What components of culture are discussed in this case?

Hospitals’ policies frequently treat different classes of people differently.
A hospital trainee once commented that “The hospital is like an elephant.
When she goes to the right, you must go to the right. When she goes to the left, you must go that way, too.” Doctors, nurses, and cafeteria workers, among others, are often treated differently in a hierarchical culture. Nurses can feel powerless and executives little involved in patient care. Studies have shown that all this negatively impacts patient care. A main issue in changing this culture is that large teaching hospitals are the big elephants of the healthcare jungle that train and spread their hierarchical cultures. Yet, hospital cultures can change when physician attitudes move from “because I said so” directives to the staff to focusing on the whys and asking for input. Staff begin to feel that they can voice their concerns and that they have a more equal role in providing patient care. Negative behaviors such as excessive deference to authority, placing blame, and empty promises with no follow-through all diminish. Hospitals that change to a more equalitarian culture find that patient outcomes improve.