Abstract
Look around you and you might be surprised to learn that the culture of your hospital is changing. For years, policy wonks complained that the major barrier to improving clinical care and productivity was the intransigent culture of healthcare organizations. If you want to achieve change, the argument goes, change the culture.
Anybody who has run a business will probably support that view, but they may have achieved their ends through a ruthless clear out of staff so imbued with undesirable cultural traits that they will never change. Such drastic measures are generally difficult in the public sector, even if you accept that they might be right.
Management textbooks will persuade you that you can apply generic management or business rules to any organizational challenge. Yet some organizations and businesses are so complex that unless senior managers sufficiently understand the operational challenges, applying generic solutions is a fool’s errand.
One fundamental issue is that clinicians and managers relate to their hospital in very different ways. Senior clinicians are there for life, a fabric of the community, and motivated by the clinical outcomes of their patients. Managers are more transient, likely to transfer out at the first sniff of a better salary – or trouble – and motivated to meet the needs of the health service and economic targets.
Managers tend to be consumed by the challenge of cultural change. It is their route to success by focusing clinical colleagues on what’s important. But hospital managers are just as resistant to cultural change as the rest of us, as Gerry Robinson discovered in his exploration of Rotherham District General Hospital.
Indeed, the evidence of Mannion and colleagues published in this month’s JRSM demonstrates how senior hospital managers in England have adopted a ‘clan’ culture for much of this decade (
What that means in practice is unclear to me – and possibly even the researchers – but hospital managers now seem to be shifting to a ‘rational’ culture, which is competitive, acquisitive, and bonded by competition and an emphasis on winning.
A shift to a rational culture, explain Mannion and colleagues, is to be expected in a pro-market environment but has only just emerged. This change in the dominant culture of hospital management will mean that healthcare organizations will pursue more competitive strategies.
While this result will please politicians and policy-makers, the effects on professional behaviour, patient experience and clinical outcomes remain unclear. In a commercial organization, cultural change among the management would have a chance of trickling down throughout the ranks. But hospitals usually have two sets of leaders: managers and clinicians, and unless both adopt a common culture change is unlikely. Let’s end this managerial confusion. Clinicians with management skills should run hospitals. That’s cultural change for you.