Cultural renewal required to restore value systems
NOT SO long ago only academics and jargon-prone management consultants spoke of the culture of organisations. Real, meat-eating executives had little time for this “soft stuff”.
Today all has changed, as the culture of organisations has moved centre-stage in attempts to explain what went catastrophically wrong in countless institutions across all sectors. The latest example is the Gibbons-Shannon report on the deaths of children in the care of the State and a few weeks ago we had the reports on RTÉ’s Mission to Prey and the problems in AE in Tallaght.
Dysfunctional cultures have been cited as the fundamental source of failure in Fás, AIB, the Department of Finance, the Garda Síochána in Donegal, Fianna Fáil, the diocese of Ferns, Our Lady of Lourdes Hospital in Drogheda and numerous other institutions.
Labels such as cover-up and collusion, denial, deference and timidity, arrogance, groupthink, extravagance, corruption, fear and so on were used variously to depict the culture of such organisations. In his excoriating criticism of the Catholic Church, Taoiseach Enda Kenny spoke of its “dysfunction, disconnection, elitism and narcissism”.
There is nothing “soft” about culture. It is the most difficult thing to change and it is high time that boards of directors and senior executives gave it due attention. A dysfunctional culture is a debilitating liability and may even carry the risk of corporate implosion as, for example, in the case of Rupert Murdoch’s News Corporation and some Irish organisations. On the other hand, a culture based on a decent set of values is a precious asset.
The significance of an organisation’s culture is brutally revealed in the health system. The suffering endured by people in hospital emergency departments has gone on for decades as they lay on trolleys or sat on chairs, for days on end in some cases. The problem seemed intractable without substantial extra resources.
But in the wake of the Health Information and Quality Authority (Hiqa) report on Tallaght hospital, Sir Keith Pearson, chairman of the hospital’s interim board gave the lie to this analysis: “It doesn’t cost money to deliver dignified care; once you get the culture, the values and the behaviours right at the leadership level, you release the clinical staff to get on and do what they do extraordinarily well.”
The metaphor of an iceberg helps to clarify the issue. Visible above the surface are the structures, procedures, physical facilities, money, demarcations and information systems. Below the surface, the culture, comprised of the beliefs, assumed pecking order, self-interest, values, attitudes and related psychological elements which gel to form a shared mindset.
Efforts to transform any system through investment in change above the surface will ultimately fail unless accompanied by explicit interventions to alter the tenacious embedded culture; as someone once said, “culture eats strategy for breakfast”.
Sir Keith’s analysis is borne out in emails I received from a senior nurse manager in another large hospital. She said: “We know what is best practice in AE . . . we know how it should be organised and run . . . we have seen it work elsewhere . . . but the problem is the culture in AE . . . especially the consultant culture . . . and unless we tackle the culture there will be no progress that will stick.”
According to Sir Keith, this is precisely what they did at Tallaght. Since the appointment of the interim board last December, they have concentrated on ensuring they had “the right values”. There were no patients on trolleys when the Hiqa report was released last month.