Leadership of a cultural change process
Ian Brooks
Explores the successful role of
leadership in initiating and
sustaining a major process of
change. The findings build on
the work of others who have
so ably demonstrated the
influence of powerful leaders.
Research is based on qualita-
tive data from an
ethnographic study which
immersed itself in the minu-
tiae of organizational life.
Outlines the processes that
have unfolded in the wider
context of NHS change. Dis-
cusses the findings and
debates supporting evidence.
The resultant model of change
indicates that successful
leadership of cultural change
requires leaders to think
culturally, to be guided by a
cognitive model of change and
to employ the cultural tools of
symbolism while actively
focusing on the politics of
acceptance. Hard systems and
structural changes can be
implemented in parallel with
soft symbolic and political
activity. A highly receptive
context, either real or created,
assists by providing a trigger
for change.
© Ian Brooks, 1996.
Leadership & Organization
Development Journal
17/5 [1996] 31–37
MCB University Press
[ISSN 0143-7739]
Principal Lecturer, Faculty of Management and Business,
Nene College, Northampton, UK
Introduction
This paper explores the successful role of
leadership in initiating and sustaining a
major process of change. More emotively, it
illustrates how a chief executive, Frank
Collins, and a cadre of skilled managers, man-
aged to win both hearts and minds. In the
space of three years’ consultants in a National
Health Service (NHS) general hospital
changed from outright objection to overt sup-
port of their unit gaining self-managing Trust
status. These consultants had begun to own
the change involved, a fact so graphically and
symbolically illustrated by their unanimous
signing of the Trust status proposal document.
This paper builds on the work of others who
have so ably demonstrated the influence of
powerful leaders (Tushman and Romanelli,
1985) or new chief executives (Grinyer and
Spender, 1979; Slatter, 1984). Although this
may appear to contradict of the work of cul-
tural purists, who argue that things are
largely unaffected by the intervention of
leaders, and by more recent research which
suggests that leadership is a pluralistic phe-
nomenon (Bate, 1994), there is, nevertheless, a
compelling story to tell. The paper does not
claim that one man, or even the management
team, transformed the organization, but that
a new CEO and senior team actively, persis-
tently and consistently sought to bring about
organizational change and achieved consider-
able success in that endeavour.
In 1990, three years before the hospital
(referred to throughout as GH) applied for
Trust status and shortly before the CEO
arrived, there was a front-page article in the
local newspaper, signed by over 20 senior
consultants at the hospital, strongly opposing
any moves towards Trust status. Change to
Trust status represented a counter-cultural
invasive force that was alien to the “local
cultural infrastructure” (Brooks and Bate,
1994).
In 1993 the Trust status application docu-
ment was signed by the 15 original consul-
tants who were still working at GH and who
earlier had publicly denounced change. The
CEO characterized this voluntary signing-up
as, “symbolic of a changing of hearts and
minds”. This is seen as a considerable
achievement by all who were interviewed
during this research exercise, including the
consultants themselves. For the CEO it was
merely the tangible manifestation of a more
significant cultural change to an organization
“that now wants and expects to succeed”.
There has been considerable research in
the field of leadership. Initially, it was thought
that good leaders possessed a series of traits
that accounted for their success. These are
well summarized by Stogdell (1974). The Ohio
State University studies argued, more con-
vincingly, that leadership is better explained
by behaviours. Unfortunately both schools
are acontextual, that is, they ignore the set-
ting or contingent factors. Contingency theo-
rists, such as Fiedler (1967), recognize that
interpersonal relationships in a context are
critical to leadership endeavours.
This paper further explores the importance
of context and builds on more recent research
on the symbolic (Bate, 1994; Johnson, 1990)
and political roles of leadership. Hence this
paper suggests that the softer, more symbolic
and less tangible, aspects of leadership are
every bit as important in securing speedy
transformation as the more tangible hard
structures and systems changes.
Research design
This paper is based on qualitative data from
an ethnographic study which was immersed
in the minutiae of organizational life. Central
to the data collecting process was a series of
20 semi-structured interviews with an array
of personnel from the Trust hospital.
