How to work better across sectors – minding the culture gap

03 February 2023

Principal consultant Aidan Rave wonders whether there is strength to be drawn from the cultural differences between the NHS and local government.

As a relatively recent entrant into the world of the NHS, I’ve been struck by some of the cultural variations that exist between it and its closest integrated care partner, local government.

I suppose it’s hardly a world exclusive to point this out. After all, why wouldn’t there be differences? When all is said and done, organisations are merely glorified groups and every group has its own distinctive norms, rules, habits and icons.

Of course, there are very practical reasons for many of these differences, access to resources and accountability for financial pressures being principal among them. Having to compete for finite resources within a context where each decision can directly affect an individual’s life chances is a heavy burden to bear for any public servant. Hardly a surprise then, that tensions occasionally boil over.

I’ve pursued an eclectic career path over the last 20 years – taking in political and managerial leadership in local government, the private sector, charities, the civil service and now the NHS. My career travels have helped me to spot these cultural variations, but they’ve also taught me an important lesson about resisting the temptation to focus only on differences. And I’d argue that there are as many startling similarities as differences between the sectors, which is pretty remarkable when you think about their wildly differing core missions.

Why difference matters

Does any of this really matter? Cultural variances are certainly interesting to observe, they make great copy for your MBA dissertation (trust me on that one), but in the real world are they something we should be really worrying about?

I have to say yes – and not just because this would be the shortest, most pointless article I’ve ever written if I didn’t. I firmly believe there is a rich seam of efficiencies, innovation and quality buried within organisational cultures which, if better understood, have the potential to make a significant contribution to public services at a time when any kind of additional headroom might make a significant difference.

This is particularly relevant to integrated care systems, but not exclusively so. The connective tissues of cause and effect that bind public services can be manipulated to create better outcomes in educational, economic and community safety just as much as health.

‘Tough on crime, touch on the causes of crime’ may now be derided as the apogee of the dark art of political packaging, but it’s still fundamentally true. Its core principle – of prevention as well as treatment – is still the holy grail of good public service design.

Moreover, if we are ever to get off the demand/capacity hamster wheel and start moving the dial on the permacrisis that the NHS seems to exist in, then forging a systems approach, based on intelligence, intervention and integration will be critical. In this regard, culture – and cultural differences – matter.

Practical actions

So, where do we go from here?

I think there are three practical actions we can take.

Firstly, we need to understand each other better. In my experience even senior officers from different sectors know little about their ‘partners’ in terms of politics, finance, regulation and the like. Perhaps we should run some ‘101’ sessions on how local government, NHS and charities work? This would create a solid platform to build on.

Second, we need to work towards a degree of interoperability between our staff. Of course, there is always going to be sector-specific learning required, but there is huge value in systems thinking, learning and leadership. To this end, a programme could be put together, involving leaders and aspiring leaders from different sectors, focused on learning, understanding and harnessing a systems approach.

Thirdly, we need to get better – much better – at hiring beyond traditional comfort zones. There is still a palpable sense of fear when it comes to recruiting people from different sectors, even into roles where there is, in reality, very little risk. Changing this will require the involvement of HR professionals, recruitment firms and those sitting on appointment panels, with a view to identifying and better understanding the role of sectoral unconscious bias and exploring the merits of not only talking about systems leadership, but implementing practical steps towards realising it.

Strength in difference

What this is not about is developing another tired cultural change programme aimed at achieving cultural homogeneity. Quite the opposite, our differences can be our strengths if we recognise, understand and then harness them.

In the coming months, GGI is going to be reaching out to leaders across different sectors to better understand the potential for a programme that might address some of these issues and the appetite for being involved.

If you have any thoughts on how we might shape a more productive but still determinedly heterogeneous culture focused on improving public service outcomes, we’d genuinely like to hear from you.

Meet the author: Aidan Rave

Principal Consultant

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Prepared by GGI Development and Research LLP for the Good Governance Institute.

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