Building the case for organisation development and workplace culture

Background

The purpose of this guide is to empower those in the NHS people profession to secure buy-in from the board and senior leaders in promoting a positive workplace culture through the work of organisation development (OD). 

This engagement is key because senior leaders are responsible for making strategic decisions about the organisation’s future priorities and resources. A positive culture, championed by the board, enhances staff experience and improves patient outcomes.

The benefits of investing in positive cultures are demonstrated in reports such as The King’s Fund – Improving NHS Culture: "It is now accepted that healthy cultures in NHS organisations are crucial to ensuring the delivery of high-quality patient care."  

Organisation development and design is a named as a specialist knowledge area in the NHS People Profession Map, published by NHS England in 2023.

Those working in the NHS people profession frequently use OD principles, theory and approaches to develop these healthy cultures. 

Introduction

This guide sets out how to build understanding of OD and its value, get to know your senior leaders, make the strategic case for recognising OD and culture at board level, build a compelling case for investment, turn that case into action through OD strategy and initiatives, and promote your work and success. 

The guide concludes with a reflective tool to help you shape a well-rounded, evidence-informed case for OD by identifying the key questions to consider as you develop your argument.

What is OD and why is it needed

The first step to influencing stakeholders is ensuring everyone knows what OD does and why it is essential to the organisation. It involves bringing individuals up to the same level of understanding.

CIPD describes OD as "a planned and systematic approach to enabling sustained organisational performance through the involvement of its people". 

Do OD views OD as improving the performance and health of systems by amplifying the humanity in our organisations, enabling people to flourish and thrive and have meaning in their work.

In practice, this means using OD to respond to the organisation’s most pressing priorities in ways that strengthen culture, support staff and improve care. For example:

• Where the priority is quality, safety and performance - OD can support leadership alignment, team effectiveness and service improvement so staff are better able to deliver safe, high-quality care.
• Where the priority is workforce experience and retention - OD can strengthen culture, engagement, inclusion, wellbeing and compassionate leadership, helping create the conditions in which people can stay, contribute and thrive.
• Where the priority is transformation and productivity - OD can enable change readiness, cross-organisational collaboration, clearer ways of working and staff involvement in improvement, supporting delivery of strategic and operational priorities.
• Where the priority is responding to staff insight - OD can translate NHS Staff Survey findings, listening activity and local intelligence into targeted action that improves culture, strengthens speaking up and supports sustained organisational performance.

In the NHS, the ultimate purpose of OD is to improve the quality and safety of patient care through improved organisational effectiveness. 

In the ongoing context of public sector change where the priorities are performance and financial accountability, OD skills and leadership are essential. 

Those working in the NHS people profession need to be at the forefront of system and service transformation, enabling the right conditions to deliver the ambitions of the 10 Year Health Plan for England and the upcoming 10 Year Workforce Plan.

In practice, this means using OD not only to strengthen culture and staff experience, but also to enable service transformation, leadership effectiveness, quality improvement, system collaboration and sustainable organisational performance.

The NHS Arden & GEM CSU report on creating an environment where people can do their best work provides some insights on this:

"Effective organisational development can ensure organisations are future-ready by developing your competency and capacity and empowering your people to meet your strategic and operational objectives. 

"Delivering services with fewer resources and increasing demand relies on optimal performance from your workforce. OD works to align the various cultural conditions central to effective and sustained high performance and to meeting the needs of the patients and wider stakeholders."

Get to know your senior leaders

The next step to influencing stakeholders is getting to know who makes up your board, who your senior leaders are, what they do, their areas of interest and how you can best engage them. This helps you position OD in ways that resonate and gain their support.

Our Get your board onboard to improve staff experience resource provides a useful summary of the role of key senior leaders and stakeholders and information on the evidence, statistics and facts you could share when presenting your case.

The resource also includes a sickness absence savings calculator to help you work out how much sickness absence is costing your organisation and what you could save by reducing it.

NHS England’s national civility and respect programme highlights the cost of incivility in the NHS. It is estimated that bullying and harassment costs NHS England over £2 billion per year. In support of the programme, the Social Partnership Forum developed a civility and respect diagnostic tool, a toolkit, a ‘supporting our staff’ poster and a cost of bullying calculator.

Making the case at board level

With a clearer understanding of your senior leaders and their priorities, you can begin to frame the strategic case for OD and culture at board level.

Senior leaders often recognise that OD and workplace culture are important. The opportunity is to build on that recognition by making the strategic link more clear: showing how investment in OD and culture can help deliver organisational priorities, improve performance and support sustainable outcomes for staff, patients and services. 

