Over a decade after the Mid Staffordshire scandal shocked the UK public, inquiry after inquiry has continued to expose deep-rooted problems in NHS organisations—from maternity care failures to neglected complaints, from concealment of medical errors to systemic leadership breakdowns.
What connects these cases isn’t a few “bad apples”—it’s a pattern of organisational cultures that fail to recognise or respond to warning signs.
A new analysis from the Patient Experience Library pulls together ten years of official inquiry reports and over 1,000 references to cultural failings. The result is a roadmap for how not to lead. It’s also a valuable resource for any sector looking to prevent harm and protect reputation through better governance, culture, and accountability.
Why Culture Still Trumps Policy
Many NHS bodies had all the right policies on safety, whistleblowing, and patient care. Yet these often sat ignored while unsafe behaviours went unchecked. The problem, as noted in the report, is that culture “bypasses policies.“ What an organisation stands for can be undermined by what it tolerates.
The key takeaway? Culture isn’t what you say. It’s what you do. When leadership doesn’t model or enforce expected standards, harmful practices can quietly and persistently embed themselves.
The Patterns That Predict Failure
The research identifies three patterns that signal risk:
- System Failures: Harm is rarely the work of a single actor. Failures typically involve multiple institutions—hospitals, regulators, councils, and professional bodies—none of which took responsibility or intervened early enough.
- Cultural States: Dysfunctional organisations tend to be in one or more of three states: complacency, avoidance, and denial. Whether they ignore feedback, deflect responsibility, or cover up mistakes, these patterns allow small issues to grow into major crises.
- Toxic Subcultures: Even within a single organisation, different departments can develop their values and behaviours. The study categorises damaging subcultures into six types:
- Poor reporting
- Lax compliance
- Lack of care
- Dysfunctional teamwork
- Weak accountability
- Resistance to learning
Understanding these dynamics is essential for healthcare and any regulated sector.
Lessons for Finance and Leadership
The message for ACCA members and professionals in governance roles is clear: leadership must engage with culture as actively as they do with strategy or risk. That means:
- Reading soft signals—a culture of silence, high turnover, and staff burnout—before they become red flags.
- Building systems that surface challenge, not suppress it. This includes weighing staff concerns, complaints data, and whistleblower feedback.
- Tracking the culture, not just the numbers. Strong governance includes monitoring values in practice, not just performance metrics.
As the report states, avoiding future harm means building a “common language“ for identifying and acting on risk behaviours early.
The Red Flag Tracker: A Tool for Accountability
The Patient Experience Library has created an open-access Red Flag Tracker, drawing from real UK health and care cases. It’s a searchable tool designed for board members, complaints teams, auditors, and risk professionals who must recognise when cultural drift is happening—and respond before damage is done.
Conclusion
Organisational failure doesn’t arrive unannounced. It sends signals—through disengaged staff, overlooked complaints, and processes that become rituals rather than safeguards. Whether you work in health, finance, or any other sector, being able to “read the signals“ is a leadership skill that matters more than ever.
