The document discusses organizational culture in the NHS using the concept of "tribes" and the "Grid-Group Cultural Theory". It describes how the NHS can be viewed as consisting of different tribes that have varying levels of power and influence. The Grid-Group model outlines four ideal cultural types - hierarchy, egalitarianism, individualism, and fatalism - based on the strength of social norms and group boundaries. Applying this to the NHS suggests there are cultural clashes between management, professionals, and other staff groups that have different values and goals. While recognizing the presence of multiple cultures could help, conflicts between them would still exist due to differing priorities and perspectives.

1. NHS Tribes
Rozalia Johnstone

2. Organisational Culture

3. Organisational Culture
• Organisational Psychology
• Social Psychology
• Social Anthropology

4. Organisational Culture

5. Organisational Culture
“The way things are done around here”

6. Organisational Culture
“The way things are done around here”
The way things are understood,
judged and valued.

7. Organisational Culture
“The way things are done around here”
The way things are understood,
judged and valued.
Far from Uniform and Coherent

9. Organisational Tribes
“Any group of people united by their
recognition of organisational hierarchy,
formal or informal, within their group, who
share a cultural identity and make up a
unique speech community”.

11. Tribes
• Different
Artefact and
• Different Levels of
Power and Influence

12. Dynamics may alter over time

13. Dynamics may alter over time

15. Tribes

16. Tribes
• Rivalry & Competition is a key feature of the
organisational culture

17. Tribes
• Rivalry & Competition is a key feature of the
organisational culture
• Most valuable resource of the NHS is its staff

18. Tribes
• Rivalry & Competition is a key feature of the
organisational culture
• Most valuable resource of the NHS is its staff
• It is important to understand and to respect
all the different tribes within the NHS

20. Manchester Patient
National Staff Competing Values
Safety Assessment
Survey Framework
Framework
What instruments and tools
exist for assessing cultures in
health care contexts?
IHI Safety Safety Attitude National Patient
Climate Survey Questionnaire Safety

21. Grid-Group
Cultural Theory

22. Grid-Group
Cultural Theory
A tool for understanding cultural diversity

24. Grid-Group Theory
• Mary Douglas - British Social
Anthropologist

25. Grid-Group Theory
• Mary Douglas - British Social
Anthropologist
• Constructs an analysis of the NHS
environment

26. Grid-Group Theory
• Mary Douglas - British Social
Anthropologist
• Constructs an analysis of the NHS
environment
• Describes four ideal-type cultures

27. Grid-Group Theory
• Mary Douglas - British Social
Anthropologist
• Constructs an analysis of the NHS
environment
• Describes four ideal-type cultures
• Establishes the differences between

28. Grid-Group Theory

29. Grid-Group Theory
“To provide a framework which could
relate differences in organisational
structures to the strength of the values
that sustain them..” (Gross, 1985).

31. High
Low
Grid
Group
Low High

32. ..the extent to which individuals are
High restricted by their commitment to social and
cultural environment...
Low
Grid
Group
Low High

33. ..the extent to which individuals are
High restricted by their commitment to social and
cultural environment...
Low ..the extent to which members of a group or
an individuals’ behaviour is constrained within
Grid well-defined boundaries.....
Group
Low High

35. “...take us to the heart of much
contemporary and historical
discussion about how to do public
management” (Hood, 1998)

36. High
Low
Grid
Group
Low High

37. High
Hierarchy
Low
Grid
Group
Low High

38. High
Hierarchy
Individualism
Low
Grid
Group
Low High

39. High
Hierarchy
Individualism Egalitarianism
Low
Grid
Group
Low High

40. High
Fatalism Hierarchy
Individualism Egalitarianism
Low
Grid
Group
Low High

41. High
Low
Grid
Group
Low High

42. High
Department of
Hierarchy
Health
Rules, Roles and Procedures
Low
Grid
Group
Low High

43. High
“Unresponsive”
bureaucracy
Low
Grid
Group
Low High

44. High
“Unresponsive”
“Efficient”
Low mechanisms
bureaucracy
Grid
Group
Low High

45. High
Individualism
Low
Grid
Group
Low High

46. High
Main Ideals are Rivalry & Competition
Management
Individualism
Low
Grid
Group
Low High

47. High
Low Egalitarianism
Grid
Group
Low High

48. High
....boundaries of the groups....
‘managing without management’
Low Egalitarianism
Professionals
Grid
Group
Low High

50. • Attempt to shift from egalitarian to
individualistic culture
• Decentralisation and introduction of
clinical budgets
• Resistance
• Miscommunication

52. Management Culture clash Professionals

53. Management Culture clash Professionals
• Different Organisation
• Different Values & Goals
• “dialogue of the deaf”

55. “Can there be a fatalist approach
to public management”?

56. High
Low
Grid
Group
Low High

57. High
Individuals /
Fatalism
staff groups
Fatalism can arise:
✦ co-operation is rejected
Low
✦ distrust widespread
✦ apathy reigns
Grid
Group
Low High

58. High
Individuals / Department of
staff groups Health
Low Management Professionals
Grid
Group
Low High

60. Is it possible to minimise or to
manage a conflict and clashes
between these cultures?

61. High
Individuals / staff Department of
groups Health
Low Management Professionals
Grid
Group
Low High

62. • Recognising the presence of
all four cultural biases has High
potential advantages Individuals / staff
groups
Department of
Health
Low Management Professionals
Grid
Group
Low High

63. • Recognising the presence of
all four cultural biases has High
potential advantages Individuals / staff
groups
Department of
Health
• Conflict and cultural clashes Low Management Professionals
between these four cultural Grid
Group
biases would still exist
Low High

64. • Recognising the presence of
all four cultural biases has High
potential advantages Individuals / staff
groups
Department of
Health
• Conflict and cultural clashes Low Management Professionals
between these four cultural Grid
Group
biases would still exist
Low High
• A solution for these clashes

66. Cultural Framework would not give a
general answer or solution to provide
better public sector management.
There is no basic form against failure.

68. Thank you