The evidence base

Why is culture important?

The need to improve organisational culture in the NHS was highlighted as a key recommendation in the Mid Staffordshire NHS Foundation Trust Public Inquiry when it was published in 2013.

As a result, NHS Improvement, The Kings Fund and the Centre for Creative Leadership began to build upon more than 20 years of research into organisational culture change, and began piloting the Culture and Leadership Programme in 2015. The resources developed through this work were initially published in 2016, with further publications and refinements being made to incorporate learning as more organisations used the approach.

…it is the overall culture – “the way we do things in the NHS” – which will define what the NHS means and does…A positive culture as described does not just emerge through the good intentions of those working in the system. It needs to be defined, accepted by those who are to be part of it, and continually reinforced by leadership, training, personal engagement and commitment.”

Mid Staffordshire NHS Foundation Trust Public Inquiry (2013)

The evidence, from research and practice, confirms that leadership, particularly compassionate, diverse and inclusive leadership, is the key to enabling cultural change that enables NHS organisations to:

  • deliver high quality care and value for money while supporting a healthy and engaged workforce
  • create a greater sense of belonging for all staff, changing the lived experience for all disadvantaged groups and those who experience discrimination, bullying and unfairness (2019 Workforce Race Equality Standard Report)
  • enables staff and leaders to show compassion, to speak up, to continuously improve and create an environment where there is no bullying, racist or unfair treatment, where there is learning, quality and the need for system leadership

For more information on the concepts, evidence and research behind the Culture and Leadership Programme, and our approach please see our revised Culture and leadership programme: concepts and evidence mini-guide – coming soon.

For more resources about compassionate and inclusive leadership, culture change and national and international perspectives, have a look at our inspiration pages.

Evaluating the Culture and Leadership Programme

Since the Culture and Leadership Programme was publicly launched in 2016, the tools and approach have been used by over 80 organisations. In 2018 we commissioned an independent Formative Evaluation of the Culture and Leadership Programme, conducted by the University of Manchester Alliance Manchester Business School, and the University of Birmingham, which reported back in 2020. Key findings were:

  • Reframing the programme and design;
  • Integrating equality, diversity and inclusion;
  • Establishing governance and relationships;
  • Creating a dedicated change infrastructure;
  • Engaging a diverse range of staff in the change;
  • The approach to programme implementation is consistent with the ethos and values of the programme
  • Focus on implementing culture change, not implementing a programme;
  • Embedding culture change;
  • Supporting networking and collaboration; and
  • Monitoring and evaluating impact.

These findings have been incorporated into the revisions of the programme, which were launched in 2021. Read the Summary formative evaluation.

Impact evaluation

We have a solid evidence base to work with, which tells us the benefits of compassionate and inclusive cultures delivered through collective leadership, but we also wanted to understand the impact that the Culture and Leadership Programme was having on the organisations and systems that worked with it. In 2021 we commissioned AffinaOD to conduct an independent impact evaluation of the Culture and Leadership Programme.

Quantitative analysis of data between 2018 and 2020 from all 35 trusts who had used the Culture and Leadership Programme compared to national averages showed improvements in all of the following areas:

  • CQC ratings
  • Single oversight framework
  • Staff engagement
  • Registered nurse turnover

Read a Summary of the impact evaluation, and the full report: An evaluation of the implementation of the NHS Culture and Leadership Programme, December 2021.

You can learn more about the Culture and Leadership Programme through our online learning course, Nurturing compassionate and inclusive NHS cultures, on our online learning page.

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