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Wednesday, 20 January 2016 16:14

Culture change is no change

Written by Alex Fox
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A while ago a wrote three blogs about three ways to avoid real change. Here’s a fourth: talk about the change we need as being ‘a culture change’. Most the most profound and important changes we need to see in public services, we describe as ‘culture changes’. Things like the need for the NHS to be patient-centred (who was it centred on before?); the end to covering up mistakes and blaming other people (‘blame culture’); a shift towards focusing on what people can do and their individuality, not what they can’t do and the label we’ve given them.

What do we mean by ‘culture change’? Generally, it’s code for a change we don’t think will happen and that we don’t think is our fault when it doesn’t. Culture is elusive and dispersed throughout an organisation. Enlightened leaders recognise that they can influence culture by setting the right tone, but in reality culture is always, always trumped by the hard levers and incentives in any system. There is no point in setting a vision based on the culture change of personalising services, if the financial realities of the system are all about lowest unit cost, highest throughput and gatekeeping scarce resources. No point wishing for a no blame culture, if whistle blowers are routinely ignored or bullied.

So Culture is elusive and dispersed. Power on the other hand, is not elusive, and rarely dispersed. It’s generally concentrated in a few easy-to-spot people. It correlates closely to money: the biggest budget centres; the biggest salaries. There may be culture changes which can’t be achieved through power changes, but I can’t think of any. No-blame culture happens when staff and people using services have real power to identify problems and make changes. Services become more tailored when they are designed by the individuals using them. Dignity relies on services being paid for outcomes and good experiences, not lowest unit cost. Systems become person-centred when people with lived experience share in the money through real jobs.

So next time someone in power suggests a culture change is needed, perhaps the appropriate question is, “So how are you going to give your power to someone else, to start that happening?”

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