What is the role of organisational culture in healthcare?

Culture is a set of shared, taken-for-granted implicit assumptions that members of an organisation hold and that determines how they perceive, think about and react to things. In other words, it is ‘the way we do things around here’.

Every interaction in an organisation both reveals and shapes its culture. For instance, how staff talk to or about patients, and how they talk to each other. Culture reflects what an organisation values: quality, safety, productivity, survival, power, secrecy, justice, humanity and so on. If there are strong values of compassion and safety, new staff learn the importance of caring and safe practice. If they observe senior staff behaving aggressively, they assimilate that. In short, if we want to improve care, we must focus on nurturing appropriate cultures.

Healthcare organisations are notoriously varied, fractured by specialty, occupational groupings, professional hierarchies, and service lines. Some cultural attributes might be widespread and stable, whereas others may be shared only in subgroups or held only tentatively.

It seems obvious that the shared, cultural aspects of organisational life must have some bearing on organisational outcomes. Yet because of the complexity of healthcare cultures and the ambiguity around health service “success,” establishing such links through research is not easy.

Fostering the right culture in healthcare organisations is essential to ensure they provide compassionate, high-quality care for patients. This requires the creation of transparent cultures in which mistakes are viewed as learning opportunities, where staff can raise concerns and know the appropriate action will be taken, and honesty and openness is promoted. The most important determinant of the development and maintenance of an organisation’s culture, including cultures of compassionate care, is leadership. Every interaction by every leader at every level shapes the emerging culture of an organisation.

For collective, distributed leadership, all staff must be engaged. To achieve this, senior leaders must understand the leadership practices and behaviours needed to nurture a caring culture. Understanding culture alone is insufficient; conscious, deliberate attention must be paid to enabling people at every level within the organisation to adopt leadership practices that nurture the cultures the organisation requires.