NHS changes

Editor’s Choice

A change of culture, but how?

Fiona Godlee, editor, BMJ


In Editor’s Choice this week,  ‘A change of culture, but how?’, Fiona Godlee flags up Iona Heath’s writes last column for the bmj. ‘Not safe in their hands’ http://www.bmj.com/content/346/bmj.f1004 ‘By making the NHS available for private profit, the government has undermined its foundations in notions of shared responsibility, reciprocity, and social solidarity.’

‘…it is a cri de coeur for those who work in the NHS, suffering as she sees it under continuous and unnecessary restructuring, ever increasing demands, and deliberate adverse propaganda. In the week after publication of the Francis report (doi:10.1136/bmj.f979), she offers a remedy for the devastating failings it so clearly documents: reciprocity. “If the government wants to see a health service permeated by the care, compassion, and respect that we all want for those we love, then it must pay much more attention to the importance of demonstrating those same qualities in its treatment of frontline health staff.”’

How does an organisation the size of the NHS achieve such a change in culture – what works and what doesn’t? In an article in Forbes magazine, John Kotter  “The key to (www.forbes.com/sites/johnkotter/2012/09/27/the-key-to-changing-organizational-culture/), Harvard emeritus professor John Kotter explains. “A powerful person at the top, or a large enough group from anywhere in the organization, decides the old ways are not working, figures out a change vision, starts acting differently, and enlists others to act differently. If the new actions produce better results, if the results are communicated and celebrated, and if they are not killed off by the old culture fighting its rear-guard action, new norms will form and new shared values will grow.’ Whereas, he explains, when some group decides what the new culture should be and the message is cascaded down the hierarchy little or nothing changes.

Cite this as: BMJ 2013;346:f1152

About bmitzi

Medical writer, author, artist. Cancer campaigner. Aiming always to improve health services and bring compassion into health care.
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