Final Report > Chapter 22: The Culture of the NHS > The complexity of culture

The complexity of culture

9 It is important to avoid caricature when referring to `culture' and to be clear what the word is intended to convey. We take it to refer to those attitudes, assumptions and values which condition the way in which individuals and the organisation work. It is also helpful to bear in mind Professor Robert Dingwall's view [2] that organisational culture is a complex notion and something which is often resilient to change. One reason for this may be that its complexity lies in the coexistence of competing cultures. This is very much the case within the NHS, where the cultures, for example, of nursing, medicine and management are so distinct and internally closely-knit that the words `tribe' and `tribalism' were commonly used by contributors to the Inquiry Seminars on this subject.

10 The positive aspects of tribalism are clear. Tribalism engenders a sense of belonging, a set of common goals, a sense of mutual support. Moreover, competition between various tribes may be beneficial if it creates an environment of creative tension within the organisation. The danger of tribalism, of course, is that where there are numerous tribes it can threaten to undermine the capacity of a large organisation to adhere internally to a set of agreed core values and to represent these values to the outside world. Moreover, when tribal groups fall out, or disagree over territory in an organisation such as the NHS, the safety and quality of the care given to the patient is put at risk.

11 The way forward must lie in creating an environment of mutual understanding among the groups rather than attempts by one group to gain dominance over others. If one group dominates in a service which calls on the skills of many groups, the interests of patients are not served. Indeed, as Dr Terry McNulty argued, the creative management of the tension between competing cultures involves finding the common ground amidst the diversity of values, accepting this diversity as a given. [3]

Footnotes

[2] Seminar 3. Professor Robert Dingwall, Professor of Sociology, University of Nottingham. Points for Discussion

[3] Seminar 3. Dr Terry McNulty, Senior Lecturer in Organisational Behaviour, University of Leeds Business School. Position Paper