Culture, the patterns of beliefs and behaviours in our organisations and systems, when aligned to strategy, is a powerful force. Organisation development (OD) professionals and academics have explored the concept of culture for decades, suggesting many ways of influencing and improving it. Culture change has a core theme in OD practice in the NHS, particularly in the years since the Francis Report recommended fundamental change in culture is needed across the NHS.
Culture is subjective. Organisations and systems are made up of many interconnected cultures. Teams have their own cultures. Regions have theirs. When we talk about culture in this resource it is shorthand for the multiple, sometimes complimentary, and at other times opposing, cultures that exist at all levels of the NHS.
We challenge the myths that culture is a single thing that can be changed by policy; that culture change takes a long time; and that culture cannot be changed. We believe culture change is possible, it can be immediate, and it happens through the conversations between people. While it can be helpful, and often necessary, to undertake a formal and structured approach to culture change, we offer a complimentary approach that says we can all change culture, all the time. This process begins by asking good questions.
This resource is built around ten culture provocations and ‘what if?’ statements that invite you to examine and challenge your views and practices. They have been developed by Stefan Cantore from foundations of research, through the lens of the challenge of changing culture in the NHS in 2021. Stefan is a senior university teacher in organisation development and management learning at the University of Sheffield Management School.
At the end of the provocations is a set of ten questions we encourage you to answer as a way of planning your next steps.
Good conversations that start with great questions lead to powerful action.
Paul Taylor-Pitt, Assistant Director of Organisational Development, NHS Employers
Karen Dumain, National OD Capability Development Lead, NHS England and Improvement
How to use this resource
Each of the ten provocations begins with a ‘what if?’ statement, followed by an idea challenge intended to help us look at culture through fresh eyes.
Provocations stimulate a reaction, sparking new questions and inquiries about our assumptions and practices. They disturb our thinking and unsettle us so that we become open to considering alternative perspectives.
We invite you to stay with the feelings and thoughts that come with these provocations. For some OD practitioners the ideas themselves might be familiar and prompt a milder response than for others. However, we can all do with re-examining our beliefs and practices so hopefully there is some challenge for everyone.
Stick with the ‘what if?’ questions. If they irritate you, then they are doing their job. Use them as an opener for your own analysis about the idea of organisational culture and how your OD practice might develop in response. Give yourself the time to chew them over. Perhaps use them as a starting point for a conversation with colleagues. We would also encourage you to create your own ‘what if?’ questions.
If you feel some energy around a particular provocation, you can explore deeper and dive into the topic in more detail. Each provocation also features practice challenges and ‘why not?’ suggestions. These are initial ideas about practical actions you might take.
Provocation 1: What if we don’t have an agreed definition of organisational culture?
A Google search into the term organisational culture and a dip into academic literature will show that there is no one definition of the concept. Therefore, we need to do our own individual and collaborative thinking to come up with an understanding of the concept that fits well with us. Ed Schein (2004) identifies more than 11 categories used to describe culture, let alone the number of definitions. These range from observed repeated behaviour patterns, shared language, articulated values, rules of interaction, embedded skills, habits of thinking, metaphors, and symbols.
Schein goes on to suggest that while all of these might be relevant, the concept of culture brings with it the implication of what he calls ‘structural stability’ (Schein 2004, p. 15). This apparent stability offers a group a sense of meaning and predictability, both of which contribute to a sense of psychological safety. Furthermore, culture, as Schein sees it, is often something of which groups are largely unaware and shapes all their activities. When taken together, culture can be seen as a continuous patterning of behaviours and deep-seated beliefs that integrate our experiences and help us make sense of the environment in which we live and work.
Getting clarity on what we mean by the word culture in organisational contexts is a challenge, it can mean different things to different people. It is often used when we wish to create a group through our descriptions of their behaviours and attitudes. In using the label culture, we also create boundaries between those who belong to the culture we are describing and those who behave differently. Using labels is an act of power and differentiation. Because of the generality of the term, we also tend to pick up specific stereotypical behaviours that for us illustrate the nature of the group dynamics we observe.
Cultural identification in this way becomes a process of continuing social construction. As we discuss the behaviours and attitudes of groups, as we perceive them, so they become more real to us. We then tend to have our biases confirmed about the reality of the culture. So, if we perceive culture as a reality, how then might we define it?
Reviewing definitions of organisational culture offers not one meaning but a cluster:
1. Routinised ways of doing and thinking about things that are shared by the majority of organisational members. This incorporates methods of production, skills, work roles and habits of managerial behaviour.
2. Unique configuration of norms, values and beliefs apparently shared across members. These are reinforced in both the stories told and the strategies adopted by the organisation (strategy is then an enactment of culture).
3. Culture is not what an organisation has but what it is. Culture is a metaphor, a way of describing how people create order and organise for a purpose. In effect, then, every part of the organisation is its culture. You cannot tease out values from strategy, technology, or job roles since all combine to form a culture, a whole organisation.
4. A set of interdependent values and ways of behaving that are common in the organisation and tend to perpetuate themselves over an extended period.
5. Culture is a means of socialising and exercising control over organisational members.
These are a small sample of definitions; many more are available. Take some time now to craft your own definitions and then reflect on your own ideas.
Perhaps it is also worth asking if we see organisational culture as a positive construct. Often culture is blamed for failure, it allows a whole group to be demonised. What if culture became a more positive construct for us? What if we framed culture as a means by which people co-create relationships and value in the lives they lead? Why not spend some time reflecting on how you tend to view culture in the context of your practice? Why not play with different ideas and images of culture and see what happens? Note your reaction to each idea and consider why some are more appealing to you than others.
What is your reaction to the ambiguity and breadth of the idea of organisational culture?
How does it impact you as you think about the implications for your practice?
What spaces do you have to explore the idea/s with others? Can you create some new ones?
- Search organisational culture on Google and read some of the definitions you find?
- Jot down some reflections. Which ones particularly resonate for you? Which ones seem odd and don’t really work for you? Why do you think this is the case?
- Share your insights with a colleague and see what they think?
Provocation 2: What if our OD approach to organisational culture is itself a reflection of the organisational culture we work in?
We inhabit work environments that shape, albeit subconsciously, our behaviours and thinking as OD practitioners. The consequence is that when talking about organisational culture and working out how to change it, we are drawn to using the same language and behaviour patterns adopted by the organisation we work for. So, we find ourselves, almost inevitably, drawn into the patterns of culture transformation programmes, key performance indicators (KPIs), culture change tools, staff engagement strategies etc. We are also influenced by preconceptions and the interpretations of past experiences we carry with us and project on to our present context. In summary, OD practitioners need to acknowledge the range of influences on our cultural diagnoses and change strategies.
