Understanding organisational culture for healthcare quality improvement

TLDR

The authors examine how cultural concepts shape service performance, quality, safety, and improvement, noting that insular, negative cultures pervade NHS levels and impede change. Investigations of NHS failures and scandals reveal that hospital culture—characterised by risk neglect, defensiveness, secrecy, and patient‑centric neglect—has been a key driver of systemic failures, prompting calls for widespread cultural reform.

Abstract

Russell Mannion and Huw Davies explore how notions of culture relate to service performance, quality, safety, and improvement ### Key messages If we believe the headlines, health services are suffering epidemics of cultural shortcomings. Extensive enquiries into failures and scandals in the NHS over several decades have indicated aspects of hospital culture as leading to those failings.(box 1).12 The recent report into over 450 premature deaths at Gosport War Memorial Hospital mentions culture 21 times.3 After such reports, widespread and fundamental cultural change is typically prescribed as the remedy (box 1).45 Box 1 ### Centrality of culture to healthcare scandals: from Kennedy to Francis From Ian Kennedy’s review of the failings in paediatric cardiac surgery in Bristol during the 1980s and 90s2 to Robert Francis’s inquiry into the systemic failings at Mid Staffordshire Hospital Trust over a decade later,1 culture has been implicated. #### Culture as culprit “There was an insular ‘club’ culture [at Bristol], in which it was difficult for anyone to stand out, to press for change, or to raise questions and concerns” (p302)2 “Aspects of a negative culture have emerged at all levels of the NHS system. These include: a lack of consideration of risks to patients, defensiveness, looking inwards not outwards, secrecy, misplaced assumptions of trust, acceptance of poor standards, and, above all, a failure to put the patient … RETURN TO TEXT