This matters because boards have a direct role in shaping culture. 

The Healthy NHS Board Principles for Good Governance report commissioned by the NHS National Leadership Council (NLC) says: “All board members share corporate responsibility for formulating strategy, ensuring accountability and shaping culture.” 

The report finds that where culture is not visible at board level, there is a risk that leaders become disconnected from staff and patient experience. It quotes a regulator report on a failing NHS Trust: “The board was insulated from the reality of poor care".

It also conveys compelling arguments for recognising OD and culture work at board level:

"A core role for the board is shaping a positive culture for the board and, by extension, the organisation. This recognises that good governance flows from a shared ethos or culture, as well as from systems and structures. 

"Embedding this culture so that it becomes a lived reality is equally important and arguably the most challenging part. This requires sustained effort and consistency of approach, often over several years."

It is recognised that better staff experience leads to overall organisational improvement. It can boost retention, enhance service quality and reduce absenteeism and temporary staff costs. Increased engagement can also advance innovation and quality improvement. Encouraging staff to speak up can help to reduce mistakes and enhance care quality.

The NLC report encourages NHS people professionals to illustrate how enhancing workplace culture aligns with NHS and organisational people objectives which can, in turn, drive improvements in retention rates, reductions in absenteeism and increased employee engagement.

The use of tried-and-tested tools can enhance staff experience and culture and promote a positive work environment with minimal investment in time and money. Use your strategy to emphasise how.

The following case studies demonstrate these points in action:

• Embracing staff feedback to embed cultural change; Liverpool Women's NHS Foundation Trust
• How we improved our reward offering and culture; Midlands Partnership University NHS Foundation Trust

Build your case for OD

The next step is to turn your case for OD into a practical, credible proposition. The following steps can help you create and present your case effectively to your board and senior leaders.

1. Clearly link to organisational strategy and outcomes

• Integrate OD into wider trust strategies so it is considered, supported and championed at a strategic level. Make connections with continuous improvement and learning and focus on how this helps transform services for staff and patients.
• Provide assurance by demonstrating how national frameworks underpin local strategies - review how your workforce strategy aligns with the 10 Year Health Plan, 10 Year NHS Workforce Plan and the Our NHS People Promise. Identify areas where local initiatives can support national goals and highlight successful local programmes that exemplify national priorities.
• Link workforce and safety indicators – there is much evidence around the impact of culture on performance, effectiveness and safety.
• Collaborate with divisions and directorates to ensure both corporate and local strategic objectives are supported, promoting a whole system and holistic approach.

2. Take a data-driven approach and build a strong evidence base

• Build a strong evidence base, using national and local data, statistics and facts to support your case for OD in improving culture and patient-related outcomes.
• The NHS Staff Survey provides good evidence base and is broadly understood at board level. Use results to help design initiatives and review impact.
• Use organisational data to evidence impacts on patient safety, operational performance and possible financial savings in time saving, automation and transformation. 
• Be careful about overpromising savings when many factors impact on these outcomes. Be realistic in what is promised, and link in with other colleagues (transformation, strategy, clinical) to develop shared narratives of likely impacts through multiple methods which include OD.
• Include qualitative data and storytelling, highlighting a broad range of staff voices. Personal impact narratives can be powerful and help navigate the difficulties of quantitative data outlined above.
• We know staff from marginalised groups often have a different or more negative experience at work. Make sure the business case explicitly considers those perspectives and how this work supports broader inclusion.
• Maintain regular, ongoing evaluation of your evidence base. 

3. Be strategic and collaborative in your positioning

• Be clear and concise in communication.
• Ensure messages to senior leaders are simple and impactful.
• Tailor your approach to highlight how your initiatives align with the specific priorities of senior leaders – learn what these are. Leaders need to understand what is in it for them and how this will help and support them to meet their goals.
• Be prepared to be flexible and responsive - leaders may need a stronger case presented in different ways.
• Clarify a realistic timeline for your initiatives to show impact. The project management tool from Primary Care One NHS Wales can help you to develop this. 
• Collaborate with colleagues outside of workforce to build your case – how can your initiative link to strategy, to clinical and operational work? Have early conversations with these colleagues to build this evidence.

