Skip to content

It is now accepted that healthy cultures in NHS organisations are crucial to ensuring the delivery of high-quality patient care. We developed a tool to help organisations assess their culture, identifying the ways in which it is working well, as well as the areas that need to change.

Which characteristics are fundamental to a healthy culture?

  • Inspiring vision and values

  • Goals and performance

  • Support and compassion

  • Learning and innovation

  • Effective teamwork

  • Collective leadership

Inspiring vision and values

The first characteristics key to shaping an organisation’s culture are vision and values.

Leaders at every level should communicate an inspiring, forward-looking and ambitious vision focused on offering high-quality, compassionate care to the communities they serve.

There should be clear values that set expectations for how staff conduct themselves and interact with colleagues and patients. Values are set out in the NHS constitution, and patient-centredness and responsiveness are core.

Good leaders reiterate at every level the message that high-quality, compassionate care is the core purpose of all staff, so that everyone understands and acts on this commitment. This takes time, sustained energy and dedication.

  • Staff engagement: six building blocks for harnessing the creativity and enthusiasm of NHS staff

    This paper encourages NHS boards and other leaders to focus on staff engagement and suggests six building blocks for ensuring a highly engaged workforce.

  • Exploring CQC’s well-led domain

    The CQC’s inspections focus on five key lines of enquiry as part of its ‘well-led’ domain. This paper sets out what boards can do in these five areas and draws on examples of good practi...

  • Chris Ham in conversation with Sir David Dalton

    Chris Ham speaks to David Dalton about Salford Royal NHS Foundation Trust's journey to becoming the safest organisation in the NHS, and about what he's learned during his time as chief e...

Goals and performance

The second cultural characteristic fundamental to the delivery of continually improving, high-quality care is to have clear goals and performance feedback.

Goals must be set at every level from the board to frontline staff. Board goals should be shaped by patient input. Performance feedback should be based on patient feedback and patient outcomes.

Staff in health services report that they are often overwhelmed by their workload and are unclear about the goals they are working towards. This produces stress, inefficiency and poor quality care.

Such situations can arise when senior managers insist on too many priorities. A clear vision and mission statement about high-quality, compassionate care provides a directional path for staff. But this must be translated into clear, aligned, agreed and challenging goals at all levels of the organisation. It must be matched by timely, helpful and formative feedback for those delivering care if they are to continually improve quality.

  • Michael West: developing cultures of high-quality care

    In the first of our series of lectures on leadership in the NHS, Michael West, Professor of Organisational Psychology at Lancaster University Management School, explored how to develop a...

  • Delivering a collective leadership strategy for healthcare

    This paper, written in partnership with the Center for Creative Leadership, shows how collective leadership can be implemented to deliver sustainable culture change and improvements in p...

Support and compassion

Supportive and compassionate behaviours form the third cultural characteristic fundamental to the delivery of continually improving, high-quality care.

If we want staff to treat patients with respect, care and compassion, all leaders and staff must treat their colleagues with respect, care and compassion.

Directive, aggressive or brusque leaders dilute the ability of staff to make good decisions, deplete their emotional resources and hinder their ability to relate effectively to patients, especially those who are most distressed or challenging. There are clear links between staff experience and patient outcomes. Staff views of their leaders are strongly related to patients' perceptions of the quality of care. The higher the levels of satisfaction and commitment that staff report, the higher the levels of satisfaction that patients report. If leaders and managers create positive, supportive environments for staff, they in turn create caring, supportive environments and deliver high-quality care for patients. Such leadership cultures encourage staff engagement.

  • A new relationship with patients and communities?

    There are welcome signs that policy-makers and NHS leaders are becoming more open to exploring how health professionals could work more collaboratively with patients as leaders.

  • Future leaders need to lead people not organisations

    Relationships and people, not skills and authority derived from powers of office, are what’s important, says Mandip Kaur as she reflects on the responses we received during our Twitter d...

  • Developing a culture of compassionate care

    The Chief Nursing Officer has launched a new vision for nurses, midwives and care-givers. But will it help to develop a culture of compassionate care?

Learning and innovation

The fourth cultural characteristic fundamental to the delivery of continually improving, high-quality care is encouraging learning and innovation.

Sustaining cultures of high-quality care involves all staff focusing on continual learning and improvement of patient care. Learning and quality improvement are dependent on continual patient input – innovation is most likely where patients’ views and feedback play a strong role.

A focus on improvement should ensure that:

  • teams at all levels collectively take time to review and improve their performance

  • quality and patient safety practices are an ongoing priority for all

  • there are high levels of dialogue, debate and discussion across the organisation to achieve shared understanding about quality problems and solutions.

All staff should encourage, welcome and explore feedback and treat complaints and errors as opportunities for learning across the system rather than as a prompt for blame. This encourages collective openness to and learning from errors, near misses and incidents.

  • Improving care: what can leaders do?

    In organisations like hospitals, many of the answers are found among staff rather than in the executive offices and boardrooms, says Chris Ham.

  • Experience-based co-design toolkit

    This toolkit outlines a powerful and effective way of improving patients' experience of services.

Effective teamworking

Effective teamwork and collaboration form the fifth cultural characteristic fundamental to the delivery of continually improving, high-quality care.

Where multi-professional teams work together, patient satisfaction is higher, health care delivery is more effective, there are higher levels of innovation in ways of caring for patients, lower levels of stress, absenteeism and turnover, and more consistent communication with patients.

Leadership that ensures effective team and inter-teamwork (both within and across organisational boundaries) is essential if NHS organisations are to meet the challenges ahead. Shared leadership in teams is a strong predictor of team performance.

  • Reforming the NHS from within

    Our paper argues for a fundamental shift in how the NHS is reformed, learning from what has worked (and what has not) in England and elsewhere.

  • Patient and Family-Centred Care toolkit

    This toolkit provides everything you need to run the Patient and Family-Centred Care approach yourself.

Collective leadership

Collective leadership is the sixth characteristic that will enable the development of cultures of high-quality, compassionate and continually improving care.

Our view is that leadership in the NHS should be collective and distributed rather than located in a few individuals at the top of organisations. Collective leadership means everyone taking responsibility for the success of the organisation as a whole – not just for their own jobs. It requires organisations to distribute leadership power to wherever expertise, capability and motivation sit within organisations. This includes patients taking on leadership roles, both in determining their own care and in shaping their health care organisations (via patient representatives and patient groups).

Collective leadership should also be collaborative with leaders working together to prioritise quality of patient/service user care overall, not simply in their own areas of operation. And with a common style of supportive, enabling and empowering leadership. It is through collective leadership that cultures of high-quality, compassionate and continually improving care will develop and thrive. Every interaction by every leader at every level shapes the emerging culture of an organisation.

  • Delivering a collective leadership strategy for healthcare

    This paper, written in partnership with the Center for Creative Leadership, shows how collective leadership can be implemented to deliver sustainable culture change and improvements in p...