Research concentrated on purposive sam-
pling. Initially, senior personnel were inter-
viewed, including two lengthy interviews
with the chief executive himself. This was
widened to include junior, non-medical and
non-managerial employees. Eventually,
domestic staff, porters, executive and non-
executive board members, the deputy chief
executive and other senior and middle
[ 31 ]
Ian Brooks managers, including business managers and
Leadership of a cultural a number of clinical professionals, were
change process interviewed. All interviews were taped and
Leadership & Organization comprehensive transcripts made. Over 30
Development Journal
hours of “rich description” (Geertz, 1973)
17/5 [1996] 31–37
resulted. Analysis was based on predesigned
categories, compiled by reference to litera-
ture in the fields of leadership, culture and
organizational power. Some of the data, in the
form of respondents’ discourse, is reproduced
in this paper to help tell the story.
Context
The processes outlined in this paper unfolded
in the wider context of NHS change. The NHS
reforms have stimulated considerable
research, largely flamed by political and
social ideologies and focused on marketiza-
tion, managerialism and conflicting value
systems. It is extensive, covering widely dif-
ferent issues and topics like financial man-
agement and information systems, the politi-
cal-managerial and professional-managerial
interfaces, and NHS structures, systems,
policies and control mechanisms. There has
been far less research at the micro process
level of organizational leadership.
In the public services generally, and the
NHS specifically, a top-down invasive model
of change has predominated, inspired by
political agendas and prevailing socio-eco-
nomic and technological conditions. Man-
agers in the NHS generally have been positive
about the changes. Manifestations of manage-
rialism abound: strategic planning systems,
business plans, mission statements, business
managers, and new initiatives like learning
organization theory, TQM and Investors in
People proliferate (Lawton and Rose, 1991;
Pollitt and Harrison, 1992; Talbot, 1994). NHS
managers, as opposed to clinicians and trade
unionists, are seen as the beneficiaries of
change (Ferlie, 1994).
This research was undertaken in a
medium-sized general hospital (fourth wave)
NHS Trust which gained its new status in
April 1994. The hospital has made consider-
able progress in many respects in recent
years and is generally considered to be a fast
improving and sound Trust. The critical
managerial-clinical interface appears to be a
more constructive relationship than others
reported elsewhere. Considerable progress
has been made on external measurements of
quality and operating success. The chief exec-
utive has recently moved to a larger hospital
Trust.
[ 32 ]
The leadership of change
Turnaround involved an all-embracing
attempt at organizational change and not a
merely persuasive campaign aimed at 15 con-
sultants. This section will demonstrate the
multiple, largely parallel, approaches adopted
by the CEO and his new management team.
Management of hard infrastructure
The management team oversaw the restruc-
turing of the organization, including the devel-
opment of separate clinical directorates, each
headed by a lead consultant who sits on the
senior management executive. Business man-
agers were introduced to each directorate and
a small senior management team appointed
and developed. Systems were introduced to
facilitate the achievement of operational and
strategic objectives. Financial systems, annual
planning cycles, internal tracking systems,
administrative systems and financial methods
were upgraded to cope with the internal mar-
ket and subsequent Trust status. They enabled
the organization to cope with and prosper in
the newly introduced “internal market” in the
NHS and, eventually, to gain Trust status.
They also facilitated the shortening of waiting
lists and the achievement of many externally
and self-imposed targets.
Politics of acceptance
There is ample evidence that the CEO and
management team paid particular attention
to the politics of acceptance. They adopted a
more collaborative and less coercive (Dunphy
and Stace, 1988) style than is often the case in
many organizations. The CEO engaged in a
great deal of discussion at an early stage and
particularly involved individuals and groups
who held both formal and informal power.
These included a group comprising the lead
consultants and the senior management
executive, external bodies like purchasing
authorities and, later, general practitioner
(GP) fundholders. Initially, these were largely
exploratory meetings in which ideas about
the future of the hospital were discussed
openly. The CEO developed a highly visible,
energetic and dynamic approach, assisted by
an effusive and out-going personality, which
was, initially at least, aimed at gaining accep-
tance of the need for change.
