Changing culture through conversation - OD in the NHS

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Paul and Karen at system thinking event

Karen Dumain, national organisational development (OD) programme lead at the NHS Leadership Academy and Paul Taylor, OD lead at NHS Employers share their thoughts on being asked to write a chapter for a new international book.

Our NHS OD community has done fantastic work in the arena of culture change and over the last four years it has been top of our agenda. We were therefore delighted to be asked to contribute a chapter to a book called Organizational change explained by Sarah Coleman and Bob Thomas.  The book looks at delivering sustainable change in organisations regardless of company size or industry sector.  Our brief was to address the questions: Where do we start? How does the NHS change its culture?

In our chapter titled changing culture through conversation, we outlined the questions that led to the development of our digital tools, resources and guidance. These products enabled us to have conversations that made a difference and resulted in practitioners from across the NHS coming together to tackle the challenge in collaboration. 

With 1.3 million staff delivering care to 1 million people every 36 hours, the NHS is one of the largest organisations in the world.  At a time of significant change and financial challenge, the focus on ensuring compassionate cultures to deliver high quality patient care becomes ever more important.  The culture of an organisation or a system shapes the behaviour of everyone in it, the quality of care it provides and its overall performance. As the NHS reorganises itself to meet the challenges it faces both now and in the future, focusing on culture is vital.
In our chapter, colleagues from Northumbria Healthcare Foundation Trust provide an excellent case study, weaving together theory and practice on developing high performing cultures and how they successfully navigated culture change across their organisation. 

We offer reflections on culture change and our learning along the way including three principles used to underpin our approach:

  • Change happens through action.
  • Conversations spark action.
  • Good questions start great conversations.
We identified tips from the experience of those leading culture change and offer a set of questions to prompt thinking and action, including:

  • What are the triggers for culture change? 
  • What are your own beliefs about culture change? 
  • What is your organisational culture change story? 
  • What is the conversation you need to have? 
Read the whole chapter and download the full list of questions. We’d love to know what you think.

Impactful organisation development is dependent on effective leadership and action. Leadership, and in particular collective leadership, is the key to enabling cultural change that allows NHS organisations to deliver high quality care and get value for money. It ensures staff are able to provide compassionate care in a learning environment free from bullying and help boards ensure their governance on the culture and capability domain of the well lead framework. 

Our colleagues at NHS Improvement along with the Kings Fund and the Centre for Creative leadership, are working with three pilot trusts to develop a practical three phase culture and leadership programme. We’re delighted to have been part of this work so far and look forward to the next steps. 

Thank you to our amazing NHS OD community for continually contributing your wisdom and energy to the challenge of changing cultures for the better. We are proud to showcase our work to the world.

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