Will prescriptions for cultural change improve the NHS?

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