The CEO saw his first task as “gaining their
[senior consultants’ and managers’] under-
standing of the environment”. At the early
stage a consultant commented that “this was
the first time we had been engaged in discus-
sion of this nature”. Collective action was
emphasized and views sought. Instilling in
Ian Brooks others a sense of ownership of both the prob-
Leadership of a cultural lem and the solution was seen as crucial by
change process the senior managers.
Leadership & Organization Rapidly impending, centrally imposed
Development Journal change in 1991 created a trigger for action.
17/5 [1996] 31–37
This was the adoption, throughout the NHS,
of an internal market for the purchase and
supply of health care and related activities.
The CEO’s awareness of this was evident: “we
were on an 11-month, externally imposed
process of change, and the clock was ticking.
It was no good saying, “we’re a little bit
sleepy can we make it 18 months?: [it was]
not-negotiable. On 1 April 1991 you would be
delivering!”. He consciously heightened this
sense of impending crisis while instilling
confidence that “we” were competent to man-
age the required changes. Use was made of
such phrases as “go under”, “we will not
survive” and “falling-over”. These, the CEO
later agreed, were quite startling messages.
‘…The imposed change and the urgency it created were, the CEO
argued, “very useful”. They helped legitimize the change process
and the discussions with consultants and managers and establish
the management team, not as the source of the demand for change,
but as the body of experts who could provide the solutions…’
On regular walkabouts he would ask people
how they were prepared for the forthcoming
reforms. He argues: “I used that ever-decreas-
ing time frame as an opportunity to legitimize
my discussions”, and he admits to “con-
sciously using some form of crisis language”.
This initial approach was largely, but not
exclusively, focused on senior consultants and
other senior and middle managers in the orga-
nization. His aim was clear to ensure that “the
road was clear for us to introduce the
reforms”. The imposed change and the
urgency it created were, the CEO argued,
“very useful”. They helped legitimize the
change process and the discussions with con-
sultants and managers and establish the man-
agement team, not as the source of the demand
for change, but as the body of experts who
could provide the solutions. The CEO was
aware of this role, suggesting that: “it wasn’t
me as the new manager who wanted the
change because I had perceived a weakness in
the organization, but I was here and so were
the reforms and ‘we’ had to do something”.
The organization coped well with the intro-
duction of the internal market, so that after 1
April 1991 “we were able to congratulate our-
selves”. This “small win” (Weick, 1979) served
to reinforce the change process. There then
followed, quickly on the heels of this success,
a series of senior management and consul-
tant away-days and other discussions “to
start thinking strategically and introduce an
annual planning cycle”. The away-days were
used to design the mission of the organization.
Although as one senior manager noted, some-
what inevitably, “some consultants were
embracing it better than others”, one consul-
tant, who enjoyed the experience, suggested
that “for the first time we realized that there
were as many views as [there were] people
present”. This divergence of opinion between
consultants from different directorates
helped legitimize management intervention
still further. Leadership was viewed as essen-
tial to ensure fair-play.
This teasing out of ideas and the process of
gaining ownership of strategy were opera-
tionalized alongside the hard structural and
systems changes discussed above. Winning
over consultants was facilitated by the
appointment of business managers who
“would act as their assistants” and help them
with day-to-day administrative responsibili-
ties. Couching this in terms of “assistance”
and relieving them of tiresome administra-
tion seemed to reduce the sense of prevailing
managerialism which many medical person-
nel resent. Another structural change which
addressed the political issues that surround
change was the decision to make the medical
directors (the lead consultant in each of 12
directorates) the majority group on the
senior management executive. This was a
vital symbolic gesture in managing the politi-
cal acceptance of strategic change. It helped
reassure the consultants and indicated to
other clinical personnel that their voice
would be heard. It also symbolized the intent
to encourage consultants to own both the
management and the change processes.
Although the CEO continued to “lead the
agenda”, a consensual approach was usually
adopted. Nevertheless, as one consultant put
it, “the management team was a forum in
which [the CEO] comes with ideas and we
leave with them”. There were a couple of
occasions when the CEO gave way to collec-
tive consultant opinion, although he argued
that these were of symbolic value in
signalling his desire to gain collective owner-
ship of the strategic organizational processes.
