Understanding organisational culture

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Part of Improving NHS culture

Since the beginning of 2015, The King’s Fund has been working with Lancashire Care NHS Foundation Trust (LCFT), using our culture assessment tool to give the organisation a more detailed understanding of its culture.

Julia Fernando, Senior Analyst at The King’s Fund, asked Professor Heather Tierney-Moore OBE, Chief Executive, LCFT, what made the organisation decide to embark on this work, what it found, and where it may lead.

Why was LCFT interested in finding out more about its culture?

When I first came to Lancashire Care NHS Foundation Trust seven years ago, I was struck by a strong need for a positive culture change across the organisation. Building on the work I had been doing before I joined the organisation in trying to understand the importance of the right leadership culture and its link to compassionate care, I set myself the ambition to create a culture of compassion in LCFT.

Before I joined LCFT, I was involved in a piece of work with a Scottish health board that was concerned about some significant failures in patient care. I remember board members were asking ‘What’s gone wrong? Have they [practitioners] lost all their compassion?

Many people were offering overly simplistic explanations. They assumed that the lack of compassion resulted from poor training. So we decided to carry out a major piece of work to explore the conditions that allowed compassion to thrive, with the aim of extending best practice, working with the local university.

We learned that the culture and leadership of teams was the main predictor or inhibitor of compassionate care. People may say ‘Well of course that’s the case’ but back then it wasn’t so self-evident.

What led you to work with The King’s Fund?

For a number of years, LCFT had been doing a lot of work to define and embed its values. The trust had been exposing leaders to tools that could help them develop their values and create a positive and appreciative culture.

However, when we got our staff survey results they were very disappointing, in that they did not reflect the extent of the culture change, or the level of staff engagement we were hoping for. Despite the work we had been doing, something was stopping us getting the traction we needed to make what we wanted to happen, happen.

I was aware of the work that Professor Michael West had been doing at The King’s Fund on collective leadership and it really resonated with me. My colleagues and I thought it could be an opportunity to build on what we’d already been doing as an organisation. The chance to discover our culture in an evidence-based way, with someone who’d done the research, was very attractive.

Were the results what you expected?

Our strength in compassion and values was very pleasing and reassuring. That was where I started from and that was where we had focused our energy, and using the culture assessment tool highlighted the value of the work we had been doing.

We were also able to identify other areas of culture that we had focused on less. I realised that if, in the future, we focus on these too, we will see improvement in these areas, particularly if they become part of a shared vision.

When we saw the findings of the culture assessment tool it felt blindingly obvious! I had just needed someone to hold up a mirror and reflect it back. The vision the organisation had made a shedload of sense to me, but it clearly did not resonate with staff. And it really made me think, what is our vision?

A vision needs to be something that gets people up in the morning. You can think that because you are busy doing lots of things well, the other parts will take care of themselves. That’s not the case. By showing us the variation in our culture it also made us think: other than our values, what else binds us together?

The nature of our services are so diverse – someone working in forensic services may not feel connected to organisational values in the same way as someone working on smoking cessation or working in schools.

What’s next for you on your journey towards a culture that delivers high-quality, continually improving, compassionate care?

We’re working as a team to improve how we define our vision, ensuring it is focused on quality but is also something that gets people in their gut rather than just their intellect. We’re also now able to use our existing approaches to help us create next steps based on the findings of this project. In this way it’s not just another corporate-based thing devised in a darkened room. These results are actionable.

But for us at LCFT, this is just the beginning. We’re now moving into a new phase of our programme of work on collective leadership, which will move from discovering our culture into developing ways of changing it. The culture assessment tool has helped us get started on that journey.

This article was originally published in The King's Fund's Insight magazine, autumn 2015.



Ankara university
Comment date
18 June 2016
Good work

john miller

nhs consultant and observer,
Comment date
07 November 2015
Great stuff. However the elephant in the room is the stranglehold DOH and devolved govts have on Trust and Board CEOS etc.......literally. It is purely Stalinist with punishment to fit. So how do you square the culture of fear with the above. See Chris Ham`s Xmas BMJ editorial 2013!

Julie Ann Racino

President and Principal,
Community and Policy Studies
Comment date
02 November 2015
Thank you; our organizational culture research was at community employment and workplaces back in the 1980s (Research Professor David Hagner is still over to the University of New Hampshire with new director, Dr. Charles Drum, also working in Europe). Dr. Drum's relatively new book was Public Health and Disability with Dr. Hank Bersani earlier from the Center on Human Policy and our national research network.

Ros Lovegrove

Head of Nursing,
Private Healthcare Hospital, Middle East
Comment date
30 October 2015
I wrote a paper on the culture of quality and care for my MSc Policy Studies in 1991. I was Assistant Director of Nursing at the John Radcliffe Hospital in Oxford at the time. I think that the progress that Julia refers to is key; 'actionable' and not 'corporate based' the tools such as the culture asessment tool makes things meaningful in terms of taking action and from intellect to practice is the bridge to cross. It's great to hear about 'how' put in to practice and ways of making everyone in healthcare behave differently, instinctively, being more of a reality.

Avril O'Leary

Interim Deputy Director of Nursing,
Northamptonshire Healthcare NHS Foundation Trust
Comment date
29 October 2015
Thank you for this article it has given me some real food for thought. In particular the reference to the nature and diversity of services in LCFT are very similar to those in my organisation NHFT and how to address the challenge across that diversity is fascinating. The exercise of developing a vision in such an organisation is compelling - someone please pass me that mirror!!

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