Cultural language and behaviour patterns are intended, as Schein (2004) 45 points out, to maintain some collective sense of structural stability. This comes across in his definition of organisational culture:
‘A pattern of shared basic assumptions that was learned by the group as it solved its problems of external adaptation and internal integration, that has worked well enough to be considered valid, and therefore, to be taught to new members as the correct way to perceive, think and feel in relation to those problems.’ (2004 p7).
Schein elaborates on this when he explores the purpose of organisational culture:
- It has a function in enabling productive working with other organisations, systems, and individuals.
- The processes are a means of socialising members to behavioural and attitudinal patterns.
- Maintenance and development of the culture, or patterns, happens over time. This gives a sense of stability and reduces anxiety.
- Culture encourages communication in a variety of ways with the purpose of ensuring cultural relevance to perceived contexts and organisational purpose. This implies that culture and its management is related to the control of group members.
The patterns that we encounter in OD practice arguably exist to support current mindsets and work routines, to reduce anxiety about what might happen next and maintain individual and group identities. If we accept this is the case, then such patterns may also be our patterns. Patterns which shape us and which we also contribute to shaping. While we aim to hold a stance of separateness from any organisation in order, for example to undertake OD diagnostics, can it be that even the sense and desire for separateness is an organisational pattern which ultimately is deceptive? Perhaps we cannot fully extract ourselves from patterns that have been a collective response to uncertainty. We are an integral part of the culture, whether we notice it or not.
It may even be that we miss organisational culture and tend to focus on the managerial culture of our peers, its language, and norms of behaviour. To an extent then, the organisation perhaps remains a mystery to us. The lens we use, a managerial worldview, can obstruct our vision of the whole.
As OD practitioners, we usually belong to the managerial community and culture, so the approaches chosen can, and often do, reflect the unacknowledged desire and imperative for stability within that sub-culture, and in its relationships with other sub-cultures in the organisation.
It is possible that we may also be creating and sustaining a distinct OD sub-culture in our organisations that contributes to the mix. If this is the case then the irony is that while OD promotes organisation development, the actual drive in any OD function, whether conscious or otherwise, may be to sustain the status quo; the very reverse of what it may be asking other groups to do.
If this is the case, then we need to take time to reflect on the patterns our OD practice may have adopted that mirror organisational patterns. This isn’t easy to do, and external facilitation and supervision could be helpful. Of course, it could be that any external enabler is also shaped in their thinking by a similar OD culture to our own.
- What is your reaction?
- Do you see points at which your practice is shaped by the organisational or sub-culture of which you are a participant?
- What are the implications?
- Does this resonate with you?
- If so, how do you personally handle the paradox of organisational culture change with the seemingly irresistible forces, sustaining old patterns of thinking and behaving?
- What can you do to surface the patterns that underpin your own assumptions about organisational culture in your own context?
- Do you have insight into why these might figure so prominently in your own understanding?
- How do your assumptions/beliefs shape your organisational culture practice?
- What resistance to change in your own practice do you notice? What sense do you make of it?
- introduce some different language and ideas about culture into a workshop you are facilitating? Notice the reactions and invite people to think/talk through their patterns of talking about culture
- review the language in some recent reports published by your organisation? What assumptions are leaders making about organisational culture?
- re-write some of your workshop materials to reflect a different way of thinking and talking about organisational culture? Reflect on how that makes you feel.
Provocation 3: What if organisational culture is made through relationships between people and the work they do?
Organisational cultures are being created and redesigned through relationships between people and the work they do. These relationships alter as people come and go and as the work they do changes.
While this dynamic process continues in both organisation-wide cultures and group or professional cultures, the nature of the work itself can be overlooked. How does the type of work and the meaning attributed to it affect how people relate to one another and thus co-create culture?
Exploring the work of Eric Trist, one of the founders of OD alongside colleagues at the Tavistock Institute, may offer some insight into this provocation. Based on his research in the 1950s he developed the idea of sociotechnical systems, which is defined by Ropohl (1999) 47 as:
‘The reciprocal interrelationship between humans and machines and to foster the program of shaping both the technical and the social conditions of work in such a way that efficiency and humanity would not contradict each other any longer.’ (p.186)
The theory behind this approach was based on the idea of joint optimisation of the technical aspects of work alongside the human contribution. There was a need to enable the social system to work in harmony with the technical system (broadly defined) for there to be both productivity and wellbeing.
The link is then made to organisational culture:
‘The pattern of work organisation - the way in which those who carried out the necessary tasks are related to each other - was analysed in terms of the quality of work roles, the kinds of task groups, the prevailing work culture, the nature of inter-group relations, and the character of the managing system.’ (Trist, Higgin, Murray, and Pollock, (1963) p.289) 48 .
Insights that flow from Trist’s work include:
- the interdependency of the social and technical
- social systems that are designed to be highly fragmented require a lot of external control
- change is best accomplished by involving those affected
- the design of work affects the level of stress
- managers tend to pay more attention to the technical rather than social innovation in spite of its importance
- organisations are poor at learning from experiments
- organisational culture affects the ease with which new ways of working can be introduced
- teams that lack social unity and technical ability will experience problems in self-regulation.
Perhaps this sounds familiar, and some have a definite OD ring about them. What is significant though is to note the emphasis on the design of the work itself. Is this any area of OD practice that is under-developed in modern organisations? Where does responsibility for the design of work rest and who is engaged with considering the social implications? In healthcare organisations, quality improvement, safety governance, workforce planning and each professional group has a role in designing the work, although perhaps they do not see that this is what they are doing. So, the question is: where is the influence of OD in this rich mix of work designers? Is it there at all and if so, what contribution is it making?
Relatively new players in the field are those who specialise in organisation design. Finding a clear definition of what this involves remains a challenge. The European Organisation Design Forum suggest that it is: ‘a systematic and holistic approach to aligning and fitting together all parts of an organisation to achieve its defined strategic intent.’
The CIPD 49 opens this definition further:
‘Organisation design is the review of what an organisation wants and needs, an analysis of the gap between its current state and where it wants to be in future, and the design of organisational practices that will bridge that gap. It’s a fundamental, wide-reaching, future-focused activity that often requires a review of the entire organisation and its context to decide what does and doesn’t work. It will therefore usually involve a holistic review of everything from systems, structures, people practices, rewards, performance measures, policies, processes, culture and the wider environment.’
