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Case Study: Analysis of Organizational Culture at Google

Google Inc came to life with the two brilliant people as the founder of the company. Those two were Larry Page and Sergey Brin . Both of them are a PhDs holder in computer science in Stanford University California. In their research project, they came out with a plan to make a search engine that ranked websites according to the number of other websites that linked to that site. Before Google was established, search engines had ranked site simply by the number of times the search term searched for appeared on the webpage. By the brilliant mind of Larry and Sergey, they develop the technology called PageRank algorithm . PageRank is a link analysis algorithm that assigns a numerical weighting to each element of a hyperlinked set of document, such as the World Wide Web, with the purpose of measuring its relative importance within the set. All this in-depth research leads to a glorious day which is on September 15, 1997 where Google.com domain was registered. Soon after that, on September 4, 1998, they formally incorporated their company, Google Inc, at a friend’s garage in Menlo Park California. The name Google originates from “Googol” which refers to the mathematical equivalent of the number one followed by a hundred zeros. In March 1999, the company moved into offices at 165 University Avenue in Palo Alto. After that, the company leased a complex of buildings in Mountain View. Ever since then, the location of the headquarter remain unchanged.

Google’s core business is to provide a search engine for the cyber user who would like to go to their desire site. The Google search engine attracted a number of internet users by its sleek and simple design but result in amazing search result. After the initial stage of Google establishing itself in the world, it began selling advertisements associated with the search keywords. The advertisements were text-based in order to maximize the page loading speed. Most of the Google Inc revenue relies on the advertisement and they had been successfully with the help of AdWords and AdSense in their system. After having some experience in the industry, Google itself launched its own free web-based email service, known as Gmail in 2004. This service is established to meet the need of the cyber user in order to store and send their document through online. In the same year, one of the most captivating technologies that Google had launched is the Google Earth. Google Earth is an amazing creation that is a map of the earth based on the satellite image. It requires you to type the desire location that you want to view and it will process the image for you. Furthermore, Google Inc made a new partnership with NASA with even enhances the Google technologies. Google also had its own Google Video which allows user to search the internet for videos. One of the most important things in the Google Inc is that they have a strong organizational culture which brings them closer and stronger compare with other firms. The values that they emphasis on are creativity, simplicity and innovation in order to gain competitive advantage against their competitor.

The Google Culture

Google is well known for their organizational cultures distinctiveness and uniqueness compared to their immediate competitors. On the Google corporate website, they have listed down 10 core principles that guide the actions of the entire organization. These are the values and assumptions shared within the organization. These values are also termed as ‘espoused values’, where it is not necessarily what the organization actually values even though the top executives of the company embrace them.

In Google, the daily organizational life is distinctive and is one that thrives on informal culture. The rituals that portray the organization’s culture as unique and possesses a small-company feel are portrayed daily at lunchtime, where almost all employees eat together at the many various office cafes while at the same time having an open, relaxed conversations with fellow Googlers that come from different teams. Also, because one of the Google culture’s main pillars are the pillar of innovation, every Googler are very comfortable at sharing ideas, thoughts, and opinions with one another in a very informal working environment. Every employee is a hands-on contributor and everyone wears several hats. Sergey and Brin also plays a big part of laying the foundation on what the Google culture is and the founders have continued to maintain the Google Way by organizing a weekly all-hands “TGIF” meetings for employees to pose questions directly at them.

Here are some of a few of their core principles which will provide a look into Google’s management philosophy and the type of culture they want to possess:

In Google, the motivated employees who ‘live’ the Google brand and are aligned to the company call themselves ‘Googlers’. Even former employees of Google have a name which they refer to themselves as ‘Xooglers’. This shows that in Google, their employees are so involved in the organization that they have their own symbolic name that mirrors the organization’s name and image, which is a sure sign of existing strong cultural values that are present within the company.

After tremendous growth in Google, the organization moved from a humble office building in Palo Alto, California back in its early days to its current office complex bought over from Silicon Graphics. The complex is popularly known as the Googleplex, which is a blend of the word ‘Google’ and ‘complex’. Googleplex is the result of a careful selection that serves to establish Google’s unique and individualistic culture in the eyes of the employees and the public. The corporate campus is built to provide a very fun, relaxed and colorful environment both inside and outside. Innovative design decisions provides Google employees 2000 car lots underground so that open spaces above and surrounding the building are filled with unique and interesting architectures that includes an on-site organic garden that supplies produces for Google’s various cafes, a bronze casting of a dinosaur fossil, a sand volleyball court, heated “endless pools” and also electric scooters along with hundreds of bikes scattered throughout the complex for Googlers to get to meetings across campuses. Googleplex is a significant departure from typical corporate campuses, challenging conventional thinking about private and public space. This also points out the alignment of values that are present in Google’s culture such as innovation, fun, laid-back, creativity and uniqueness that clearly shows that their organizational culture is truly unique and different from that of their competitors and other organizations.

Within the Googleplex, a truly attractive, fun and extraordinary workplace environment exists for Google employees. The interior of the headquarters is furnished with items like lava lamps and giant rubber balls while sofas, Google color coded chairs, and pool tables can be found at lounges and bar counters to express Google’s laid-back working atmosphere. The lobby contains a grand piano and a projection of current live Google search queries. The employees’ various needs are also taken care of by facilities such as the 19 cafes on campus which serves a variety of food choices for their diverse workforce, a gym, massage parlor, laundromats, and even micro kitchens, which provides snacks for employees who want a quick bite. This ensures that employees can be more productive and happy without ever leaving the workplace. A manifestation of Google’s creative and innovative culture is shown by the unconventional building design with high ceilings to let natural light in, durable floors made of tiny quartz stones, working British phone booths splashed in Google colors, and lounges that also serve as DIY libraries with cleverly placed low-reach book racks adorned with colorful Lego sets and cubes. All these innovative, creative and colorful designs are symbols of Google’s unique organizational culture that emphasizes on continuous innovation.

Google engages their employees by applying adaptive culture in the organization. From their core competency in search engine technology, Google has responded to customers change in needs by expanding onto the mobile market. The employees analyze, anticipate and seek out the opportunities to improve the organization’s performance by being proactive and quick in coming out with new technologies and solutions for mobile services. It aims to help people all over the world to do more tasks on their phone, not to mention the several different ways to access their Google search engine on a mobile phone. In addition, Google recently entered the smartphone market by launching the Google Nexus One smartphone in response to customer’s increasing need for smartphones, which is gaining ground on popularity because everyone is going mobile in the Information Age. This is the result of Google employees’ common mental model that the organization’s success depends on continuous change to support the stakeholders and also that they are solely responsible for the organization’s performance. The employees also believe that by entering into other markets beyond their core competency, the change is necessary and inevitable to keep pace with an ever changing and volatile technological market.

Google’s organizational culture places a huge importance of trust and transparency by having an informal corporate motto namely “Don’t be evil”. This slogan has become a central pillar to their identity and a part of their self-proclaimed core principles. It also forms the ethical codes of the organization where Google establishes a foundation for honest decision-making that disassociates Google from any and all cheating. Its ethical principles means that Google sets guiding principles for their advertising programs and practices, which is where most of their revenues come from. Google doesn’t breach the trust of its users so it doesn’t accept pop-up advertising, which is a disruptive form of advertisement that hinders with the user’s ability to see the content that they searched. And because they don’t manipulate rankings to put any of their partners higher in their search results or allow anyone to buy their way up the PageRank, the integrity of their search results are not compromised. This way, users trust Google’s objectivity and their ethical principles is one of the reasons why Google’s ad business had become so successful. The founders of Google believe strongly that ‘in the long term we will be better served, as shareholders and in all other ways, by a company that does good things for the world even if we forgo some short term gains.’

Analysis of Google Culture

Satisfied employees not only increase productivity and reduce turnover, but also enhance creativity and commitment. Google is already having a playful variation culture in the organization for the employees. This can enable the employees to have an enjoyment environment and this will be able enhance the relationship between the employees and strengthen their bond to work as a team. An enjoyment environment definitely can let the employees to feel satisfied and subsequently will increase productivity. Apart from that, this will shape a convenient work process for the employees that will smoothen the decision making process for the management team. Google already identified the employees are the organization’s internal customers and this is the reason why it has been constantly giving employees a sense of purpose, enhancing their self-esteem and sense of belonging for being a part of the organization. The company was reorganized into small teams that attacked hundreds of projects all at once. The founders give the employees great latitude, and they take the same latitude for themselves. Eric Schmidt says that Google merely appears to be disorganized. “We say we run the company chaotically. We run it at the edge. This can adapt the culture Google and therefore they can individually to generate the ideas on their own.

On the other hand, Google hires employees that have good academic results but without practical experience and this will be a threat to Google in terms of their organization’s operation. Google is a results-driven organization and if employees with only creative ideas but lacking of skills to realize the ideas they have initially planned, this will absolutely reduce the productivity of the organizations. Google had been public listed on year 2004 and therefore Google had to take the shareholders’ views into consideration before making any decision. The shareholders had been strongly emphasizing on reducing the employee benefits due to the high cost invested on it. This leads to the organizational culture would be degraded and the employees would feel less satisfied and affect their produced results. Employees are very important asset the Google while the shareholders also the contributor of funds for Google. The management team has to weight the importance of both of the stakeholders for the Google as this will create a different organizational culture .

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Culture at Google

• Format: Print
• | Language: English
• | Pages: 34

About The Author

Nien-he Hsieh

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• Faculty Research
• Culture at Google  By: Nien-hê Hsieh, Amy Klopfenstein and Sarah Mehta

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Analysis of Organizational Culture: A Multiple Case Study

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• Journal Of Organizational Behavior Research 7(2):267-279
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• Organizational Development
• 17 Organizational Culture Survey Questions...

17 Organizational Culture Survey Questions To Include

“Culture eats strategy for breakfast.” –   Peter Drucker.

Because your organization’s culture has such a profound impact on success, you must stay in touch with how employees perceive it.

The HR facts

• Employee engagement : 50-point increase over three years
• Net profit : 85% increase over five years
• Workforce growth : 25% increase over three years
• Patronage : 138% improvement over five years.

Why measure organizational culture?

• 3.7 times as likely to be engaged in their jobs
• 68% less likely to often feel burned out at work
• 55% less likely to be on the lookout for a new position
• 5.2 times as likely to strongly recommend their employer to others. 

The benefits of conducting an organizational culture survey

• Identifying the current culture and establishing benchmarks for future assessments
• Being aware of what employees appreciate about the culture
• Identifying issues and practices that undermine the culture
• Fostering transparency and communication with employees
• Demonstrating a commitment to valuing employee input
• Empowering changes that drive improvements.

