Changing leadership, management and culture in mental health trusts

Purpose: This study aims to explore how leadership, management practices and organisational cultures have changed in low and high-performing mental health (MH) providers between 2015 and 2020 in the English National Health Service.

Design/methodology/approach: The authors used a qualitative case study design comprising a purposeful sample of two low-performing and two high-performing MH providers, based on semi-structured interviews with 60 key informants (mostly internal to the organisation with some external informants from local Clinical Commissioning Groups).

Findings: The authors found major differences regarding leadership, management and organisational culture between low and high performing MH 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: To the best of the authors’ knowledge, this is the first study to explore the relationship between changing organisational factors and the performance of MH 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.