Search results

This study aims to explore how leadership, management practices and organisational cultures have changed in low and high-performing mental health (MH) providers between 2015 and 2020 in the English National Health Service.

The authors used a qualitative case study design comprising a purposeful sample of two low-performing and two high-performing MH providers, based on semi-structured interviews with 60 key informants (mostly internal to the organisation with some external informants from local Clinical Commissioning Groups).

The authors found major differences regarding leadership, management and organisational culture between low and high performing MH providers in 2015/2016, and that the differences had diminished considerably by 2019/20. In 2015/16, low performing providers were characterised by a “top-down” style of leadership, centralised decision-making and “blame cultures”. In contrast, the high performing providers were characterised as having more distributed, collaborative and inclusive styles of leadership/management, with open and supportive cultures. As the low performing providers changed and adapted their styles of leadership and management and organisational culture over the five-year period, they more closely resembled those of the high performing trusts.

To the best of the authors’ knowledge, this is the first study to explore the relationship between changing organisational factors and the performance of MH care providers. It provides evidence that it is possible for radical changes in leadership, management and organisational culture to be enacted over a relatively short period of time and that such changes may help low performing providers to turnaround their underperformance.

This study aims to compare and contrast the core organisational processes across high and low performing mental health providers in the English National Health Service (NHS).

A multiple case study qualitative design incorporating a full sample of low and high performing mental health providers.

This study suggests that the organisational approaches used to govern and manage mental health providers are associated with their performance, and the study’s findings give clues as to what areas might need attention. They include, but are not limited to: developing appropriate governance frameworks and organisational cultures, ensuring that staff across the organisation feel “psychologically safe” and able to speak up when they see things that are going wrong; a focus on enhancing quality of services rather than prioritising cost-reduction; investing in new technology and digital applications; and nurturing positive inter-organisational relationships across the local health economy.

Highlights considerable divergence in organisation and management practices that are associated with the performance of mental health trusts in the English NHS