Changing leadership, management and culture in mental health trusts

Purpose - To explore how leadership, management practices and organisational cultures have changed in low and high performing mental health providers between 2015 and 2020 in the English National Health Service (NHS). Design/methodology/approach - We used a qualitative case study design comprising a purposeful sample of two low performing and two high performing mental health providers, based on . The main form of data collection was semistructured interviews with 60 key informants (mostly internal to the organisation with some external informants from local Clinical Commissioning Groups). Findings - We found major differences regarding leadership, management and organisational culture between low and high performing mental health providers in 2015/2016, and that the differences had diminished considerably by 2019/20. In 2015/16, low performing providers were characterised by a ‘top-down’ style of leadership, centralised decision-making, and ‘blame cultures’. In contrast, the high performing providers were characterised as having more distributed, collaborative and inclusive styles of leadership/management, with open and supportive cultures. As the low performing providers changed and adapted their styles of leadership and management and organisational culture over the five-year period, they more closely resembled those of the high performing trusts. Originality/value - This is the first study to explore the relationship between changing organisational factors (leadership, culture, management practices) and the performance of mental health care providers. It provides evidence that it is possible for radical changes in leadership, management and organisational culture to be enacted over a relatively short period of time and that such changes may help low performing providers to turnaround their underperformance.