Human Resource Management - Organizational Culture & Organizational Leadership Effectiveness

PROFESSIONAL ISSUES

British Journal of Nursing, 2015, Vol 24, No 12 633

© 2

01 5

M A

H ea

lt h ca

re L

td

Influencing organisational culture: a leadership challenge

R obert Francis QC, a barrister with extensive experience in clinical negligence claims, led a public inquiry into why poor care at the Mid Staffordshire NHS Foundation Trust in the UK between January

2005 and March 2009 resulted in the unnecessary deaths of up to 1200 people. In February 2013, his final report on the commissioning, supervisory and regulatory bodies, and their role in monitoring Mid Staffordshire hospital between January 2005 and March 2009, was published (Francis, 2013). The document and its 290 recommendations are built on Francis’s earlier report on the findings of the independent inquiry on the failings in the Mid Staffordshire NHS Foundation Trust (Francis, 2010). The first report focused on failings within the trust itself and concluded that patients were routinely neglected by an inward-looking trust preoccupied with savings, targets and processes at the expense of its fundamental responsibility to provide safe and effective care to patients. The second report highlighted the need for a culture across the NHS whereby patients are the first and foremost consideration of the system and all those who work in it.

In the wake of Francis, the need for NHS trusts and hospitals to adopt a culture of learning, safety and transparency were themes running through three important subsequent publications. The Berwick report (2013) made recommendations ‘from board to bedside’ on how to address patient safety in the NHS. The Keogh review (2013) into the 14 NHS trusts and NHS Foundation trusts identified as having higher than average mortality rates highlighted areas of action to address issues of safety and quality of care. The Department of Health (DH) publication Hard Truths: The Journey to Putting Patients First (DH, 2013) underlines the importance of seeing everything from the patient’s perspective, the need for transparency, having a learning culture and accountability as key messages for all staff working in the NHS.

The major regulatory organisations have published statements in response to the Francis Report and all trusts in England have formulated action plans to prevent such events happening

Ann Muls, Lisa Dougherty, Natalie Doyle, Clare Shaw, Louise Soanes, Anna-Marie Stevens

again. While the Francis Report is important for all professional groups represented in health care, nursing care lies at the heart of our healthcare system’s ability to thrive—but also, as has been seen, to fail. This article will reflect on the importance of leadership in health care and how organisational culture plays a significant role in ensuring patient safety and in implementing the recommendations of the Francis Report.

The Francis Report

‘It is a truism that organisational culture is informed by the nature of its leadership. The Department of Health has an important leadership role to play in promoting the change of culture required throughout the healthcare system.’ (Francis, 2013: 64)

There is consensus that patients and their families were badly let down by the failures of care at the Mid Staffordshire NHS Foundation Trust. To prevent it happening again, a proactive as well as a reactive response to cultural change is called for. This is no time to be complacent. The introduction of the Statutory Duty of Candour (DH, 2014) is seen as a mechanism to support cultural change, particularly for providers who have not fully embedded a bottom-up approach to openness and transparency as part of a continuous improvement processes (Care Quality Commission (CQC), 2014).

To evolve in response to society’s healthcare needs, all provider organisations need to engage in a variety of ways to ensure that care and services are high quality, safety focused, culture sensitive and responsive to the needs of patients. Jane Cummings’, Chief Nursing Officer (CNO) for England at

Ann Muls, Macmillan Nurse Consultant (GI consequences of cancer treatment); Lisa Dougherty, Nurse Consultant (IV therapy); Natalie Doyle, Nurse Consultant (Living with and beyond cancer); Clare Shaw, Consultant Dietitian; Louise Soanes, Teenage Cancer Trust Nurse Consultant for Adolescents and Young Adults; Anna-Marie Stevens, Macmillan Nurse Consultant (Palliative care); Royal Marsden NHS Foundation Trust, London

Accepted for publication: June 2015

Abstract In the wake of the Francis report, the need for NHS trusts and hospitals to adopt a culture of learning, safety and transparency has been highlighted. This article considers different aspects of culture in health care, and hones in on the link between culture and safety for patients in putting the patient first, embedding the 6Cs and considering the options to measure and influence organisational culture. The article reflects more deeply on how leadership across all levels can influence and inspire change in organisational culture, ensuring that the patient remains the focus of any changes in care delivery.

