Organisational culture can have a profound impact on practice, says Jonathan Webster
Helping nurses develop their practice isn’t always easy. At times we can be faced with a problem that needs addressing - the outcome may appear obvious but the intended change may not achieve the result we were hoping for.
Staff may not see the “problem” as being a “problem”, or the need to change practice. I have often heard, “we’ve always done it this way, why change?” Evidence to support change may be clear; it may be related to improving patient safety or experiences of care, therefore why the need for debate? Surely, we all share the same goal?
Understanding how teams and organisations work is vital. Defining culture can be difficult, we can’t see it or touch it; however, workplace culture is fundamental to good or poor practice. Culture can be described as how things are thought about and done in a workplace by those within it (Royal College of Nursing, 2007).
Across an organisation there may be many different cultures - from one team to another. Culture is influenced by a number of factors, including the values and beliefs of team members. Does everyone share the same values and beliefs about patient care? In addition, how is leadership reflected in the team? Leaders should support, nurture and develop. Are care standards set and does the leader take action when these standards are not met? Does the leader enable the team to develop a vision for care that everyone owns? Do nurses feel able to challenge and question each other (irrespective of grade) in relation to care without feeling belittled or criticised?
Making sense of workplace culture is key to developing practice that aims to improve care. If we don’t understand it, we are gambling on the success of the change. The Team Culture Tool (Pritchard and Dewing, 2000) and Workplace Cultural Analysis Tool (McCormack et al, 2009) provide us with a framework to help make sense of this. There is also the need for skilled facilitation to help us work out what to do.
We shouldn’t feel frightened about developing practice that improves care; however, we shouldn’t underestimate the power of workplace culture. Understanding whether it supports and enables, or disempowers and weakens, what we are trying to achieve is key to embedding sustainable development in practice.
Tips for a supportive and enabling culture
● Create a vision of care, which reflects the values and beliefs of the team members
● Make sure that clinical leadership is visible and seen to uphold these values
● Be clear about your standards and take fast and decisive actions to uphold them
● Make sure everyone understands and agrees with the vision and keep checking in with them about this
● Create an environment that makes people feel able to challenge their peers
McCormack B et al (2009) Making practice visible: the workplace analysis tool. Practice Development in Healthcare; 8: 1, 28-43.
Pritchard E, Dewing J (2000) A multi- method evaluation of an independent dementia care service and its approach. Aging and Mental Health; 5: 1, 63-72.
Royal College of Nursing (2007) Workplace Resources for Practice Development. London: RCN.