Positive organisational cultures take time to develop and require supportive leaders who are values-driven, writes Marcus Powell

I’m a relative newcomer to the NHS having spent my career outside the public sector in executive positions at Marks and Spencer, as a change consultant at Ashridge Business School and more recently on the Board of Nuffield Health. I’ve worked with senior leaders in many different sectors both nationally and internationally.

So I read Nick Timmins’ new report based on interviews with a dozen former or departing NHS chief executives with a great sense of anticipation. Their testimonies reveal a job that can be rewarding and which brings a sense of achievement and fulfilment.

But they also point to the day to day reality of leaders grappling with the need to improve quality, innovate, and manage constrained resources with a workforce whose morale is at an all-time low.

Positive culture

I am struck by the consistency of the commentary that the levers to do the job have been nailed to the floor. That the system micro manages and that at times regulation seems to favour process rather than outcome.

This is a toxic combination and one which no talented leader whether clinical, financial or administrative would for long want to endure.

The private sector’s response would be based on an understanding that the only way to address this is to develop a positive organisational culture that works for both the employee and the employer. For the employer, this is about creating a culture in which innovation and improvement are encouraged and valued.

When change is needed, leaders need to be at their most confident

For the employee, this goes way beyond pay and benefits but understands the importance of values-driven leaders who support, nurture and encourage people to be at their best. The advent of social media, the constant news about lack of funding, a relentless media and over regulation can very quickly provide access to what it’s really like to work in health.

When change is needed, leaders need to be at their most confident. The bullying and fear of failure that many health sector leaders experience – and which is implicit in the testimonies documented in Nick’s report – does the exact opposite.

They retreat into what they know and behave in a way which perpetuates more of the same. The change never materialises.

Not only that, but the bullying is contagious and soon the bullied themselves become the bullies. So at some point, the system has to collectively address this by recognising that all aspects of the system play a contributing part in colluding for it not to change.

Shifting this culture has to be done locally and much is being done. Most local leaders know that a positive, engaged workforce will deliver high quality care. So the challenge is for the national bodies, regulators and legislators, the media and local communities to work together to fundamentally shift attitudes.

Avoid the blame game

If we want a vibrant, innovative health sector then the systemic bullying has to stop.

These cultures take time to develop, positive behaviours need to be encouraged, supported and nurtured.

Our recent report Improving Quality in the English NHS contrasted “regulated trust” and “real trust” which is based on a belief that people have a strong intrinsic motivation to perform to the best of their abilities. Real trust is not fostered through reliance on rules but through the development of positive organisational cultures that encourage risk taking and avoid blame.

These cultures support people to act in a way that is trustworthy and to do the right thing. But these cultures take time to develop, positive behaviours need to be encouraged, supported and nurtured.

This requires leaders who are values-driven and understand how to support positive cultures.

The driving need of a regulatory environment for consistency and order goes in the opposite direction to one which values and encourages innovation and improvement. In the private sector organisations that can’t renew become irrelevant, replaced by new ones providing new and innovative services.

We should not relax the drive for quality and the regulatory environment has an important part to play in assuring progress. But when the regulators become a stick to beat organisations then surely we’ve gone too far?

We need assurance but we also need improvement. We need an appreciation that the only way sustained improvement will happen is by developing long term strategies that foster positive cultures which encourage risk taking and avoid blame.

At The King’s Fund we are repositioning our development offer so that we are ready to support this change. We want to become even more relevant to the challenges facing leaders in health.

The ability to provide individual development and coaching is still vital but we see a shift towards system wide change and organisational development. Our Organisational Development offer will be designed to work in partnership with leaders to build confidence, competence and find the energy to grapple with problems where solutions seem currently to elude them.

Marcus Powell is director of leadership and organisational development at The King’s Fund. The chief executive’s tale: Views from the front line of the NHS can be downloaded for its website.



Trust chiefs speak out against 'bullying' regulators