17 organizational culture survey questions to ask

1. is the organization’s mission and vision clear to you , 2. do you see the impact of your duties on achieving organizational goals, 3. how effective is overall communication throughout the organization.

HR tip In-depth (20+ questions) company culture surveys should generally be conducted at least once a year. Shorter pulse surveys can be useful to send out a few times per year. These can help to understand the impact of significant organizational changes, measure cultural improvement initiatives, and help allocate resources.

4. Is there transparency in how high-level decisions are made?

5. are the organization’s ethics and compliance policies clearly defined and carried out , 6. does the organization provide a safe working environment for all employees.

HR tip Inform employees that their survey responses are confidential. You must guarantee anonymity for employees to feel safe sharing the kind of candid feedback you need from them.

7. Does the organization honor and promote Diversity, Equity, Inclusion and Belonging?

8. does the organization support employee wellbeing and work-life balance, 9. does your manager empower you to make decisions.

HR tip Ask executive leaders to participate in the survey as well. Consider isolating their results and comparing them to the overall results. This will reveal any disconnect between how leadership and the rest of the workforce interpret culture.

10. Do you feel free to voice your ideas and opinions on work matters?

11. can you voice concerns without fear of repercussion, 12. do you feel encouraged to originate and experiment with creative ideas .

HR tip Anticipate any obstacles employees might face in completing the survey. For example, will they have enough allotted time for it? Will the survey load and be easy to complete on their devices?

13. Is the onboarding process effective in helping new employees settle into the workplace?

14. are conflicts and interpersonal issues addressed and resolved effectively, 15. are enough opportunities provided for continuous learning and acquiring new skills.

HR tip No survey can cover everything, so allow employees the chance to offer more input. Include a section where employees can share additional comments or suggest other questions they’d like to see on the survey.

16. What do you like best about our company’s culture?

17. how could the organizational culture be improved, checklist: how to conduct an organizational culture survey.

• ✓ Identify the objectives: Determine the purpose of the survey. In other words, why do you want to gather this information from employees? Do you want to affirm the overall culture’s strengths and weaknesses? Are you trying to assess whether the culture is affecting employee engagement? Maybe you want to see how well the culture reflects the company’s core values. Once you decide on the end goal, you’ll be able to design the survey specifically with this in mind.
• ✓ Collaborate with stakeholders: Getting stakeholder input on the survey structure and topics will generate diverse perspectives to ensure the survey is comprehensive and relevant to the entire organization. Key stakeholders to engage with may include executives, team leaders, other HR team members, and employee representatives.
• ✓ Choose the survey delivery method: The right survey delivery method is crucial to getting maximum participation and optimal results. A user-friendly online platform streamlines the process by providing easy access and simplifying data collection and analysis. If you have deskless employees with varying degrees of access to digital tools, be sure to incorporate alternative formats. Make the survey as concise as possible. Reveal the number of questions upfront so employees know what to expect. A progress bar displayed throughout the survey may keep respondents on task.
• ✓ Choose question types and craft the wording: Several question formats are commonly used in culture surveys. For example, multiple-choice, yes/no rank order, opinion scale, Likert scale, and open-ended short answer. Using a combination of types will gather different types of data, break up the monotony of the survey, and give respondents more options for expressing their opinions. Ensure that each question is worded to be clear, concise, and focused on relevant feedback. Avoid biased wording that prompts the desired response. (i.e., “How amazing is our relaxed work environment?”) Use straightforward language and avoid HR or other kinds of jargon that some employees won’t be familiar with.
• ✓ Conduct a pilot survey: Before officially launching the survey, do a trial run with a small number of employees from various departments. They can describe what it was like to take it and reveal any problems with the survey format, question comprehension, or response options.
• Promote the survey within all applicable communication channels
• Provide the link to the survey and share how long it will take them to complete
• Communicate the purpose of posing employee questions about culture
• Explain why employee input is so valuable and how it will be used
• Describe what types of actions or initiatives may come about from the survey results and how this will affect employees.

Organizational culture survey: Top tips for analyzing the results

How to make the most of your survey results.

• Analyze survey responses : Use a spreadsheet or the survey platform to organize and sort through the data. The quantitative data from numerical or scaled responses makes it quick to deduce the lowest and highest scoring areas.
• Integrate open-ended response information : This unstructured quantitative data is time-consuming to analyze but can hold beneficial insights. Sorting it into categories such as positive, negative, and neutral sentiment makes it more manageable. AI tools and software solutions are also available to simplify this task.
• Identify patterns and trends : Look for common themes in the data. Identify which areas stand out as strong or weak. Notice whether patterns are visible across different teams and if some have a more unified impression of the organizational culture than others.  
• Develop an action plan : Once you have a grasp on the current state of your organizational culture and which factors stand out as problematic, determine the highest priority issue(s) to address. Create an action plan for targeted initiatives. Set specific goals, establish timelines, identify key stakeholders, and assign ownership.
• Communicate results and plans to employees : Share the survey findings with the entire staff. Use visual elements such as charts and graphics to show and explain the data in a more relatable way. Describe what is being planned to enhance the workplace culture. Let employees know their feedback is valued and directly impacts upcoming improvements and initiatives.

Key takeaway

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The New Analytics of Culture

• Matthew Corritore,
• Amir Goldberg,
• Sameer B. Srivastava

Culture is easy to sense but hard to measure. The workhorses of culture research—employee surveys and questionnaires—are often unreliable.

Studying the language that employees use in electronic communication has opened a new window into organizational culture. New research analyzing email, Slack messages, and Glassdoor postings are challenging prevailing wisdom about culture.

Some of the findings are (1) cultural fit is important, but what predicts success most is the rate at which employees adapt as organizational culture changes over time, (2) cognitive diversity helps teams during ideation but hinders execution, and (3) the best cultures encourage diversity to drive innovation but are anchored by shared core beliefs.

What email, Slack, and Glassdoor reveal about your organization

Idea in Brief

The problem.

Culture is easy to sense but difficult to measure. The workhorses of culture research—employee surveys and questionnaires—are often unreliable.

A New Approach

Studying the language that employees use in electronic communication has opened a new window into organizational culture. Research analyzing email, Slack messages, and Glassdoor postings is challenging prevailing wisdom about culture.

The Findings

• Cultural fit is important, but what predicts success most is the rate at which employees adapt as organizational culture changes over time.
• Cognitive diversity helps teams during ideation but hinders execution.
• The best cultures encourage diversity to drive innovation but are anchored by shared core beliefs.

A business’s culture can catalyze or undermine success. Yet the tools available for measuring it—namely, employee surveys and questionnaires—have significant shortcomings. Employee self-reports are often unreliable. The values and beliefs that people say are important to them, for example, are often not reflected in how they actually behave. Moreover, surveys provide static, or at best episodic, snapshots of organizations that are constantly evolving. And they’re limited by researchers’ tendency to assume that distinctive and idiosyncratic cultures can be neatly categorized into a few common types.

• MC Matthew Corritore is an assistant professor of strategy and organization at McGill’s Desautels Faculty of Management.
• AG Amir Goldberg is an associate professor of organizational behavior at Stanford’s Graduate School of Business. He and Sameer B. Srivastava codirect the Berkeley-Stanford Computational Culture Lab.
• SS Sameer B. Srivastava is an associate professor and the Harold Furst Chair in Management Philosophy and Values at the University of California, Berkeley’s Haas School of Business. He and Amir Goldberg codirect the Berkeley-Stanford Computational Culture Lab.

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Organisational Culture: A Case Study

Culture plays an important role in the performance of the organisation and in how potential employees perceive the company as an employer. A review of organisational culture and the lessons learnt from other successful organisations is imperative for the growth of the organisations. With the Schein’s model of organisational culture as a theoretical framework, this paper discusses the employee-centric culture of Asia Pacific International Limited (APIL). The paper reviews the strengths and weaknesses of APIL in terms of its organisational culture. The paper would then discuss the case-studies of two successful organisations, J.C Penny and Infosys, both of which have a strong employee-centric culture like APIL. Based on the lessons learnt from these two case studies, we recommend a few organisational changes in the culture of APIL, which would lead to the success and growth of APIL.

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Organizational Culture for Innovation: A Case Study Involving an University Faculty

• Published: 07 October 2022
• Volume 14 , pages 4675–4706, ( 2023 )

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• Jairo Iván Orozco Arias   ORCID: orcid.org/0000-0002-2337-8941 1 &
• Olga Lucía Anzola Morales   ORCID: orcid.org/0000-0002-4865-9125 2  

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This research was made in the faculty of Social Communication and Journalism of a Colombian private university, renowned for its high-quality standards, with the goal to identify the actual characteristics of its organizational culture and its relationship in favor of innovation. This study was made with a mixed approach and involved compiled information gathered by using two instruments: the Inventory of Organizational Culture in Education Institutions (ICOE), designed by Marcone and Martin in  Psycothema, 15 (2), 292–299 ( 2003 ), and the TB Test, designed by Bridges in  The character of organizations: Using personality type in organization development . Davies-Black Publishers ( 2000 ), as well as semi-structured interviews done to professors and administrative staff. The gathered information was compared with both theoretical models of cultural analysis built for superior education organizations and representative researchers in the area of organizational culture for innovation, a field of study broad and consolidated nowadays but one that is not usually geared toward understanding and explaining the relationship between organizational culture and innovation in high education organizations. Our findings let us make a characterization of the organizational culture of the faculty and identify its cultural strengths and weaknesses regarding adopting and favoring innovation. Also, this empirical research adds up to an effort to make studies regarding organizational culture for innovation specifically geared toward high-education organizations.

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Source: Martins and Martins ( 2002 )

Source: Author’s own using data from Amar and Juneja ( 2008 )

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Afsar, B., & Umrani, W. (2020). Transformational leadership and innovative work behavior The role of motivation to learn, task complexity and innovation climate. European Journal of Innovation Management, 23 (3), 402–428.

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Ahmed, P. (1998). Culture and climate for innovation. European Journal of Innovation Management, 1 (1), 30–43.

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ANNEX 1. Inventory of Organizational Culture in Education Institutions (ICOE) (Marcone & Martin, 2003 )

This questionnaire aims to understand your perception regarding the organizational culture of the Faculty of Social Communication and Journalism. Please, assign a grade from 1 to 5 the following 62 states, being 1 “I disagree completely;” 2 “I disagree;” 3 “neutral;” 4 “I agree;” 5 “I agree completely.”

I believe this faculty offers an environment that motivates students to give the best of themselves.

At the faculty, “being on the look” means to be alert to signals and messages that are generated in the pedagogical process and to act accordingly.

At the faculty, all ideas that change past educational practices are strengthened periodically and formally.

