| Summary: | Evidence exists that the NHS has had, over many years, persistent problems of negative and intimidating behaviour towards staff from other employees in the NHS. The evidence also suggests the responses to this behaviour can be inadequate. Pope and Burnes (2013) model of organisational dysfunction is used to investigate and explain these findings. A qualitative approach was taken to research the organisational responses to negative behaviour, and the reasons and motivations for those responses. Forty three interviews and six focus groups were conducted. The Framework Method of thematic analysis was chosen for the main analysis and fourteen Framework Themes were identified. ‘3 word summaries’ of the culture were analysed. Further analysis was undertaken of words relating to fear, rationalisations/justifications, what people don’t want to do, the culture, and assumptions/beliefs. The model of organisational dysfunction has been extended. The findings show that participants consider the NHS to be a politically driven, “top down”, “command and control”, hierarchical organisation; a vast, enclosed, bureaucratic machine/system under great pressure. They believe there is a culture of elitism, fear, blame, bullying and a lack of accountability; a culture where power, self-interest and status matters. There is constant change. Saving money and achieving targets are seen to be the priority. A lack of care and humanity is described and negative behaviour seems to have become tolerated and normalised. Bullying is mentioned many times, and viewed as “rife” and “endemic”. Good practice/behaviour can be punished, and bad rewarded, as can failure. Corrupt and unethical behaviour is identified as are totalitarian and Kafkaesque characteristics. Participants describe resistance to voicing concerns and any information which puts individuals or organisations into a ‘negative light’. Employees who raise concerns can be victimised. The “top-down bullying culture ... suppresses constructive dissent”. There can be rhetoric, “empty words” and “spin”, rather than reality. A desire for “good news” and the rejection and hiding of “bad news” is described. There seem to be “islands” and “pockets” with a positive culture, however, the generalised evidence suggests the NHS is systemically and institutionally deaf, bullying, defensive and dishonest, exhibiting a resistance to ‘knowing’, denial and “wilful blindness”; a dysfunctional, perverse and troubled organisation. The NHS could also be described as a coercive bureaucracy and under certain definitions, a corrupt entity. The NHS appears to be an organisation with a heart of darkness; a “self perpetuating dysfunctional system”. There may be widespread “learned helplessness”. Overall, the needs of the NHS and the protection of image appear more important than the welfare of staff or patients. It does seem to be a “good news factory”. The NHS appears to have “lost its way” and its focus/purpose as an institution. The dysfunctional organisational behaviours manifest in the NHS need to be addressed urgently as there is a detrimental, sometimes devastating, impact on the wellbeing of both staff and patients. The NHS needs to embrace an identity of being a listening, learning and honest organisation, with a culture of respect.
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