"The people not the policy": quality improvement, junior doctors, and cultural change.

BACKGROUND: Health care is a highly regulated environment. This has driven what could be characterized as a paper-safe approach, whereby organizations are required to demonstrate to a multiplicity of regulators, inspectorates, and accrediting bodies that they are paper safe. However, for many organizations, this has not produced a system that is actually patient safe; rather, it has in practice operated as a parallel system that does not reflect the true state of safety. This project looks at a quality improvement and patient safety program and critically asks the question of whether it is flawed because of failure to address issues surrounding doctors and cultural change.
METHODS: Johnson & Schole's cultural web framework was used to explore the attitudes of junior doctors toward a patient safety and quality improvement program. Data collection was through the use of focus groups backed up with quantitative data from a web based questionnaire survey.
RESULTS: It has been demonstrated that doctors represent a dominant subculture within the National Health Service and their beliefs, attitudes, and value are often at odds or unrecognized by senior health care managers.
CONCLUSIONS: Unless the cultural differences are adequately addressed, transformational change projects such as "Best & Safest Care" are unlikely to succeed. A better understanding of the organizational context allows for more appropriate change interventions to be developed.