They see organisation development following on from the design to ensure that the people dimension is fully attended to.
Where does organisation design sit in your context? What is its impact and how does it relate to the practice of organisation development? To add further complexity, the popularity of agile and lean concepts adds to the challenge the OD practitioner has in working with the interfaces between design and development.
What connection do you make in your OD practice between the characteristics of the work people are engaged with, the organisational culture and emerging integrated care system (ICS) cultures?
What does the language of the work and the organisational culture tell you about the cultural patterns and legacy being handed down to the next generation of the workforce?
What do you notice about your own language and the materials you create as an OD practitioner? How do these offer difference to prevailing cultures?
- talk to colleagues from different groups and professions about what is important to them about their work? Ask how the work affects how they relate to other groups of people in the organisation and the wider ICS
- talk to OD peers about how the work you do affects how you experience your organisation’s cultures and inter-personal dynamics?
- reflect on your insights? How is this shifting your understanding of the relationship between work and organisational culture?
Provocation 4: What if we practised as though culture is a living, constantly developing process?
If we accept that organisational culture is a dynamic, living process this opens new ways of thinking and intervening. It offers the possibility that we can continually co-design organisational culture. This practice of ‘culturing’ or ‘culture crafting’ highlights the idea of culture not as a noun, with fixed characteristics, but a verb with a sense of collectively and actively shaping and re-shaping relationships, symbols and behaviour patterns.
Culturing as a practice enables us to work with groups, organisations and systems in proactively shaping cultures. It has the potential to help us do the following:
- Enable inclusion
As we take on board that culture is constructed and reconstructed between and through our interactions, so we can actively decide together to include a wider range of voices and perspectives in co-designing than we might otherwise consider. The power dynamics that once seemed so fixed are weakened and changed as we talk about what has happened and explore what might happen. This radical inclusion opens new learning for us individually and collectively. Of course, we can find ourselves seeking safety in old patterns of behaving, but these become potentially less appealing as we acknowledge what is happening.
- Acknowledge needs
All of us do have needs for belonging and safety. Traditionally, much of organisational culture has focused on enabling this for the members, but what about those people who are outside? Arguably they too have needs that are as legitimate as anyone else’s. Culturing invites us to surface the needs we feel we have and bring them explicitly into the co-design process. This requires a collaborative, trusting environment. Such an environment supports great conversations where relationships begin to flourish. This forms the foundation for trust.
- Discuss assumptions and beliefs
When we give space and time to considering the ‘artefacts,’ or outward expressions of culture, the visible and felt evidence of what goes on from day to day, we also could look carefully at the assumptions and beliefs that underpin our ways of working. People do things for good reason, but usually we do not give ourselves permission to consider together why we might adopt certain practices or behaviours. They just become the way things are done.
By opening conversations about the practices there is an opportunity to discuss the underlying beliefs. This needs not to be rushed, but once the discussion starts it can lead us to considering new ways of doing things. In this way, the culture starts to shift for us. At the beginning of a co-design process we can make early choices, not just about the ways of working, but also agreeing that talking about these things is fundamental to the ongoing design process. Co-designing is, in part, about culture creating and re-creating.
- Choose language that enables co-designing
In complex systems, like ICSs, people bring their own languages. By this we mean not just the words and the many acronyms that they have developed over many years in their organisation, but also the specific and nuanced meanings they attach to the words. Culturing invites us to explore language explicitly and the contribution it makes to how we work. Language is both an artefact and an expression of core beliefs. Making explicit choices about language enables us to shape our lived experiences.
- Recognise and work with difference
By becoming more culturally aware it becomes much more likely that we will be able to recognise both the artefacts and develop some skill in listening for the assumptions to which they give expression. Given that in system work we will always be encountering many cultures, it is helpful if we can notice difference and feel confident in engaging with it. Such confidence then enables us to act particularly, regarding what we might consider to be the external environment that ultimately shapes the culture for work. We also develop a sense of what can be left alone and what aspects of culture are important to surface.
- Become culturally proactive
Arguably, one of the principal reasons why culture is considered stable and difficult to change is because theorists and practitioners have treated it as such. The idea that we might co-design cultures in the way described in this chapter is new to many. It does though challenge us to become, through practice, proactive in working with culture and move away from what can be a very pessimistic sense of helplessness. That sense of helplessness is itself an artefact of culture and worth exploring if you feel it. Ultimately, culturing is about acting to intentionally make and remake the cultural context in which work happens.
- Develop a spirit of inquiry and learning
There is much to be uncovered in the practice of culturing. It calls us to inquire into the whys of organising. We may not always be comfortable with what we uncover, but nonetheless such inquiry opens the possibility for new insights and deep learning. Because culture can be perceived to be quite intangible, such inquiry is often best undertaken within a group context. This gives opportunity to test out perceptions, share new learning, and grow together in confidence.
- Help shape system leadership
One manifestation of culture is the manifest behaviour of those in leadership roles across the system. Culturing gives permission to engage in conversations about the impacts of behaviour on how the system works. Leadership here includes those who have any role in how services are experienced. This means those traditionally perceived as clients or customers. The conversation encouraged by culturing opens up the possibility of entirely new thinking about what the system is intended to accomplish and how the different roles support or detract from success, however that is defined.
Behind the practices rest several assumptions about the mindset we adopt:
- Those involved in the work are people of goodwill. They are not involved to deliberately frustrate the process. They bring, as we all do, a set of biases and intentions that may make culturing a challenging journey, but they are still people who have in common a shared humanity.
- Proactive culturing will see changes in mindsets and final outcomes. This implies holding a future orientation. Culturing does not encourage retrospection on past successes but, in its language and focus, invites all involved to look at what the future may bring as new approaches to relating and working begin to emerge.
- Encouraging honest and open communication will bear fruit, particularly in the potential to continually explore the nature of cultures as they develop between us. This will at times call for courage to speak about things that often go unspoken. We might feel the risk of rejection and alienation, but without facing, and voicing, these fears, a potentially unhelpful cultural pattern grows.
- Culturing and learning go together. As we work together in creating new cultures, we are learning about how to develop new organisations and systems.
- The external environment is amenable to change through the actions of culturing in one part of the system. Sometimes we can hold a view that while we might change cultures in our group, this effort will be futile because the rest of the system remains unchanged and just forces us back into our old ways of behaving.
