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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.