One senior manager argued that the
approach taken and the range of tactics out-
lined above “locked people in to the strategic
management and change processes”.
Management of symbols
Many organizational leaders virtually ignore
both the concept and the reality of culture,
[ 33 ]
Ian Brooks while others consider culture as a contextual
Leadership of a cultural variable which resists or, on rare occasions,
change process promotes change. This latter category of
Leadership & Organization manager thinks about culture. The CEO in
Development Journal this case, it can be argued, thought culturally:
17/5 [1996] 31–37
that is, he apprehended the situation in cul-
tural terms and used cultural tools to manage
change. The distinction is significant. He
made considerable effort to utilize the power
of symbols. He showed awareness that his
actions carried both overt face-value influ-
ence and symbolic significance. This enabled
him to calculate the effects of his language,
dress, style and actions in symbolic and,
therefore, cultural terms. What is more, this
knowledge consciously influenced his
approach. It can be argued that a leader’s
effectiveness is, in part at least, determined
by his ability to make activity meaningful
(Pondy, 1978) and to communicate that mean-
ing and vision to those in the organization
(Peters, 1978). The CEO chose the power of
symbols to assist in this process.
Thus his insistence on “wearing jeans and
t-shirts” and playing loud pop music at middle
management away-days was a symbolic
attempt to reduce barriers and to introduce
“fun”; the suggestion being that experimenta-
tion and change were exciting experiences. He
graphically symbolized innovation and enthu-
siasm by his style of facilitating meetings.
Darting from flipchart to flipchart, synthesiz-
ing debate, publicly embracing respondent
concerns and views. Stories of his energetic,
probing, listening, experimental style are
numerous and he actively encouraged their
dissemination. Additionally, the CEO’s fre-
quent gifts, such as baskets of fruit, to islands
of progress in the hospital and sub-units
which had exceeded targets, symbolized the
rewarding of desired behaviours and attitudes.
‘…Public criticism following press coverage of an overseas visit,
some difficulties in engaging trade unions on issues such as local
pay, and interface difficulties with a local Community Trust
ensured that progress was often painful…’
Twelve staff representing a diagonal slice of
personnel from across the organization, were
designated networkers by mutual agreement.
The aim was to facilitate communication,
largely between lower levels and the execu-
tive group. It proved to be a useful tool with
which to hear common reality on the ground;
but symbolically it also demonstrated man-
agement’s desire to listen. Acutely aware that
symbols can be interpreted differently by
various audiences, the management team
was careful to ensure that the networkers
[ 34 ]
were never used to disseminate managerial
information nor instructed to persuade
people of the benefits of change.
Of course it was not all “fun and flipcharts”,
as the CEO was at pains to acknowledge.
Progress often was slow. Public criticism
following press coverage of an overseas visit,
some difficulties in engaging trade unions on
issues such as local pay, and interface difficul-
ties with a local Community Trust ensured
that progress was often painful.
Ritual
Ritual is a prescribed activity, usually rigidly
observed in a solemn and ceremonial fashion,
which holds symbolic significance. The NHS is
characterized by ritual. For example, the daily
drugs and drinks dispensing round at 6 a.m.,
which often involves waking patients prema-
turely, the procession of hand maidens waiting
on a surgeon, and each clinical discipline’s
insistence on collecting the same personal
data from patients, all take on ritualistic signi-
ficance (Brooks, 1996). These and many other
rituals serve to preserve the existing culture.
New rituals were created which symbolized
change. It is their symbolic significance,
rather than the importance of the activity at
face value, which is crucial in attempts to
manage cultural change. Hence reclassifica-
tion of hospital porters, cleaners and catering
staff as ward assistants was signalling a new
and enhanced social identity for this group
which helped to overcome old demarcation
issues. Frequent away-days became rituals
which symbolized a genuine attempt to listen
to and resolve employee concerns and to help
people makesense of the ongoing changes. The
away-days became rites of sensemaking, as
the CEO explained: “I started to do some work
with the consultants, to help them to under-
stand the nature of the environment and of
the internal responses required in terms of
skills, competences and structures.” Further
extensive discussions with senior and middle
managers became rites of challenge, as the
CEO, it was noted, “encouraged questioning
of the way we do things”. It was suggested that
“it is essential to have some radical people in
the organization to continually challenge”.
