Recognising and developing effective workplace cultures that are also good places to work

Dr Kate Sanders PhD, MSc, BSc (Hons), HV Cert, RN - Practice Development Facilitator

Kate Sanders, Practice Development Facilitator, FoNS

We know that workplace culture has a significant influence on care (Manley et al., 2011). This has been highlighted many times earlier this decade in reports into significant failures in health and social care (Francis, 2013, 2010; Parliamentary and Health Service Ombudsman, 2011; Patterson, 2011), but sadly also very recently, press coverage has exposed substantial concerns in hospitals caring for people with learning disabilities. Whilst an increasing amount has been written about culture, and it is definitely spoken about much more often, I am not sure how much progress we are really making towards helping staff to really understand what culture is and how they might facilitate cultural change.

Everyone who is working in health or social care is embedded in a workplace culture i.e. ‘the most immediate culture that is experienced and/or perceived by staff, patients, users and other key stakeholders. This is the culture that impacts directly on the delivery of care. It both influences and is influenced by the organisational and corporate cultures as well as other idiocultures’ (Manley, Sanders, Cardiff and Webster, 2011).

During the summer of 2017, Kim Manley, Shaun Cardiff and Jonathan Webster and I, shared a series of blogs that began to outline our interests in workplace culture, as the start of a collaborative inquiry. We are interested in growing our knowledge and understanding about how to recognise and enable workplace cultures across health and social care; cultures that are effective, safe and also good to work in. Our aim is to answer the questions: What works, for whom, and why, when developing and embedding such cultures?

In March 2018 we hosted a Twitter Chat (#EWCulture: Effective workplace cultures that are also good places to work) and then used a realist evaluation approach to work with the data from the tweets to create a broad tentative hypothesis and CMOs (context, mechanisms and outcomes). We then shared these outputs with participants at the Enhancing Practice 18 conference in Basel, Switzerland, on 23rd August 2018, offering them up for comment and critique.

Subsequently, we have engaged in further work with the data to distill the essence of effective workplace cultures that are good places to work, creating 4 simple rules and associated descriptors. Our proposition is that each simple rule incorporates intermediate/process outcomes that when combined with the other simple rules account for the achievement of ultimate outcomes.


We are now presenting the 4 simple rules for review and critique. You can get involved by:

  • Visiting our blog site and leaving comments; and/or
  • Joining a Twitter Chat 12 November 2019 from 20.00-21.00 hrs GMT (21.00-22.00 hrs CET)

The review/critique will be guided by the following questions:

  • How credible and plausible are each of the simple rules in your experience?
  • How valid is the claim that simple rules 1 plus 2 plus 3 plus 4 results in the ultimate outcomes?

When you participate in the Twitter Chat, please use the hashtag #EWCulture in every tweet so we can analyse your feedback.


We look forward to your participation – Kim Manley (@IPDKim), Kate Sanders (@KateatFoNS), Shaun Cardiff (@ShaunCardiff) and Jonathan Webster (@Jonatha85888249).


FoNS Guide to Joining in a Twitter Chat



Francis, R. (2010) Independent Inquiry into Care Provided by Mid Staffordshire NHS Foundation Trust. Volume I. London: HMSO.

Francis, R. (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: HMSO.

Parliamentary and Health Service Ombudsman (2011) Care and Compassion? Report of the Health Service Ombudsman on Ten Investigations into NHS Care of Older People. London: HMSO.

Patterson, M. (2011) From Metrics to Meaning: Culture Change and Quality of Acute Hospital Care for Older People. Report for the National Institute for Health Research Service Delivery and Organisation Programme. London: HMSO.

Manley, K., Sanders, K., Cardiff, S. and Webster, J. (2011) Effective workplace culture: the attributes, enabling factors and consequences of a new concept. International Practice Development Journal. Vol. 1. No. 2. Article 1.

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