Journal of Research in Nursing

2017, Vol. 22(1–2) 57–59

Review: Healthcare workers’ ! The Author(s) 2017
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DOI: 10.1177/1744987116685959
journals.sagepub.com/home/jrn
culture and the impact on the
delivery of compassionate
quality care

Theresa Shaw
Chief Executive, Foundation of Nursing Studies and Honorary Senior Research Fellow, Nursing and
Applied Clinical Studies Faculty of Health and Social Care, Canterbury Christ Church University,
Canterbury, UK

I was pleased to be asked to review this paper setting out to explore the links between culture
and the quality of care alongside a desire to understand staff experiences and perceptions. The
paper presents the qualitative findings of healthcare workers’ perceptions of organisational
culture and its impact on compassionate quality care. With its focus on healthcare workers, I
was curious about the focus on organisational culture when the workers participating were, as
Manley et al. (2011) might argue, representative of workers in a ‘workplace culture’. Although
it is often organisational culture that is spoken about, organisations are made up of smaller
‘workplace cultures’, such as departments, wards, clinics, surgeries, and amongst teams. The
workplace culture is ‘the most immediate culture experienced and/or perceived by staff,
patients, users and other key stakeholders . . . the culture that impacts directly on the
delivery of care’ (Manley et al., 2011: 9).
From experience, there are often aspects of the organisational culture that healthcare
workers feel are outside of their sphere of influence, whereas the workplace culture is one
which they arguably influence directly. As the authors allude, ‘people make culture’,
influenced by their values and beliefs (Sanders and Shaw, 2015). The authors could have
considered Drennan’s definition of culture – ‘how things are done around here’ (Drennan,
1992: 9), which, translated to care workplaces, is represented through the patterns, habits
and routines of care. Exploration of these through open questioning about how things are
done and what is important to the workers may have revealed more.
Linked to data collection, I also noted that the participant sample across two trusts and
four wards was particularly small in terms of both its size and its composition. The authors
note this limitation and argue that in terms of qualitative data, they unearthed rich and

Corresponding author:
Theresa Shaw, Chief Executive, Foundation of Nursing Studies and Honorary Senior Research Fellow, Nursing and Applied
Clinical Studies Faculty of Health and Social Care, Canterbury Christ Church University London, UK.
Email: theresa.shaw@fons.org
58 Journal of Research in Nursing 22(1–2)

meaningful information. It is hard to argue against this without scrutinising the data.
However, taking account of the authors’ desire to gain real insight into practice, the use
of another data collection method, such as observations, may have been complementary in
illuminating the culture beyond the workers’ perceptions.
All this said, the findings highlight some important messages that are gaining momentum
across health and social care. Under the global areas of professional practice, workforce and
service delivery were interlinked basic themes relating to the healthcare workers’ ability to
feel satisfied with care given and having time to fulfil their desire to offer the kind of care
family and friends would have confidence in. More recently, several studies and reports have
highlighted that not being able to give of one’s best affects well-being – a factor we also know
impacts on the ability of staff to be compassionate (Cornwall, 2014; West, 2013).
Another theme which stood out for me was people-centred care. Over the past decade, the
notion of person-centredness has become better understood in the context of nursing and
healthcare practice. In 2011, Manley et al. identified person-centredness as one of the three
domains for an effective workplace culture, one which guides relationships with others.
Furthermore, it is increasingly acknowledged that person-centredness needs to reach beyond
those receiving care to reach staff and influence culture (McCormack and McCance, 2016).
The final theme which caught my attention was leadership and reference to facilitation.
The relationship between leaders and co-workers is a vital aspect of both workplace and
organisational culture (Maben et al., 2012; Manley et al., 2011). Transformational leadership
and skilled facilitation can enable the development of an effective workplace culture with
positive outcomes for staff and patients (Manley et al., 2011), a view also supported by West
et al. (2014) who note that if ‘leaders and managers create positive, supportive environments
for staff, those staff then create caring, supportive environments for patients, delivering high
quality care’ (West et al., 2014: 10). Evidence that effective leadership is embodied in
relationships is also demonstrated by Dewar and Cook (2014) in their evaluation of a
leadership programme to enhance the delivery of compassionate care. Along with greater
reflection, self-awareness and enhanced relationships they argue the leaders created
workplaces where compassion and respect were experienced and heard through
conversation and action.
In conclusion, this work contributes to understanding regarding culture and its impact on
compassionate care. It would be interesting to know what this work contributed to the larger
feasibility study to develop a ‘Cultural Health Check Toolkit’ along with what this toolkit
offers in comparison to the ‘Culture of Care Barometer’ (Rafferty et al, 2015), a tool
developed in direct response to the Francis Report (2013). However, the more difficult
task ahead, I would argue, is helping healthcare workers, particularly clinical leaders, to
find ways to strengthen culture in the workplace. Culture change is not easy or quick, but
there are some practical steps that can be taken to begin conversations about ‘what happens
in practice’ and ‘what is important’; free access Creating Caring Cultures Resources (FoNS)
can help leaders and teams ‘get started’ (Sanders and Shaw, 2015).

References
Cornwall J (2014) Staff Care: How to Engage Staff in the
NHS and Why it Matters. London: The Point of Care
Foundation.
Drennan D (1992) Transforming Company Culture. London:
McGraw-Hill.
Dewar B and Cook F (2014) Developing compassion through a
relationship centred appreciative leadership programme.
Nurse Education in Practice 34(9): 1258–1264.
Maben J, Peccei R, Adams M, et al. (2012) Patients’
experiences of care and the influence of staff motivation, affect
Shaw 59

and wellbeing. Final report. NIHR Service Delivery and
Organisation programme. HMSO: London.
McCormack B and McCance T (2016) Person-centred Practice
in Nursing and Health Care: Theory and Practice, 2nd edn.
Chichester: John Wiley & Son.
Manley K, Sanders K, Cardiff S, et al. (2011) Effective
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‘Culture of Care’ in NHS Trusts. London: National Nursing
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Sanders K and Shaw T (2015) Creating caring cultures: Getting
started. London: Foundation of Nursing Studies. Available
at: www.fons.org/learning-zone/culture-change-resources.
aspx (accessed 26 November 2016).
West M (2013) Developing cultures of high quality care. The
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west-developing-cultures-of-high-quality-care.pdf (accessed
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West M, Eckert R, Steward K, et al. (2014) Developing
collective leadership for health care. London: The Kings
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(accessed 26 November 2016).

Theresa Shaw (NursD, BA (Hons), RNT, RN) is CEO of the Foundation of Nursing
Studies, UK and an Honorary Senior Research Fellow at Canterbury Christ Church
University, Canterbury, UK. She is passionate about enabling nurses to flourish as caring,
knowledgeable and skilled practitioners. Along with colleagues at FoNS she has gained
extensive knowledge and experience with regard to the impact of culture, staff well-being
and leadership on health and social care practice.