The widely reported failures of Stafford Hospital and the Mid Staffs NHS Trust show that leadership plays a key role in determining organisational culture. Certainly inadequate leadership played a part in the scandal, as was identified in the damning report by Robert Francis QC. In the presentation of his report, Francis described the hospital failings as "a lack of care, compassion, humanity and leadership". The key leadership shortcomings included the failure to listen to patients and frontline staff and the tolerance of poor standards of care. The local NHS leaders were culpable in developing the culture of patient neglect, as they placed greater emphasis on cost control and the gaining of foundation trust status than the care given to patients. However, there were other factors at play which were affected the culture which are wider than Stafford Hospital and apply to other parts of the NHS. In terms of Charles Handy's classification of culture the NHS would exhibit some aspects of "role culture", i.e. it is inward-looking and bureaucratic with many layers of hierarchy. This contrasts with Total Quality companies and more customer-focused organisations where the frontline staff who interact with customers are viewed as the most important employees and the role of more senior management is to support them. For instance, companies such as South-West Airlines claim they are organised in an "upside-down pyramid" with frontline staff and the customer determining the priorities and behaviours within the organisation. This is a million miles from the culture of Stafford Hospital described in the Francis report where the customer (i.e. the patient) was neglected. So as well as leadership being a key factor in the culture of the Stafford Hospital, the organisational structure of the NHS and its occasional tendency to place the interests of senior employees above those of customers played a part in the disastrous failings that occurred there.
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