Leading by example: getting behaviours and culture right in the NHS

Leader dictionary definition

06 / 06 / 2014

Friday 6 June – 9.15am–10.15am

Many of those charged with leading the NHS recognise that the culture of many NHS organisations has to change. Much of the responsibility for shaping culture rests with leaders.

This seminar that the NHS Confederation's annual conference and exhibition 2014 explored the findings from a Department of Health-funded research programme on organisational culture in the NHS. 

Presented by Professor Micheal West, it highlighted some of the best examples of leaders who have created the right conditions in their organisations to foster compassion, promote leadership behaviours at every level and recognise that if they expect staff to treat patients with respect and dignity, staff must be managed in the same way too.


  • Professor Ian Cumming OBE, Chief Executive, Health Education England (seminar chair)
  • Professor Michael West, Professor of Organisational Psychology, Lancaster University

Key learning

  • Values-based recruitment is crucial -- don't employ or train those without the values we want to see in the NHS and leadership.
  • Culture is difficult to change without transforming leadership
  • Organisations need three main ingredients to create the right culture: an aspiring mission/vision; clearly aligned goals/priorities; and people management and engagement.

The presentation: main points

  • Professor West was clear that culture is important in NHS organisations, but it is difficult to change without transforming leadership. For leadership to be transformed, we need to have a strategy, a plan for recruiting and attracting the leaders we want. 
  • Leadership is a collective responsibility – everyone should be a leader.
  • Culture is created by leaders – leaders who tell staff that paperwork is more important than patients create a culture akin to that at Mid Staffs.
  • Organisations need three main ingredients to create the right culture:

    1) Aspiring mission/vision. Professor West said that Salford NHS Foundation Trust noted it was on its way to becoming the safest hospital in Britain and everyone in the organisation worked successfully towards that. Leaders need to be persistent in motivating staff towards a vision/mission, referring to leaders from board level to front-line staff.

    2) Clearly aligned goals/priorities with clear, measurable objectives.
    3) People management and engagement. If we want staff to treat patients with respect, leaders have to treat staff with respect. West added, the NHS is “a single ocean, how we interact with each other spreads across the system.”
  • Staff engagement is important for a healthy organisation: “staff engage if they feel people are leading fairly”. Leaders need to treat staff from every background the same, which is what we expect from staff and their treatment of patients. 
  • All leaders should propagate the same values.
  • If you want to attract the right leaders, you need to develop a leadership strategy:

    1) discover the leaders you want versus existing leaders in the organisation

    2) design how you are going to recruit those leaders

    3) deliver – get these leaders who will create the culture you want.

The debate: comments from the floor

A delegate remarked that culture at the top of the organisation is toxic – the Care Quality Commission (CQC) and Monitor are concerned with form-filling, not patient-centred leadership, they said.

CQC and Monitor need to recognise the need for leadership and formalise what we need from leaders if we want everyone in the NHS to lead in the way required to create a patient-centred culture where we deliver high-quality care for all. 

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