In their latest revision of the Key Lines of Enquiry (KLOEs) for adult social care last November, the CQC strengthened the ones for ‘well-led’. This appears to reflect a growing recognition that strong management and leadership is key to providing a high quality and caring service. Furthermore, KLOE W1 asks the question:
Is there a clear vision and credible strategy to deliver high-quality care and support, and promote a positive culture that is person-centred, open, inclusive and empowering, which achieves good outcomes for people?
But what exactly is a ‘positive culture that is person centre, inclusive and empowering’? And more to the point how do you create (and sustain) such a culture?
As I pointed out in a previous post on organisational culture, there is no one, agreed definition of the term. But perhaps what’s more difficult is to try and work out how to change a culture – and do so in a cost effective manner. I suspect many providers who have received a ‘requires improvement’ or ‘inadequate’ rating are more focused on addressing the specific issues identified in the report, rather than worrying too much about something as nebulous as ‘culture’, even though they well may acknowledge the need to ‘do something’ about it.
However, it is quite possible to change an organisation’s or service’s culture, even though this does demand time and energy (but not necessarily money) from the provider. And in case there are some providers reading this who think they should be focusing their time and energy on addressing the problems identified by the CQC in their report, my message to them is that by addressing such problems you also address the problem of culture.
In other words, by addressing the practical issues highlighted in the CQC report the provider immediately comes up against the culture (or in many cases cultures) of the service. Culture is not some ethereal, nebulous ‘thing’ which ‘floats’ around the organisation; rather, it is embedded in the everyday practices of the organisation. And this is not only about what the people who make up the organisation do, but how they do it.
The other key thing to remember about culture is that it is not something that can be ‘imposed’ on the organisation or service by senior management. The fact that this is still a widespread belief amongst managers and consultants might explain why so many change management projects fail; the rest of the organisation need to be properly involved as well. Culture emerges from the everyday practices of the organisation, rather than something that can be ‘engineered’ by senior managers.
This is not to say that managers don’t have a critical role to play in transforming the culture of the organisation; they undoubtedly do. Perhaps the best place for them to start is to have a clearer understanding of how the organisation or service actually ‘works’ in a practical, everyday sense. By doing this they will get a much firmer grasp of the culture as a lived experience, rather than as something abstract. And they will be in a much better position to appreciate how addressing specific, practical issues in the service impacts upon its culture.