Project Description

A better culture for better healthcare

Royal Berkshire NHS Foundation Trust


In the context of the Francis Report, published in 2013, which highlighted improvements necessary across the NHS, the Trust prioritised a number of key areas, including culture, behaviour and values.

Thus, in the summer of 2014, The Pacific Institute® was brought in to assist with this endeavour. Several   staff   members   were   trained   up as Investment In Excellence® (IIE®) Facilitators, with the aim of rolling the programme out across the organisation. Rather than focusing solely on senior management, the programme has been offered to all levels of employees.

To date, 215 staff members have been through the programme, with the 15th cohort having completed at the end of 2016. Further cohorts are scheduled throughout 2017.


Edwards decided that her first strategy was to partner with The Pacific Institute®. And, to ensure that there were measurable benchmarks as they embarked upon their culture journey, Edwards used the Organizational Cultural Inventory (OCI®) survey with her staff to assess the initial culture. The results solidified her initial perception that the culture was defensive, rigid, and fear-based.

Since she had previously experienced TPI’s curriculum, Edwards introduced Investment In Excellence® to her department. The program was required for all managers, and voluntary for the rest of the organization. Edwards started the intense culture work first with her executive team and spent two years working with them to align and unite their group. A TPI senior consultant was brought in to facilitate the process of alignment, and they laboriously crafted the department’s mission, vision, and values. As a part of those executive discussions, it was also uncovered that there was an element of fear among the members, left over from past circumstances, and, after reflection and conversation, those limiting beliefs began to be addressed.

Two years later, in 2017, Edwards conducted another OCI® survey to measure their progress. She was thrilled to discover that the results had improved since the last survey.

As a result of the second survey, a culture team was created, which included members from multiple levels of the organization. The executive team and the culture team then went out to every location in the organization and presented the findings of the culture survey. Then, the team created what they called “Culture Cafes” - where the culture team visited every location and set up a café-type environment, with coffee, treats and individual tables. Every single staff member was invited, and the goal was to get input from everyone at all levels of the organization on how to address the findings of the most recent survey.

The response was tremendous! It took several months, but the team received over 6,000 suggestions. There was so much data that they needed to hire researchers to sort and compile all the information. As a result of the department’s monumental work, a new strategic plan was born, with the number one priority of creating a supportive work environment.

Edwards is currently implementing the new plan throughout the entire organization. As she reflects on their work, she states, “Staff are excited. I have received tons of emails from staff after they participated in a Culture Café saying, “We actually feel like you are listening to us and really want our input.” That was one of the criticisms - that it’s a top down organization. Nobody asks us what we think. We have good ideas, and we’re the ones doing the work. So, now we are listening to them and asking them to come up with the plan on how to implement it.” In addition, each location has identified a culture ambassador to maintain the focus on culture. These ambassadors are key to the rollout of the organization’s new strategy.


The dramatic improvements to the culture of Marsh Ward has not just been felt by the staff, but is also evident from the statistical data measured annually. Comparing the results of annual data collected in 2015 to that of 2016, the improvements identified are staggering and clearly reflect the transformational and tangible effect that that the programme has had on the ward’s performance.

Indeed, these changes have also translated to patient care, with improved feedback noted. One patient even compared the ward to an all-inclusive holiday, demonstrating the high levels of patient satisfaction.

With Marsh Ward the envy of the other maternity wards and departments across the Trust, many senior managers are now looking to replicate this model, aspiring to achieve similar levels of success. As more staff from across the Trust experience the programme, it is anticipated that similar improvements will be measured across the board.

Moreover, recognition of the positive impact of this initiative has also come at a national level, with the Trust having recently won the ‘Chamberlain Dunn Learning Award for Education, Learning and Development’ at the 2017 HPMA Excellence in HRM Awards. This award recognises organisational cultures within healthcare organisations that promote an open, constructive and innovative approach to learning, talent and performance, whilst also linking learning and development strategies with key organisational goals.