The changes experimented by our faculty, from its beginnings, demonstrate a creative and innovative life.

At the faculty, we value the directors’ efforts to create and keep a good communication system with other faculty members.

The existence of agile and expeditious communication channels guarantee our work’s success.

Directors let us know what is expected from each of us in a clear and explicit way.

Work meetings are announced in advance, in such a way that we know, opportunely, the topics that will be addressed.

In our university life there is a sequence of events that show a close union of the members.

At the faculty, we share the firm commitment to our students’ learning, which drives us toward pedagogical change.

By putting innovative ideas into practice, our leaders publicly express their willingness to change.

At the faculty, we tell how, thanks to our willpower and work, we have overcome the challenges that pedagogical change implies.

We value mistakes as part of our very nature and as a sometimes necessary step for learning.

At the faculty, we share the idea that error is deferred success.

In this faculty, it is common for directors to hearten us frequently, which encourages us to move forward.

In this faculty, every work well done or success of the staff is recorded, carefully and in a timely manner, in their resume.

Our history reveals a permanent learning of the faculty members, which has contributed to the current success achieved.

In this faculty, the directors support the professors in their work initiatives.

Daily conversations reveal our conviction that we will achieve the changes that this faculty requires to move forward.

Pedagogical innovation is constantly and publicly supported by directors.

Many projects, which at one time seemed unfeasible, have become a reality thanks to our efforts.

Opinions about work are well-regarded, no matter where they come from.

The search for consensus is the best way to resolve conflicts that originate in the faculty.

In this faculty we are used to telling each other things clearly and directly.

In the faculty, when there have been differences between professors and directors, positive action has always been taken.

In the faculty, the directors value the opinions and feelings of the staff.

The management style of directors reveals that they consider professors as responsible and capable of taking on challenges.

The directors’ communications clearly reflect what they want to say and do so with deep interest and respect for us.

We have photographs that remind us of the various stages of development we have gone through.

Directors do not miss an opportunity to demonstrate, with their own example, their commitment to the faculty.

At the faculty we act with great security, since we all know the rules of the game that rule our work.

The language used between directors and professors is clear and direct, which facilitates tasks and duties.

Many rumors circulate in the faculty about the impossibility of achieving the changes that positively transform life in this university.

In this faculty it is customary to recognize the efforts of the professors in the educational task.

The credibility of directors has been sustained, over time, in the coherence that they have managed to establish between what they say and what they do.

At the faculty, the work environment fosters autonomy and authenticity, on a level of equality and respect.

Our beliefs are very clearly reflected in the facts of daily life at the faculty.

Our students fully identify with the faculty, which is verified in daily life and in their behavior in public events.

We can easily reconstruct the history of the faculty by studying the existing documents.

In the faculty there is a real concern about the working conditions of all the staff.

At the faculty we think that managers are motivated by our good professional performance.

When we take action, the directors let us know, clearly and directly, that we have their support.

It is customary to promote our students' achievements, no matter how small they may be.

At the faculty we are told, clearly and firmly, that continuous effort is the key to success in our teaching work.

We meet periodically to review the established goals and determine what we have achieved and what we still need to achieve.

At the faculty, stories are told about how, thanks to joint efforts, very difficult goals were achieved.

The goals that are being pursued at this university respond to the demands and expectations of the community.

In the faculty, the directors encourage the participation of all the staff in the achievement of the objectives.

At the faculty, at the beginning of each academic term, the objectives and goals that will guide our efforts are established.

The history of our faculty shows us how the established goals have been achieved over time.

This faculty works to maintain communication that facilitates the integration and cohesion of the staff.

In this university, the professors’ councils constitute instances of study of deep reflection and search for adequate coordination.

The constant effort of directors and professors has made it possible to visualize a promising future.

An open doors policy allows us to participate equally in university life.

In the speeches and acts of university life, the importance of equity is highlighted as a norm of life.

In the faculty there is a recognition of efforts and a fair allocation of rewards.

In this university, when allocating resources, it has always tried to act with equity.

The motto “always do what is right” guides our actions in the daily life of the university.

What sets us apart from other universities is the enthusiasm we put into achieving our goals.

The instructions and guidelines for students, parents, guardians and the public are clear and precise.

In the faculty, before starting a new project, it is customary to create the conditions so that the professors can concentrate on their work.

Past events show us that the achievements reached have originated with the constant effort of professors and directors.

ANNEX 2. Bridges’ Test (Bridges, 2000 )

This questionnaire aims to identify the innovation profile of the organizational culture present in the faculty. Please rate the following 36 questions from 1 to 4, based on what is specified in each question, where the extreme values (1 and 4) imply that there is a strong point of view, while the average values (2 and 3) imply that the point of view is slightly inclined.

Does the faculty pay more attention to the requests of the clients-students or to its internal knowledge on how to work well? – Clients 1 2 3 4 know how to work well

Is the faculty better at producing and delivering goods and services or creating new ones? – Producing 1 2 3 4 creating new ones

What matters more to the faculty: management systems or people’s dedication to their work? – Management systems 1 2 3 4 people’s dedication

What does the faculty like more: to make procedures and policies very clear and explicit or do you prefer to leave people without much detail so that they can work their way within the basic instructions? – Make clear 1 2 3 4 leave without much detail

Can employees openly see how decisions are made in the organization or are decisions hidden from top management and appear mysteriously? – Very open 1 2 3 4 very hidden

Is leadership based on decision-making, taking into account detailed information on facts and events, or is it based on an approach to the fact or event in a schematic way and in general terms? – Detailed information 1 2 3 4 general terms

Is the faculty concerned about fulfilling the roles and functions of people, established effectively, or does it allow people to work based on the full exercise of their talents? – Official roles 1 2 3 4 people’s talents

Would you say that the faculty emphasizes rapid decision-making or waits for all points of view, even if this implies delays? – Rapid decision-making 1 2 3 4 delayed decision-making

Are decisions made based on market data and facts or rather on internal factors such as the experience and beliefs of the directors and the capacities of the faculty? – Market data 1 2 3 4 internal factors

Are the actions of the faculty based on current events and the present, or are they focused more on trends and expectations for the future? – Present 1 2 3 4 future

How decisions are really made in the faculty: with the head (moderated with a bit of humanism) or with the heart (supplemented with information)? – Moderated, with the head 1 2 3 4 balanced, with the heart

If there is an error in the faculty, is it due to hasty decisions or because many options were kept that delayed the decision? – Hasty decisions 1 2 3 4 too many options

In a project or job, do people collaborate naturally from the beginning or do they do it in a forced way and after each one defines the extent of their responsibilities? – From the beginning 1 2 3 4 in a forced way

When the changes have already been discussed, what demands more attention: the monitoring of the steps to achieve the objective or the final result and meet the agreed deadline? – Monitoring of the steps 1 2 3 4 final result

When it comes to staff issues, what is taken more seriously: policies and rules or individual circumstances and situations? – Policies and rules 1 2 3 4 individual circumstances

Are the actions of the faculty based mainly on the priorities and strategies already traced or on the opportunities and signs identified in the market or the environment? – Priorities 1 2 3 4 opportunities

Are the actions of the faculty influenced more by relationships with customers and competitors or are they the result of its identity, of following the organizational mission and culture? – Relationships 1 2 3 4 identity/mission

Is the faculty better at producing reliable products and services or generating ideas and designs whose results are presumed to be good? – Reliable products and services 1 2 3 4 novelty ideas

In the faculty, does the word “communication” mean giving and receiving information or keeping in touch with all the collaborators? – Giving and receiving 1 2 3 4 keeping in touch

Does the faculty work by established procedures and rules or does it work and decide mainly as things happen? – Procedures 1 2 3 4 as things happen

Is the scope of the faculty determined by the external challenges that are presented to it or by the availability of resources? – External challenges 1 2 3 4 resources

Is the form of leadership in the faculty identified more as solid and down to earth or more as intuitive and visionary? – Down to earth 1 2 3 4 visionary

Which is more accurate to describe what is expected of leaders: to act according to rational policies and rules or to act according to their sensitivity and sense of humanity? – Rational policies 1 2 3 4 sensitivity and a sense of humanity

To deal with situations, does the faculty choose between trying to decide as soon as possible or looking for options? – Decide soon 1 2 3 4 look for options

Does the faculty have an open point of view and allow itself to be influenced by the clients-students and the opinion of the employees or does it have a closed point of view and always respond to an already established management system? – Open 1 2 3 4 closed

Is action taken more in a practical and efficient way or in an ingenious and inventive way? – Practical way 1 2 3 4 inventive way

When you think of “what is right,” do you think more of what is logical and rational or what is human and sensible? – Logical and rational 1 2 3 4 human and sensible

Does the faculty in general seek to “hold on to something solid” or “go with the flow”? – Hold on something solid 1 2 3 4 go with the flow

In terms of strategy, is the faculty more focused on satisfying the clients-students and competitors or on the maximum use of the capacities of its employees? – Clients and competitors 1 2 3 4 capacities of its employees

When there are big changes, does the faculty prefer to do them step by step or all at once and in an integral way? – Step by step 1 2 3 4 integral way

Is the structure of the faculty based mainly on the hierarchy and the tasks of the organizational chart or on the relationships of its members? – Based on tasks 1 2 3 4 based on relationships

When planning projects, are deadlines followed and delivery dates met or are schedules made flexible and negotiated according to circumstances? – The plan is followed 1 2 3 4 it is flexible

Does the faculty seek alliances to work with other organizations or does it prefer to face the market on its own? – Works with others 1 2 3 4 goes on its own

Is the faculty better described as clinging to tried and true ways or open to new and uncertain ones? – Clinging to tried ways 1 2 3 4 open to new ways

Which word best describes your leader: criticism or motivation? – Criticism 1 2 3 4 motivation

Finally, are plans made thinking about the future or are they made living day to day? – Future 1 2 3 4 day to day

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Orozco Arias, J., Anzola Morales, O. Organizational Culture for Innovation: A Case Study Involving an University Faculty. J Knowl Econ 14 , 4675–4706 (2023). https://doi.org/10.1007/s13132-022-01069-9

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DOI : https://doi.org/10.1007/s13132-022-01069-9

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How organizational culture influences holistic review: a qualitative multiple case study

Bettie coplan.

