We must make the NHS an employer of excellence – valuing, supporting, developing and investing in our people.

Despite inclusion being a founding value of the welfare state in the United Kingdom the organisational cultures in health and care continue to reflect discrimination of the wider society. The pandemic has shone a spotlight on the effects of discrimination on health society with far higher proportions of those with disabilities or those from ethnic minority groups dying from Covid-19. To truly respond in a way which will create the conditions for high quality, compassionate and continually improving healthcare for current and future generations, leaders must understand and better nurture inclusiveness, promoting equity and valuing diversity. Without doing this, a culture and leadership cannot be characterised as compassionate. However, as we see more compassionate and inclusive working environments, there is potential for the positive impact to be felt beyond organisational boundaries, through the homes of our colleagues and into wider communities.

Our evidence, reports and occasional blogs on culture provide the resources which our change teams and wider stakeholders tell us have been most important in shaping their understanding of the importance of culture and leadership in healthcare, and compassionate collective leadership.

Featured case study

Read about Mark Fulford’s experience of being a member of the Culture and Leadership Programme’s change team at Nottingham University Hospital NHS Trust and how this experience changed his perception of senior leaders in his Trust.

Read this and more case studies on our sharing your stories page.

Michael West: Compassionate and inclusive leadership

In this video Michael West shares his thoughts on compassionate and inclusive leadership for our recent event ‘The challenge of culture change: sharing system-wide learning to deliver the NHS Long-Term Plan’.

Resources for culture change

We recognise that there are a wide range of resources which describe compassionate and inclusive cultures, and culture change across a range of sectors. However, it can be difficult with limited time available to find relevant resources for your needs. We’ve therefore collected a range of resources within these pages which we feel are a good place to start.

• Read: Better culture starts with better conversations  – Centre for Creative leadership. In this white paper, the Centre for Creative Leadership describe how people interact with one another – in the hallways, in meetings, even in informal chats by the coffee maker — is the truest indicator of a company’s culture, and offer four core behaviours which make the biggest difference to strengthening those conversations.
• Read and watch: How to talk about race at work – Chartered Institute of Personnel and Development (CIPD). The importance of inclusion and awareness of race disparities in the workplace are not new subjects for most. The CIPD have published principles, steps and considerations for organisations on how to have conversations about race with their employees through guidance, tips and a short video, all collected here.
• Watch: Paying attention to inclusion. John Ameachi talks about his views on allyship in the workplace.
• Read: Time to think: the ten components of a thinking environment. In her book, Time To Think, Nancy Kline identified ten behaviours that generate an environment which supports independent thinking; a key component to improvement, innovation and compassion.
• Read: The King’s Fund: Caring to change: how compassionate leadership can stimulate innovation in health care. This paper from The King’s Fund looks at compassion – which involves attending, understanding, empathising and helping – as a core cultural value of the NHS and how compassionate leadership results in a working environment that encourages people to find new and improved ways of doing things.

Significant reports on culture – national and international perspectives

The desire to provide the best quality health and care services is both a national and international priority, with this forming the focus on a number of commissioned research projects around the world. Here we’ve collected a number of resources which are particularly relevant to creating compassionate and inclusive working environments through collective leadership.

• Read: Health and social care review: leadership for a collaborative and inclusive future (Messenger Review)
  In June 2022 the Department of Health and Social Care published an independent report from General Sir Gordon Messenger and Dame Linda Pollard into leadership across health and social care in England. General Sir Gordon Messenger said: “A well-led, motivated, valued, collaborative, inclusive, resilient workforce is the key to better patient and public health outcomes, and must be a priority.”
• Read: The Point of Care Foundation – Behind Closed Doors: Can we expect NHS staff to be the shock absorbers of a system under pressure? The Point Of Care Foundation – Behind Closed Doors: Can we expect NHS staff to be the shock absorbers of a system under pressure?
• Read: Mid Staffordshire NHS Foundation Trust Public Inquiry (Francis Inquiry). The final report of the Mid Staffordshire NHS Foundation Trust Public Inquiry was published on Wednesday 6 February 2013. Volume 3 includes the findings which particularly focus on culture.
• Read: Culture in the NHS: A promise to learn – a commitment to act. Don Berwick published this report on safety in the NHS. He said:  The most important single change in the NHS in response to this report would be for it to become, more than ever before, a system devoted to continual learning and improvement of patient care, top to bottom and end to end.
• Read: The ABC (and DE) of cultural competence in clinical care. This paper builds on previous publications which focus on cultural competence by discussing key attributes that fall into three domains (affective, behavioural and cognitive) and extends the framework to consider the dynamics of difference, clarify the goal of equity, and recognise the importance of practice environments in the development of cultural competence in clinical care.
• Read: “Caring for doctors Caring for patients”. Making a conscious choice about the kind of cultures we need in order to retain Doctors.
• Read: The courage of compassion: Supporting nurses and midwives to deliver high-quality care. This review investigated how to transform nurses’ and midwives’ workplaces so that they can thrive and flourish and are better able to provide the compassionate, high-quality care that they wish to offer.
• Listen: Professor David Williams on racism, discrimination and the impact they have on health. Podcast: Professor David Williams from Harvard University brings to life why an inclusive health culture is so important.
• Read: Culture and behaviour in the English National Health Service: overview of lessons from a large multimethod study. Problems of quality and safety persist in health systems worldwide. Mary Dixon-Woods et al conducted a large research programme to examine culture and behaviour in the English National Health Service.