The frequent attempts to benchmark the
hospital’s performance and activities against
the best in the sector served, in a ritualistic
fashion, to challenge existing practices.
During his first few months at the hospital,
the CEO walked the job and confronted peo-
ple concerning their plans to manage the new
requirements of operating in an internal
market. This rite of legitimacy was justified
by the CEO: “I could legitimize asking the
Ian Brooks question of people who had not changed sig-
Leadership of a cultural nificantly for more than a decade.”
change process
Leadership & Organization Stories
Development Journal Organizational stories symbolize what is
17/5 [1996] 31–37
important in an organization and help to
shape its culture. The stories of how the CEO
held meetings, refusing to sit down, jumping
from whiteboard to flipchart, noting ideas for
public consumption and so forth, are told by
many respondents in the hospital. For them it
symbolizes an open, frank and dynamic style
of management, and also indicates that new
ideas are welcomed and that challenging exist-
ing practices is the norm. It indicates a desire
to listen to and involve many people in creat-
ing the agenda for change. The CEO’s behav-
iour, particularly on away days has, according
to one consultant, “locked him in the folklore
of the organization”. It has, a senior manager
confided, “changed people’s view [of him] from
a manager to a leader”.
Values
Collectively held values underpin organiza-
tional culture. It is not surprising that atten-
tion to the organizational value system
became a top priority for the management
team. From the early stages, planned work-
shops and impromptu discussions with
senior and middle managers and consultants
worked on developing the organizational
mission – perhaps the prime symbolic expres-
sion of any organization. The workshops
sought to build gradually a value statement
which reflected both individual’s personal
values and the fundamental purpose of the
hospital. The resulting statement is simple
and holds few surprises; but, far more impor-
tantly, it is owned by many.
Discussion and conclusions
We have explored some of the activities of the
CEO and the management team in their en-
deavours to manage change in this rich context.
We will now assess the likely reasons for the
success of their strategies and present a simple
model which illustrates these observations.
A receptive context for leadership
Although to a certain extent an organization
has the ability to renew and replenish itself,
rapidly changing external environmental
conditions, such as those experienced in the
NHS in recent years, demand the interven-
tion of leadership at the organizational level.
External pressure for change operating
on this scale “demands invention and
creativity beyond the performance of role
requirements; it requires leadership of a high
order” (Katz and Kahn, 1966). The arrival of
this charismatic, dynamic and change ori-
ented leader, who rapidly assembled a skilled
cadre of managers, coincided with the need
for such talents. In other words, the organiza-
tion was a highly receptive context.
Leadership was needed to make sense of
environmental flux and, paradoxically, to
help produce stability of purpose out of the
ensuing chaos. Leadership qualities and the
emotional involvement and loyalty of follow-
ers were enhanced by the context. As the
introduction of the internal market and other
government-led invasive changes were immi-
nent, the organization experienced stress and
crisis which facilitated leadership attempts at
change. It is not surprising that the leader in
question heightened the sense of crisis. Envi-
ronmental change and perceived crisis pro-
duced followers – the essential ingredient for
all leaders.
The period 1990-95 could be viewed as a turn-
around at GH. At the commencement of this
period, the appointment of a new chief execu-
tive held symbolic significance. He was a pro-
fessional manager and not, as always previ-
ously had been the case, a clinician. It was
change itself which was signalled. This paper
has argued that the CEO had many of the char-
acteristics of a skilled turnaround manager:
that is, leadership and motivational skills,
flexibility and courage. In short, he was the
right person at the right time (Slatter, 1984).