1 Department of Physician Assistant Studies, Northern Arizona University, Phoenix Biomedical Campus, Phoenix, AZ USA

2 Present Address: Adjunct Faculty, College of Health Solutions, Arizona State University, Downtown Phoenix Campus, Phoenix, AZ USA

Bronwynne C. Evans

3 Edson College of Nursing and Health Innovation, Arizona State University, Downtown Phoenix Campus, Phoenix, AZ USA

Studies primarily involving single health professions programs suggest that holistic review in admissions can increase underrepresented minority (URM) representation among admitted students. However, data showing little improvement in the overall proportion of URMs in many health professions, despite widespread use of holistic review, suggest that relatively few programs using holistic review admit substantial proportions of underrepresented minorities. Therefore, more research is needed to understand factors that facilitate holistic review practices that successfully promote diverse student enrollment. The literature suggests that a supportive organizational culture is necessary for holistic review to be effective; yet, the influence of culture on admissions has not been directly studied. This study employs a qualitative, multiple case study approach to explore the influence of a culture that values diversity and inclusion (‘diversity culture’) on holistic review practices in two physician assistant educational programs that met criteria consistent with a proposed conceptual framework linking diversity culture to holistic admissions associated with high URM student enrollment (relative to other similar programs). Data from multiple sources were collected at each program during the 2018–2019 admissions cycle, and a coding manual derived from the conceptual framework facilitated directed content analysis and comparison of program similarities and differences. Consistent with the conceptual framework, diversity culture appeared to be a strong driver of holistic admissions practices that support enrolling diverse classes of students. Additional insights emerged that may serve as propositions for further testing and include the finding that URM faculty ‘champions for diversity’ appeared to strongly influence the admissions process.

Introduction

Disproportionately high rates of coronavirus disease 2019 (COVID19) infection and related deaths among racial and ethnic minorities in the United States shine a spotlight on the urgent need to address pervasive and persistent health disparities. The issue is complex; disparities result from an array of interrelated factors including adverse social determinants of health and societal racism as well as implicit bias among healthcare professionals (Owen et al., 2020 ). While there are no straightforward solutions, increasing the number of underrepresented minority (URM) healthcare providers has long been recognized as one way to improve the quality of care minority and underserved patients receive (Cohen et al., 2002 ; Mitchell & Lassiter, 2006 ; Sullivan, 2004 ). Minorities underrepresented in the U.S. health workforce relative to the general population include Hispanics/Latinos (all races), African Americans, American Indians or Alaskan Natives, and Native Hawaiians or other Pacific Islanders (Health Resources & Services Administration 2019 ). African Americans and Hispanics/Latinos, for example, comprise just 8.2% and 7.6% of the physician workforce respectively, compared to 13.4%, and 18.3% of the general population (U.S. Census Bureau, 2019 ; U.S. Department of Labor 2019 ). Over the last decade, health professions educational programs have widely adopted holistic review admissions practices as one means to increase diversity among students (Urban Universities for HEALTH, 2014 ). Although the existing literature suggests that holistic review is effective, much of the evidence for its association with increased URM enrollment stems from evaluations involving a single institution or small numbers of programs (Felix et al., 2012 ; Grabowski, 2018 ; Wells et al., 2011 ; Witzburg & Sondheimer, 2013 ; Wros & Noone, 2018 ; Zerwic et al., 2018 ). Findings from one large 2013 national survey of 228 publicly-funded health professions schools showed that a high percentage of schools—including 93% of dental and 91% of medical schools—self-identified as using holistic review, and a majority using it reported increased diversity among students (Urban Universities for HEALTH, 2014 ). Yet, in recent years, despite an increasingly diverse U.S. population, URM representation among dental and medical students nationally has not substantially increased (Lett et al., 2019 ; Slapar et al., 2018 ). Assuming numerous health professions programs do in fact use holistic review, the collective national data suggest that many of them do not admit significant numbers of URMs.

The apparent discrepancy between widespread use of holistic review and little if any overall progress toward increasing proportions of URM students also exists in the physician assistant (PA) profession. Created in the late 1960s mainly to address physician shortages in rural communities, PAs, like nurse practitioners, have been increasingly relied on to care for medically underserved patients, who are disproportionately racial and ethnic minorities (Physician Assistant History Society, 2017 ; Proser et al., 2015 ; Shin et al., 2013 ). Therefore, a diverse PA workforce may be particularly important. Until the 1990s, PA programs educated higher proportions of URM students than other health professions programs like medical schools (Mulitalo & Straker, 2007 ). In recent years, however, the proportion of URM PAs has remained stagnant. As of 2019, only 7.6% of first-year PA students were Hispanic/Latino and just 3.9% were African American (Physician Assistant Education Association, 2020 ).

In 2017, this paper’s first author, BC, conducted a survey of PA educational programs and found that 77% reported using holistic review in admissions. The survey was distributed by the national Physician Assistant Education Association (PAEA) and included responses from 99% of the 223 U.S. PA programs accredited at the time. Results included a modest positive association between use of holistic review practices and percentage of URM first-year students (Coplan et al., 2021 ). However, the association was largely driven by high percentages of URM students admitted to a relatively small number of the programs using holistic review. This finding, which served as a main impetus for the current study, raises the question: Why are some programs that use holistic review so much more successful at achieving diverse student enrollment than others?

Holistic review refers to a mission-driven selection process that incorporates balanced consideration of applicants’ experiences, attributes, and academic metrics (Association of American Medical Colleges n.d.). Model holistic review practices—which are based on four core principles shown in Table ​ Table1 1 include developing a mission statement for admissions that includes diversity as an essential goal and evaluating non-academic criteria related to a program’s mission as part of the initial application screening process (Addams et al., 2010 ). A main objective of holistic review is to encourage diversity (Association of American Medical Colleges n.d.). Additional guidance for adopting holistic review emphasizes the need for a comprehensive approach to improving diversity that involves outreach and recruitment and evaluation of diversity-related outcomes (Addams et al., 2010 ; American Association of Colleges of Nursing, 2016 ). It is important to note that diversity encompasses the range of human differences, including attributes related to socioeconomic status, sex, sexual orientation, gender identity, religion, geography, disability, and age. Accordingly, holistic review may incorporate consideration of a broad range of diversity- as well as mission-related factors (e.g., commitment to service in an underserved community) and personal characteristics (e.g., leadership qualities or experiences with adversity). However, due to the persistent lack of URM representation in the health workforce, discussions of holistic review often focus on increasing the numbers of racial and ethnic minority students (Addams et al., 2010 ; Coleman et al., 2014 ).

Core principles of holistic review*

a Under federal law (and where permitted by state law); seven states have banned the use of race in admissions. These states are: Washington, Michigan, Nebraska, Arizona, New Hampshire, California and Florida

* Source : Urban Universities for HEALTH 2014. Originally adapted from the Association of American Medical Colleges “Roadmap to excellence: Key concepts for evaluating the impact of medical school holistic admissions,” 2013

A potential barrier to successful adoption of holistic review is the absence of an associated conceptual framework (Artinian et al., 2017 ; Glazer et al., 2016 ). Furthermore, health professions educators have called for more resources to assist them, including case studies involving successful practices (Artinian et al., 2017 ; Glazer et al., 2016 ). Several articles describe individual program experiences with holistic review; however, a framework has not been tested. Another factor that may limit the utility of holistic review is a failure to appreciate the influence of organizational culture. In their review of interventions to enhance diversity in medical schools, Vick and colleagues ( 2018 , p. 57) note that, among the principles to improve diversity, culture is the one most often neglected. Moreover, the need for a supportive organizational culture—in other words a culture that values diversity and inclusion (or ‘diversity culture’)—is often mentioned in articles about holistic review (DeWitty, 2018 ; Glazer et al., 2018 ; Wros & Noone, 2018 ); yet, the influence of culture has not been specifically examined. The purpose of this study was to enhance understanding of effective holistic review by exploring the role diversity culture plays in the holistic admissions process at two PA programs (or ‘cases’) with high URM enrollment (relative to other programs using holistic review). A conceptual model (described below) was used to help create a picture of diversity culture in practice and generate insights useful to health professions programs seeking to meaningfully improve diversity through admissions.

Conceptual model

The conceptual model was derived from the literature on holistic review and from Schein’s concept of organizational culture (see Fig.  1 ). Schein ( 2017 , p. 6) defines culture as

[…] the accumulated shared learning of a group as it solves problems of external adaptation and internal integration; which has worked well enough to be considered valid and, therefore, to be taught to new members as the correct way to perceive, think, feel, and behave in relation to those problems.

While various definitions of culture exist, nearly all include the notion that shared beliefs and assumptions (e.g., underlying values) drive behavior (Schneider et al. 2013 ; Scott-Findlay & Estabrooks, 2006 ; Tierney, 2011 ). Schein’s model of organizational culture was selected because it provides a practical framework for culture examination. According to Schein ( 2017 ), culture exists in the context of three levels: (1) basic underlying assumptions, (2) espoused beliefs, and 3) artifacts. Shared basic assumptions constitute the deepest, ‘taken-for-granted,’ level of culture that directs attitudes and behavior. Insight into these basic assumptions can be derived from the next level of culture—espoused beliefs—which include stated values and goals (e.g., a mission statement). Culture also manifests in artifacts—such as displayed photos and observable ceremonies—which comprise the most superficial and visible level of culture. Schein ( 2017 ) cautions, however, that although artifacts and espoused beliefs provide insight, an appreciation for the basic underlying assumptions requires assessing whether attitudes and behavior are consistent with the more superficial levels of culture. In other words, a discrepancy may exist between espoused culture (e.g., what is stated) and enacted culture (e.g., what is done). A germane example of the potential divergence between layers of culture is a university that attests to the value of a diverse learning environment but does not have a diverse faculty or student body.

Conceptual model depicting the relationships between organizational culture, program outcomes, and program practices

Creating a mission statement for admissions that promotes diversity is recommended as an initial step for conducting holistic review; however, a mission statement may or may not accurately reflect basic assumptions that guide behavior. The conceptual model for this study depicts an organizational culture in its entirety (i.e., all three levels) that values diversity and inclusion (i.e., diversity culture) as the primary mechanism for effective holistic review (see Fig.  1 ). Additionally, the model shows that culture influences the determination of outcomes a university or educational program deems important enough to measure (Tierney, 2011 ; Zheng et al., 2010 ). Through its influence on attitudes, culture also affects how people enact practices designed to achieve outcomes (Zheng et al., 2010 ). In the case of holistic review, for example, culture may affect how low socioeconomic status is evaluated—as a weakness or a strength. The model also demonstrates the typical relationship between organizational practices and outcomes, whereby practices are reinforced or revised in response to performance on outcome measures. Based on this case study’s findings, a depiction of the effect diversity-related outcomes (e.g., increased numbers of URM students) can have on organizational culture, such as strengthening appreciation for diversity, was added to the preliminary model (using a dotted line). The model’s underlying hypothesis is that, while mission-driven admissions practices are useful, in terms of increasing URM enrollment, holistic review is most effective when it is culture-driven.