Key words: Organisational culture ■ Health care ■ Leadership ■ Influencing change ■ 6Cs ■ Schwartz rounds

634 British Journal of Nursing, 2015, Vol 24, No 12

© 2

01 5

M A

H ea

lt h ca

re L

td

the NHS Commissioning Board, work in shaping the 6Cs in health care—care, compassion, competence, communication, courage and commitment (Table 1)—reflects aspects that are

equally important in the vision and strategy for leadership in nursing, midwifery and care staff (Cummings, 2012). Health professionals must set aside time to pause and look at what they do and how they do it, and, if necessary, to change the way they do it for the sake of better outcomes. Embedding the 6Cs in health care is fundamental to this process. This article considers some of the initiatives available to do this.

Culture in health care The word ‘culture’ is mentioned 486 times in the full Francis Report. Although the report does not give a broad definition of culture, it does describe a positive culture and outlines what an undesirable culture looks like (Figure 1).

The Francis Report highlights the need for organisations to create and maintain the right culture to deliver high-quality care that is responsive to patients’ needs and preferences. Francis describes a positive culture as ‘a shared positive safety culture’ (Francis, 2013: 1357) (Figure 2). Several initiatives throughout the NHS, such as the ‘Sign up to safety’ and ‘Freedom to speak up’ campaigns and the inspections led by the CQC, have resulted in the promotion of a culture of openness, learning, and professional and institutional humility as the bedrock of safe care (DH, 2015).

Linking culture and safety: putting the patient first There is an overall agreement in the literature that the concept of organisational culture is complex, diverse and not well-defined (Scott et al, 2003a; Davies and Mannion, 2013). However, a plethora of studies discuss various aspects of organisational culture relating to safety and safety culture (Cox and Cox, 1991; Guldenmund, 2000; Scott et al, 2003b); Hudson et al, 2009; Singer et al, 2009; Carillo, 2012; Davies and Mannion, 2013). This concept comes from industry and has been adopted in health care. Safety culture is the way by which safety is managed in the workplace and often reflects ‘the attitudes, beliefs, perceptions and values that employees share in relation to safety’ (Cox and Cox, 1991: 93). Safety culture within health care comprises multiple distinct dimensions or domains (Hudson et al, 2009). The notion that organisational culture is just one part of the many pieces that make up the puzzle of public-sector organisations is an important one (Jung et al, 2009).

Appeals for a shift in culture in health care are based on the belief that culture is correlated with organisational performance. There is some evidence to suggest that organisational culture may be a relevant factor in healthcare performance, yet articulating the nature of that relationship is difficult. Simple statements such as ‘strong culture leads to good performance’ are not supported. Instead, the evidence suggests a more contingent relationship, in that those aspects of performance valued within different cultures may be enhanced within organisations that exhibit those cultural traits (Scott et al, 2003b; Singer et al, 2009).

The Francis Report calls for a common and shared culture. It specifies that patient safety should be a priority at all times. However, culture in a large organisation is seldom uniform and subcultures do exist (Morgan and Ogbonna, 2008; Davies and Mannion, 2013). Morgan and Ogbonna (2008) found

Unhealthy Of blame

Passivity and

habituation

Of poor record

keeping

Of denial

Of neglect and

disregard

ScepticalNo self- analysis

Abnormal

Inward- looking

Closed

Tolerance of poor practice

Target- driven

Culture

Figure 1. Aspects of an undesirable organisational culture

Table 1. The 6Cs explained

Care Our core business and that of our organisations, and the care we deliver, helps the individual person and improves the health of the whole community. Caring defines us and our work. People receiving care expect it to be right for them, consistently, throughout every stage of their life.

Compassion How care is given through relationships based on empathy, respect and dignity—it can also be described as ‘intelligent kindness’ and is central to how people perceive their care.

Competence All those in caring roles must have the ability to understand an individual’s health and social needs, and the expertise, clinical and technical knowledge to deliver effective care and treatments based on research and evidence.

Communication Central to successful caring relationships and to effective team working, listening is as important as what we say and do and essential for ‘No decision about me without me’. Communication is the key to a good workplace with benefits for those in our care and staff alike.

