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NHS leaders note: organisational culture is key

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4814 (Published 28 July 2014) Cite this as: BMJ 2014;349:g4814
  1. Kunal Kulkarni, core surgical trainee, Oxford University Hospitals, Headley Way, Oxford, OX3 9DU
  1. kunalkulkarni{at}doctors.org.uk

Successful organisations value and foster a culture that develops organically rather than through diktat, reflects Kunal Kulkarni

“Free tea and coffee is no longer available.” That saves a few hundred pounds a year but is it worth the dent to staff morale? Why shouldn’t staff pay their employer’s extortionate yet unavoidable car parking fees? What are salaries for if not to subsidise collapsing study leave budgets? Who doesn’t want to sit on a grimy sofa when the Trust won’t pay the cleaners to work weekends? And even though evidence shows you’d be a safer doctor after a power nap, who needs an on-call room to rest?

A few such dents can soon rust, and before long you’ve got a hole. When freezing pay, cutting pensions, and expecting staff to work more, it is advisable to try to repair those dents. Holes in an NHS that is increasingly described as a slowly sinking ship can only hasten the inevitable. A few expensive locums might temporarily cover the cracks, but they can’t re-create the organisational culture required to get the ship afloat.

Lessons from corporate mergers provide insight into why engaging a positive culture of improvement is a …

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