title: "The people not the policy": quality improvement, junior doctors, and cultural change.
abstract: BACKGROUND
  Health care is a highly regulated environment. This has driven what could be characterized as a paper-safe approach, whereby organizations are required to demonstrate to a multiplicity of regulators, inspectorates, and accrediting bodies that they are paper safe. However, for many organizations, this has not produced a system that is actually patient safe; rather, it has in practice operated as a parallel system that does not reflect the true state of safety. This project looks at a quality improvement and patient safety program and critically asks the question of whether it is flawed because of failure to address issues surrounding doctors and cultural change.
  
  
  METHODS
  Johnson & Schole's cultural web framework was used to explore the attitudes of junior doctors toward a patient safety and quality improvement program. Data collection was through the use of focus groups backed up with quantitative data from a web based questionnaire survey.
  
  
  RESULTS
  It has been demonstrated that doctors represent a dominant subculture within the National Health Service and their beliefs, attitudes, and value are often at odds or unrecognized by senior health care managers.
  
  
  CONCLUSIONS
  Unless the cultural differences are adequately addressed, transformational change projects such as "Best & Safest Care" are unlikely to succeed. A better understanding of the organizational context allows for more appropriate change interventions to be developed.
authors: St. Thomas' Hospital, Lambeth Palace Road, London SE1 7EH,, England. drpaul.grant@doctors.org.uk
authors: Paul
authors: P
authors: Grant
mesh_terms: D001291:Attitude of Health Personnel; D017144:Focus Groups; D006801:Humans; D008505:Medical Staff, Hospital / Q000523:psychology*; D015279:Organizational Culture; D018802:Patient-Centered Care / Q000458:organization & administration; D057766:Policy; D058996:Quality Improvement / Q000458:organization & administration*; D017751:Safety Management / Q000458:organization & administration*; D013222:State Medicine / Q000458:organization & administration; D006113:United Kingdom