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Title: Culture and behaviour in the English National Health Service : overview of lessons from a large multimethod study
Authors: Dixon-Woods, Mary
Baker, Richard
Charles, Kathryn
Dawson, Jeremy
Jerzembek, Gabi
Martin, Graham
McCarthy, Imelda
McKee, Lorna
Minion, Joel
Ozieranski, Piotr
Willars, Janet
Wilkie, Patricia
West, Michael
First Published: 9-Sep-2013
Publisher: BMJ Publishing Group
Citation: BMJ Quality and Safety, 2014, 23 (2), pp. 106-115
Abstract: Methods: Mixed-methods study involving collection and triangulation of data from multiple sources, including interviews, surveys, ethnographic case studies, board minutes and publicly available datasets. We narratively synthesised data across the studies to produce a holistic picture and in this paper present a highlevel summary. Results: We found an almost universal desire to provide the best quality of care. We identified many ‘bright spots’ of excellent caring and practice and high-quality innovation across the NHS, but also considerable inconsistency. Consistent achievement of high-quality care was challenged by unclear goals, overlapping priorities that distracted attention, and compliance-oriented bureaucratised management. The institutional and regulatory environment was populated by multiple external bodies serving different but overlapping functions. Some organisations found it difficult to obtain valid insights into the quality of the care they provided. Poor organisational and information systems sometimes left staff struggling to deliver care effectively and disempowered them from initiating improvement. Good staff support and management were also highly variable, though they were fundamental to culture and were directly related to patient experience, safety and quality of care. Conclusions: Our results highlight the importance of clear, challenging goals for high-quality care. Organisations need to put the patient at the centre of all they do, get smart intelligence, focus on improving organisational systems, and nurture caring cultures by ensuring that staff feel valued, respected, engaged and supported.
DOI Link: 10.1136/bmjqs-2013-001947
ISSN: 2044-5415
eISSN: 2044-5423
Version: Publisher Version
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © 2013, The Authors. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license (, which permits others to distribute, remix, adapt, build upon this work non commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
Appears in Collections:Published Articles, Dept. of Health Sciences

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