Courage Enables us to do the right thing for the people we care for, to speak up when we have concerns, to have the personal strength and vision to innovate, and to embrace new ways of working.

Commitment A commitment to our patients and populations is a cornerstone of what we do. We need to build on our commitment to improve the care and experience of our patients, to take action to make this vision and strategy a reality for all, and to meet the health, care and support challenges ahead.

(Department of Health, 2012)

PROFESSIONAL ISSUES

British Journal of Nursing, 2015, Vol 24, No 12 635

© 2

01 5

M A

H ea

lt h ca

re L

td

that there are only two united views held by NHS staff across different settings and disciplines: the need for care to be based on individual need rather than funding; and a dislike of constant interference by successive UK governments into healthcare provision. In general, the notion of shared values is over- emphasised and over-simplified (Morgan and Ogbonna, 2008).

It is recognised that several values compete at different levels and in different professional groups. Organisational culture differentiates across two dimensions: an emphasis on stability, order and control, versus an emphasis on flexibility, discretion and dynamism. Four basic organisational cultural types can be distinguished. Over time (2001–2008), the NHS has moved from a predominantly ‘clan’ culture towards a more ‘blended’ culture, adding more attributes of developmental, hierarchical and rational cultures into the mix (Jacobs et al, 2013). This begs the question of whether the concept of a shared organisational culture needs to include core aspects correlating to the code of conduct for health professionals in general, yet simultaneously reflect subcultural attributes and dynamics.

As the definitions of both ‘organisational culture’ and ‘culture barometer’ are open to consideration, there is an opportunity to reflect the notion that organisational culture manifests itself in different ways and has several components at its core, but, at the same time, is part of something bigger.

Carillo (2012) opens her article with a candid reflection:

‘Maintaining safety as a priority in people’s minds is a leadership challenge.’ (Carillo, 2012: 35)

Several organisational influences, such as leadership style, supervisor involvement and communication systems, determine the importance allocated to safety (Carillo, 2012).

As change is continuous, static approaches such as rules and procedures do not influence priorities, and how people interact within and across departmental lines is an indicator of the organisation’s ability to prevent failure (Carillo, 2012). This is reflected in four common characteristics that can unlock an organisation’s potential: confidence, curiosity, connectedness and compassion (Hadridge and Pow, 2008).

Learning as an organisation, collectively, requires creativity, flexibility and adaptability to an ever-changing reality, whether this be financial, structural, educational or service- development related (Malby, 2007). A dynamic approach to developing character strengths that include creativity calls for investment and commitment on an intellectual, social and emotional level. A response as an innovative connector, rather than an isolated competitor, enhances diversity, increases social resource and results in attracting the right people for the job (Kramer, 2013). Perseverance and grit (defined as ‘perseverance and passion for long-term goals’ (Duckworth et al, 2007: 1087) are shown to correlate with achievement and retention, and are, alongside creativity, very important qualities in leadership (Hokanson and Karlson, 2013).

A brain-based model for collaborating with and influencing others explains that understanding the drivers of human social behaviour brings insights that can be applied in practice. The ‘SCARF’ model (Rock, 2008) involves five domains of human social experience: status (relative importance to others); certainty (being able to predict the future); autonomy (a sense of control over events);

relatedness (a sense of safety with others); and fairness (a perception of fair exchanges between people).

Two themes emerge when thinking of human social behaviour in this way. First, much motivation that drives our social behaviour is governed by an overarching principle of minimising threat and maximising reward (Gordon et al, 2008). Second, several domains of social experience draw on the same brain networks to maximise reward and minimise threat as the brain networks used for primary survival needs (Lieberman and Eisenberger, 2008). A mind set of constant awareness and inquiry is the strongest preventative measure against missing the signs of when things go wrong (Weick et al, 1999). The Francis Report showed that warning signs were present, but ignored. In embedding the 6Cs, the improvements in openness and transparency, as endorsed by the Duty of Candour (DH, 2014), can become interlinked.

How can we measure organisational culture? Several consultancy agencies suggest a variety of tools to assess the culture within an organisation and their scope is varied (Scott et al, 2003a; Smith, 2013). Reviews have highlighted that there are no published, widely accepted criteria for comparing and contrasting existing survey tools. The tools vary greatly, with some looking specifically at the culture itself, and others aiming to identify and assess existing culture as well as modifying culture with the aim of aligning ‘high-performance’ or successful organisations. The tools may aim to assess a variety of predefined categories or domains of organisational culture (Singla et al, 2006; Jung et al, 2009).