Holding these beliefs is not always easy. Our feelings and thoughts change. Working with people with whom you can share your concerns, doubts, thinking, and learning as you engage in culturing is a very helpful practice 53 .
The following five practices could be a good starting point to explore to culture craft:
When forming and re-forming groups, find ways of making membership and participation as inclusive as possible.
The framing of interesting questions about culture and patterns of behaviour can support people to learn for themselves about what is helping or hindering them with collectively developing new ways of working.
Taking time to explore how people are using words and acronyms will highlight how they use language to create their shared social reality.
Inviting people to walk around the physical spaces that form the system. Discuss what the different spaces, signposts, pictures and design features communicate about the existing culture. What could be changed and what might that communicate?
- review your work plans for the next couple of months and identify which activities could potentially directly contribute to culture-crafting, both in your organisation and the ICS?
- set out some intentions and practical steps that you can take to culture-craft?
- work with an interested team in the organisation to explore how they might act to culture-craft? Support them to implement an action plan and then gather to reflect on the impact and learning about a month later
- try the process with your own team?
- try the process with a group drawn from across the ICS.
Provocation 5: What if the NHS People Plan 2020/21 and the Our People Promise are, in totality, an organisational culture agenda?
A recent trend in NHS organisations is to categorise culture and culture change or transformation as one strand of a development agenda. This might formally be located within HR, the people function or an OD directorate. In doing so it comes with its own plans, action lists and KPIs. In a hierarchical bureaucracy, where policies and procedures dominate alongside authority, accountability and chains of command, then this is understandable.
What if this transactional understanding of organisational culture is no longer helpful nor effective? If the NHS People Plan and the Our People Promise in their totality are about developing both organisational and system culture, how will OD practitioners respond and act? Rather than viewing culture as part of the organisation, what if culture is the organisation system? How then is the culture-crafting process undertaken?
Organisational culture themes are evident throughout the NHS People Plan 2020/21 and Our People Promise. The documents incorporate ideas around compassion, inclusivity, psychological safety, belonging, working differently, autonomy, equality, digital transformation, voice, learning and teamwork. The list could on. Taken together it is reasonable to conclude that separating out culture from the lived experience of working in the NHS, according to the authors of the plan, is likely to be frustrating. In other words, organisational culture is the organisation and not simply one aspect of it.
Putting the effort and time into exploring ideas around organisational culture can deepen our own insights and practices.
McCalman and Potter (2015) 55 put forward their own reasons why it is worth doing this:
- Culture constitutes society. To understand a culture, or at least to seek to do so is to be able to better understand its inhabitants.
- Culture is the organisation (as opposed to being one aspect of an organisation).
- People are expressive beings and culture represents both the process of human expression and the outcomes.
- Similarly, on a smaller scale, organisations are organising processes with outcomes that represent something of what their leadership considers to be of value both to themselves and their context.
They go on to argue:
- If we truly wish to understand the people in organisations, we can best do so by engaging with the culture.
- If we wish to facilitate change in organisations profoundly then we need to also engage with supporting the change of culture.
- We need to increase our appreciation of the value of organising effort and cultural environmental fit of a culture (put more simply enhance our perceptions/reality of an organisations commercial and/or social success and value…. or otherwise). This point links with the idea that organisational cultures contribute to the broader culture of society and function within it.
Different perspectives on organisational culture can spark in us fresh thoughts. Try reflecting on the following three perspectives and ask how they match or differ from how you see culture:
- Three-dimensional view.
- Culture as an integrated and clear meaning system within an organisation.
- Culture as distinct set of sub-cultures linked by common themes.
- Culture as fragmented with an agreement to agree on a particular view of reality to enable a working consensus (this can appear like integration when it is not).
(Meyerson and Martin, 1987) 56
2. A web (multi-perspectives)
The web entraps us in a sense of having significance from which we cannot escape. It does this by:
- sustaining a central organisational paradigm that acts as a centrifugal force that weaves themes together as interconnected strands of control
- maintaining performative elements to sustain the ‘threads’ of the web including stories, symbols, power structures, organisational structures, rituals and routines and control systems
This frame offers a way of seeing organisational culture from a range of perspectives. (Geertz,1973) 57 .
3. Culture as a sense-making device
Sense-making happens as we construct reality through the attribution of meaning to symbols.
These symbols can be:
- anything made by us
- ideas and philosophies.
Sense-making can be considered a ‘conversational and narrative process through which people create and maintain an inter-subjective world.’ (Balogun and Johnson 2004:524) 58 .
‘Shared means, shared understandings and shared sense-making are all different ways of describing culture. In talking about culture, we are really talking about a process of reality construction that allows people to see and understand particular events, actions, objects, utterances or situations in distinctive ways.’ (Morgan, 1997:138) 59
‘Constructed reality means the world we know and understand is our invention.’ (Ford, 1999: 481).
Now spend time re-reading the NHS People Plan 2020/21 and Our People Promise. What are you seeing now that you did not notice before? What culture is being crafted through the themes, language and narratives? How do you feel called to respond in your practice?
By giving space for inquiry and learning together it becomes possible to start seeing the complexities and dynamics of organisational culture through a new set of lenses. Organisational structures tend to divide domains functionally into finance, operations, quality, planning and HR/people and so on. Culture often finds itself located in the people box. For a systemic approach to culture to take root, all the individual functions will need to incorporate an awareness of how they shape culture and contribute to the whole experience of an organisational culture. Once aware choices become possible around intentional culture-crafting for leaders, actions can follow with support and feedback.
- Arrange to meet with as many heads of organisational functions as you can?
- Ask them for their views on organisational culture. What contribution do they think their role and function can make to culture-crafting?
- Find out from them what learning and development support will help them contribute to culture change?
- Discover how culture-crafting actions can be routinely incorporated into annual operational plans?
Provocation 6: What if the global pandemic is a systemic culture change process?
OD is classically defined as:
‘.…a system-wide application and transfer of behavioural science knowledge to the planned development and reinforcement of the strategies, structures and processes that lead to organisation effectiveness.’ (Cummings and Worley, 2009 p2).
While there is much that can, and should, be critiqued about this definition and others like it, it needs to be noted that the primary organising unit is the organisation (called ‘the system’ in this definition). However, it is helpful not to lose sight of the reference to systems in the definition. The authors make no attempt to define what they view as the system and its boundaries although they seem to be assuming the organisation is a closed system which everyone can see, understand and to a great extent control. But what if the organisation is more of an open system with a wide range of interdependencies that connect it with the wider world in which it operates?
