Culture Diagnostic – NHS Trust – Case Study 3

Culture Cosimo Consulting was commissioned by an NHS Foundation Trust through Training 2000 to understand how its employees perceived its culture and the changes employees would  like to see reflected in a future culture. The results would inform strategy, engagement, training and leadership development approaches.

Given current challenges faced, we advised an approach which could be deployed both actively with invited groups and passively. The passive mode provided opportunity for individuals to drop in and contribute their thoughts and views on culture. The number of contributors were extended through the use of a Survey Monkey questionnaire and sent to those who wanted to contribute but could not make the opening times.

Based on research about the Trust, knowledge of Galbraith’s Star Model and the Culture Web we designed a room where people’s thoughts and views on future culture could be captured. It took the form of a past, present and future journey. It asked questions, required voting and summarised some key aspects of the Trusts journey to date. There was a creative zone for people to articulate the future culture pictorially. The approach reinforced the Trusts promise to its employees to engage them more effectively a process begun earlier in the year.

We trained NHS staff to run these rooms and gather data. A diagonal slice representation from the Trust including its Board members took part. Where there were invited groups the facilitators led the activity and when in passive mode the facilitators were asked to orientate people and support when required. They were asked to reinforce a culture of engagement begun at the beginning of the year by their CEO.

The Trust asked us to review and analyse other data they had which could be combined with the outputs of these rooms. Engagement survey data revealed insights around the sustainability of discretionary effort. Highly demanding work and lower pay means individuals need to feel they are rewarded in other ways. Not recognising those efforts poses a significant risk to the service. We compiled a preliminary report and presented our culture findings back to the Trust board.

There were many common themes and actions identified. Many reinforced current workstreams and others suggested new activity. One example was to create a closer alignment of the new strategic focus and the Trusts key values. Another was the need for clearer communication of the direction the strategy was pointing to. It brought out the key role that all leaders play in enabling the right culture and in particular the role clinical leaders (Consultants, Doctors and Specialists) could potentially play.

Many of the lessons learned probably apply across all of the NHS.


“Sean has been a valuable organisational development resource for our organisation over recent months, in assisting us to carry out a cultural diagnostic and develop team members to support this important piece of work. Sean has demonstrated that he has the skills, knowledge, and expertise to help achieve our desired goals in this area in a friendly, approachable, and always professional manner. We also value his ‘fresh eyes’, warmth, sense of fun and willingness to offer in ‘added value’ time”.

Head of Organisational Development – NHS Foundation Trust

“Thanks for this it is a really good and professional piece of work which shows the quality you have personally bought to the project.”

Neil Gutteridge – Director of Enterprise T2K