The proposed conceptual model served as a foundation for a novel approach to studying holistic review. Rather than focus on a transition to holistic review and associated outcomes, this study examined two PA programs that had already achieved high URM student enrollment. The goal was to enhance understanding of the potential influence of diversity culture on effective practices. The central research question was: How is an organizational culture that values diversity and inclusion (diversity culture) manifested in holistic review practices that achieve high URM student enrollment? Sub-questions were: (1) What specific admissions practices do programs that enroll high proportions of URM students use (e.g., for initial applicant screening)? and (2) How are these practices supported?

A qualitative, multiple case study approach involving two instrumental cases was used to facilitate analysis and comparison of effective holistic review admissions practices (Crowe et al., 2011 ; Yin, 2018 ). Instrumental cases are theory-dependent, seen in relation to other cases and examined in the “all-together,” as unique collections of inseparable variables (Sandelowski, 2011 , p. 158). Case study methodology focuses on intensive examination of data from multiple sources to gain in-depth understanding of a phenomenon in natural settings and is therefore ideal for studying complex concepts like organizational culture (Sandelowski, 2011 ; Yin, 2018 ). Additionally, case study lends itself to pragmatism, which, as our guiding orientation, allowed for flexibility in our approach to collecting data and conducting analyses that would best address our research question (Creswell & Poth, 2018 ). Due to the nature of intensive inquiry, case study research often focuses on a single case (Miles et al., 2014 ; Sandelowski, 1996 ; Yin, 2018 ); thus, statistical generalizability may be limited. However, investigating large numbers of cases can impede thorough analysis and threaten the integrity of the methodology (Creswell & Poth, 2018 ; Sandelowski, 1996 ). Therefore, we analyzed two cases. This decision allowed for in-depth analysis while enabling cross-case comparisons and replication of findings that enhance transferability of findings to other settings (Miles et al., 2014 ). Moreover, case definitions (described below) were constructed so that the conceptual model linking diversity culture to holistic review practices that achieve high URM enrollment could be qualitatively tested. Thus, we were able to generalize findings to a theoretical understanding of the issue under study and apply generalizations (also called assumptions or propositions in qualitative research) derived from the findings across cases, which strengthens trustworthiness and further promotes transferability (Horsburgh, 2003 , p. 311; Miles et al., 2014 ).

Sample and setting

We chose two ‘best possible’ cases, that best exemplified diversity culture and holistic review practices associated with high URM student enrollment. These cases provided an intensive “opportunity to learn” about the phenomenon of interest (Stake, 2008 , p. 130) and increased transferability because they varied with regard to factors that may serve as alternative explanations for high URM attendance (Creswell & Poth, 2018 ).

Responses to questions contained in the 2017 survey of PA programs discussed in the introduction were used to identify programs (i.e., cases) that met criteria for best possible cases. Criteria derived from the main principles of holistic review were that programs must have: (1) indicated they use holistic review; (2) responded affirmatively to three questions that assessed commitment to diversity, including having a mission that supports diversity; and (3) reported that use of holistic review was associated with increased racial and ethnic diversity among students. Additionally, programs must have enrolled a proportion of URM first-year students that was at or above the 90th percentile for all programs using holistic review. Percentiles were determined using a ratio of program first-year student demographics to a program’s regional population demographics (e.g., percentage of Hispanic students in a program located in a regional division of the U.S./percentage of the Hispanic population in that regional division of the U.S.) (Kaiser Family Foundation, 2016 ). This ratio was used to account for the influence of population demographics in PA program locations, which have been shown to moderately correlate with URM enrollment (Coplan et al., 2018 ).

The aforementioned survey of PA programs was used to identify seven programs—three public and four private—representing best possible cases, whose identities were only known to PAEA, the national organization that distributed the survey. To maintain program anonymity, a PAEA staff member sent email invitations to the program directors of all seven programs on behalf of the researchers, who offered a $2000 honorarium for study participation. Four programs expressed initial interest. To strengthen transferability, we selected maximum variation sampling, using parameters such as public versus private funding and different geographic location (Creswell & Poth, 2018 ). Ideal maximum variation was not achieved on these parameters; however, other characteristics that may influence URM enrollment, for example degree of minority representation among faculty (see Table ​ Table2) 2 ) varied across cases, maintaining the integrity of the selection criteria and study methodology. The two cases selected—both private, nonprofit programs in the same regional division of the country—demonstrated the greatest willingness and ability to allow researcher access to their inner workings, which is essential for case study research (Sandelowski, 2011 ; Yin, 2018 ). It should also be noted that 62% of PA programs are housed in private, non-profit institutions (Physician Assistant Education Association, 2020 ).

Comparison of program characteristics and admissions requirements

Table reflects national (Physician Assistant Education Association, 2019 ) and study PA program characteristics at time of program site visits in 2019

a Health Resources & Services Administration

b Racial URMs = students identified as African American, American Indians or Alaskan Natives, Native Hawaiians or other Pacific Islanders, or multiracial

c Once program identities were known, publicly available PA program data from the National Center for Education Statistics Integrated Postsecondary Education Data System ( https://nces.ed.gov/ipeds/ ) were assessed to confirm that 2017 student demographics were comparable to student demographics in the preceding 3 years (Institution of Education Sciences n.d.)

Data collection

After obtaining Arizona State University Human Subjects Institutional Review Board approval, we collected data from a variety of sources: (1) texts and artifacts, such as information from websites and admissions materials, (2) semi-structured interviews, using a protocol derived from the conceptual framework, pilot-tested, and revised for clarity, (3) formal and informal observations using a worksheet to capture organizational characteristics and processes for applicant selection, and (4) a focus group of URM students at each program (see Table ​ Table3). 3 ). The semi-structured, pilot-tested student focus group protocol focused on students’ reasons for selecting their program as well as their perceptions of the admissions process and program culture. After collection, all focus group and interview data were anonymized and transcribed.

To complete the study’s field research, BC visited each program for four days during the 2018–2019 admissions cycle, when knowledge of the admissions process would be fresh in study participants’ minds. At each program she was given a tour, observed one faculty meeting where admissions-related topics were discussed, and conducted the focus group of URM students. At both programs, seven first-year URM students, an optimal number for focused discussion, participated (Morgan, 1997 ). An overview of individual interviews and additional sources of data from each program are listed in Table ​ Table3. 3 . During the program visits, BC remained onsite during ‘off-times’ to familiarize participants with her presence and minimize their sense of intrusion. Remaining onsite also provided opportunities for informal observations and impromptu discussions.

Data analysis

Directed content analysis, which is a strategy used to examine a phenomenon for which existing theory may be underdeveloped, was used to evaluate the data (Hsieh & Shannon, 2005 ). To facilitate this process, existing literature and theory were used to create an initial list of codes, which are labels attached to portions of text (or units of meaning) to designate themes (i.e., subjects that appear with regularity in the data). These start codes/themes were then used to guide initial data analysis (Hsieh & Shannon, 2005 ). A codebook, developed a priori, organized codes into five domains derived from the conceptual model (Colorafi & Evans, 2016 ) and phrased codes as gerunds, which are words ending in ‘-ing’ that signify observable or conceptual action (Miles et al., 2014 , p. 74). Using the codebook, study authors initially team-coded the data, making revisions or adding new codes to reflect themes or domains that were not captured within the initial codebook. Next, the revised coding scheme was used to re-code interview data and further refine the codes. The reliability of the final coding scheme was evaluated by assessing interrater domain agreement (Kappa = 0.89 [95% CI, 0.82–0.97]). The finalized codebook was then used to complete a thematic analysis of Case 1, and the approach was repeated for Case 2, which is a replication tactic used to assess for congruent patterns (Miles et al., 2014 ; Yin, 2018 ).

The interview codebook was also used as a basis for thematic analysis of student focus group data. Additionally, new codes were added to identify themes reflective of student reasons for choosing to attend their respective program. Focus group data for each case also were analyzed sequentially, applying the revised coding scheme derived from analysis of Case 1 to Case 2, thereby assessing for common themes and patterns (Miles et al., 2014 ; Yin, 2018 ). Interrater domain agreement for Case 2 was also assessed (Kappa = 0.92 [95% CI, 0.86–0.99]). Analysis of observational and artifact data was primarily conducted using analytic memos, which are narratives that record the researcher’s thoughts and enhance and maintain transparency in relation to data interpretation (Miles et al., 2014 , p. 95). During a final phase of analysis, data from each case were organized into matrices, or data displays, to facilitate the classic techniques of case study research: within-case and cross-case comparisons of similarities and differences, development of propositions for further testing, and additional evaluation of data relevance to the conceptual model (Crowe et al., 2011 ; Miles et al., 2014 ).

Methodological integrity is maintained in this report through grounding in the meaningful, contextual, and coherent evidence provided by the case study report format, attention to transferability in the study design, and acknowledgement of investigators’ perspectives (Levitt et al., 2018 ). Neither study author identifies as URM; both have worked extensively in clinical and educational settings with URMs and have experience with holistic review. Through their experiences, both authors became accustomed to challenging their own assumptions and identifying issues of power and privilege. In addition to using holistic review, BC has participated in standard admissions processes and has published research on diversity in the PA profession. The study’s second author, BE, used holistic admissions at the baccalaureate and PhD levels in nursing for well over a decade, has published extensively on educating diverse populations, and is a federally funded mixed-methods researcher studying caregiving Mexican–American families.

Findings: within-case analyses

Below, we present a description and analysis of each program in the context of the conceptual model (see Fig.  1 ). We use pseudonyms to maintain participant anonymity and have withheld details that may reveal program identity.

Case 1: recent holistic review adopter

Program 1 description.

Program 1 was established in the 1990s at a private, nonprofit university that only offers degrees in the health sciences and is located in an urban area with a diverse population. The university as well as the program mission statement includes a commitment to diverse communities. A large majority of program faculty are non-Hispanic white; however, minorities comprise a majority of university and program staff. Program admissions requirements include paid or volunteer healthcare experience and PA shadowing. No standardized examination (e.g., Graduate Record Examination [GRE]) is required. The average overall GPA of admitted students was slightly below the 2016–2017 national average of 3.57, and total tuition was higher than the national average of $87,160 for private programs. Additional program characteristics are listed in Table ​ Table2. 2 . Program 1 intentionally revised its admissions process in 2012 due to faculty dissatisfaction with class diversity (in 2010, the class had no African American or Hispanic/Latino students) and in response to a university-wide effort to increase URM enrollment.

