Culture versus human

Culture versus human – Kate Jury, Managing Partner

Good organisational culture is the remedy for everything it seems; it is a high ideal. Over the years, working with well over 350 trusts, I estimate that I may have encountered around three organisations where I would describe the culture as overwhelmingly (and demonstrably) ‘positive’. I’ve come across many more where people describe the culture as ‘negative’, the vast majority reside somewhere permanently in the middle, as is completely normal.

How to identify a bad culture in healthcare

Characterising an entire organisation’s culture in a single term is reductive and unhelpful, particularly in an environment of increasing integration between organisations. Over the years, there have been many examples of cultural misalignment between merged organisations where staff engage in ‘othering’ cultures; either ‘they bring us down’ or ‘they think they are above us’.  Of course it is infinitely much more complex than that.

We know that the NHS is made up of multiple cultures. A ward is a culture, a directorate is a culture, a board is a culture, nurses have a culture, and medics have a culture. All a ‘successful’ culture is, is a positive balance of mostly good departments where the ‘bad apples’ are kept in check.

Successful cultures in healthcare start from the bottom-up

Not one single NHS organisation is absent of all ‘toxicity’, but a successful organisation is better at normalising to a positive culture, so that pockets of poor culture they don’t turn eventually into a closed culture or a crisis; this is why a good ward manager is often the most important person in an organisation.

A good ward manager will make sure they apply even-handed approaches to all staff, they don’t have ‘favourites’, they tackle poor conduct instantly and visibly, and things are not left to fester. Supporting this approach means staff can build up a reliance upon the fact that they will be treated fairly in all circumstances – the epitome of a just culture.

Good leadership, which is trusted, with a consistent vision at every level of an organisation, from the ward to the board, is the best way to achieve a positive net-balance where culture is concerned.

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