This is also reflected in the Do OD definition of organisation development:
‘OD enables people to transform systems. It is the application of behavioural science to organisational and system issues to align strategy and capability. It enhances the effectiveness of systems through interventions that enhance people’s collective capability to achieve shared goals.’
The belief in the organisation as having a firm boundary, and particularly that it has one unified and manageable culture, permeates much of the academic and practitioner literature in this and the last century. But is it sufficient? What if one among many lessons being learned through human responses to the pandemic is that unless we consider our interdependencies at a local and a global level, humankind is unlikely to survive long? This means that systemic patterns of behaving really do matter and are shaping organisational cultures in ways that we are only just beginning to grasp. So, what if organisational culture is not the lens to look through to understand how people behave? What if we were to explore the dynamics between people and processes (whether technical or relational) and consider the complexity and multiplicity of influences outside of the definitions of organisation we currently work with?
If the way organisations interact in systems changes behaviours and cultures, then it is worth giving some attention to the nature of systems. For the OD practitioner in a very interconnected world, it is important to understand these dynamics and the way in which systems themselves may be amenable to being co-designed by participants.
Many are familiar with the saying: ‘Every system is perfectly designed to get the results it gets.’ It suggests a starting assumption that, regardless of how complicated or seemingly random behaviour may appear in a system, there is at the heart a purpose or, more accurately, purposes, that shape the way it works. This offers OD practitioners a lens through which to see a system of purpose. Using the word purpose suggests a fixed statement, so it may be more helpful to understand systems as continually exploring purpose or ‘purposing.’ It is a clumsy word but nonetheless gives a good sense of a dynamic practice at play within systems.
The practice of purposing is the intentional asking of questions that help exposed people in systems to shared inquiry. It does this by first encouraging active reflection on why systems have formed themselves to be systems and, second, to help people in those systems continuously redefine the purposes that they believe they are called to enact.
- the personal sense of meaning they ascribe to work and collaboration in the context in which they exist day by day
- differing perspectives and meaning ascribed to working by colleagues with who they have interaction (such as team members)
- disconnected approaches that often manifest themselves between stated purposes and enacted purposes
- mindsets around purpose that have become routinised.
- conversations about what purposes may be emerging through the experience of living and working in the system
- potential shifts in acting that help with aligning expressed or desired purposes with attitudes and behaviours
- grounded and critical reflecting on what is happening between different elements in the system.
Purposing enables systems to begin to move away from relatively fixed narratives that are often just an amalgam of organisational mission statements. Very rarely is space given in conversation to exploring the purpose of a system. The narrative always moves swiftly toward fixing system ‘problems’ and perceived challenges. The dominant political voices move to place their own perspective and agenda to the forefront, while other less prominent voices are ignored. Often such lesser voices are those who rely heavily on the system, like patients or customers.
Purposing is therefore part of the development process for a system. It has an immediacy that enables, through inquiry and conversation, the opening of new purposes and questions. Building capacity for purposing therefore needs to figure as a shared process across the system.
In doing this, purposing opens potentially difficult issues and tensions. For the health of the system these are to be welcomed. Without such issues having space to breathe, what will happen is a continuation of past habits of relating and performing. Purposing enables people to look at the reality of lived experience together and the culture they are co-creating.
Just as the pandemic may be prompting some thoughts in us about our individual purpose going forward, it encourages whole systems to practise purposing around the way each element relates and the necessary outcomes. This can perhaps be most vividly seen in health systems around the globe that have had to shift culturally to enact a new set of purposes for the time of crisis. OD practitioners now have some opportunities to support ongoing purposing in local systems that will together help shape the whole culture of healthcare into the future 65 .
Take time to reflect on what you have observed recently regarding new patterns of behaving. Perhaps these include examples of less formal control of teams; more collaborative working across ICSs; rapid decision-making; leaders taking greater initiative and ownership for actions; greater recognition of the interconnections between public health behavioural initiatives and demand/pressure on health services. Perhaps rapid vaccine development along with regulatory approval is also an example of shifts in attitudes and behaviours across many boundaries?
It could be too early to draw conclusions, but it is worth thinking through from an OD practice perspective how sense–making and culture-crafting can be enabled across complex systems like an ICS.
- Meet with your peers in neighbouring organisations to learn about their own understanding of organisational culture and how they enable change?
- Explore areas of shared concern across the ICS and consider what actions you can take in your own organisations to grow a system culture?
- Take some actions and review impact together?
Provocation 7: What if organisational culture is all about control?
Arguably, the role of organisation is to control. To control strategy and finances and ultimately to ensure that all processes are controlled in accordance with the wishes of the owners/shareholders. Is control of this type still feasible or is control illusionary in complex systems? Do all the KPIs presented in board reports reflect the reality of organisational culture, or are they constructed in a way to satisfy the hope of the owners (or political representatives) that everything is under control?
What part does control play in your organisation’s culture?
Do you agree or disagree? Why?
If we think organisational culture is all about control, then we need to ask ourselves some fundamental questions. The first is how do we make and perform cultures, including how is control performed?
Schein (2004), suggests that we make and re-make culture through three elements:
These are the expressive consequences of actions ground in values and assumptions. It can be material like a building, conceptual like capitalism, process like organisational procedures, and rituals like award ceremonies.
Social principles and standards collectively considered to have worth. These are expressions of assumptions and underlying theories in use. Choices are available to leaders about which values framework they wish to promote. People can participate in supporting these values even if they do not match entirely their own framework. Values can guide operating cultures and behavioural norms.
Taken-for-granted beliefs about reality or human nature.
We then need to think through how these elements mix to form cultures. One option is to consider the idea of cultural themes; a construct usually found in anthropological literature. These themes are either firm rules or soft guidelines (patterns and habits of behaving and speaking) that set out what is an appropriate way to think, talk, communicate, behave and demonstrate knowledge or identity in the multiple spaces that make up an organisational culture. So how might we recognise a cultural theme?
- Several assumptions and values that are pre-existing before the theme is identified.
- Enough people share one or more assumptions.
- They are pervasive across sub-cultures.
- They are so pervasive they are usually difficult to identify.
- They are deeply embedded in power and political relations.
An example of a cultural theme could be that management development is a waste of time with no real benefit.
So how do cultural themes act as a means of control?
