Eighteen months ago came an offer I couldn’t refuse. A journey into the unknown, to reduce the level of preventable harm taking place in Britain’s national health service hospitals through culture change.

How difficult could this be I thought, considering our experience with names like BAE Systems, National Grid and British Energy.

Yet our work at the NHS is unlike any other environment in which we’ve enacted culture change. The NHS employs nearly 1.5 million people, their work is diverse and cutting edge (no pun intended). And every day is a matter of life and death played out under the full scrutiny of the media, government and public.

Elephant resting its foot on the NHS logo

We began work in earnest at two large acute NHS trusts employing about 15,000 people. And despite the pressure and challenges we faced, we’ve seen steady progress and learned lessons that apply to anyone who cares about safety in their organisation.

Involve the right people

CEO and/or Chairman are crucial. They must put in place the means to deliver work through leadership, commitment and action if this is to stick in the long term. A genuine project delivery team is required to lead a successful journey and these senior leaders will create and empower your team.

Identify and nurture internal champions, these individuals recognise the status quo is not an option and have a vision for the future.

Identify and involve the blockers too. Convince them and bring them into the fold, generate some quick wins aligned to the process.

Remember the elephant

Start small, one bite at a time and build on success. Our initial approach was hospital-wide but this was doomed to failure. Large sites like hospitals employ many thousands and the complexity of the organisational structure is almost beyond comprehension when compared to say a traditional manufacturing setting.

Even though the suggested approach is to start small, organisation wide communication should make staff aware of the culture change programme at an early stage.

Perseverance pays

The rate of progress can be slow, release of the staff to attend workshops can be problematic because large organisations like the NHS are genuinely 24/7 365 days of the year and they have limited control over the flow of work.

What comes through the door at A&E has to be treated – a major RTA or an outbreak of norovirus takes priority over culture change – that’s just how it is. I once worked in a production environment delivering revitalising safety workshops and they closed the site for 3 full days to allow this to happen!

The NHS is certainly a mighty beast and complacency is not an option. But the personal challenge is motivating and we have and are making steady progress one bite at a time.