Leadership and culture

Leadership is a significant factor in shaping an organisational culture that delivers high-quality care, and thus effective leadership behaviours, strategies, and development are fundamental to NHS Scotland’s objectives (46). Positive, effective leadership is built on trusting relationships between supervisors and their staff, in which decisions are inclusive, participation is promoted, staff are empowered to access support, and opportunities to grow are available (52-54).

The quality of nursing leadership is significantly associated with staff wellbeing, workplace satisfaction, and retention rates (52, 53, 55). Combined with adequate nursing supervision it is associated with better outcomes for nurses’ wellbeing, with observed correlations between clinical supervision and physical symptoms of anxiety (56). In contrast, poor leadership is associated with work-related burnout in healthcare professionals (57). Effective leadership is also associated with improved outcomes for patients; leaders that prioritise compassion for both staff and patients enabled effective collaboration between multiprofessional teams which positively influenced patients’ experiences (57-60).

Evidence suggests that nursing leadership skills can be acquired and developed through experience and education (61). Thus, EiC will explore further opportunities to foster leadership development across Scottish health boards to ensure effective leadership for the benefit of staff and patients.

A key challenge facing the NHS is to nurture cultures that guarantee the delivery of safe, high-quality, person-centred care that demonstrates continuous improvement (62). Organisational culture can be conceptualised as the beliefs and values that are facilitated by the social interactions of staff and patients, and through the decisions and objectives set by management (63). Researchers have proposed five elements of an effective workplace culture that assures a high-quality of care within healthcare organisations: operationalising an organisation’s vision across all levels of work, setting clear objectives for staff, encouraging supportive management styles, supporting team working, and embedding quality improvement and innovation in day-to-day practice (58, 60).

The relationship between organisational culture and the wellbeing of staff and patients is well established in literature (63). For example, workplace settings which foster resiliency through supportive interpersonal relationships have been demonstrated to promote wellbeing and facilitate higher levels of job satisfaction, thus improving retention rates of healthcare staff (62, 63). Encouraging a culture of psychological safety in particular (ie staff feeling comfortable to discuss one’s feelings and using them to guide the decision making process) is associated with high levels of nursing compassion and empathy towards patients (65).

Organisational culture has also been demonstrated to impact patient safety and mortality rates; with workplaces that encourage initiative taking, innovative approaches, and problem solving reporting less safety issues and lower mortality rates than those that place a strong emphasis on hierarchy and control (66-68). Similarly, hierarchal structures–characterised by high levels of bureaucracy and regulation–are linked to poor patient satisfaction across the literature (69, 70). Thus, EiC has prioritised shaping organisational culture within NHS Scotland, incorporating staff and patients’ perspectives to guide our quality improvement efforts to deliver safe, person-centred care consistently.