McCalman and Potter 67 suggest the answer is a construct they describe as cultural hegemony: ‘…a system of cultural themes that have no counterweight and thus morph into what is effectively a system of themes that stand over and suffocate any new form of cultural expression.’ (2015: 74) Introducing a new or counterweight theme in an organisation may stimulate defensive reactions and even aggressive outbursts against the proposers. Cultural hegemony is the process where those with power in organisations (usually a very small minority) act to maintain their own interests over the weaker majority.
OD practitioners will most likely encounter cultural control mechanisms as soon as they attempt to offer an alternative cultural theme or highlight the existing themes.
What part does the desire to control play in your OD practice?
This question recognises the inherent tensions and paradoxes in organisational culture around power and control. For example, we speak of empowerment but only want people to operate in the empowering limits that we define. What type of empowerment is that in reality?
Organisations talk of trusting their staff but then put in place monitoring mechanisms that demonstrate a lack of confidence, or trust.
Is it uncomfortable or disturbing to consider these paradoxes? How might colleagues in your team or organisations feel about discussing them?
If organisational cultures are ultimately about finding ways to control the behaviours of people, then what is the role of OD?
- Spend time with colleagues discussing how control impacts on your individual and collective working lives?
- Work with OD peers to explore the paradox of a culture of empowerment and control?
- Find a team of people who are interested in working through the practical implications of working with such a paradox?
- Reflect on your conversations and see if there are any other cultural paradoxes that you notice? What is the impact of these on how you and others behave?
Provocation 8: What if no organisational culture interventions ever work (at least not in the way we thought they might)?
Given the perspective on culture we have adopted, fully evaluating organisational culture change/development work is probably close to impossible. We can try and take a scientific approach by collecting numerical data (which is always a proxy for something that can’t be measured by numbers) and attempt to maintain an objective perspective. We are invariably left unsatisfied at the result. If we get close to the process of evaluation, then further frustration results because we know that the act of measuring itself is a culture change intervention. In any case, outside influences in the wider system usually have an unmeasurable impact on the change process.
When this is combined with the range of power interests vested in ensuring either a successful or unsuccessful intervention (at least regarding how it is described in the public arena) it is quite easy to see that determining what works or otherwise is very difficult indeed.
Just because evaluating culture change may be difficult it does not mean it is not worth attempting. The process of evaluation will itself impact on the culture change. It is not a neutral activity but one that shapes the language and mindsets around culture in the organisation. Therefore, it seems wise to consider the process as ongoing and contributing to the development of new ways of acting and thinking. If we do so, then the focus shifts towards learning from what is happening rather than expecting some form of definite conclusion at a pre-determined point in time. So, what steps might help in giving a learning focus?:
- Clarify the intended culture change as much as you are able through developing a shared frame of reference. Use open questions to allow wider engagement in the process and encourages fresh perspectives:
- Why do we need culture change?
- What would success look like?
- How will we know if we are moving toward the required culture?
- Are key stakeholders aligned about the need for change?
- What beliefs exist about how to achieve the desired culture?
- It is worth recognising the ambiguity and challenge of the process that will call for a change in mindset when contrasted with other evaluations?:
- Allow the process to be adaptive and emergent.
- Use any data collected in real time to support learning in the moment.
- Co-design ways of engaging with as many people as possible in the learning rather than confining conversations about data to a small group of people.
- Identify as many different methods as possible for collecting views and stories that illustrate experiences.
- Take opportunities for learning pauses to step back from what you have immersed yourself in. Sense-make with others.
- Work collaboratively around what it is that you wish to measure and how you plan to do this:
- Appreciate that measures shift attention and in doing so will also affect some sort of change in the culture. People can also respond to measures by gaming them and creating a range of dynamics that will similarly affect culture in some way.
- Co-design a mix of methods that will offer a range of perspectives. Some you will wish to use frequently, like mini surveys, others, like group conversations, may be less frequent but are nonetheless valuable.
- Develop a plan for how you will use collected material and inquiry processes to shape the ongoing development of the culture.
Adapted from Stawiski, S. (2018) How to know if your culture change strategy is working. White paper: centre for creative leadership. 69
One option open to the OD practitioner is to use appreciative inquiry (AI) as an evaluation process. It has the advantages of collecting rich stories of culture and culture change alongside a future orientation. Finding ways to inquire about culture change in complex systems offers plenty of opportunities to be creative. AI encourages collaborative inquiry focused on what works in any system. The intention is to discover what is excellent and life-sustaining and then agree together how these attributes can be amplified. The system is therefore encouraged to grow in the direction of its strengths. The process is underpinned by a philosophical stance that proposes the following:
- Reality in a social system is subjective.
- The moment we begin an inquiry or even ask a question we initiate change and movement.
- In choosing our questions for inquiry we already change our systems.
- Human systems move in the direction of their images of the future.
- Momentum for change develops through social bonding.
AI processes typically follow five sequential stages:
- Working with people from across the system to explore the theme for an inquiry. This broad topic then acts as the guide to developing questions and processes. For example, life-enhancing organisational culture might be the choice where cultural development is a priority.
- The discover stage enables people to tell their stories of when the system worked at its best in the past. This surfaces information about what makes the system work well and builds social bonds.
- The dream stage invites small groups to co-create their collective image of the future if the best of their past experiences happened all the time. This generative image opens possibilities for a better future.
- The design stage enables group conversations around how best to make the generative image become a reality. It is more like a conventional change process.
- The final destiny stage explores with individuals how they are going to take the next steps to their desired future
(Adapted from Lewis, Passmore, and Cantore, 2016) 70
The stages can be covered in a day or over six months, and the number of people involved can be flexed to meet different circumstances. The process offers opportunities to co-design specific evaluatory/change processes. The choices are for people in the system to make. In this way, it can become a highly collaborative process with the benefits seen immediately through the social bonding and sharing of narratives from the start. Of course, like any inquiry process it is not possible to define the endpoint. AI is not a controllable managerial process, but rather one that invites people to shape their own collective futures based on active evaluation of previous experiences.
If you accept this ‘what if,’ then how will this impact on your planning of organisational culture interventions? How will it shape your implementation and ongoing evaluation? How comfortable are you with the range of perceptions and judgements this type of work can evoke in people?
- Have some conversations with leaders of your organisation about how they evaluate the success or failure of your work?
- Find ways of encouraging a spirit of learning to support engagement with culture change processes when things don’t go to plan?
- Research the idea of action research, which brings action and reflection on impact together, and consider how you could adopt the approach in your work?
