Purpose: The objective of this critical review was to establish a synthesis of the literature of organizational culture and to assess whether a single dominant organizational culture exists in public hospitals. Data sources: A search was contacted in four electronic data bases (MEDLINE, EMBASE, CINAHL and SCOPUS) using terms ‘‘Organizational culture’’ AND “Health care sector”. Study selection: Three inclusion criteria were applied: 1) the report of an original research study, 2) a study focus on evaluation of organizational culture and 3) a conceptualization of culture. Data extraction: Data was extracted by two reviewers independently. Results: Twelve studies met inclusion criteria. Although most studies were cross-sectional in design and variability was noted with respect to assessment instruments, all suggested a significant association between a strong organizational culture and employee and patient satisfaction. Operating culture found to be inconsistency within public and private healthcare settings as well as within health care professionals. Conclusion: While an association between organizational culture and healthcare performance was found, some of the relationships were weak.