My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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Culture eats strategy for breakfast and the Culture of the NHS

Filed Under (Culture of the NHS) by Paul on 13-05-2009

Looking back on it, it was an easy decision to decide to write about the topic of culture in my Health Service Journal regular end piece. It was the topic that everyone involved in change wanted to talk with me about and it was the topic that those who resisted change never had to mention. Almost by definition, if you are in a culture you don’t notice it but if you straddle the inside and outside of a culture, then you notice it every day, all the time.

In those terms the bifurcated reaction to my first column is not surprising. Some people, who straddle the inside and the outside of the culture have been sort of saying at last. At last someone is talking about the issue that really matters that make a particular world go round and that stops radical change from happening. People want to talk about it both in general and particular and I hope they will use this blog to do that. I certainly will.

But there has also been a rather puzzled silence from those inside the culture. Much of my time is spent working with these folk who have spent their significant working life within the NHS and are quite rightly proud of their achievements and proud of their contribution. But if you are inside then – well you are inside and the configuration of what you see every day looks and for you is different.

So those of us who straddle the culture have one form of understanding of it- seeing it against other cultures and trying to develop external interventions to become internal ones. But the more normal experience for the NHS is for those who are inside it and see different things from us.

Those of us involved in cultural change have to ensure that we BOTH understand the outside but also given this is the majority experience what it really feels like to be completely inside.


2 Responses to “Culture eats strategy for breakfast and the Culture of the NHS”

  1. Hello Paul. You made this comment about culture eating strategy for breakfast a couple of years ago at the NHS Alliance conference, in conjunction with a John Lennon lyric reference, to ‘Imagine’. I asked you in a question about why NHS culture more often feels akin to a medley of ‘Happiness Is A Warm Gun’ and ‘Cold Turkey’.

    You’ve done time in some central bits of a deeply centralised system. Do you think the insider-outsider culture wars (and indeed the insider-insider culture wars) are part of the polarity of a centralised system?

    Can you think of examples of very ‘stuck’ centralised cultures that have undergone a sustained change? If so, what would you say made the difference?

  2. Hi Andy
    I do remember your comment about the different possible Lennon/Mcartney themes tunes for change in the NHS at the Alliance conference with affection. Then, as now someone trying to change real people in real situations, I dont think metaphors or songs which allude to violence are very useful. I am not being po-faced here but in my experience cultural change is hard enough without using metaphors which involve guns or deaths.

    My time close to the centre of the NHS has both taught me that change is possible and very hard. (Too often people see change as either easy or impossible!) It needs some people ‘from outside’ but it also needs working with the contradictions of the culture inside. For example the value held by most that there should be equal access for all free at the point of need is contradicted by a lot of outputs and outcomes of all of our work. Talking with people about that exposes a contradiction and give us the opportunity for movement.

    Two very centralised cultures that are undergoing and have undergone change are the army and the Metropolitan police.The leadership of both organisations recognise that if they genuinely dont look out and keep looking up, they fail. Both contain very strong hierarchies but a recognition that success on the ground depends upon certain moments when the hierarchy doesnt take precedence.For things to work you need to break one of the main cultural taboos.

    The best operating theatres begin to look like this with the nurse insisting on the WHO protocol and all the senior staff adhering to it. I know that this is a struggle all round but the increasing number of surgeons agreeing to this are won to it because of scientific evidence that it will improve their practice.

    The down side of change for the leadership of both the army and the Met is that the past culture does not go quietly. It fights back and there is real conflict between the old that has some much history and adherence on its side and the new which all the time has to prove itself.

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