Different methodologies to collect information on the organisational culture are used. Self-reported questionnaires range from a structured approach to the gathering of more unstructured data, including emergent ethnographic

Shared values

Recognising staff for their contribution

Empowering front-line staff

Zero-tolerance for substandard

care

Safe care delivery

Professional responsibility

Patient- centred care

Figure 2. Aspects of a shared, positive safety culture

636 British Journal of Nursing, 2015, Vol 24, No 12

© 2

01 5

M A

H ea

lt h ca

re L

td

approaches obtained from qualitative research paradigms. The latter methodology has been identified as generating data on the underlying values, beliefs and assumptions that influence the cultural dynamics within an organisation. A more structured approach has, perhaps in more recent years, provided more information from a large sample of participants, but has been criticised for its more rigid approach and the use of predetermined categories within the tools used, thereby limiting the information gleaned.

When considering whether to use a tool to assess organisational culture in practice, it is important to ask what the purpose of the assessment is and how to translate and use this information in clinical practice (Jung et al, 2009).

The choice of the most suitable tool must be based on the underlying intention of assessing culture in an organisation, the personal perspectives of those assessing culture, in addition to the resources available.

A tool such as the cultural barometer has been suggested as a way forward to raise awareness of factors influencing organisational culture throughout the NHS. A cultural barometer is proposed as a tool to give the employed health professional the chance to assess the resources and support available for the job; how worthwhile it is; and what opportunities there are for improving teamwork. This is combined with a request that he or she records actions the employee could take in respect of these matters, thus reinforcing personal professional responsibility for the standards applied and the value placed on personal contribution (Francis, 2013). Two specific recommendations (2 and 198) in the report mention the use of the cultural barometer as a tool to achieve this, and its use is recommended on a trial basis.

The 6Cs Culture is shaped by the language that we use. Jane Cummings and Viv Bennett (Director of Nursing at the Department of Health) shaped the 6Cs (DH, 2012). The 6Cs reflect aspects that are each equally important in the vision and strategy for leadership in nursing, midwifery and care staff. In 2014, the initiative was rolled out to allied health professionals, doctors and non-clinical staff, as it embraces the values of a high- quality care environment (Stephenson, 2014).

The values and behaviours covered by the 6Cs are not new; but putting them together to define a vision for building and strengthening leadership in health care reinforces the values and beliefs that underpin care, wherever it takes places.

Role of leadership in health care The role of leadership in health care is pivotal and has been addressed by a number of health professions. The Point of Care Foundation (2014) highlights the need to accelerate change and the role of leadership. The NHS Leadership Academy has developed a Healthcare Leadership Model with nine dimensions supported by appropriate tools and resources, encouraging professionals to develop their leadership skills and consider the implications for the safety and quality of the service they provide (NHS Leadership Academy, 2013). The Berwick report (2013) also clearly outlines leadership at every level throughout the NHS, and asserts that:

‘Cultural change and continual improvement come from what leaders do.’ (Berwick, 2013: 16)

Allied health professions have been encouraged to be involved in the ‘Big Conversation’ about professionalism and professional behaviour (Hughes, 2012; Middleton, 2012). The aim of this is to encourage discussion and debate within departments (communication); create an environment where unprofessional behaviour is challenged (courage and competency); and where professional behaviour is supported despite the presence of external challenges (commitment). Discussion across professional groups provides additional debate, enhances collective learning and ultimately feeds into the culture of an organisation.

Leadership is not limited to nursing and evidently includes all professions in health care. However, from a nursing and allied health care perspective, the role of senior staff members is essential to ensuring that a ‘culture of leadership’ filters through all levels in the healthcare system. Leadership development should focus on developing individual performance in order to improve the performance of the team, organisation or system, and should include all staff (The King’s Fund, 2013).