Diversity culture

Although case selection criteria (which included responses to survey questions) aimed to identify PA programs with stated commitments to diversity, a more thorough evaluation was necessary to gain a true appreciation of culture (Schein & Schein, 2017 ). Consistent with diversity culture, artifacts and espoused beliefs at Program 1 reflect a strong appreciation for diversity and inclusion, as well as a commitment to service. Webpages and brochures prominently display students, faculty, and patients from diverse backgrounds and consistently highlight service in diverse communities. These more superficial reflections of culture were in turn supported by student, staff, and faculty attitudes, behaviors, and actions. Data collected from the URM student focus group and from observations, for instance, reveal that students experience a sense of inclusion and support within the program. For example, they discussed “how family-oriented it is, how inclusive everyone is,” and remarked that “the culture is all about supporting one another, empowering one another, and supporting the community.” They also agreed that seeing “people who look like me” helped them determine that the program’s publicized diversity was authentic.

Attitudes reflective of tolerance and appreciation for every individual’s inherent value were consistent among faculty, who frequently mentioned applicants’ and students’ unique ‘stories.’ The program’s director for 11 years, ‘Nick,’ has been with the program for 20 years. During the observed admissions interview day, he praised faculty members—whose average tenure at the program (13 years) is more than twice the national average—and highlighted the program’s many community service activities. He went on to welcome interviewees with the statement, “We value you, your presence here, and your time.” Matriculated students appreciated his desire to “[hear] us out as people” and recalled him sitting down with them to ask, “‘Okay. How are you guys feeling? What do you guys need from me to succeed?’”.

Nick’s attitude is also reflected in his substantial efforts to improve diversity within the program which include: facilitating the program’s more holistic admissions process, instructing faculty to utilize more URM guest lecturers, and recruiting URM faculty. In fact, just prior to the study visit, the program hired its first African American faculty member.

In addition to leadership, a potentially important aspect of Program 1’s culture is that the level of commitment to diversity appears to have been increasing in recent years, although not without some challenges. Students and faculty uniformly expressed a feeling of inclusion and support within the program; however, faculty and staff seem to be experiencing a slow but positive shift in university culture that one staff member described as “definitely diverse” and “moving towards inclusive.” Both faculty and staff believed that university resources to support the increasing numbers of minority students were not yet sufficient. Notably, the impact that the diverse student body is having on the culture as well as the curriculum was mentioned several times.

‘Dee,’ Program 1 staff interview : The student body is very social justice-oriented as a whole. They're driving and forcing faculty to shift and change, right, and the school to shift and change. So it's more inclusive than when I got here 15 years ago, far more inclusive. I feel way better about being on campus as a person of color these days. I feel like we have great conversations, we have hard conversations, we have very uncomfortable conversations. And we create really safe spaces to make that all happen.

The circumstance described below was noted by three faculty and one staff member, all of whom viewed it as a positive occurrence.

‘ Katie,’ Program 1 faculty interview : One thing that a student brought to our attention was more representation of people in color in our PowerPoints. This is just fresh […] a couple months ago and she actually brought it up to me in advising and she did speak to our diversity center here on campus about it. So that became a good faculty conversation and I wholeheartedly agreed with her. She's like, ‘What does a blue dot sign look like?’ It's a physical diagnosis kind of sign. ‘What does a blue dot sign look like on a black person? Or do you even see that? What does a melanoma look like on, every slide and every PowerPoint is Caucasian skin.’ And so I thought that was an excellent point.

Program practices

When Program 1 revised its admission process in 2012, faculty weren’t aware they were creating a ‘holistic review’ process. That said, the practices they now use reflect core principles of holistic review (see Table ​ Table1), 1 ), with the exception that the process has been aligned with re-evaluated program values as opposed to a specific mission. Additionally, the program has relied, in part, on a faculty key informant or ‘champion for diversity.’ Non-academic metrics related to experience and background are considered as part of the initial screen of applicants, and the overall process is intentionally design to create a diverse pool of interviewees and accepted candidates that includes URMs.

As part of re-visioning the program’s admissions process, Nick (the program director) recruited a ‘champion for diversity’: ‘Umberto’—a Latino pediatrician who is a first-generation college graduate and founder of a successful network of pipeline programs. Umberto led “… soul searching within the department about our admissions process to try to identify the part of our admissions process that favored a majority group …” and helped re-evaluate program values, particularly with regard to clinical experience.

As someone dedicated to service and actively involved in supporting youth from diverse backgrounds, Umberto serves as a source of insight, vision, and connection to diverse communities. His discussion of revising the admissions process, supported by faculty interview data, illustrate his influence.

Umberto, Program 1 faculty interview : When we restructured those values that were more humanistic and more about interfacing with people and working with people, then that opened it up to a lot more different jobs and volunteer experiences. Patient educators, working at community-based organizations, mobilizing people, all of that. A lot of those experiences that a lot of kids of color come in with because that's their values. That made it less stringent upon clinical experience and academic standards. Although we still value them and we score it, it wasn't just about that.

‘Uma,’ Program 1 faculty interview : It used to be before [Umberto] came onboard, it was pretty much all just GPA and healthcare experience and that was pretty much it, and when we really looked at what's important to us, we can teach medical knowledge, we can teach some of these—like we can teach skills. What do we really want them to get out of healthcare experience? We’re really looking for the exposure to the profession, and really it's about teamwork and communication.

During the re-visioning process, faculty came to consensus around valued criteria and revised the matrix used to evaluate applicants—which now includes scoring more types of experiences and placing greater weight on valued attributes—and incorporated consideration of most recent academic performance (i.e., last 60 credit hours). Additionally, a few years ago, the program added supplemental questions to the centralized national PA program application that ask applicants to describe how their background and experiences align with the program’s core values and to explain any academic deficiencies. Perhaps more importantly, interview data suggest that faculty thoughtfully consider responses to these questions: “…you learn a ton about the applicant. Like, ‘my mom was diagnosed with breast cancer my freshman year in college and I was her primary caregiver.’ You know, these stories that make me go, oh, no wonder you got a 2.9.”

Although faculty noted that they share program values such as tolerance and appreciation for diversity, they also contribute individual viewpoints to the admissions process. For example, some faculty focus on healthcare experience or GPA more than others do, but they collectively acknowledge the need for resilience, community-mindedness, and appreciation for the PA role. Faculty also consider feedback from current students, alumni, and adjunct faculty who participate in the program’s unique day-long admissions interview experience. Groups of candidates rotate through multiple stations, participating in individual interviews with faculty, a team decision-making activity evaluated by alumni, and, among other things, an informal discussion conducted by a panel of current students. Students also serve as greeters and guides throughout the day, which is structured to provide opportunities to evaluate candidates in different situations and generate feedback from multiple perspectives.

Outreach and recruitment

Program 1’s university Office of Diversity and Inclusion (ODI) organizes numerous outreach and diversity-related activities throughout each year. University students are encouraged to attend and participate in a program that provides financial support for those who regularly take part in community and on-campus events designed to engage youth from diverse communities. Each PA program cohort has a ‘service chair’ to help facilitate community service activities, and several PA students serve as mentors to local high school students involved in the pipeline program founded by Umberto, who noted that mentoring “…is a lovely way where many of our minority students feel that they are giving back and bringing up the next generation.” Program recruitment activities include regular online and on-campus informational sessions. Additionally, the ODI specifically invites students who unsuccessfully applied to the PA program to an on-campus event involving current URM students that focuses on ways to strengthen their applications.

Academic support

Program 1 faculty are aware that students from diverse backgrounds may face unique challenges. For example, two faculty members discussed the difficulty students whose first language is not English can have finishing exams, because translating in one’s head takes extra time. Moreover, the program reaches out to students after an initial exam failure and provides several means of informal and formal support to ensure academic success, including instruction on test-taking strategies; the services of a writing specialist, tutor, or counselor; and meetings with faculty. They “…pull out all of the stops because the earlier you catch them, the better.” Despite faculty commitment to these efforts, several discussed the need for more resources.

Umberto, Program 1 faculty interview : [We] realized, that if we were going to open up our program to students who perhaps weren't as well prepared academically or may potentially pose a challenge, that we as an organization had to make sure that we responded. In some ways, that's something we still need to work on. It has challenged us. The fact that we have diversified our cohort so much has helped us to define where the gaps are in our support system.

Faculty acknowledged that the ability to support students can affect selections decisions.

'Ugo,' Program 1 Faculty interview : When we're agonizing over [an applicant] who doesn't quite have the grade point average in looking at their academic record and it's making us wonder, are they going to fail anatomy? Are they going to fail courses? […]. What could we do if we take the stretch and admit them to make sure that they succeed? What are the resources?

Outcome measures

To explore the specific relationship between outcome measures and admissions, we chose to ask faculty and staff about how they determine whether an admissions cycle has been successful and how they respond when admissions outcomes are not achieved. Faculty discussed typical approaches, including monitoring academic performance (e.g., course grades, Physician Assistant National Certifying Exam [PANCE] pass rates) and professional behaviors of cohorts. They also look back to determine if any admissions criteria correlate with poor academic performance, although none have been identified. In addition, several faculty discussed informally assessing the diversity composition of cohorts, not only with regard to racial and ethnic diversity but also gender, age, and socioeconomic diversity. The influence of this assessment is perhaps best illustrated by the program revising its admissions process in 2012 in response to poor URM student enrollment.

Case 2: mission-based holistic review

Program description.

Established in the 1970s, Program 2 is among the oldest PA programs in the U.S. It is administratively housed in a private, nonprofit medical school but physically located on a separate campus that, like Program 1’s campus, is in an urban area with a diverse population. Program 2’s medical school and university do not include diversity in their mission statements; however, the program itself was created with an express mission to serve medically underserved communities and educate students from diverse backgrounds. Requirements for admission, which are shown in Table ​ Table2, 2 , include completion of the GRE or Medical College Admission Test® (MCAT), although the scores are not heavily weighted. In fact, the program is considering eliminating the standardized exam requirement. Paid clinical experience and PA shadowing are preferred but not required. The average overall GPA of admitted students was slightly below the national average, and total tuition was higher than the national average for private programs. The program has engaged in mission-based holistic review of admissions applications for multiple decades.

Program 2’s diversity culture is grounded in its mission. Program artifacts and espoused beliefs—including a program magazine; student-led website; and program celebrations, such as African American Day—uniformly reflect a commitment to diversity, inclusion, and service in medically underserved communities. Faculty, staff, and student attitudes—which provide insight into the deepest level of culture—consistently demonstrated an appreciation for the program’s mission, and faculty and staff expressed satisfaction with the ways the university and medical school, in particular, promote diversity and provide support for the program’s diversity-related pursuits. Interviewees articulated the program’s long-term commitment to its diversity-focused mission “….because of where we are, who we are, how the program has evolved over the years, and the belief of the faculty and leadership.”

