Understanding the dynamics of organisational culture change: creating safe places for patients and staff

Lorna McKee, Michael West, Rhona Flin, Adrian Grant, Derek Johnston, Martyn Jones, Christine Miles, Kathryn Charles, Jeremy Dawson, Sharon McCann, Steven Yule

    Research output: Book/ReportCommissioned report


    Aims: This multidisciplinary, multi-method research aims to explore links between organisational culture change and domains of patient safety and staff well-being: domains often researched in isolation. Qualitative and quantitative perspectives are mixed to investigate complex interactions and organisational factors influencing high and low performance in these domains.

    Objectives are to:
    - Extend the evidence base on organisational culture and performance, using the Healthcare Commission NHS Staff Survey database [NSS] to document variation over time, extend data and measurement, and develop depth cases.
    - Research key measurement issues: identifying high and low performance in domains of patient safety and staff well-being, tracking impacts of policy change and linking culture to care across settings and professional groups.
    - Identify policy and environmental change and internal context issues, studying how change-receptive and change-intransigence contexts link to culture and performance in, eg, leadership and management practices.
    - Pilot and assess interventions to improve patient safety and staff well-being.

    Type and Location: The programme comprises recursive, iteratively linked strands, using theoretical insights from HRM, organisational climate and safety change measurement literatures, behavioural and psychological models of staff well-being and processual models of organisational change.

    Methods: NSS data will be used to explore key predictors of culture and performance and different analytical tools will be used to rework questions in the parallel strands.

    Determining Culture: Organisational Climate Measures and the NSS

    Culture factors will be determined from the NSS national database. Its staff well-being data also provides rich insights into patient care and patient/staff safety. Early analysis of 100 Trusts will be used to select 16, along dimensions of patient safety and staff well-being (stability/change; high/low performance, 4 per cell). 8 of these will be interrogated over-time using different tools/methods, tracking the implementation and impact of policy initiatives and the role of management. An action research component will also be piloted, through development of a culture change programme with a sub-group of cases.

    Staff Well-Being: Effort, Reward and Control: Nursing in Different Work Cultures

    Nurses' perception of stress, the organisational determinants of and changes to reduce stress will be assessed between 4 selected Trusts with different cultures and degrees of performance. Working conditions and participants' responses to work will be surveyed using standardised questionnaires and established electronic monitoring techniques to measure real time responses to stress of 75 nurses per Trust. Electronic diaries will record both critical incidents and routine responses. Measures of, for example, demand, control, reward, emotional states and social support will link work environment to staff and patient outcomes. Characteristics of the work situation and perceptions of managerial support will be assessed by standardised questionnaire, along with distress (GHQ12), mood (POMS), satisfaction (Parkes, 1993) and health and emotional response styles (PANAS).

    Senior Managers' Leadership and Safety

    In 8 case study Trusts a combination of depth interviews and quantitative self-report and upward appraisal data will be collected from 5 senior managers to identify leadership styles and associated behaviours relating to safety. For each manager six direct reports will be collected from reporting line staff, using standard instruments (MLQ) used in safety research in industrial settings (Bass and Avolio 1995) and in the oil sector (Flin 2003).

    Development of In-depth Comparative Cases

    Longitudinal comparative cases will be developed in 8 Trusts: 4 depth cases with a minimum of 30 interviewees and extensive documentary and observational data; 4 mini-cases restricted to telephone interviews with up to 10 key stakeholders, site visits, interviews with core personnel and documentation. A processual change perspective and the model of Receptive Change Contexts for Change will be applied (Pettigrew et al. 1992). Direct links and integration with other strands will be ensured at each stage, building cumulative insights and complementary data and achieving economies of time, depth and scope.
    Original languageEnglish
    Number of pages425
    Publication statusPublished - Feb 2010


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