There are three elements in any organisation – structure, systems and culture and most effort aimed at improving healthcare has been put into structural reorganisation. Structure is of course important, Gandhi said there is no structure that can make bad people behave well but the wrong structure can make good people behave badly so it is important to identify and remove barriers to behaving well but structure is much less important that the two other elements – systems and culture. Of these two, most people who have studied organisations give more importance to culture than to systems, for example you can design an excellent system but if there is not a collaborative culture the system won’t work. This can be represented in a picture:



One of the five modules on transformation focuses on creating the culture of stewardship, but it is important to appreciate that the first two modules, which help the learner understand and use the key concepts – value, waste, outcomes resources and stewardship, are not ‘theory’, with other modules being ‘practice’.

The new language helps create the new culture. As we have emphasised, the use of new terms such as ‘optimality’ or ‘outcomes that matter to patients’ and stopping using confusing or unhelpful terms such as ‘outpatients’ or ‘savings’, not only creates new ways of thinking in the individuals who use those terms, indeed neuropsychologists explain that it creates new circuits in the brains of those people, it also creates the new social reality.

Edgar Schein, regarded as one of the best writers on culture defines it in this way:

“Culture is the shared tacit assumptions of a group that it has learned in coping with external tasks and dealing with internal relationships.” Schein EH (1999) The Corporate Culture Survival Guide. John Wiley & Sons. Page 186.

He also clearly defined that the creation of culture is the key responsibility of leadership:

“When we examine culture and leadership closely, we see that they are two sides of the same coin; neither can really be understood by itself. If one wishes to distinguish leadership from management or administration, one can argue that leadership creates and changes cultures, while management and administration act within a culture.” Schein, E.H. (2004) Organizational Culture and Leadership. John Wiley & Sons Inc. (pp.10-11).

In developing the right culture the leadership has to find time to discuss and decide on the culture they want to drive their organisation and the OVSP has produced a set of resources that stimulate and support culture change:

  • The OVSP Glossary, with the top twenty clusters of terms, each of which has its own podcast. Every organisation needs to develop its own version of the glossary
  • The OVSP Specialised Glossary on Culture.
  • The top ten books on culture, distilled for rapid reading and each with a podcast.
  • Our book on How to Create the Right Healthcare Culture.