."Yes, they always have a joyful face which portrays positive energy due to the recognition they are given, by seeing that you can see that they are wholly immersed in their work" (P12).
Training "Yes, employees are well trained to understand the significance of being a health worker, therefore they are wholly immersed in their work" (P13)."Yes, the employees are trained to fully aware that the patients' lives are in their hands therefore they are engrossed with their work" (P15).
Do you think employees find their work meaningful and significant in this organisation?(Justify) Appreciation "Yes, the employees feel appreciated with the significant health improvements they have contributed to the society and the lives of the people in the community" (P3)."Yes, employees use their skills in their work to derive meaning.Their experiences and competences have been merged in a special and powerful way that makes them very appreciated at the workplace" (P6)."Yes, employees are appreciated for their hard work in the hospital, they find their work meaningful" (P8).

Rewards
"Employees find their jobs meaningful, the hospital provides rewards to employees who produce outstanding results and treat employees with much care and attention" (P10)."Yes, workers of this hospital are passionate about their jobs because they rewarded by the hospital for the good healthcare services they give to patients" (P13).
Workers felt they were working in a secure and pleasant atmosphere, where they were listened to, understood, and valued, and were more engaged overall.The management responded in a true, honest manner, showed flexibility, and successfully communicated goals making employees feel more engaged.Workers who felt suffocated, as if they had to hide their genuine nature, and/or as if their needs were not being met were less engaged.Employees who are engaged are characterised as being passionate about and loyal to their company.Engaged workers are useful to the hospital since they are highly productive and motivated in accomplishing their duties.
The findings from the qualitative study are congruent with the results of the quantitative study.

DISCUSSION OF THE RESULTS
The findings of the study concluded that the employees at the hospital display positive perceptions of the organisational culture (Mean = 3.665).Similar studies by Shologu (2019) concur with the findings of this study.An in-depth examination of organisational culture revealed that respondents display the highest level of adaptability (Mean = 3.747), followed by mission (Mean = 3.719), involvement (Mean = 3.620) and lastly, consistency (Mean = 3.549).The outcome of the study also indicated that the majority of the employees agreed that the comments of clients led to changes and impacted decision-making at the hospitals, while some employees disagreed that innovation and creativity are encouraged at the hospitals.In addition to ensuring an organization's survival, a company's culture also helps employees connect with one another and feel proud to work for the firm (Metin & Coşkun, 2016;Pathiranage, 2019;Warrick, 2017).The qualitative study also revealed that the majority of the participants unanimously agreed that rewards and acknowledgements contribute to showing appreciation for the hard work of employees (Fakhri et al., 2020;Zhang & Min, 2021).
In addition, some employees agreed, according to this study, that they understood the hospital's strategic direction.The mission a firm provides clear goals that help improve the performance of employees (Alegre et al., 2018;Olughor, 2014).However, some employees disagreed that there is a long-term purpose and direction for the hospitals.If workers do not understand the mission of the company, it will be hard to attain the goals of the organisation (Laran et al., 2016;Ogbeibu et al., 2018).Furthermore, the qualitative study indicates that the performance, encouragement, and sense of belongingness of employees are vital factors that impact their mission.
Furthermore, it was clear from the study that most participants concurred that choices are frequently made at the level where the best information is available, while some employees concurred that collaboration among various hospital departments is encouraged.Similar studies support the findings of this study and maintain that high involvement demonstrates a sense of ownership and a chance to contribute to the company's success (Murunga & Karugu, 2019;Sinha & Dhall, 2020).Finally, the study revealed that most of the employees agreed that there is a moral code that governs the behaviour of workers and tells right from wrong, whereas some employees agreed that the approach to doing business in the hospital is very consistent.Employees are more likely to agree and take coordinated action that improves effectiveness when they have similar values and opinions (Roscoe et al., 2019).
In regards to employee engagement, the findings of this study showed that employees had positive views on the levels of engagement (Mean = 3.883).This implies that employees at the hospitals are very engaged in their work; however, it can still be enhanced.In a similar study by Dlamini (2018), the employees were highly engaged.Furthermore, an in-depth investigation of the dimensions of employee engagement revealed that engaged employees demonstrate signs of dedication (Mean = 3.982), vigour (Mean = 3.851) and absorption (Mean = 3.826) when performing their duties.The study's results also showed that most employees concurred that working at the hospital gives their work a sense of meaning and purpose.The results of the qualitative study also showed that appreciation, devotion, rewards, and punctuality are elements that support employee engagement.Workers who are enthusiastic and effectively connected to their jobs are better able to handle the challenges of their jobs (Sun & Bunchapattanasakda, 2019).
Additionally, the current study also found that the majority of the employees agreed that they feel strong and vigorous doing their jobs.Employees with high vigour have vibrant energy, resilience, and passion during work, whereas those with low vigour have low vitality, passion, and resilience (Lapoint & Liprie-Spence, 2017).Also, some employees agreed that they are mentally resilient at their jobs, while the qualitative study revealed that the majority of the participants were of the view that productivity, communication, and motivation enabled employees to be vigorous in performing their duties.Lastly, the study found that the majority of participants agreed that when they are working, they forget about everything else around them, and some employees agreed that they feel happy when they are working hard at the hospital.The workers have a difficult time disengaging from their work because they are so engrossed in it (Al Mehrzi & Singh, 2016; Jaya & Ariyanto, 2021).
According to the results of the current study, organizational culture and employee engagement have a significant and positive relationship.This suggests that having a positive perception of the organizational culture will raise employee engagement levels.There is a relationship between culture and engagement, according to numerous studies ( This present study found that the subdimensions of organisational culture (involvement, consistency, adaptability, and mission) significantly correlate with those of employee engagement (vigour, absorption, and dedication), respectively.This infers that any change in the sub-dimensions of organisational culture (involvement, consistency, adaptability, and mission) has an impact on employee engagement (vigour, absorption, and dedication), respectively.A similar study by Pandya

