Developing Practice through Collaborative Working

Developing Practice through Collaborative Working

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Given that an attempt is to be made at a cultural transformation within healthcare providers (as it surely is within the NHS with the advent of clinical governance. Several valuable cultural traits already exist in the NHS on which any new quality strategy can build, most notably a commitment to equity and belief in the founding principles—that is, a universal comprehensive service available to all without regard to ability to pay(5). More recent helpful values that are beginning to emerge include, for example, the centrality of patient care, a belief in evidence, and a growing willingness to examine quality issues, although these values may be conceptualised rather differently by different professional groups. Thus, any strategy for cultural change should be selective, aiming for a balance between continuity and renewal, identifying those cultural aspects to keep and reinforce, and those which need to be reworked (Barrett 2005).

Assumptions are the basic “taken for granted” views of the world and how one can understand and intervene in it—that is, ontology and epistemology. For example, medical research has traditionally been predicated on the use of rational scientific methods as the basis of generating and accumulating knowledge (controlled trials rather than qualitative and interpretative methods). Thus, assumptions about measurability, aggregation, and transferability of knowledge are deeply ingrained in medical care.

The gradual acceptance of the management culture in the NHS. Newcomers to an organisation may bring with them prior expectations about the culture when they join, but culture is also transmitted to new arrivals by established staff, sometimes explicitly but more often implicitly. The organisational culture is shaped and articulated not just by individuals but also by new and old organisational features. The organisational structures, routines, command and control expectations, and operational norms all have influence.

Rituals and Routines: Values constitute the basic foundations for making judgements and distinguishing “right” from “wrong” behaviour. In the medical profession conduct has traditionally been based on the Hippocratic principle of placing the needs of individual patients above broader economic and corporate objectives; this, in turn, has led to clinical freedom being a highly prized cultural “value” (Carnwell & Buchanan 2005). Artefacts include the physical and behavioural manifestations of culture. In the medical profession these may include such diverse issues as dress codes (the doctors' ubiquitous white coat and tie), standard ways of running services (the physician's beds, the surgeon's list, juniors attached to seniors), or methods of performance assessment (the dominance of confidential peer review, the reliance on professional self-regulation).

Organizational Structure: The structure of the NHS can seem very confusing. NHS North East is the strategic health authority (SHA) for North East of England, one of ten SHAs across the country. SHAs plan health care for the population of the region they cover and are responsible to the Department of Health. Strategic health authorities are responsible for the performance of NHS organisations known as trusts. This includes primary care trusts (PCTs), acute trusts, mental health trusts and ...