Organisational culture: problem-sensing and comfort-seeking

Abstract

Back in 2004 Bill Moyes, who was at the time executive chair of the foundation trust regulator Monitor, said: ‘There is no such thing as a perfect organisation. The best we can ever hope for is that an organisation is self-aware, recognises its issues, and deals with them effectively’. This remains as true today as it was nearly 20 years ago. The complexity of large organisations and even greater complexity of working within systems challenges organisations to be self-aware. The evidence of what is going well, what can be improved and what requires urgent attention is readily available in organisations that use soft intelligence effectively. There will always be the temptation to take comfort in getting most things right rather than being disconcerted by the significant minority of things that go wrong. There will always be a danger in regarding compliance as an end in itself rather than as useful, but limited, intelligence on organisational performance. In this section Mary Dixon-Woods and Graham Martin contrast problem-sensing with comfortseeking, confront structural complacency and a lack of eagerness to use hard and soft intelligence, and discuss the crucial importance of openness. It would be surprising if there were many who would disagree with the content of this chapter, but the challenge is to embrace openness and make real a learning health system in which structural secrecy is identified and challenged at all levels.