There's a paradox within culture change, and we have to embrace it | Heather Tierney-Moore

Heather Tierney-Moore

In a few days, I will be joining colleagues at the NHS Confederation’s annual conference and exhibition to discuss the importance and challenges of changing the culture of NHS organisations.

It feels like a conversation I started nearly 20 years ago and one that I have repeated many times with different people over the intervening period. So why are we still talking about it? Why has it not happened already? How many times do we need to be told before we just do it?

But of course, it’s not that simple.

Few things are easily achieved that are as fundamentally important as a consistently positive culture, particularly within a complex, diverse and dispersed system such as the NHS. In fact, as you start to understand culture and culture change, you have to embrace the paradox that while it is probably one of the most, if not the highest priority area for leaders, it is infuriatingly difficult to achieve, requires a long-term approach and absolutely does not happen because you told someone to do it! Increasingly loud exhortations and greater urgency of message to ‘get on with it’, coming from so many quarters, has probably had precisely the opposite effect.

Everyone who believes that change in culture is needed must start with themselves – “being the change you want to see”. The NHS employs more than 1.6 million people and deals with over 1 million people every 36 hours. It’s the way all these people behave with each other, all day, everyday that constitutes the culture. 

There are conditions leaders can create that help to support the positive behaviours they wish to underpin culture – and that takes effort. There are actions they can take when they see, hear about or experience the less positive behaviours – and that takes courage. There are evidence-based interventions, hard-wiring and soft stuff that help shift the culture within teams, within services and within organisations – and that requires knowledge. 

But it becomes even more challenging across and between organisations. It needs even more consistent leadership approaches and behaviours to change how a whole system demonstrates its culture, and that’s everyone’s responsibility. Every part of an organisation and all the individuals within any system both create and are impacted by the culture. 

My organisation consists of nearly 7,000 people, working in 700 locations spread over 3,500 square miles. Trying to build a consistently positive values-based culture has been my priority for the last six years and it is still work in progress. Increasingly, I am having conversations about culture across the health and wider public sector economies within Lancashire and the North West, as we seek to achieve the transformation that is required over the next five years. 

One of the powerful tools of change is conversation. You can make change happen one conversation at a time. So maybe the fact that I have been having conversations about culture change for the last 20 years is a good thing. Perhaps we need more people to have conversations about the things that matter, which involve more listening than talking, to help us in that journey.

Perhaps that’s where our energy and effort should be directed. “A little more conversation, a little less action please,” to misquote Elvis, though that might not be quite right, as moving to action once you understand what is needed is important. Maybe we all need to try asking more questions and really listening to the answers. Maybe one of these questions might be ‘how does my behaviour impact on you and the culture of our team?’.

Heather Tierney-Moore is chief executive of Lancashire Care NHS Foundation Trust. Follow her on Twitter @HeatherCEO

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