Culture Change Resources

What is culture?

What exactly do we mean by culture?

Put simply, culture is ‘how things are done around here’ (Drennan, 1992, p9) - the patterns, habits and routines of practice. Each one of us makes up the culture and so whatever our role, it’s important for everyone to know that as individuals our ideas and actions can change things.

Why do we need to change culture?

One of the most significant factors that influence the quality of care is workplace culture (Manley et al., 2011). This has been highlighted by recent reports into significant failures in health and social care, which have identified the need for change (Francis, 2013, 2010; Parliamentary and Health Service Ombudsman, 2011; Patterson, 2011).

Although it is often organisational culture that is spoken about, organisations are made up of many smaller cultures, for example within departments and teams and at ward and unit levels (workplaces). It is these cultures that have the greatest influence on the experience of patients, families and staff (Manley et al., 2011).

A caring culture makes things better for everyone. Patients, service users, residents and their families and carers experience good care. Staff feel valued and supported which helps them to provide the care patients want with compassion and confidence.

How do you know if your culture needs to be improved?

The complex nature of health and social care means that wherever you are working, there will always be aspects of care that can be improved, even if there are not any specific concerns. As patients’ needs change, services reconfigure, new staff join the team etc., it is really helpful to continuously reflect on practice to ensure that the care being delivered is safe, effective and person-centred.

Here are some questions that may help you to begin to think about your workplace culture:

  • What do patients and relatives say about their experiences of care?
  • What do staff say about what it is like to work here?
  • What do students say about their experiences of working in your workplace?
  • What aspects of care (if any) do you think need to be improved?
  • What concerns (if any) do you have about patient safety – falls, pressure ulcers?
  • What gaps are there between what people say they do and what actually happens in practice?
  • What are the recruitment, retention and sickness rates like?
  • How open are staff to change?

You could also look at audits, dashboards, Friends and Family Test, staff surveys, patient surveys, compliments and complaints, exit interviews or use tools such as the 15 Step Challenge (NHS Institute for Innovation and Improvement, 2012) and the ‘Culture of Care’ Barometer (Rafferty et al., 2015).

All of this information will help you to develop a better understanding of your workplace culture, by identifying:

  • What is working well and how you could make this happen more often
  • What needs to be improved and where you might need support
Wider Resources

Context Assessment Index

Workplace Culture Critical Analysis Tool


Drennan, D. (1992) Transforming Company Culture. London: McGraw-Hill. p 9.

Francis, R. (2010) Independent Inquiry into care provided by Mid Staffordshire NHS Foundation Trust January 2005 – March 2009. Volume I. London: HMSO.

Francis, R. (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. Executive Summary. London: The Stationary Office.

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.

NHS Institute for Innovation and Improvement (2012) 15 Steps Challenge. Retrieved from: http://www.institute.nhs.uk/productives/15stepschallenge/15stepschallenge.html. Last accessed 1st April 2015.

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 ResearchService Delivery and Organisation Programme. London: HMSO.

Rafferty, A., Philippou, J., Fitzpatrick J.M. and Ball, J. (2015) ‘Culture of Care’ Barometer: Report to NHS England on the Development and Validation of an Instrument to Measure ‘Culture of Care’ in NHS Trusts. London: Kings College London.