Doctors attitudes to a culture of safety: lessons for organizational change.

Healthcare is a highly regulated environment. This has driven what could be characterized as a papersafe 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 which 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 programme and critically asks the question of whether it is flawed because of failure to address issues surrounding Doctors and cultural change. We used Johnson & Schole's cultural web framework to explore the attitudes of junior doctors towards a patient safety and quality improvement programme. Data collection was through the use of focus groups backed up with quantitative data from a web based questionnaire survey. It has been demonstrated that Doctors represent a dominant sub-culture within the NHS and their beliefs, attitudes and value are often at odds or unrecognized by senior healthcare managers. Unless the cultural differences are adequately addressed then transformational change projects such as 'Best and Safest Care' are unlikely to succeed. A better understanding of the organizational context allows for more appropriate change interventions to be developed. [ABSTRACT FROM AUTHOR]