By connecting the 6Cs of nursing and the issues about professionalism in allied health care to the knowledge and skills framework, it is apparent that all six core domains of this framework—communication; personal and people development; health, safety and security; service development; quality; equality, diversity and rights—offer leaders in health care the opportunity to influence culture through a wide variety of ways (NHS Staff Council, 2010). Leaders in health care are both the architects and the products of organisational culture (Malby, 2007). One could add that the leaders in health care today are the designers of our health care for the future.

In health care, the quality of relationships among staff members correlates with the quality of care delivered (Carillo, 2012). This includes basic communication but also courage and compassion, in addition to awareness of the unexpected and remaining mindful that personal expectations limit one’s ability to see reality. Personal expectations also influence the process of gaining knowledge through experience and through interactions with experienced individuals; the ability to interpret data accurately; and the ability to act on the data to adjust conditions. Such themes were explored in the seminal work about emotions in the workplace—The Managed Heart by Arlie Russell Hochschild (1983). This book established the concept of emotional labour and describes the emotionally draining process of managing one’s emotions in the service of a job or organisation. Often, people are required to express an emotion that they simply do not feel, or not to express one that they do feel (Ashkanasy et al, 2009).

Conversations in which divergent perspectives are heard and result in the correct action require commitment, time investment, listening skills, and openness to different viewpoints. Maintaining trust and open communication requires constant reinforcement (Carrillo, 2012). Creating an inclusive environment is a prerequisite for enabling open communication and links in with mindfulness (Ross, 2011).

PROFESSIONAL ISSUES

British Journal of Nursing, 2015, Vol 24, No 12 637

© 2

01 5

M A

H ea

lt h ca

re L

td

Behavioural observation, as encouraged by allied health professionals, is based on reinforcement theory and is designed to encourage the development of safe behaviour and professionalism. However, without ongoing interaction, assessment and vigilance, the behaviour may revert to poor practice (Carillo, 2012). Relationship psychology proposes that people decide what they believe according to conversations with people they trust, which helps with making sense of a complex situation (Weick, 2013).

Not recognising the trade-off when shortcuts are taken, or making exceptions without thorough communication, may ultimately influence priorities and compromise safety (Carrillo, 2012). Collaborative learning is key (Singer and Edmondson, 2006).

Inspiring change Organisational culture has been referred to as an anthropological metaphor used to inform research and to explain organisational environments (Parmelli et al, 2011). There has been an increased focus on reviewing the cultural environments that healthcare staff work within, with the aim to change cultures and, where necessary, to improve healthcare performance. It is recognised that healthcare cultures, where values mirror an environment that encourages staff to feel part of a group, promotes teamwork and coordination, sustained levels of quality improvements, and delivers high-quality compassionate care (Scott et al, 2003a; DH, 2009). Culture cannot easily be dictated; it develops over time as an adaptation to conditions and brings desired results (Carroll and Quijada, 2004). Ensuring that staff are part of the vision of an organisation and understand the meaningful consequences of any organisational change includes all the concepts of the 6Cs. This is crucial in ensuring that change is necessary, otherwise staff will believe that current practices are acceptable and change is not needed.

One way of achieving collective learning that feeds into the culture of an organisation is by generating discussion across professional groups through ‘Schwartz rounds’—meetings that provide an opportunity for staff from all disciplines across the organisation to reflect on the emotional aspects of their work. Several organisations in the UK have set up these rounds on a monthly basis, with the focus on fostering healing relationships, providing support to professionals, enhancing communication between caregivers, and improving the connection between patients and caregivers (Penson et al, 2010; Goodrich and Cornwell, 2012; Pepper et al, 2012).

Various models have been developed to guide and understand change (Brown, 1998). If it is agreed that to improve healthcare performance it is necessary to look at changing the culture within an organisation, consideration must be given to the best way to do this. A systematic review of the effectiveness of strategies to change organisational culture recognised over 4000 articles within the authors’ search terms (Parmelli et al, 2011). Out of those 4000 articles, selection criteria only identified two articles suitable for inclusion in the review. The two articles, while reporting positive outcomes, were, according to Parmelli et al (2011), at risk of bias. The authors suggested that before implementing any strategies to support organisational change in culture,

an evaluation using a robust design should be considered. Leadership, which is addressed within this article, is key when engineering change of organisational culture.

