Intended for healthcare professionals


Will prescriptions for cultural change improve the NHS?

BMJ 2013; 346 doi: (Published 01 March 2013) Cite this as: BMJ 2013;346:f1305
  1. Huw Talfryn Oakley Davies, professor1,
  2. Russell Mannion, professor2
  1. 1School of Management, University of St Andrews, Fife KY16 9RJ, UK
  2. 2Health Services Management Centre, University of Birmingham, Birmingham B15 2RT, UK
  1. Correspondence to: H T O Davies hd{at}

The recent Francis report diagnoses serious cultural deficiencies in the NHS and recommends fundamental cultural change. Huw Davies and Russell Mannion examine what research tells us about the likelihood of success

It is hard to escape the conclusion from the Francis report into care at Mid Staffordshire NHS Foundation Trust that the primary culprit at the heart of this latest NHS scandal is “the culture” of our healthcare organisations.1 Francis suggests that “a fundamental culture change is needed” and is clear that he is seeking a move to something overarching and comprehensive for the whole NHS.

The Francis inquiry, like the Kennedy inquiry into paediatric cardiac surgery at Bristol more than a decade earlier,2 has gone to considerable trouble to try to understand the meaning of culture in a healthcare context. Yet the subtlety of some of the supporting evidence to the inquiry has not been matched by the same degree of nuance in the inquiry’s recommendations about culture, which are somewhat aspirational and broad brush (box 1). This is a pity, since the research literature has much to say about the nature of culture and the possibilities for shaping cultural change to produce benefits.3 4 5

Box 1: Core recommendations relating to culture in the Francis report 1

Recommendation 2: The NHS and all who work for it must adopt and demonstrate a shared culture in which the patient is the priority in everything done. This requires:

  • A common set of core values and standards shared throughout the system

  • Leadership at all levels from ward to the top of the Department of Health, committed to and capable of involving all staff with those values and standards

  • A system that recognises and applies the values of transparency, honesty, and candour

  • Freely available, useful, reliable, and full information on attainment of the values and standards

  • A tool or methodology …

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