title: A qualitative study of the cultural changes in primary care organisations needed to implement clinical governance.
abstract: BACKGROUND
  It is commony claimed that changing the culture of health organisations is a fundamental prerequisite for improving the National Health Service (NHS). Little is currently known about the nature or importance of culture and cultural change in primary care groups and trusts (PCG/Ts) or their constituent general practices.
  
  
  OBJECTIVE
  To investigate the importance of culture and cultural change for the implementation of clinical governance in general practice by PCG/Ts, to identify perceived desirable and undesirable cultural attributes of general practice, and to describe potential facilitators and barriers to changing culture.
  
  
  METHODS
  Qualitative: case studies using data derived from semi-structured interviews and review of documentary evidence.
  
  
  METHODS
  Fifty senior non-clinical and clinical managers from 12 purposely sampled PCGs or trusts in England.
  
  
  RESULTS
  Senior primary care managers regard culture and cultural change as fundamental aspects of clinical governance. The most important desirable cultural traits were the value placed on a commitment to public accountability by the practices, their willingness to work together and learn from each other, and the ability to be self-critical and learn from mistakes. The main barriers to cultural change were the high level of autonomy of practices and the perceived pressure to deliver rapid measurable changes in general practice.
  
  
  CONCLUSIONS
  The culture of general practice is perceived to be an important component of health system reform and quality improvement. This study develops our understanding of a changing organisational culture in primary care; however, further work is required to determine whether culture is a useful practical lever for initiating or managing improvement.
authors.affiliation: National Primary Care Research and Development Centre, University of Manchester. martin.marshall@man.ac.uk
authors.forename: Martin
authors.initials: M
authors.lastname: Marshall
authors.forename: Rod
authors.initials: R
authors.lastname: Sheaff
authors.forename: Anne
authors.initials: A
authors.lastname: Rogers
authors.forename: Stephen
authors.initials: S
authors.lastname: Campbell
authors.forename: Shirley
authors.initials: S
authors.lastname: Halliwell
authors.forename: Susan
authors.initials: S
authors.lastname: Pickard
authors.forename: Bonnie
authors.initials: B
authors.lastname: Sibbald
authors.forename: Martin
authors.initials: M
authors.lastname: Roland
mesh_terms: D001291:Attitude of Health Personnel; D005194:Family Practice / Q000458:organization & administration* / Q000592:standards; D018166:Health Care Reform / Q000458:organization & administration*; D006284:Health Plan Implementation; D007407:Interviews as Topic; D008485:Medical Audit / Q000458:organization & administration*; D015279:Organizational Culture; D009936:Organizational Innovation; D008486:Physician Executives / Q000523:psychology; D011787:Quality of Health Care / Q000458:organization & administration; D013222:State Medicine / Q000592:standards*; D006113:United Kingdom