Talking leadership: Julia Fernando on understanding culture to enable compassionate care

Julia Fernando

Julia Fernando is Research Manager, Leadership Development at The King’s Fund. She is working with NHS Improvement and the Center for Creative Leadership on a two-year project to help trusts to understand their culture and develop interventions to enable more compassionate care. We asked Julia what she’s learnt so far.

Why do you think culture is so important in today’s NHS – and so difficult to change?

Culture is the backdrop in organisations against which all interactions take place. It sets the tone, guides people’s behaviour and helps them make sense of what is accepted and what is not. Getting the culture right in the NHS will enable compassion to thrive in all interactions between staff and will also manifest in the care they deliver to their patients. In the current resource-constrained landscape, a compassionate culture can also act as a protective buffer, supporting staff to deliver high-quality care despite mounting pressures and an increasing need for efficiency.

The difficulty is that once a culture is set and norms are established, it can be hard to change the status quo. Changing a culture of fear and blame can therefore be difficult. Leadership plays a vital role in driving forward such changes, and the leadership style you use will reflect the culture you want to create.

Can you tell us a bit about your work with NHS Improvement to help trusts to understand and improve their culture?

It’s a two-year programme of work that will provide a series of practical resources to support trusts to diagnose their cultural issues, develop collective leadership strategies to address them and implement any necessary changes.

The first stage of the programme (the discovery phase) resulted in a diagnostic tool, developed with three pilot trusts, which was released earlier this month and is now available on the NHS Improvement website.

The pilot trusts tested and evaluated the diagnostic tools. What did you learn from their involvement?

Yes, we have been working with Central Manchester University Hospital NHS Foundation Trust, Northumbria Healthcare NHS Foundation Trust and East London NHS Foundation Trust.

The early stages of this work drew from a robust and expansive evidence base to create a first draft of the tools. I was aware that there would be testing, evaluation and possible refinement, but had not expected much to change. Nonetheless, each time we met with the trusts to discuss their use of the tools, another unexpected revelation would emerge. Some of this learning would be positive – perhaps something had worked particularly well or another insight had been gained. In other instances I would be taken aback by things that we had not considered in the first iteration but that had subsequently emerged through the piloting. I was equally surprised by how receptive the NHS Improvement team were to implementing the suggested changes. This climate of collaboration was a key ingredient for the work’s success. We have come an incredibly long way since we started, but in the spirit of reflexivity remain open to the prospect of further testing, evaluation and refinement.

What are your hopes for the programme and the tools?

Because of the rigour and dedication that has gone into this work from both NHS Improvement and the three pilot trusts, I feel it has the potential to be a tremendous success. The diagnostic tools are the vehicles driving the vision for compassionate and collective cultures throughout the system. But for me, there are two things that will determine the effectiveness of the tools: first, a strong commitment and determination from trusts seeking to use this programme to change their culture and second, support and compassion from the national and political bodies that interact with those trusts.

Where would you advise trusts to begin on their journey towards understanding their culture?

I would say that getting senior leadership/board engagement is the crucial first step. Strong leadership is a key determinant of this work’s success and so before any other work begins, getting formal leadership support is essential. The message that ‘culture is a priority’ needs to be consistently relayed throughout your organisation, from the senior leadership team to the front line.