Conclusion This article has focused on how organisations have been affected by the Francis Report and how it has enabled the leaders within them to reflect on their own organisational culture and its bearing on patient safety. A commitment to share a culture of safety among all health professionals assures that the patient remains the focal point of any changes in care delivery. Many research papers highlight the complexity of organisational culture and of how to measure it.

The organisation, in its learning, needs to ensure leaders hold the shared values of a culture of zero tolerance for substandard care, and work towards empowering staff to report poor practice and recognise their contributions towards good care by creating an environment conducive to collective leadership and embedding the 6Cs.

How organisational culture is measured, and how that information is used to guide leaders in health care to start a continuous process of improvement, needs to be carefully considered. A shared set of values and a shared purpose is more important than small differences in subcultures that exist in any organisation.

Fostering leadership at every level throughout the organisation, and creating capacity to develop future leaders by investing in programmes to support this, highlights the education and ongoing development aspect of health care. If, as leaders we can embed the 6Cs into our practice, this will allow us to build and strengthen leadership throughout healthcare organisations for the benefit of patients and staff. BJN

Conflict of interest: none

Ashkanasy N et al (2009) Developing leaders: teaching about emotional intelligence and training in emotional skills. The SAGE Handbook of Management Learning, Education and Development. Armstrong SJ and Fukami CV, eds. Sage, Thousand Oaks, CA

Berwick D (2013) A promise to learn – a commitment to act. Improving the Safety of Patients in England. http://tinyurl.com/q6a7zkh (accessed 11 June 2015)

Brown A (1998) Organisational Culture. 2nd edn. Pitman Publishing Carrillo R (2012) Relationship-Based Safety Moving Beyond Culture &

Behavior. Professional Safety 57(12): 35 Care Quality Commission (2014) Regulation 5: Fit and proper persons: directors and

Regulation 20: Duty of candour – Guidance for NHS bodies. http://tinyurl.com/ nbsz62e (accessed 11 June 2015)

Carroll J, Quijada M (2004) Redirecting traditional professional values to support

KEY POINTS

n The Francis Report suggests using a cultural barometer to measure organisational culture and its impact on patient care

n The concept of organisational culture is complex, diverse and not well-defined, and comprises a wide variety of domains

n Leadership is not limited to nursing and includes all professions across all levels in health care

n Schwartz rounds focus on fostering healing relationships and provide support to health professionals in order to enhance communication between caregivers and improve the connection between caregivers and patients

638 British Journal of Nursing, 2015, Vol 24, No 12

© 2

01 5

M A

H ea

lt h ca

re L

td

safety: changing organizational culture in health care. Qual Saf Health Care 13(Suppl 2): ii16–ii21

Cox S, Cox T (1991) The structure of employee attitudes to safety – a European example. Work and Stress 5(2): 93–106

Cummings J (2012) Developing our culture of compassionate care. NHS England. http://tinyurl.com/oahbyuy (accessed 11 June 2015)

Davies H, Mannion R (2013) Will prescriptions for cultural change improve the NHS? BMJ 346: f1305

Department of Health (2009) NHS Health and Wellbeing Review – Interim Report. DH, London

Department of Health (2012) Compassion in Practice. Nursing, Midwifery and Care Staff. Our Vision and Strategy. http://tinyurl.com/c5lc4n2 (accessed 15 June 2015)

Department of Health (2013) Hard Truths: The Journey to Putting Patients First. http://tinyurl.com/pufpdqc (accessed 11 June 2015)

Department of Health (2014). Introducing the Statutory Duty of Candour. http://tinyurl.com/pru8wlf (accessed 11 June 2015)

Department of Health (2015) Culture change in the NHS: Applying the lessons of the Francis Inquiries. http://tinyurl.com/ny4zdvs (accessed 11 June 2015)

Duckworth A, Peterson C, Matthews M, Kelly D (2007) Grit: perseverence and passion for long-term goals. J Pers Soc Psychol 92(6): 1087–101

Francis R (2010) The Mid Staffordshire NHS Foundation Trust Inquiry. http:// tinyurl.com/lrh42ch (accessed 11 June 2015)

Francis R (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. http://tinyurl.com/bkgyem7 (accessed 11 June 2015)

Goodrich J, Cornwell J (2012) The contribution of Schwartz Center Rounds to hospital culture. The King’s Fund. http://tinyurl.com/nsvhogj (accessed 17 June 2015)

