The challenge of culture change in the NHS

 

Chair: Professor Michael West, Lancaster University & Visiting Fellow at the Kings Fund

Presenters & contributors:

Professor Naomi Chambers (workshop coordinator), University of Manchester

Professor Graham Martin, Director of Research, THIS Institute, University of Cambridge

Jeremy Taylor, Director for Public Voice, National Institute of Health Research

Suzie Bailey, Director of Leadership, Kings Fund

 

Session Summary:

Connection, inclusion and compassion are certain, unchanging, and provide a safe refuge to deal with what feels frightening and isolating for so many. The challenge set by the Francis Inquiry Report – to create a compassionate, inclusive organisational culture – is now amplified in the Covid19 era, which the NHS entered with pre-existing record levels of staff stress and chronic excessive workloads.

This session explores, through three linked presentations, the problems and opportunities associated with changing healthcare organisation cultures. The first presentation draws on a recent NIHR funded mixed-methods evaluation of the translation into practice of several ‘post-Francis’ policies that have aimed to improve openness in the NHS, and identifies key conditions necessary for policies to make sustainable impact on culture and behaviour. The second presentation reflects on material from a forthcoming book which will offer unfiltered accounts from patients, carers and healthcare professionals about their good and bad experiences of how care is organised, from birth up to the end of life. Their testimonies indicate the salience of kindness and attentiveness combined with efficiency and competence. Finally, the context for a culture of openness and for patient-centred services will be presented, alongside the development of a culture change programme which is being used in 70 Trusts in England. Significant and unacceptable variations in the availability of high quality care and in staff wellbeing persist across the NHS and social care, exemplified by very different Covid19 experiences across the sector. How far does this kind of research on culture and these kinds of programme interventions help us to gain whole system traction in this important area of laying the conditions for reliably compassionate patient care? How can positive cultures and new working practices that have developed during the Covid19 pandemic be sustained

Significant and unacceptable variations in the availability of high quality care and in staff wellbeing persist across the NHS and social care, exemplified by very different Covid19 experiences across the sector. How far does this kind of research on culture and these kinds of programme interventions help to gain whole system traction in this important area of laying the conditions for reliably compassionate patient care? What positive cultures are exemplified and how can they be sustained?

The presenters of this session have made their slides available to download.

Add your voice to the conversation

This should also be an interesting session as I believe there's been a need for change within the NHS for some time now. It should be quite a debate I would imagine as partnership working is still being encouraged when we were introduced to working in partnership 20 years ago. How the NHS goes on from here will be of particular concern as the strain on services is currently extremely demanding, particularly mental health and psychological services. I'm concerned and interested in how the National both Scotland and England intend to rebuild our NHS to cope with the demand of the aftermath of the pandemic. I envisage a very different approach being taken and some time to try and restore the excellent work of the staff and the faith from the Public in our ability to carry out the roles/responsibilities of each area of the Organisation.

I have challenged the hierarchy on numerous occasions and now firmly believe these aren’t necessarily bad people, they just have seriously misplaced brand loyalty.

What a fascinating and reflective session - especially in the final comments. Thank you to all the panelists. I especially enjoyed Suzie's presentation as am interested in the role of regulators and their capacity to illuminate, guide and support - not just make determinations. This is a space where their expertise and practice has clearly progressed - unlike that of inquiries (as Kieran Walshe outlined in the panel session of failure and turnaround) which have an approach relatively unrefined across 30+ years.

Thank you all for your talk. One of my key 'takeaways' is the power of qualitative research and evaluation in health and how it helps to understand and make sense of organisational culture and relational experience.

Thank you to all the speakers and the chair. I thought this session was well-structured with including research and factors for staff, the public, and whole organisations/regulatory bodies. As a healthcare professional interested in research I took points away about engaging different parties in research, and some factors to consider when implementing change, recommendations etc that may come from research. But I also found the discussion about the context of the pandemic interesting on a personal level, as a healthcare professional working in a very busy team that has continued to function throughout the pandemic, of what prompts real change, and issues around what changes may be kept and what we may go back to doing. There are concerns were I work, for example, that we have shown what we are capable of doing when pushed to limits, but as discussed in this session, this cannot mean that we can or should keep doing that.

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