How doctors in senior leadership roles establish and maintain a positive patient-centred culture

What were the key findings?

This independent study finds that good leadership and positive cultures are vital to health care and patient safety. Findings include:

  • The notion of a positive culture is not simple – it’s rich, complex, varied and largely implicit. 
  • Doctors in senior leadership roles have a huge amount of wisdom about organisational culture. This should be respected, acknowledged and developed further to better meet the needs of staff and the people who use health services. 
  • Complex and intersecting factors influence leaders’ thinking on culture. They draw heavily on their own knowledge and experience from their career journeys to shape working practices in their organisation, and their style of leadership. But many find it challenging to reconcile competing aims and demands.
  • They don’t see culture as a ‘thing’ or an add-on and for the most part they do not set out to do culture management as a discrete task. Rather, some element of culture management is embedded in their everyday leadership activity. 
  • Senior medical leaders use both hard and soft data to establish if a positive culture is present or absent. They identified the following organisational subcultures that can present problems: diva, factional, patronage, embattled and insular subcultures. These require different solutions, involving significant time and resources, to turn them around.
  • New service structures and patterns of care can make leadership roles more complex. This can have unintended negative impacts on working practices as well as creating opportunities to improve culture.
  • Participants revealed the most demanding – but unsupported – step they make in their medical leadership journey is that beyond consultant. And they may not have access to training and peer support to manage the transition and early phase of the new role.
  • As leaders mature in their role, they evolve from focusing on achieving tasks and outputs to enabling people and culture. But this shift generally comes the hard way after learning from their mistakes. 

Why did we commission this research?

This independent research set out to explore the lived experiences of doctors in senior leadership roles, their leadership journeys, the everyday challenges, and what they see as their role in shaping their organisation’s culture. 

It asked what positive culture means to senior leaders and how they recognise when a positive culture is present or absent. It also examines what they try to do to build or sustain a positive culture, or where they identify a negative culture is in place, how they try to change this.

What did the research involve?

We commissioned independent researcher and consultant Dr Suzanne Shale after a competitive tendering exercise. It involved 27 in-depth qualitative interviews with senior doctors in leadership across a broad sample of organisation types and roles. 

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How doctors in senior leadership roles establish and maintain a positive patient-centred culture