“Culture eats strategy for breakfast” is a remark attributed to Peter Drucker and popularised in 2006 by Mark Fields, president of the Ford Motor Company. It resonates now in the wake of the publication of the Mid Staffs Inquiry Report as we try and understand how a comprehensive system of regulation and governance was undermined by a culture of targets and financial outcomes. And a culture of compassion, caring and consideration, to which all health-care staff surely aspire, was replaced by one of callous disregard, fear and disinterest. For how otherwise could individuals tolerate what was going on in front of them?
Any strategies put in place to change culture will be eaten by the existing culture
Can you change cultures and attitudes by imposing strategies and structures? I don’t think so, because culture eats strategy for breakfast. And any strategies put in place to change culture will be eaten by the existing culture. And that is why the recommendations from Robert Francis that will be most difficult to achieve are those that call for a change in attitudes and culture. How do you change an attitude or manipulate a culture from one of disengagement and cynicism to curiosity, energy and positivity? Well, a culture can only arise from a group of people who display similar attitudes. So, to change culture we have to change attitudes and to change attitudes we have to work with individuals by challenging their stance and modelling an alternative attitude that has credence within the same environment. Working with individuals requires skills of leadership and interpersonal effectiveness and for that we have to rely on selected champions who are imbued with such qualities, whether or not they are identified as a leader. Where do we find such people to carry out this task and how do they do it, particularly in the current climate? It is these questions that those in any large organisation, but particularly the NHS, need to answer in order to prevent such a disaster as occurred at Stafford Hospital happening again.
The right attitude can inspire and motivate anyone
In 1962, President Kennedy, was on a tour of NASA space centre. He noticed a janitor carrying a broom. Breaking away from the tour he approached the janitor and introduced himself “Hi, I’m Jack Kennedy, what are you doing?” The janitor responded, “I’m helping put a man on the moon, Mr. President.” This apocryphal story is used often in demonstrating how important it is for individuals in any organisation to understand the purpose of their role and how it fits into the overall strategic objectives for the organisation. It is a great example of how an attitude can inspire and motivate anyone, however menial their task may seem to others.
Sticking with the car manufacturing example, Toyota broke the mould in car production by introducing “lean working”. In a nutshell this change of attitude focuses on value from a customer point of view during every step of the production process. It aims to create a healthy obsession within the workforce to remove waste within the ‘whole system’, use a bottom up approach in identifying value and waste and promote a flow of outcome that requires little command and control from the top. The emphasis is in enabling staff to prevent blockages, enable efficient throughput and troubleshoot effectively – if there is a problem on the production line that interferes with flow, anyone can call for senior assistance to resolve it immediately in order to minimise any delays. Many trusts are now adopting the principles of “lean working” because of the demonstrable success that can be achieved when applied to health-care settings. However, in a health-care setting, the product and consumer is a patient or stakeholder and the system (for it is a system) works by enabling a change of attitude in staff leading to a change of culture. This is an example of a system that hangs on the coat tails of a culture.
So the brave new world of NHS and other healthcare must address the change of culture question by addressing attitudes in the first instance and using whatever systems that are available to support and promote such change. The rest of the necessary top down regulation, audit and governance flows easily from this. In LPP Consulting, our patients and customers are acutely aware of the importance that we give to their “product”, whether it be an illness that needs treating, a behaviour that needs changing or an organisation that requires developing, and how keeping them always at the centre of our decisions and training programmes not only determines the success of our outcomes but also alerts us to any shortcomings or difficulties at the earliest opportunity.