CONCLUSION
In conclusion, the study revealed that employee engagement is a vital construct in the healthcare industry since it improves employee performance and has a positive impact on the hospital from both an economic and health point of view.In addition, the culture of the hospital supports the idea that employees are adaptive, involved, and consistent, which enables them to strive through any challenging task.The organisational culture and employee engagement are inextricably linked.The study found that healthcare employees had positive perceptions of organisational culture and engagement.An organized and dynamic culture will aid in improving employee engagement and, as a result, increase employee performance.The combination of a healthy organisational culture and engaged employees is the most important factor in boosting the effectiveness of the organisation and the experiences of its employees.
The made guidelines to influence the management of hospitals to implement these suggestions to enable them to improve employee engagement and employees' perceptions of organisational culture to build a stronger relationship between the variables.The study revealed that the hospitals' strategic direction was not clear to them.The study recommends that the management of the hospital keep the lines of communication open with its workers through a variety of channels.Sharing the hospital's strategic direction with employees is crucial.The strategic direction and plans of the hospitals should be shared, posted, and followed by employees.The study further recommends that the management of the hospital should communicate efficiently to reduce confusion among employees and resolve disputes amicably.Workers are more inclined to work hard when they understand their roles and duties, as well as the goals of the organisations (Mathews & Khann, 2016).
Additionally, the study indicated that the employees at the hospitals are not certain if they feel like going to work in the morning.This study recommends that management foster a helpful work environment that demonstrates concern for employees' emotions, offers constructive feedback, and aids in advancing new skills to solve job-related issues.Furthermore, the study suggests that this can be nurtured by offering employees advanced training and development programs that will help them comprehend the duties of their positions and provide them with the opportunity to learn enough information about their profession.Additionally, the study found that some employees disagreed that they find their jobs very challenging and hence reduced their level of engagement.The study recommends that the management of the hospitals give workers challenging but doable tasks.Management should organise social events and outings for employees.
This research was conducted in private-sector hospitals.Hence, the findings of this study may be restricted to private hospitals in Ghana.Comparative studies can be conducted in public hospitals and other industries to create insights with respect to the findings of the study provided.Incidentally, replicating this study in diverse sectors would be worthwhile to increase the objectivity and generalisability of its findings across varied settings.There are numerous models and precursors of organisational culture and employee engagement that could be investigated to extend the scope of their effect on service quality within the Ghanaian healthcare industry.Future studies could consider a comparative study between private and public hospitals in Ghana relating to service quality or even across hospitals in developed and emerging economies.
The present study provides empirical evidence regarding the positive relationship between organisational culture and employee engagement.Furthermore, this study provides empirical evidence regarding the positive relationship between the subdimensions of organisational culture and the subdimensions of employee engagement.These findings enrich the literature and expand the body of knowledge related to conflict management, work motivation, and employee commitment.This study concludes that employees have positive perceptions of organisational culture as well as employee engagement.This study also has some limitations since the research instruments were restricted to the 3 private hospitals that consented to participate in the study in Accra, Ghana.Since the study was only conducted in Ghana, this has implications for the generalisability of the research verdict across geographical borders.Thus, a similar study should be conducted in other industries that are significant to the growth of the Ghanaian economy.
(2021) concurs with the findings of this study.Furthermore, creating a meaningful or positive organisational culture helps with employee engagement since a supportive workplace encourages people to work hard and promotes good working relationships among employees (Pepra-Mensah & Kyeremeh, 2018; Saleem et al., 2020; Sirisetti, 2012).

Table 1 .
Validity of measuring instrument

Table 2 .
Reliability of measuring instrument

Table 3 .
Descriptive statistics: dimensions of organisational culture and employee engagement

Table 4 .
Correlation between organisational culture and employee engagement

Table 5 .
Intercorrelation amongst sub-dimensions of organisational culture and employee engagement

Table 6 .
Findings of organisational culture qualitative study (Part 2)