Students reported feeling supported at the program and remarked on the influence of their diverse faculty.

‘Alexis,’ Program 2 student focus group : The diversity of the faculty really hit me because I went to [University] for undergrad and I've never had a diverse faculty member my entire four years there. So when I came here, I was like, ‘What, there's a Latina PA, who's [working in] family medicine, ER, a bunch of stuff.’ So I was just like, ‘What? What's going on?’ I was never used to that. That's why I never connected with the professors over there, I don't know, because of that maybe. So I never went up to them, I was like, I'm gonna’ do this on my own. That's how I've done it all the time, so I'm just gonna’ continue doing it on my own. [Though] here I actually feel comfortable going somewhere because they understand where we're coming from.

Program 2’s director, ‘Lloyd,’ joined the program as its director eight years ago. He has embraced its culture and backed development of a faculty member-initiated pipeline program. He recruited Mike, an experienced African American PA educator known for his success supporting URM students, to focus solely on recruiting and mentoring URM and socioeconomically disadvantaged students interested in pursuing a PA career. When discussing the program’s new street medicine project, which he worked to establish, Lloyd relayed a story to illustrate the impact of class diversity.

Lloyd, Program 2 faculty interview : Our development of the street medicine program this year has tweaked our curriculum a little bit to start to prepare them for caring for those who experience homelessness. And having a couple of students in the room that experienced homelessness was a real shocker for the class and really humanized the issues… because they suddenly realized that their respective colleagues had that life experience.

Program 2 periodically makes changes to its admissions process but, unlike Program 1, has used a similar process for many years—long before the concept of holistic review gained recognition. Similar to Program 1’s admissions practices, Program 2’s practices are consistent with holistic review core principles. Mission-related factors, for example, comprise a substantial portion of the initial application screening matrix and interview scoring sheet. Additionally, individual candidate interviews are ‘blinded’ in that interviewers do not have access to candidates’ applications when evaluating them. Candidates are interviewed individually by a pair of program representatives comprised of a combination of faculty, adjunct faculty, or current students; and students and alumni conduct panels to answer candidate questions.

The admissions selection committee, which includes a subset of the faculty, is diverse, and like Program 1, Program 2 has a supplemental application questions about how the applicant will fulfill the program’s mission and about any instances of poor academic performance. Faculty, staff, and student interview data reinforce that the mission is central to selections decisions. One of the two admissions committee co-chairs, ‘Ben,’ a Latino faculty member, explained the approach he began using when he became co-chair: “…I’ll put the mission up on the screen. I'll say… ‘Let's read the mission. Let's just remember why we're here. Let's remember the type of student we want here.’ Right? That's all I would say.”

When asked about the most important applicant attributes, many faculty and staff identified ‘mission’ first, and all mentioned mission fit as a significant consideration. Like Program 1 faculty, they also mentioned the different perspectives that admissions selections committee members contribute. The faculty carefully attend to evaluating all applicants fairly, but considering different views appears to contribute a sense of equity and balance.

Program 2 faculty and students engage in numerous outreach activities focused on serving and engaging youth from diverse communities. Both faculty and students seemed inspired by the program’s commitment to a mission that welcomes disadvantaged students and students of color, fosters hiring diverse faculty and staff, and advocates for underserved communities. One student enthused, “…I knew they were true to their mission statement. And I saw their awards for diversity and I knew that they didn't only talk the talk but walk the walk.” Moreover, Lloyd (the program director) reported that promoting the program’s mission and diversity contribute to its success with URM enrollment.

Lloyd, Program 2 faculty interview : So, to me it's been really a mindfulness of trying to send a message to students of color, students from underrepresented minority backgrounds or disadvantaged communities that this is a welcome place and that also starts with hiring faculty and staff of underrepresented minority backgrounds and making sure that we have a reflective group of who we are as a culture.

Pipeline program activities, which include monthly sessions delivered to 60 youth from underserved areas, expose potential future students to various health professions and provide resources for support. ‘Nora,’ a Latina faculty member who in her youth participated in a health careers opportunity program (HCOP), spearheaded the program’s pipeline efforts when she joined the faculty approximately seven years ago. She noted that the pipeline program works because PA student volunteers lead the sessions, and a PA student volunteer stated that they keep coming back because the youth who participate are so inspiring.

Mike, whose work focuses on supporting undergraduate students specifically interested in the PA profession; Ben, the admissions committee co-chair; and Nora are all ‘champions for diversity’ identified at Program 2.

Program 2 has formal and informal approaches to identifying and supporting struggling students. The formal process is based on assessing exam performance across courses, with one test failure triggering a meeting with the course directors, a second failure resulting in a learning contract stipulating use of different resources, and a third failure necessitating a meeting with and review by the student progress meeting, which “…looks at a broader depth and kind of kicks up the bar a little bit in terms of the level of support.”

In addition, course instructors work with students individually, and one faculty member has been designated to, among other responsibilities, provide learning support services. This faculty member noted that students who have never relied on others are often reluctant to ask for help. As part of her relatively new role, she hopes to establish a way to help students better prepare for the program’s challenging curriculum prior to starting classes. A few faculty members discussed ongoing efforts to provide more support, with one describing the program’s efforts as a continual “work in progress.”

In addition to formally monitoring academic performance and student professionalism and informally assessing student body diversity, Program 2 faculty track what percentage of their students go on to practice in primary care and medically underserved areas. The program also surveys and interviews students as they exit the program to determine if certain program goals were achieved, including whether students developed a greater appreciation for diverse communities. At the time of the researcher’s program visit, faculty had just assessed for any associations between admissions criteria and attrition but found none. Regarding outcome measure impact on admissions, the program director noted that, in order to promote greater URM student enrollment, approximately five years ago, the program adjusted its initial application screening rubric to weight mission-related factors more heavily.

Cross-case analysis and discussion

In this section, we first discuss case differences, then address the research questions through an examination of case commonalities (see Table ​ Table4). 4 ). Next, we describe factors other than program culture and practices that may influence URM enrollment and discuss study limitations and strengths.

Cross-case analysis: program commonalities

Differences

As shown in Table ​ Table2, 2 , the programs differ with regard to several characteristics that have the potential to influence URM student attendance: admissions requirements, faculty demographics, and experience with holistic review (Alger & Carrasco, 1997 ; Coplan et al., 2018 ; Wells et al., 2011 ; Yuen & Honda, 2019 ). Although most PA schools require a standardized exam (e.g., 58% require the GRE and 6% accept the GRE or MCAT) and hands-on clinical experience for admission (Physician Assistant Education Association, 2020 ), Program 1 does not require a standardized exam. Program 2 does not require experience and is considering eliminating the standardized exam requirement. While limited, research suggests that the GRE is a poor predictor of PA certification exam performance and may be an obstacle for URM applicants, irrespective of score (Butina et al., 2017 ; Higgins et al., 2010 ; Yuen & Honda, 2019 ). In addition, the only study of prerequisite experience showed no relationship between hours of clinical experience prior to and clinical performance during PA school (Hegmann & Iverson, 2016 ). Whether clinical experience is a barrier for URMs has not been studied; however, Program 1 faculty determined that the types of experience they considered (prior to revising their admissions practices) were likely disadvantaging URMs. Overall, both programs have achieved high URM student enrollment (relative to other PA programs) despite different admissions requirements, which suggests that other influences may be more important.

Program 2’s more diverse faculty appears to attract URM students and clearly has a positive influence on the learning environment (Bowman, 2013 ; Umbach, 2006 ). Program 1’s faculty are more reflective of the overall PA population, which is approximately 80% non-Hispanic white (National Commission on Certification of Physician Assistants, 2019 ); however, the staff and study body are diverse, which appears to positively impact program culture. In addition, Program 1 is recruiting more URM guest lecturers and recently hired its first African American faculty member. Thus, an appreciation for diverse representation among instructors appears to exist at both programs.

Program 1’s more recent transition to holistic admissions helps illuminate the fact that, although particular values may be necessary for effective holistic review, they may not be sufficient. Despite valuing diversity and inclusion, Program 1 did not achieve diverse student enrollment until the faculty deliberately aligned their admissions practices with those values. Additionally, while faculty and staff at both programs discussed the benefits of diversity among students, Program 1’s more recent experience with high proportions of URMs highlights the impact their perspectives can have on curriculum and culture. The story about the URM student asking to see people of color represented in course material is a strong example.

Commonalities and research questions

Central research question.

How is diversity culture manifested in holistic review practices that achieve high URM student enrollment? Consistent with the conceptual model, authentic diversity culture at both programs appears to drive holistic admissions practices that have effectively achieved diverse student enrollment (see Table ​ Table4). 4 ). Interestingly, neither program relied on established guidance when creating its admissions process. Instead, firmly held beliefs about the importance of serving underserved communities, which is an aspect of each program’s culture, served as a compelling motivator to develop practices that would promote URM attendance. Another important similarity is that both program leaders (i.e., program directors) seem to have translated beliefs about the value of diversity into actions that facilitate diversity-related goals, including asking individuals who we identified as champions for diversity to play leadership roles in the admissions process.

The influence of ‘champions’ may provide the greatest insight into how diversity culture manifests in admissions practices. In their eloquent study of Multiple Mini-Interview (MMI) interviewers’ ‘taste’—defined as “…individuals’ subjective judgments as a matter of practical sense”—Christensen and colleagues (2018, p. 292) describe the influence of alters (e.g., role models or leaders) on actors who, in the context of admissions, are applicant raters. They note that according to socialist Crossley ( 2013 ), “Alters teach actors how to appreciate and enjoy cultural objects that they might not otherwise ‘get’” (in Christensen et al., 2018 , p. 291). Consequently, actors develop shared appreciation for alters’ tastes. (Christensen et al., 2018 ). Christensen et al. conclude that medical school applicant raters’ similar preferences for particular attributes may partially result from “shared habituated norms.” (Christensen et al., 2018 , p. 301). They also note that enculturation appears to profoundly influence rater preferences for candidates who have attributes and characteristics with which they can identify.

By illuminating the influence that social interactions, habituated norms, and values may have on subjective rater judgments, it could be said that Christensen et al. ( 2018 ) demonstrated the influence of culture. Although we did not focus on how raters (i.e., faculty) form their impressions, it’s clear their judgments are influenced by program culture. At both programs, while different faculty perspectives are welcomed, having individuals (i.e., champions) who have deep insight into diverse communities participate in and help lead (or perhaps act as alters in) the admissions process facilitates a connection to those communities and appears to impart a stronger appreciation for applicant attributes associated with diversity-related program goals. Interestingly, the appreciation faculty seem to have for different points of view raises questions about the best way to achieve equity in admissions. For example, how do educational programs reconcile simultaneous recommendations to include diverse perspectives on admissions committees and strive for interrater reliability (Addams et al., 2010 )?

