Recommendation 198

Measuring culture on the front line

Healthcare providers should be encouraged by incentives to develop and deploy reliable and transparent measures of the cultural health of front-line nursing workplaces and teams, which build on the experience and feedback of nursing staff using a robust methodology, such as the “cultural barometer”.

Both teams and organisations should develop ways to measure their cultural health, and act on these measures to improve.  Cultural health is a matter for all staff groups; everybody who works in the health and care system is integral to improving and maintaining good cultural health.  Many tools and methods are available and the Department of Health and other arm’s length bodies are promoting these.  For example, the Cultural Barometer, which was highlighted as a case study in the government’s initial response to the inquiry, Patients First and Foremost, is being developed and piloted.  The National Nursing Research Unit at Kings College London are evaluating the pilot and are expected to publish their report in November 2013. NHS England supports the use of tools such as the cultural barometer and real time staff experience feedback. The friends and family test for staff will be rolled out from April 2014.

The Chief Nursing Officer is providing leadership through Compassion in Practice, the vision and strategy for nursing in England. Key action areas include:

  • developing a set of tools that enable organisations to measure their culture
  • providers undertaking a review of their organisational culture and publish the results
  • reviewing implementation of the cultural barometer once pilots have taken place
  • strategies to secure meaningful staff engagement
  • commissioning leadership role (build into Action Area 4 in Compassion in Practice), and
  • commissioning an approach to ensure that staff feedback is being used to develop cultural health of front-line staff


Promoting positive and learning cultures remains critical to supporting service improvement.

The Staff Friends and Family Test was introduced in April 2014. It is a feedback tool for staff, predominantly for local improvement work. It consists of two questions (with options to give free text feedback for each) through which organisations can take a temperature check of how staff are feeling. It is a quicker feedback mechanism than the existing NHS annual staff survey, and will help staff to voice their concerns (on a regular basis if they wish to) and help organisations to respond.

Following the first pilot phase of the cultural barometer by King’s College London, further work has taken place in two community and mental health sites to develop the tool further. Piloting will be complete by the end of the year and work is now underway to consider how best to make the barometer accessible and enable uptake. Further information on the barometer is available online.

The Social Partnership Forum produced guidance on staff engagement and partnership working and highlights areas of excellence in NHS organisations where management and trade union representatives work together effectively to identify and resolve issues.  The need for this guidance was indicated in Hard Truths and builds on the six key messages developed by the forum to support the development of the values, culture and working environment in the NHS that would best ensure that patients receive safe, effective and compassionate care.