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Negative culture in the NHS working against employee engagement

11-February-2013 0:00
in General
by Chris Marshall

 Reading about the appalling state of patient care at Mid Staffs hospital I was reminded of the maxim attributed to Peter Drucker of culture eats strategy for breakfast. Mid Staffs clearly had a strategy, a purpose, objectives, targets and measures in the hope that they would attain Foundation status. The Francis report was clear, however, laying the blame squarely for the dreadful state of affairs on the culture of the NHS citing too many negative aspects including:

  • • a lack of openness to criticism
  • • a lack of consideration for patients
  • • defensiveness
  • • looking inwards not outwards
  • • secrecy
  • • misplaced assumptions about the judgements and actions of others
  • • an acceptance of poor standards
  • • and a failure to put the patient first in everything that is done.

None of these aspects would be allowed to thrive in an organisation with strong leadership and an engaged workforce. Francis’s report has 290 recommendations. That does not fill me with confidence. Far from it. 290 initiatives all with measures to check progress and outcomes feels like more of the same to me.


Instead of 290 recommendations here’s my slightly reduced version:


  1. 1) Put high quality clinical leaders in charge of NHS organisations, not managers
  2. 2) Teach them about leadership and employee engagement
  3. 3) Trust them to get on with it

I realise that sounds far too simplistic, but surely that is the case where less it better. Let's hope for all our sakes they get it right.

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