“Culture eats strategy for breakfast”. I’m pretty sure I used that line from Peter Drucker in an essay when I was a management trainee. Back then, I thought it was just some management rubbish that might help me to get a better mark. But it’s true and, after enjoying a breakfast of strategy, culture will gobble up pretty much everything else by lunchtime.
Culture – "the way we do things round here" – can inspire and improve, or degrade and destroy, any and every aspect of behaviour in an organisation. For some reason though, too many leaders seem to disregard what we know to be true about the importance of culture and this needs to change.
Why culture matters
Culture is important. That isn’t a statement of opinion, it is a statement of fact with a strong evidence base. Just look, for example, at the work published by Professor Michael West and his team over many years linking NHS staff survey data to performance and outcomes data in health services. Positive culture and strong staff engagement are linked to better clinical outcomes, lower mortality and better management of resources. There are leaders who equate having a positive culture with being soft or wishy-washy, but the facts do not support that view. If leaders nurture a positive culture then fewer people die and resources are more effectively spent. Positive cultures save lives and save money. If you’re still not convinced, read the report of the Mid Staffordshire NHS Foundation Trust Public Inquiry and learn about how poor culture was such an important factor in one of our worst healthcare tragedies.
Despite the overwhelming weight of evidence and the catastrophes that we know that poor culture has enabled to happen, we still don’t take culture seriously enough. It’s the leadership equivalent of denying climate change. Too many leaders ignore the evidence and too many leaders seem to think that changing their behaviour, changing the way they lead their teams, changing the way they do things round here either doesn’t matter or won’t make a difference. And too often, poor leadership behaviour seems acceptable because we see it everywhere. Let’s call some of it out, from the top of the shop down.
Stress and sub-optimal results
The organisational behaviour of our national bodies can be awful. Take pretty much any piece of policy or planning guidance as an example, often delayed or announced at short notice with ridiculous deadlines to meet and horrendous templates to fill in, putting unrealistic expectations on people to rush important work, creating huge amounts of unnecessary stress and sub-optimal results.
Regulators at national and regional levels can create dreadful cultures, particularly in areas like performance management. I have heard regulators say “we need to hold their feet to the fire” and managers on their way into performance meetings make wry comments about “turning up for a beating” - as if blame and fear are the things we need to foster positive change and improvement.
There are still chief executives and directors in our NHS who shout and swear at people in their organisations and call people into corridors to tear strips off them in public. That behaviour is unacceptable, especially from our most senior leaders who are our role models – whether they are modelling a role positively or not. But a lot of the time people feel too afraid, too stressed or too unsupported to challenge behaviour like that from people in such senior positions. If the Chief Exec is behaving like that it must be ok, right?
Turning the tide
I could go on and everyone who has worked in the NHS for longer than five minutes will have their own stories to tell. Thankfully there are reasons to be cheerful and the tide genuinely seems to be turning, raising the importance of culture for our leaders. Culture is at the heart of the NHS People Plan, and the People Promise features a clear commitment: “We want our culture to be positive, compassionate, and inclusive – and we all have our part to play.” I couldn’t agree more and as managers we can do so much to shape and nurture the culture in the places where we work.
Start by reading the Managers In Partnership guide to Organisational Culture. It’s a short read but it sets the bar high. Learn about what defines and drives culture, learn about the barriers to achieving an effective culture, learn about why culture matters and how to measure it and understand it where you work. Put that learning into practice. Talk about culture with your colleagues and think about the changes you can make together. Encourage conversation, encourage openness. Support good practice when you see it. Say “thank you” more.
What MiP members can do
Think about what you can do as a member of MiP. Our guide makes three suggestions: be an advocate by promoting best practice; be a custodian by supporting staff; be a mentor and support your colleagues to develop. If you want to do more the door is open to be more active in the union. Sign up for our training courses: they’re restarting soon, Covid-secure and free for members. Become a Link Member or a Rep and become a local champion and activist for MiP. Attend our virtual Summit in November and engage in shaping how MiP supports improvements in culture in the years to come. We will be re-electing the National Committee this year – is this the time for you to join the committee and be part of the leadership of MiP?
If you need to challenge poor culture where you work, we’ve got your back. Talk to your local reps, your national officer and the committee member for your region. We are passionate about supporting all our members to make health and care in our four nations the absolute best it can be and we will stand with you every step of the way to face any challenges that you need to overcome. We are committed to compassion, positivity and inclusivity – and we will fight for those things if we have to.
I heard someone say recently that it would be useful to maintain a “culture of crisis” in the NHS after the pandemic because we have managed to get so much done. No, it wouldn’t – it would be a disaster. People have been traumatised, burned out and pushed to their limits by the crisis we are still going through. We have so much work to do to recover and it will take us years. Now more than ever we need a positive, supportive, learning culture in health and care, where all our people feel safe and can thrive as we all put our shoulders to the wheel. You can make that a reality. If you need a hand, give MiP a call.
- Geoff Underwood is MiP National Committee member for South West England and a vice chair of MiP.