Thinking culturally
Slatter (1984) argues that leadership in turn-
around situations involves:
• communicating a sense of direction;
• establishing a sense of urgency;
• defining responsibilities;
• resolving conflict;
• conveying enthusiasm and dedication;
• giving due credit and rewarding success.
The new CEO must also take on the burden of
communication further down the organiza-
tion. This paper has illustrated that the lead-
ership was well blessed in these areas, yet it
has been the use of symbolism and skills in
managing the politics of acceptance which
really ensured the success that has been
experienced.
Two imperatives in the management of
cultural change are the leadership’s ability to
think culturally and to conceptualize, via a
working model, the change process (Brooks
and Bate, 1994). There is considerable evi-
dence that leadership in this case thought
culturally and created and communicated a
[ 35 ]
Ian Brooks vision and model of change. The extensive
Leadership of a cultural and conscious use of symbolism, the inten-
change process tional proliferation of organizational stories,
Leadership & Organization the attention to personal and shared values
Development Journal and the development of rites of legitimacy,
17/5 [1996] 31–37
renewal, sensemaking and challenge are
testimony to this.
‘…leadership established where the organization was coming
from and where it needed to be, what is more a cognitive map was
employed which guided activity along that journey. This involved
conscious and purposeful operation, simultaneously, at the
tangible or overt levels and at the political and cultural levels…’
Model of change
The process of change management con-
ceived of and undertaken by the CEO and his
management team was based on a cognitive
model of change that was not articulated,
but which served to delimit and guide his
leadership activities. The author has
attempted to conceptualize and illustrate
that model here after piecing together the
research evidence (see Figure 1). This paper
has outlined, albeit briefly, the three-
pronged approach to change management
adopted in this context: that is, a focus on the
politics of acceptance, the management of
symbols and the concurrent management
of a “hard” infrastructure. The three ap-
proaches combine to form an integrated and
purposeful leadership endeavour. These
mechanisms have been employed during the
process of change to “move” the organiza-
tion from its position in 1991 towards the
desired state.
The mental map owned by the team would
have been less concrete and certain than
the model suggested here. Nevertheless,
Figure 1
Model and process of change
Current Desired
state Process of change future state
R R
E E
C C
E E
P Politics of Management P this organization through its period of great-
T acceptance of symbols T
I I
V V
E E
C C
O O
N N
T Management T
of the “hard”
E E
X infrastructure X between subcultures”, Journal of Management
T T
[ 36 ]
possession of such a model of change and the
ability to conceptualize the process are
important leadership qualities. They com-
prise, in political jargon, “that vision thing”.
Hence leadership established where the orga-
nization was coming from and where it
needed to be, what is more a cognitive map
was employed which guided activity along
that journey. This involved conscious and
purposeful operation, simultaneously, at the
tangible or overt levels and at the political
and cultural levels.
When studying change in a Civil Service
agency, Brooks and Bate (1994) argued that
four aspects essential for facilitating success-
ful change were absent, so making change
problematic and probably doomed to failure.
It was noted that major change is best stimu-
lated by a real or perceived crisis which
serves as a trigger and by leadership paying
careful attention to the politics of acceptance.
This involves change agents diagnosing the
current state of the organization and its cul-
ture and holding a vision of the desired future
state.
These features are encompassed by the
model shown in Figure 1 and were addressed
by management in this case. Hence the new
CEO entered a receptive context and helped
create the appearance or enhance the reality
of crisis. The trigger was in place. The polit-
ics of acceptance were managed by focusing
on powerful formal and informal leaders,
symbolizing an intent to listen to everyone
and take on board their concerns, and to re-
structure in favour of clinical personnel.
Leadership was highly aware of the present
state of the organization and its culture and
held a vision of the desired future state; a
vision that was continually and collectively
constructed and deconstructed and which
evolved from a cultural and political process
of dialogue. The CEO actively managed cul-
tural change in the hospital by utilizing the
power of symbols. This process of change was
punctuated by the consistent upgrading of
systems and structures which facilitated
improvements in efficiency and effectiveness,
enabling more tangible changes to be regis-
tered and acknowledged.
Although the desired future state is an ever-
evolving ideal, leadership successfully guided
est change since its opening.
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