Our leadership and organisational development (L&OD) work takes us into NHS organisations who are often seeking to look at – and change – their organisational culture. Like many, they understand how important it is to get the culture right and the impact culture has on staff engagement, staff performance, innovation in practice and, importantly, clinical outcomes and patient experience. Not only is there a desire to move towards a better culture, there is often a flight from a prevailing culture that is variously described as ‘top down’, ‘toxic’ and one of fear, blame and bullying, with uncritical deference to those in power.
In these cultures silence is pervasive, people may keep their head down and, at worst, are inhibited or even frightened of speaking their truth for fear of bullying, harassment or suspension; a fear that is not wholly irrational according to one (non-NHS but relevant) study that tracked the reactions of some leaders to even the most constructive forms of challenge. Sadly these were predominantly negative and included labeling those who spoke out as ‘poor performers’ or subjecting them to abusive behaviour.
This is far from the inclusive learning culture to which many aspire to, or the compassionate leadership advocated in the NHS long-term plan, or the direction encouraged by many a public enquiry.
The seemingly polar opposite of such dysfunctional cultures are cultures of ‘niceness’, perceived to be particularly prevalent in the not-for-profit sector. Nice cultures are characterised by espoused values of teamwork and mutual respect, yet such places of supposed intra-organisational harmony can be equally problematic if they are simply conflict-averse. They often lead to poor performance as only ‘nice’ feedback is given for fear of upsetting people and difficult conversations are avoided. Meetings are characterised by politeness (which may be inauthentic), suppressed ideas and group nods in agreement with whatever the ‘leader’ has suggested. Dissent is noticeable by its absence. Challenge, debate and heated discussion with a range of voices and opinions are not common for fear of upsetting the niceness balance and a desire to remain comfortable.
This ‘pervasive niceness’ limits critical and creative thinking, breeds conformity and collusion and leads to poor decision-making. It does nothing for equality as the burden of embodying the ‘niceness’ falls particularly to women as a result of deeply embedded cultural expectations. It may also mask simmering resentments which find expression in passive aggressive behaviors cloaked (of course) in ‘niceness’.
The challenge common to both examples of culture is the lack of ability to work constructively with conflict.
In the ‘nasty’ culture, power is overtly used to shut conflict down and to end the discussion through use of fear and intimidation. Unpleasant confrontations and uncivil communication have a chilling effect on those who feel relatively less powerful, preventing the real issues from being discussed in a generative way.
In the ‘nice’ culture, the use of power is much more covert in shutting down conflict. Here, it relies on peoples’ need to belong to the ‘in’ group and subtle pressure not to make trouble but can be equally effective in stopping real issues being discussed.
Difficult conversations about substantive issues are avoided in both types of culture. Instead, the conflict becomes about the behaviours of the people raising these issues and those shutting it down. This type of interpersonal conflict absorbs a lot of time and energy in both formal processes (such as grievances, complaints and investigations) as well as through informal processes (such as gossip, alliances, loss of trust, stress, illness and staff retention).
So what’s the solution? In short, we all need to be much better at working with conflict. Most people associate the word conflict with fighting, anger, hurt feelings or ruptured relationships. Our view is that these are symptoms of conflict handled badly. Conflict itself is neither good nor bad, but it is inevitable. The issue is: how can we deal with it as a signal that something is wrong and treat it as an opportunity for positive change?
Here are our top tips for encouraging positive and inclusive conversations.
- Cultivate a growth mindset. Become more interested in self-reflection and learning than in being right.
- Welcome conflict as healthy. It is where differences meet and can be a signal that something important requires our attention. Look for underlying causes of conflict rather than just treating the symptoms. People have conflicts when they care about something.
- Create psychological safety. Make sure people feel safe and are encouraged to disagree and speak up.
- Encourage cognitive diversity. Make sure all perspectives and voices are allowed into the discussion and given equal consideration, including those whose voices are usually absent in some way. Groupthink creates pseudo-harmony and leads to serious errors. Invite challenge from the ‘unusual suspects’.
- Get comfortable with emotion. People have feelings for good reasons. Be curious. In our experience, leaders who have engaged in some exploratory or development work around their own feelings – and deepened their own self-awareness – are often better placed at being comfortable with the emotions of others.
- Make development central to everyone’s job. Frame conflicts and mistakes in terms of learning opportunities.
- Focus on creating a culture of dignity and respect for all. Challenge attitudes and behaviours that are not aligned to these values.
These steps can be difficult to put into practice, especially when they are counter-cultural to the environment we work in, but they can help to reframe how you handle conflict and ensure everyone’s voice is heard.
I have worked in both cultures in previous job roles. 'nasty' - whilst not conducive to retaining staff, is easy to spot and less damaging to individuals. 'nice' has led to counselling to repair my damaged mental health, as pervasive niceness, makes it hard to understand and perceived issues become personal as everyone else is so nice that the issue must be yours and not the systems!
Politicians should realise that they have destroyed professionalism which has been the thing which has been the cornerstone of the NHS from the 1940s to the 1980s when they started to destroy it with central directives, privatisation and abuse of clinical staff. Doctors and nurses and other clinicians are not perfect but they are infinitely more so than politicians and until politicians accept that they are the problem it is difficult to see how things are ever going to progress. Your points 1-7 are fine but they can not be implemented until politicians accept that they have been the cause of problems starting many years ago which have escalated ever since.
Thank you for sharing a really helpful perspective on the ranges of organisational culture. To achieve competence in the behaviours cited in the article takes a substantial investment over time in teams and individuals. I would be interested in seeing what other changes in leadership culture have to happen to create space and permission for this journey given the heavy emphasis on activity and efficiency in many organisations.
Excellent perceptive article. Whilst a top-down, toxic, bullying 'nasty' culture is readily-recognizable as being poor, the authors are right to identify the dangers of 'nice' cultures in which challenge and dissent is suppressed. Serious problems can ensue in a 'nice' culture in which speaking out is seen, wrongly, as disloyalty to the organisation. Such organisations can rapidly switch from 'nice' to 'nasty' if prevailing groupthink is challenged, with negative consequences such as those identified in this article.