Division of Medical Education, University of Manchester, Oxford Road, Manchester, UK.
Department of Psychology, Manchester Metropolitan University, Birley Building, 53 Bonsall Street, Manchester, UK.
Int J Qual Health Care. 2019 Jul 1;31(6):492-494. doi: 10.1093/intqhc/mzy200.
Health and social care organizations continually face change to coordinate efforts, improve care quality and better meet patient needs in the context of growing pressure on services. NHS 'vanguard' teams funded to pilot organizational change in England have argued that alongside new structures, policies and governance, a shift in 'workplace culture' is needed to implement change. Although now defined in the literature and seen as an important driver of quality care, it was not clear what teams themselves meant when discussing workplace culture.
In a qualitative study nested in a wider behavioural science programme, 34 managers and frontline NHS staff took part in interviews and focus groups on the role and meaning of 'workplace culture' in their experience of change. Participants were from organizations in four NHS England vanguards implementing new models of care. Inductive thematic analysis revealed six interlinking themes: unity, emotions, support, consistency, openness to innovation and performance.
The term 'workplace culture' was nuanced and used in various ways. It was seen as a determinant, measure and/or consequence of change and linked to workplace behaviours, emotions and cognitions. Participants agreed that imposed top-down change in new models of care was a common cause of damaged culture and had knock-on effects on care quality, despite manager accounts of the importance of staff ideas.
Our findings suggest that exploring teams' own meanings of culture and behaviour change barriers, gathering ideas and co-developing tailored support would help overcome cultural challenges in implementing new models of care.
在服务压力不断增大的情况下，卫生和社会保健组织不断面临协调工作、提高护理质量和更好地满足患者需求的变革。在英格兰，获得资金支持以试行组织变革的国民保健制度（NHS）“先锋队”团队认为，除了新的结构、政策和治理之外，还需要转变“工作场所文化”，以实施变革。尽管现在在文献中已经对其进行了定义，并被视为优质护理的重要驱动因素，但团队在讨论工作场所文化时，并不清楚他们自己的意思是什么。
在一个更广泛的行为科学计划中嵌套的定性研究中，34 名经理和一线国民保健制度工作人员参加了关于“工作场所文化”在变革经验中的作用和意义的访谈和焦点小组。参与者来自英格兰 NHS 四个先锋队组织中正在实施新的护理模式的组织。归纳主题分析揭示了六个相互关联的主题：团结、情感、支持、一致性、对创新的开放和绩效。
“工作场所文化”一词含义微妙，用法多样。它被视为变革的决定因素、衡量标准和/或后果，并与工作场所行为、情感和认知有关。参与者一致认为，新护理模式中自上而下的强制性变革是破坏文化的常见原因，并对护理质量产生连锁反应，尽管经理们强调了员工意见的重要性。
我们的研究结果表明，探索团队自己对文化和行为变革障碍的理解，收集意见并共同制定定制支持，将有助于克服实施新护理模式的文化挑战。