Gordon E, Barnett KJ, Cooper NJ, Tran N, Williams LM (2008) An ‘integrative neuroscience’ platform: application to profiles of negativity and positivity bias. J Integr Neurosci 7(3): 345–66

Guldenmund F (2000) The nature of safety culture: a review of theory and research. Safety Science 34: 215–57

Hadridge P, Pow R (2008) What the NHS needs to improve: four behaviours to sort out the health system. J R Soc Med 101(1): 7–11

Hochschild AR (1983) The Managed Heart: Commercialization of Human Feeling. University of California Press Ltd, London, England

Hokanson B, Kalrson R (2013) Borderlands: developing character strengths for a knowmadic world. On the Horizon 21(2): 107–13

Hudson D, Berenholtz S, Thomas J, Sexton J (2009) A safety culture primer for the critical care clinician. Contemporary Critical Care 7(5): 1–12

Hughes R (2012) Promoting professionalism: have you had the conversation? British Journal of Healthcare Assistants 6(4): 198

Jacobs R, Mannion R, Davies H, et al (2013) The relationship between organisational culture and performance in acute hospitals. Soc Sci Med 76(1): 115–25. doi: 10.1016/j.socscimed.2012.10.014

Jung T, Scott T, Davies H, et al (2009) Instruments for the Exploration of Organisational Culture. http://tinyurl.com/n86lmnv (accessed 11 June 2015)

Keogh B (2013) Review into the quality of care and treatment provided by 14 hospital trusts in England: overview report. http://tinyurl.com/p3cypjn (accessed 11 June 2015)

King’s Fund (2013) Patient-centered leadership: Rediscovering our purpose. http:// tinyurl.com/okqdrb7 (accessed 15 June 2015)

Kramer A (2013) Ready for the future: the four principles of nomadic learning in organisations. On the Horizon 21(2): 149–57

Lieberman M, Eisenberger N (2009) Pains and pleasures of social life. Science

323(5916): 890–1. doi: 10.1126/science.1170008 Malby B (2007) How Does Leadership Make a Difference to Organisational Culture

and Effectiveness? http://tinyurl.com/d2oqfef (accessed 11 June 2015) Middleton K (2012) Professionalism – The Big Conversation. http://tinyurl.

com/qbsm7bl (accessed 11 June 2015) Morgan P, Ogbonna E (2008) Subcultural dynamics in transformation: a multi-

perspective study of healthcare professionals. Human Relations 61(1): 39–65 NHS Leadership Academy (2013) The Healthcare Leadership Model – The nine

dimensions of leadership behaviour. http://tinyurl.com/qgxmn34 (accessed 15 June 2015)

NHS Staff Council (2010) Appraisals and KSF made simple – a practical guide. http://tinyurl.com/o8zqcoe (accessed 15 June 2015)

Parmelli E, Flodgren G, Beyer F, Baillie N, et al (2011) The effectiveness of strategies to change organisational culture to improve healthcare performance: a systematic review. Cochrane Database Syst Rev 2011; (1): CD008315. doi: 10.1002/14651858.CD008315.pub2

Penson R, Schapira L, Mack S, et al (2010) Connection: Schwartz Center Rounds at Massachusetts General Hospital Cancer Center. The Oncologist 15: 760–4. doi: 10.1634/theoncologist.2009-0329

Pepper JR, Jaggar SI, Mason MJ, Finney SJ, Dusmet M (2012) Schwartz Rounds: reviving compassion in modern healthcare. J R Soc Med 105(3): 94–5. doi: 10.1258/jrsm.2011.110231

Point of Care Foundation (2014) Staff care: How to engage staff in the NHS and why it matters. http://tinyurl.com/qjs3uyy (accessed 15 June 2015)

Rock D (2008) SCARF: a brain-based model for collaborating with and influencing others. http://tinyurl.com/nfvhpd2 (accessed 11 June 2015)

Ross R (2011) Creating an inclusive environment. Training Journal 7: 28–30 Scott T, Mannion R, Davies H, Mashall M (2003a) Implementing culture change

in health care: theory and practice. Int J Qual Health Care 15(2): 111–8 Scott T, Mannion R, Marshall M, Davies H (2003b) Does organisational culture

influence health care performance? A review of the evidence. J Health Serv Res Policy 8(2): 105–17