Research sub-question 1

What specific admissions practices do programs that enroll high proportions of URM students use? Both programs’ admissions practices are consistent with recommendations for model holistic review (Addams et al., 2010 ; American Association of Colleges of Nursing, 2016 ). Perhaps as a result of the insight gained from champions who understand the challenges that students from diverse backgrounds may face, both programs also include a question in their application that allows applicants to address instances of poor academic performance. In addition, current students are heavily involved in applicant interview experiences. Whether they influence URM attendance is unknown; however, based on URM student focus group data, current students of color in particular may help URM applicants feel comfortable and provide an indication that publicized commitments to diversity are authentic.

Research sub question 2

How are these practices supported? At both programs, outreach activities and engagement with a pipeline program contribute to working across a continuum of efforts aimed at supporting diverse student enrollment (Addams et al., 2010 ; Coleman et al., 2014 ; Glazer et al., 2018 ). Additionally, case study data suggest that involvement in pipeline programs, which students at both programs find rewarding, helps foster mentorship relationships. The proactive approach to academic support and faculty comments about the need to do more were also similar across programs, which suggests that supporting diverse classes of students requires sustained commitment. Finally, in response to monitoring diversity-related outcomes, both programs supported their holistic admissions practices by making revisions to promote greater diversity among students.

Potential alternative explanations for high URM enrollment

In a prior study, Hispanic/Latino and American Indian students described the pain of leaving home and feeling isolated when attending nursing school (Evans, 2004 ). Underrepresented minority students at both PA programs expressed a similar notion as they described choosing to apply to PA schools close to home or in diverse communities. Neither program was able to provide an accurate account of the percentage of their applicants that were URMs; however, both almost certainly receive more applications from URMs than programs located in areas with less diverse populations. Yet in 2010, Program 1, situated in an area with a diverse population, did not enroll any African American or Hispanic/Latino students. Therefore, while location may influence the ability to attract URM students, admissions and other program practices appear to have a stronger impact.

Another plausible explanation for high URM enrollment, not borne out by this study, is low tuition or the availability of scholarships. Tuition rates at both programs are higher than the average tuition for private programs and significantly higher than the average in-state tuition of $47,886 for public programs. Both programs have received U.S. Health Resources & Services Administration grants to provide scholarships for disadvantaged students, and Program 1 offers a need-based scholarship to two URM students in each cohort. However, scholarship award decisions are made after matriculation, and scholarship offerings do not reduce costs to an amount comparable to in-state tuition at public programs. Although tuition was identified as a “con” by URM students at both programs, it was not a deciding factor. Similarly, a national survey of PA students showed that they did not rate tuition and scholarships as very important or essential factors when selecting a PA program (Physician Assistant Education Association, 2018 ). Focus group data suggest that that URM students’ desire to be close to home and serve their communities counterbalanced their recognition of costs, which was mitigated by the potential for increased personal income and security.

Limitations and strengths

Limiting the study to two programs in the same geographic region was necessary to preserve the in-depth focus and integrity of the study methodology. However, because this case study was theory driven, the main concern was “… with the conditions under which the theory operates…,” not with ‘representativeness’ or statistical generalization of findings (Miles et al., 2014 , p. 33). Thus, maximum variation sampling to promote transferability, and research questions and analysis driven by the conceptual model buttress the study, allowing for analytic generalization of the findings to the conceptual model (i.e., the theory) (Polit & Beck, 2010 ). Based on the findings, the model was supported and expanded (to include the potential impact of diverse classes of students on culture) in preparation for theoretical transfer to other ‘cases.’ We also promoted transferability of findings to PA and other health professions programs by offering propositions for further testing (which are described below) (Miles et al., 2014 ) and providing context-rich descriptions “… that allow readers to make inferences about extrapolating the findings to other settings” (Polit & Beck, 2010 , p. 1453).

A possible bias of qualitative work is the potential for findings to be interpreted as more patterned than they actually are (Miles et al., 2014 ). We addressed this analytic bias by seeking negative evidence from study participants and investigating potential alternative explanations for high URM enrollment. In addition, several measures were undertaken to promote trustworthiness and authenticity (validity and reliability in quantitative terms). We strengthened confirmability by providing a detailed description of study procedures, analyzing data from multiple sources, and maintaining awareness of personal assumptions through the use of analytic memos. Finally, dependability and credibility were enhanced by using conceptually-driven analytic procedures replicated across cases, confirming findings with study participants, and triangulating across data sources (Miles et al., 2014 ).

Implications and conclusions

The benefits of interracial interactions among students include reduced prejudice and gains in psychological well-being, cognitive skills, and intellectual and civic engagement. (Bowman, 2013 ). Although we did not specifically assess the benefits of diversity, study findings shed further light on how students from diverse backgrounds may influence organizational culture. Consequently, the original conceptual model was revised to show that achieving diverse classes of students—which is a desired holistic review outcome—can reinforce or strengthen diversity culture. The connection is depicted as a dotted line, because the effect of failing to achieve high URM student enrollment is unclear.

Because factors known to facilitate effective holistic review were incorporated into the conceptual model, study findings, which supported the model, also help validate existing recommendations to advance holistic review: through outreach, by supporting students beyond the admissions process, and by monitoring diversity-related outcomes (Addams et al., 2010 ; American Association of Colleges of Nursing 2016; Association of American Medical Colleges n.d.; Glazer et al., 2016 ; Wros & Noone, 2018 ). Study findings also suggest that leader efforts to promote diversity can have a significant impact. Thus, prior insight about the need for leader buy-in (Glazer et al., 2016 ; Wros & Noone, 2018 ) was also supported. In addition, future examination of the specific influence of program-level leaders on holistic review may prove valuable.

By introducing a conceptual model for effective holistic review and illustrating the influence of diversity culture, this study may enhance health professions educators’ understanding of what successful holistic review involves. Additionally, the potentially meaningful new insights produced may serve as practical suggestions as well as propositions for further evaluation.

• A commitment to service (e.g., in the community, through involvement in pipeline programs) may enhance diversity culture and strengthen efforts to enroll URM students.
• Key informants or champions for diversity can significantly influence or shape the application evaluation process. Therefore, recruiting such individuals or having them assume a leadership role in admissions may increase the effectiveness of practices aimed at increasing URM enrollment.
• Incorporating a question into the admissions application that provides applicants the opportunity to explain academic deficiencies may increase the racial and ethnic as well as socioeconomic diversity of those considered for and consequently offered admission to the program.
• Programs committed to diversity can welcome and may attract URM candidates by incorporating diverse groups of students into the interview experience.

Marc Nivet ( 2012 ), former Association of American Medical Colleges Chief Diversity Officer, has observed that a huge disparity exists between declared commitments to diversity and demonstrable evidence of improvement. In relation to holistic review, going beyond mission statements and strategies by focusing on cultivating greater appreciation for diversity may help achieve more meaningful progress. Utilizing appropriate admissions practices is undeniably important; however, based on study findings, it is difficult to envision a circumstance where practices alone are highly effective.

While organizational culture may seem entrenched, change is possible. Moreover, the disproportionately high burden of COVID19 disease on minority populations along with worldwide protests sparked by racial injustice may serve as a catalyst for evaluating the impact of cultural attitudes and beliefs. Indiana University School of Medicine (IUSM) purposefully created a new culture of compassion, respect, and collaboration through an innovative approach designed to prompt reflection on instances of desired attitudes and behaviors already being exhibited within the school (Cottingham et al., 2008 ). Notably, the culture change inspired several new initiatives, including revising the admissions process to promote matriculation of students whose attributes aligned with new cultural priorities (Cottingham et al., 2008 ). Considering the potential for change and the failure thus far to achieve widespread progress toward achieving a more diverse health workforce, it may be time to address diversity in admissions through a focus on culture.

Acknowledgements

The authors wish to extend their sincere appreciation to the students, staff, and faculty who participated in the study and wish to thank the Physician Assistant Education Association, the PA Foundation, and Arizona State University for their funding support.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

Bettie Coplan, Email: [email protected] .

Bronwynne C. Evans, Email: [email protected] .

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State of Alaska Department of Revenue: Organizational Culture

How the State of Alaska Department of Revenue used data-driven decision-making to improve organizational culture, morale, and productivity.

NYC Department of Education: Leadership Development

How the New York City Department of Education is training its next generation of leaders.

Ascentra Credit Union: Culture Transformation

How Ascentra Credit Union took control of its culture. 

JetBlue: Process Improvement

Reorienting culture for better business results. How JetBlue engaged crewmembers to solve their operational problems.

IT Department of a Larger Hospital System: Culture Transformation

How the IT Department of a large hospital system leveraged culture as a strategic business driver.

Public Transit Authority: Alignment and Leadership Development

How a public transit authority achieved organizational alignment to achieve its goals. 

Tech Firm: Leadership Program Architecture

How a growing tech firm improved the delivery of critical management skills to its global managers through Leadership Principles and a Leadership Program Architecture.

Promedica: Leadership Development

How gothamCulture helped ProMedica develop high performance through the lens of leadership and culture.

Large Public Trust: Board Alignment

How a Board of Trustees achieved significant organizational alignment and change. 

Federal Government Agency: Onboarding Experience

gC helped improve the employee onboarding experience that was affecting productivity, work performance, engagement, morale, and retention. 

Comair: Organizational Change Management

How Comair created a clear case for change by gaining commitment from key stakeholders through engaging and creative methods.

The Milspo Project: Process Improvement

How gothamCulture helped to refine internal processes and leadership development for The Milspo Project.

jetBlue: Culture of Service Excellence

How jetBlue started new conversations with crew members and help them reconnect with jetBlue’s mission.

Bronx Community Health Network: Change Management

Through a dialogue-design and facilitation process, gothamCulture led BCHN through a discovery process that would help them understand how culture makes or breaks the implementation of a strategic plan.

U.S. Military Department: Leadership Development

How gothamCulture provided leadership coaching and training to improve operations in a U.S. Military Department.

IT Department of a Large School System: Culture Assessment

How leaders in an  IT department gained insight into its culture, equipping themselves for future challenges.

Saas-Based Payroll & Management Company: Culture Articulation

How gothamCulture helped a SaaS-based payroll and human capital management software articulate its culture to support growth.

Workscapes: Culture Assessment

Through a dialogue-design and facilitation process, gothamCulture led Workscapes through a process that would help them understand four main areas of opportunity for culture change.

Mass Transit Organization: Leadership Development

A mass transit organization successfully developed leaders to better achieve culture change goals.

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