• accreditation
• anaesthesia
• attitudes

Contemporary health policies frequently invoke notions of ‘culture’ and ‘cultural change’ as levers for achieving performance improvement and good-quality healthcare.1 But it has remained unclear whether talk of culture is largely empty rhetoric or whether framing healthcare organisations in ‘cultural’ terms offers useful insights that might improve organisational processes and outcomes of care. When considering the role of organisational culture in facilitating high-quality care and improved outcomes, a first important step is to explain what is meant by organisational culture, and then consider the evidence that organisational culture can be purposively managed and form part of efforts to improve quality and clinical performance in healthcare delivery organisations.

A recent systematic review found a consistent association between positive organisational and workplace cultures and beneficial clinical outcomes, including reduced mortality rates across a variety of health settings.2 Most ‘included’ studies in the review consisted of observational and cross-sectional designs, and only four were intervention studies. It is therefore very timely that two linked articles in this issue of the journal draw on an interventionist study design and present fresh empirical evidence for a culture–clinical outcome relationship in hospital settings.

Leslie Curry and colleagues3 conducted a 2-year, mixed-methods, prospective interventionist study (Leadership Saves Lives) designed to promote positive changes in organisational culture in 10 hospitals in the USA. Quantitative changes in organisational culture were measured using a validated 31-item survey instrument (reflecting five subscales of domains …