Am I the only NHS chief executive who goes cold in response to the daily directive to “build a culture of compassion in the NHS”? Don’t misunderstand me; it’s not the belief that compassion should be at the heart of healthcare that I disagree with, although I do struggle with the presumption that the majority of us who work in the NHS don’t have compassion as a core value. Nor is it the critical importance of organisational or team culture that I challenge – far from it – addressing culture in my organisation is one of my top priorities.
What I take issue with is the implication that we can devise a carefully planned process to construct a set of attitudes and behaviours that collectively equal compassion – like following a recipe to produce a meal with a certain taste.
We have spent the last year in my trust, pre-Francis, observing, assessing and debating our culture, inspired by a general recognition that we didn’t have the embedded behaviours or relationships that would promote the very best care all the time. We noticed our language was full of “them” and “us” rather than a unified sense of purpose and support. Our surveys and feedback sessions told us people did not feel adequately valued and, perhaps most crucially, people felt more likely to be judged than supported when things went wrong. Underlying all the observations was a sense of overwhelming demand and an inability to influence.
We believe from our reflections that treating people with compassion comes from all of us feeling valued, supported and empowered. It isn’t a skill to be learnt; it’s a by-product of team or organisational cohesiveness.
We are now embarking on a programme of change based on this view and on the premise that culture is a set of consistent behaviours arising from clear, visible values. We had no difficulty reaffirming our values, but how do we create an organisational framework that enables them to be lived out and reinforced daily?
With the support of experienced coaches acting as ‘critical friends’, we have set up a clinical cabinet and staff forum to lead the change. We plan an intense programme of team building at the front line focused on autonomy and support. Clinicians and managers will be supported in delivering this through leadership development and coaching, and honest feedback will be a key expectation for us all.
I don’t know if this will deliver the change we all want to see. But I hope to share progress and hear comments from others on a similar quest. I don’t believe there is one template that successfully builds culture, although collectively agreeing the change we want to see seems critical. But cascading from individual forums and seeing impact across a widely dispersed set of services is the goal – yet to be achieved.
As my coach observes: “Angela is keen to take personal and collective action to learn how to develop a culture that enables the trust’s values and provides best care. As we formulate first steps in the organisation, our essential questions are:
- how do dedicated health professionals create a culture that impedes best care?
- can we change culture?
- will any of the culture change models actually work here?”
I hope this post will stimulate other chief executives to share how they are embarking on the ‘culture change quest’, so that we can share learning and experience and generate new questions and ideas.
Angela McNab is chief executive of Kent and Medway NHS and Social Care Partnership Trust. Follow the trust on Twitter @kmptnhs.