Provocation 9: What if all OD interventions influence culture?
Our way of thinking and the language we use are closely connected. Each shapes the other. One pattern of thinking and speaking we have been accustomed to is the separation of OD interventions into categories: leadership development, coaching, team development, and organisational culture change. This categorisation offers us a shorthand way of describing the type of work that OD practitioners typically get involved in. What if this way of thinking about OD work misses the interconnections between the different types of intervention? What if they all form part of the process of re-shaping and re-designing relational work patterns and power? What if each type of activity intentionally, or unintentionally, prompts cultural shifts?
This is a difficult question to explore and quite possibly there is no correct answer. All OD interventions are in a specific place and time. Given that they focus on development of people and systems any interaction in such a complex context is likely to prompt a shift, albeit slight at times, in cultural dynamics and consequently people’s experience. How are we ever to know which action has which impact? One route is to prioritise learning within OD practice. In doing so we open ourselves up to considering questions like this one, both as individuals and collectively.
What can you do to strengthen your learning as a practitioner?
Developing a spirit of inquiry
Getting into the habit of framing questions about your practice and the contexts within which you work and live is a helpful way of initiating opportunities to learn. Questions that interest us stimulate energy to explore and investigate. Allow the energy to help you read, visit places, engage in conversations, watch films, and listen to podcasts. As you inquire, allow new questions to emerge. In this way, the process of learning continues to develop and strengthen.
Time spent reflecting on your experiences of leading for learning is never wasted time. It can help to have a framework to work through, so perhaps begin by identifying an experience where you felt you initiated some learning. Write down the details of what happened. Then ask yourself the following questions:
- What was the context?
- Who else was involved, if anyone?
- What happened?
- What were the outcomes?
- What have you learned through the event?
Questions like these enable you to mine for the richness of the learning. Gillie Bolton (2018) 73 has written a very helpful book on how to use writing to support professional development. See the end of the chapter for details.
Definitions of coaching are varied but, in the context of this discussion, coaching can be considered a conversational process to intentionally support learning. Work with a coach happens on a one-on-one basis, with the coach asking questions that help the individual make sense of experiences and deepen their reflections on practice. Barry Oshry (2007) 74 has developed a model of coaching that focuses on helping individuals see the role they and others play in complex systems.
Listening out for learning stories
Working in a complex system means that there are plenty of diverse perspectives on learning among the people involved. It is worth giving time to hear what people are saying about the journeys they have made. These provide insights into both the experience of people and the language and metaphors used by people in relation to learn.
Finding other people who have made a similar journey to your own can be very helpful in sustaining your learning over time. Hearing their stories of the ups and downs of working in complex systems can open new avenues for inquiry, as well as practical support and encouragement to continue the journey. Becoming a mentor to others can also stimulate personal learning, as you find yourself needing to reflect on what you have discovered when you seek to communicate it to another person.
Of course, learning as an individual is just one strand, the other is to support collective learning processes. The selection of which processes to adopt depends on context and preference. Options include:
This is a facilitated small-group process originally developed for managers by Reg Revans (1982) 75 . It works just as well with people who have roles in different parts of a complex system. The idea is that members of the group meet every two or three months to present practical issues they face in their work. Through a process of questioning by group members, individuals gain insight into actions they can take to make progress. Back at work, individuals act and then report back to the group what happened and what they learned from acting and the process itself. This cycle of action and reflection underpins the learning work of the group. This rich mix of activities encourages high levels of engagement in learning as people actively support one another.
Participatory action research
Participatory action research (PAR) is not a defined methodology but a set of approaches to inquiry that are based on some explicit social values, including the need to:
- enable the participation of all people
- acknowledge the equality of all people’s worth
- actively seek the wider good of society
- encourage the expression of people’s full potential.
Consequently, it assumes that:
- Those affected by the problem under investigation should be involved in the process of inquiry.
- Participants involved in the inquiry engage in collecting data and reflect on the information to transform their understanding of the nature of the issue under investigation.
- The new set of understandings are then used to inform and implement action plans that are then collectively evaluated.
The aim is to support people to learn about their world, to make sense of their lives and develop new and creative ways of looking at things (Heron & Reason,2006) 76 . Through meeting together to agree upon inquiry questions and actions, people, after taking action, can reflect on their experience. Through this cycle of inquiry and action, people learn how to act to change the systems in which they work.
How does holistic OD practice look for you in your context? What are the encouragements and what are the hindrances in taking this approach?
Key to OD practice is the use of self. Do you understand yourself to be an OD intervention? Your presence, showing up in all contexts, modelling values and behaviours that others catch from you, all of these offer cultural interventions. What will help you sustain this approach in your context?
- Take time with your team to map the interconnections between all your work streams?
- Identify culturally related themes and explore their implications for the work you do collectively? Are there any you would wish to change and develop?
- Gather some feedback from colleagues around how your presence, language and action contributes to organisational culture?
Provocation 10: What if organisational culture is best discovered on the boundaries?
The idea here is that organisational cultures are not a unified whole, but rather composed of a set of micro-cultures each overlain and continuously interacting at boundaries. Can OD practitioners, by exploring and working at these boundaries, discover more about the nature of the patterns of relating between micro-cultures and their impact on the whole organisational context?
This idea also asks us to consider the nature of the boundaries. Are they perceived as very fixed, with people talking about ‘silos,’ or do they have a degree of fluidity? Do the boundaries extend outside of organisational boundaries and, if they do, what does this mean for understanding how organisational cultures are shaped by external patterns of relating?
In work we are familiar with boundary distinctions as part of formal organisation. Jobs are often defined by their role description. This entails a set of points about the responsibilities and duties of a role within a specific organisational context, and a wider industry or system environment.
What is the relationship between a role and boundaries? Often a role will be designed and structured in a functional correspondence to tasks and activities. These tasks may be defined by their skill level and level of expertise. This kind of identification is similar to the nucleus of a cell, it encodes what it performs. The longer we stay within a boundary as a practitioner, the more likely we are to become habituated into a specific set of routines and behaviours: what is often called competence. We can understand the functioning of a role along different dimensions. Often, efficiency and productivity are standard concepts, but there are many others. The longer someone practices a specific task, the better they will get, according to the 10,000-hours rule of expertise (Hambrick et al. 2014) 81 . Practising builds experience, knowledge, memory, decision heuristics, and muscle memory. This is the benefit of boundaries; they lead to refinement.
