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Paul Corrigan on NHS cultures

My problem with a single powerful culture comes from growing up in the 1950s. English culture was pleased with itself. Its rejection of difference threatened that the cost of being different would be high. You would be on your own.

Later I had the opportunity to walk out of that culture and be part of a “counter culture”. Apparently there could be more than one culture and being different could still bring friends as well as fun. Politics taught me that the point of change wasn’t just the structures of our society but also the culture that made the structures move and work.

Culture also excludes

My story partly explains my difficulties with the culture of the NHS. Culture joins the NHS together and makes us feel that we at least know what we are doing. It also excludes.

That exclusiveness isn’t just a moral issue for the excluded. It has an impact on the ability of the NHS to move forward. On too many occasions the NHS people appointed to a tranche of NHS jobs are all just that – “NHS people”. The cultural strength this provides is obvious - “We all know what we are doing” - but the weakness is the same because “We only really know what we have done”.

“A strong culture makes it harder to bring about change from outside”

My strongest experience of the dual nature of this outcome was when, in June 2006, the new SHA chief executives were appointed.

They had all achieved a great deal in their collective 200 years’ experience of NHS work. They knew their organisation and how to make it work well. The minus was that the majority of their work experience had been in that one culture. Where was the different working going to come from?

A strong culture makes it harder to bring about change from outside. The management of change phrase ‘Culture eats strategy for breakfast’ shows its power. The interaction between that culture and big changes will be the subject of this column. One response to a dominant culture is to join the culture; another is to become indigestible.

Readers' comments (1)

  • Sarah FRASER

    I wonder if here are some shades of grey between the culture vs counter-culture positions? If culture is the sum (resulting outcome) of the behaviours of individuals then one way to look at the problem is to attend to the detail of behaviours of individuals. "NHS Culture" is a big statement. In my experience there are a variety of sub-cultures within teams, divisions, organisations and regions. These arise from history, are played out in context, and are tied to the way people behave. Behaviours themselves are set in a context, specifically of expectations.

    Can we enable different culture (outputs) to arise though helping increase self-awareness of behaviour, use ongoing feedback to link behaviour to result and start a debate about behaviour. Just as different families accept different behaviours and it is difficult to judge which are right or wrong from the outside, maybe we can encourage a curiosity about behavioural patterns in our organisations and seek to understand them without judging them.

    For me this is about doing some chewing before swallowing - time to reject or change, before becoming indigestible.

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