Changing Culture in the NHS: It starts with the courage to let go

Dr Christopher Lloyd, Associate Medical Director, The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust

Culture change is often spoken about as if it’s a programme, a strategy, or a neatly costed workstream. But anyone who has led in the NHS for more than five minutes knows the truth:

Culture is not what we write.

Culture is what we walk past.

And for years, we’ve walked past behaviours that no longer fit the workforce we’re trying to attract, retain, and inspire.

The NHS I joined two decades ago was built on a different set of expectations — stoicism, hierarchy, personal sacrifice as proof of commitment. Those behaviours weren’t malicious; they were inherited. They were survival mechanisms for a different era.

But the workforce standing in front of us today has grown up in a world where:

• Psychological safety is a right, not a reward
• Feedback is normal, not insubordination
• Boundaries are healthy, not a lack of dedication
• Leadership is earned through behaviour, not title
• Wellbeing is essential, not optional

And yet, too often, we still default to outdated norms — the unspoken rules, the “that’s just how it is”, the behaviours we absorbed without ever consciously choosing them.

So how do you change the culture of an organisation as vast, pressured, and emotionally complex as the NHS?

You don’t start with a policy.

You start with a mirror.

• Name the behaviours we’ve normalised that no longer serve us — the eye‑rolling, the silence in meetings, the avoidance, the martyrdom.
• Model the alternative even when it feels uncomfortable or exposes you to scrutiny.
• Create spaces where people can speak without fear of being labelled “difficult”. – Invite the next generation in rather than expecting them to wait their turn in a queue that no longer exists.
• Challenge the mythology that burnout is a badge of honour.
• Reward courage — the person who speaks up, not just the person who stays late.

Culture doesn’t shift when we tell people to behave differently. Culture shifts when leaders behave differently — consistently, visibly, and with humility.

And here’s the uncomfortable truth many organisations avoid:

You cannot create a new culture while protecting the behaviours of the old one.

If we want an NHS that is compassionate, modern, inclusive, and psychologically safe, then we must be willing to let go of the habits that once defined us but now hold us back.

The next generation isn’t asking for less commitment.

They’re asking for a culture that reflects the values we say we believe in.

That’s not disruption. That’s progress.

You can find Chris on LinkedIn