Word Cloud using '3 word summary' descriptions of culture
A model of organisational dysfunction in the NHS A model of organisational dysfunction has been proposed (Pope and Burnes, 2013, p. 684) |
Organisational silence (Morrison and Milliken, 2000; Morrison and Rothman, 2009), normalised organisational corruption (Ashforth and Anand, 2003) and protection of image (Douglas, 1986; Brown, 1997; Brown and Starkey, 2000) are key concepts supported and enabled by the theory of selective moral disengagement (Bandura, 2002). The three concepts are seen as overlapping, completely entwined and mutually reinforcing. In the above model negative behaviour between employees is seen as a normalised organisational corruption. The protection of individual and organisational image and self-esteem appears to be the dominant influence. '3 word summary' description of culture in the NHS The ‘3 word summary’ words from the main participants in the focus groups and interviews were grouped to assess the most commonly used words. These were: Hierarchical (x 9); Defensive (x 6); Bullying/harassing (x 6); Top down (x 5); Bureaucracy/bureaucratic (x 5); Variable (x 5); Control (x 5); Oppressive (x 4); Pressure/pressured (x 4); Not/un-caring (x 4); Lack (x 4). Framework Themes Fourteen Framework Themes were identified: Structure/form/groups; Positive characteristics; Hierarchical/top down/power; Bureaucracy/policy; Finance/business/targets; Change/variable; HR/other roles; General lack/dysfunction; Raising concerns/communication; Negative behaviour; Self-interest/relationships; Scenario; Selective moral disengagement/ego-defences; and Actions Extended model of organisational dysfunction Based upon the findings the model has been extended and developed to reflect the specific characteristics of the NHS (Pope, 2015, p.15).
The ‘Good news factory’ A conversation with a risk manager after a focus group contributed to the title of the doctoral thesis: "The NHS: A health service or a "good news factory"?" The conversation reflects several of the Framework Themes. “It is very tempting to join the club and be part of the ‘good news factory’. I dip in and out of that. Trying to protect the organisation, but also trying to protect the interests of patients and staff as an advocate…They [Directors] don’t care about anything else as long as not reported.” R “Talk a bit more about the ‘Good news factory’. Is that a term you use normally?” “Not used it before. It’s like, no... Somebody told me, ‘iced cake syndrome’. Lovely on the outside, mouldy on the inside. Part of a culture being led by the government. Present a pretty picture fed up to the voters. Underneath it’s a bit of a shambles.” R “Mid Staffs – How did Mid Staffs happen?” “I don’t know much about that, but kidded themselves. We do it a lot. We cannot bear doing any more work putting it right, so much to do, almost go into denial. It’s like... there is some power wielding person, like a Hitler figure, going to do something really nasty to them. Under great threat. Something really, really nasty. Why don’t people say no?” R “It’s like one person said, why don’t people push back?” “Only interested in themselves, in the next job. People are very short term at that level, looking for the next job” When another focus group of NHS managers was asked to give their opinion on there being a “…good news factory” one person said, “It’s a ‘stopping bad news factory’…rather than ‘good news’”. This person also thought that “There are many cultures within NHS organisations, but a common denominator with each is defensiveness”. A ‘Self perpetutating dysfunctional system’ One participant described the NHS as a “self perpetuating dysfunctional system”. “So that is the sort of culture we have got. And then people who don’t enjoy that sort of culture or cannot thrive in that sort of culture, or even break down in that sort of culture… move out. And so you have this Darwinian selective pressure and then only the ones who enjoy or thrive in that sort of environment, stay, and become managers and move on up the hierarchy. So it is a self perpetuating dysfunctional system” Conclusions "There seem to be “islands” and “pockets” with a positive culture; however, the generalised evidence suggests the NHS is systemically and institutionally deaf (with its fingers stuck in its ears, humming loudly), bullying, defensive and dishonest, exhibiting a resistance to ‘knowing’, denial and “wilful blindness”; a dysfunctional, perverse and troubled organisation. Corrupt and unethical behaviour has been identified, as have totalitarian and Kafkaesque characteristics. The NHS could also be described as a coercive bureaucracy and under certain definitions, a corrupt entity. The NHS appears to be an organisation with a heart of darkness; a “...self perpetuating dysfunctional system” where there is the perverse dynamic of “...survival of the unfittest”. There may be widespread “learned helplessness”. Overall, the needs of the NHS and the protection of image appear more important than the welfare of staff or patients. It does seem to be a “...good news factory”; rejecting and hiding any “bad news”; retreating from reality. The NHS appears to have “lost its way” and its focus/purpose as an institution. Negative behaviour is one of many ‘Elephants in the room’ in the NHS". "The behaviours can be extremely destructive and dangerous. This is particularly seen in situations such as the Mid Staffordshire trust. Both patients and staff can be extremely damaged. Everything possible should be done to address these problems to protect the welfare of patients and staff. There is an urgent need to very consciously and determinedly move counter culturally. There has got to be a healthy level of individual and collective narcissism. The NHS needs to embrace the identity of being a listening, learning and honest organisation" (Pope 2015, p.19). There needs to be a culture of respect. "A culture of respect is a ‘precondition’ for the changes needed to make health care safe" (Leape et al, 2012, Part 2, p.1) |