4. Recognise good work achieved in this space and build on your organisation’s strengths

• Celebrate good work in OD and culture change by ensuring wins are communicated to senior leaders with plans on how to maximise them in the future.
• Show how your strategy or initiatives have tackled and overcome previously outlined areas of concern in the organisation. 
• For longer timelines, include early and middle markers to demonstrate progress towards the goal, even when the goal cannot yet be achieved.
• Close the feedback loop - share evaluation outcomes and staff feedback on how initiatives have improved culture and supported staff to deliver their work. This builds trust, psychological safety and engagement.

5. Highlight the impact of non-action

OD plays a crucial role by fostering a positive work environment, enhancing communication and promoting change and innovation. When OD is absent or very limited, organisations may experience a range of negative consequences, including:

• Ineffective change management - organisations may struggle to implement necessary changes due to a lack of structured approaches, leading to misdiagnosed problems and ineffective interventions.
• Reduced staff engagement - a lack of OD can result in low staff satisfaction and engagement, which is crucial for productivity and overall organisational success.
• Increased turnover - disengaged staff are more likely to seek new opportunities elsewhere, leading to higher turnover rates and increased costs associated with hiring and onboarding. 
• Decreased patient care - poor organisational performance and staff experience can negatively impact the quality of patient care.
• Inability to adapt - organisations that are static and resistant to change may struggle to meet targets.

To avoid these issues, organisations should prioritise OD as a strategic approach to improve their effectiveness, adaptability, and overall health.

Put your strategy into action

Once you have built the case for OD, the next step is to turn that commitment into visible action. This means putting your strategy into practice in ways that engage staff, involve leaders and create the conditions for sustainable cultural change.

• Build a network of staff across departments and system partners who can lead on OD activities. Use this network to test and refine your plans and encourage them to endorse and advocate your strategy.
• Organise workshops and training sessions focused on improving culture and the importance of this work. Read how Mersey Care NHS Foundation Trust implemented a just and learning culture and the impact it has had on its workforce.
• Establish programmes which recognise and reward staff contributions to a positive workplace culture.
• Involve staff in collaborative projects and groups aimed at enhancing the workplace environment and addressing specific concerns.
• Encourage senior leaders to support and participate in your OD activities.
• Encourage leaders to access coaching and training which empower them to use OD tools with their teams; give leaders the confidence to make their own impact on culture. Helpful resources include the NHS Leadership and Management Framework Code, our webinar on the new NHS Leadership and Management Framework and our Do OD Leaders Culture Change Toolkit.
• Implement regular surveys and feedback sessions to gather staff input and demonstrate that staff voices are heard and valued.

Promote your work and success

As your OD strategy and initiatives begin to take shape, it is important to communicate progress, share impact and build wider understanding of the value of this work. 

Promoting your successes helps sustain momentum, strengthen credibility and encourage continued support from leaders, staff and stakeholders.

• Work with your communications team to share progress and updates on OD initiatives via the internal communications channels available.
• Use posters, digital displays and other visual materials to promote the importance of a positive culture throughout the organisation.
• Share success stories and case studies of how your OD initiatives have positively impacted on staff and the organisation.
• Our guide to communicating your health and wellbeing campaign offers a range tips and tools to help you deliver successful communications campaigns and initiatives.
• Share evidence of impact and return on investment (ROI) with key stakeholders to support continued commitment to OD. This does not need to rely on financial savings; it can include outcomes such as improved staff experience, retention, engagement, wellbeing and service quality, reduced absence, stronger leadership or increased change readiness. Resources to support ROI calculations include this template from the ROI Institute and this chapter from Measuring the Success of Organization Development.

Our case study Transforming workplace culture through an OD approach outlines how a leadership transition provided an opportunity to reimagine organisational culture, strategy and staff engagement through a cultural transformation programme and renewed response to the National Staff Survey (NSS) results. 

The results of these joint initiatives demonstrated that a sustained, system-wide focus on culture and engagement can lead to measurable improvements, even amid organisational change.

Reflective tool for building the case for OD

Taken together, the sections in this guide are intended to help you build a clear, credible and persuasive case for OD and workplace culture. 

The prompts below offer a practical way to bring that thinking together and shape a well-rounded, evidence-informed case that speaks to your organisation’s priorities.

Further resources

• 20 OD examples from top businesses – Academy to Innovate HR
• The impact of OD initiatives on business performance - Research Gate 
• A case for culture - a 5 step guide – Talent Culture 
• What does compassionate and inclusive leadership mean to us? - NHS England
• Writing your NHS business case - Health Innovation Network
• Guidance on how to appraise proposals, policies, projects and programmes - HM Treasury 
• Business case tools and templates for practitioners and reviewers – HM Treasury