The downsides of fixed boundaries are familiar to us in organisational life. There is the well-known silo effect (Tett, 2015) 82 . The dysfunctions of bureaucracy and formal departmental boundaries lead to a long list of dysfunctions of a mechanical organisation: lack of integration; dehumanising work environment; operating procedures crowding out exploration and adaptation; efficiency preferred over effectiveness; and competition between individuals, teams, and departments within the same organisation. When there is a sense of a holistic boundary at one level, says the organisation, the boundaries at layers beneath this, the individual, team, and project, are seen to be in service to the high level. This is the basic idea of hierarchy of functions and identity. The argument against relying on silos is one of alternatives and possibilities and the psychosocial experience of being imprisoned. The fixed boundary leads to exploitation of resources, not exploration of possible uses of resources.
Boundaries can then lead to practices and behaviours that are out of shape, old, disused, and decaying. Without new growth and new inputs of energy and resources, living things gradually die. This is the kind of boundary that OD practitioners often encounter and struggle with. We therefore come to the tension within human organisations between fixed boundaries and flexible boundaries. Clearly, some boundaries are more fixed than others. It is conversations between those on either side of the boundary that lead to more fluidity. How do you identify fixed boundaries at work and how can you help make them more fluid?
One potential answer to this question is to test out what might happen if we design roles to be fluid rather than fixed? To do this, a discussion of roles needs to get beyond individual tasks and responsibilities to consider roles as relationships. Roles do not only define what the role incumbent does, but also what others they interact with should also do. This is a theatre analogy of organisations: everyone plays their part on the stage. The duties of work roles within service settings often involve doing things to, or with, service users. For example, this might be to ensure patient safety or enhance student experience. This has implications for the role of those other actors. In role theory, the idea of the role set is a powerful idea because it places any individual role into a web of relationships. Each role defines and shapes other roles with which it comes into contact. Roles are effectively mutually constitutive: there can be no ‘teacher’ without a ‘student,’ no ‘doctor’ without a ‘patient,’ and no ‘leader’ without a ‘follower.’
This process of defining mutual service positions through a service encounter naturally creates a service boundary. At each boundary there is a potential for it to be ‘hard’ with one person or group defining boundaries, or more fluid where there is a shared understanding of the roles each party plays. Just as this happens in a micro sense in each service encounter, so it happens at an organisational and system level. OD practitioners can offer expertise in helping people see the boundaries, explore, and learn from them. 83
Beverly and Etienne Wenger-Trayner (2015) 84 suggest OD practitioners must consider boundaries as learning assets rather than as obstacles or things we need to somehow remove. By seeing boundaries as assets, we recognise the challenge of crossing boundaries of all kinds, especially given the tensions or contradictions between different practices as sources of accountability. The same authors offer the following helpful set of questions when thinking of boundaries as assets:
- What kinds of boundary activity, joint project, visit, mutual storytelling, or learning partnership can serve as a productive encounter for negotiating and exploring a boundary?
- How can boundaries be used to trigger a reflection process about the projects on either side?
- What kind of boundary objects (documents, templates, materials) and activities can support this boundary-oriented learning approach and create points of focus for engaging multiple perspective?
- Who can act as brokers to articulate regimes of competence across boundaries?
Standing on a boundary and looking across in different directions is a way to understand competing learning perspectives. It also offers OD practitioners clues and insights into the dynamics of organisational culture that otherwise might be missed when the perspective often taken is a top down one from the board.
- collectively map with colleagues the boundaries that impact on your team?
- identify how you might work with the boundaries that you perceive exist?
- find a multi-professional team with whom you can discuss the boundaries they perceive to exist and how it impacts on them?
discuss with OD colleagues what might happen if OD practitioners intentionally focused on enabling learning at the boundaries as integral to both organisational and ICS culture development?
Stefan’s work prompted us to think about the following ten questions for you to consider as you plan the next steps of your culture change journey:
- What are your own clear beliefs about culture change and how has this changed?
- What are the contextual conditions shaping your organisation / system right now?
- What assumptions do you make about change in your organisation and how do you know?
- What are the stories about culture change told in your organisation that could be re-framed into a new narrative?
- What is the immediate trigger for culture change?
- What does organisation development look and feel like in your organisation now?
- What OD theories and models have shaped your past culture change efforts and are they appropriate for the future?
- What practical tools and people resources do you have to support you in this work?
- What is the story about culture change that needs to be disrupted?
- What is the next most important conversation you need to have?
(Adapted from Angus, Dumain and Taylor-Pitt, 2017)
Further reading on culture change
- Inclusive culture: North East London NHS Foundation Trust
Find out how one NHS trust improved its culture by putting people first, engaging with staff and ensuring its recruitment process was inclusive.
- Implementing a just and learning culture
Read how Mersey Care NHS Foundation Trust implemented a just and learning culture and the impact it has had on its workforce.
- Improving staff engagement, the Chesterfield way
Explore how Chesterfield Royal Hospital NHS Foundation Trust improved its NHS Staff Survey results through a programme of staff engagement using Listening into action.
Culture tools and approaches
- NHS England’s Culture and leadership programme provides a practical, evidence-based approach to help you understand how colleagues working within your organisation or system perceive the current culture, and guides you to create and implement a collective leadership strategy.
- The King’s Fund have a tool to help organisations assess their culture, identifying the ways in which it is working well, as well as the areas that need to change.
- Members of our NHS Do OD community have recommended Affina OD and People Centred Insights for assessing organisational culture.
Interesting reads, video and online resources
- The book Organizational change explained features a chapter by Do OD’s Paul Taylor-Pitt and Karen Dumain with Kelly Angus on changing culture in the NHS (you can read the chapter for free as part of the Google Books preview).
- Working on organisational culture in COVID-19- a blog post by Tom Kenward on using the NHS England and Improvement’s culture and leadership toolkit.
- Mee Yan Cheung Judge’s Just in case podcast series features conversations with leading OD thinkers. Bob Marshak has recorded one on the Hidden dynamics of organisational change.
- This presentation on the challenge of culture change in the NHS from the Health Services Research UK 2020 conference explores, through three linked presentations, the problems and opportunities associated with changing healthcare organisation cultures.
- The HSJ published an article on managing cultural change in a crisis.
- This article from the BMJ looks at how notions of culture relate to service performance, quality, safety, and improvement.
- Access Hofstedes model of organisation culture.
We are keen to hear from you
Share your good practice examples of changing culture or let us know how you’ve used the provocations in your own culture work by getting in touch with us at firstname.lastname@example.org.