Singer S, Falwell A, Gaba D, et al (2009) Identifying organisational cultures that promote patient safety. Health Care Manage Rev 34(4): 300–11. doi: 10.1097/ HMR.0b013e3181afc10c

Singer S, Edmondson A (2006) When Learning and Performance are at Odds: Confronting the Tension. http://tinyurl.com/q5er2so (accessed 15 June 2015)

Singla A, Kitch B, Weissman J, Campbell E (2006) Assessing patient safety culture: a review amd synthesis of the measurement tools. J Patient Saf 2(3): 105–15

Smith S (2013). How to build a proactive safety culture. EHS. Accessed via: http://ehstoday.com/print/news/ehs_imp_36640.

Stephenson J (2014) NHS England to roll out ‘6Cs’ nursing values to all health service staff. Nursing Times online. http://tinyurl.com/obpvjgx (accessed 15 June 2015)

The Kings Fund (2011) Schwartz Center Rounds, Evaluation of the UK Pilots. The Kings Fund, London

Weick K, Sutcliffe K, Obstfeld D (1999) Organising for high reliability: processes of collective mindfulness. In: Sutton RS, Staw BM, eds. Research in Organizational Behavior. Volume 1. Jai Press, Stanford

Weick K (2013) Leadership When Events Don’t Play By The Rules. Stephen M Ross School of Business. http://tinyurl.com/ov3l7v9 (accessed 11 June 2015)

Clinical Leadership: Bridging the divide is relevant to clinicians of all professional backgrounds and for health care managers and policymakers. It aims to provide a better understanding of the key topics surrounding clinical leadership today and provides practical tips and advice on ways to make your organisation function better to deliver higher quality, more ef� cient patient care.

This book provides a comprehensive and inspiring overview of the knowledge, skills and behaviours required for effective clinical leadership today. It re� ects the growing emphasis on quality of care and clinicians’ role in building and running great services as outlined in the National Health Services’ Next Stage Review.

It is unique in that it is written by junior doctors who are all passionate to develop as leaders, in combination with senior leaders who have extensive experience of leadership.

ISBN: 978-1-85642-398-4; 234 x 156mm; paperback; 200 pages; publication 2009; RRP £19.99

Develop your clinical leadership skills

Order your copies by visiting www.quaybooks.co.uk

or call our Hotline +44(0)1722 716 935

edited by Emma Stanton, Claire Lemer and James Mountford

Clinical Leadership Bridging the divide

foreword by Professor the Lord Darzi of Denham

9 7 8 1 8 5 6 4 2 3 9 8 4

ISBN 1-85642-398-0

www.quaybooks.co.uk

Clinical Leadership: Bridging the divide will be relevant to clinicians of all professional backgrounds and for health care managers and policymakers. It aims to provide a better understanding of the key topics surrounding clinical leadership today and provides practical tips and advice on ways to make your organisation function better to deliver higher quality, more effi cient patient care. It was also written in the hope that it will shed light on many of the conundrums of the health service. This book is the fi rst to provide a comprehensive and inspiring overview of the knowledge, skills and behaviours required for effective clinical leadership today. It refl ects the growing emphasis on quality of care and clinicians’ role in building and running great services as outlined in the National Health Services’ Next Stage Review. This book is unique in that it is written by junior doctors who are all passionate to develop as leaders, in combination with senior leaders who have extensive experience of leadership. The authors are a group of specialist registrars, selected to participate in NHS London’s 2008 ‘Prepare to Lead’ scheme. Through this scheme, each junior doctor was matched with a senior leader from within the NHS who became their mentor. This book presents the challenges and lessons they encountered in their efforts to be effective future leaders.

“I believe this book will become essential reading for any clinician who wishes to learn more about leading within the NHS.” Professor the Lord Darzi of Denham Professor of Surgery, Imperial College London

C linical Leadersh

ip: B ridgin

g th e divide

edited by E

m m

a Stanton, C laire Lem

er and Jam

es M ountford

Clinical Leadership press.indd 1

29/10/09 17:36:56

Copyright of British Journal of Nursing is the property of Mark Allen Publishing Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.