Analysis of cultural diversity in a NHS Trust using Schein’s 3 level scheme

Following on from sub-culture, I think we can see that these 3 groups within a hospital have their own distinctive identity (see what you think!).  I’ll consider some of the implications in the next post. 

Level 1 Surface manifestations

Medical: White coats, stethoscopes, ritualised ward rounds, fellowships of Royal Colleges, eminent personalities
Managerial:  “civilian” clothes, plush offices remote from patient areas, separate hierarchy
Nursing: Uniforms, “hands-on” work, largely female, local training

Level 2 Values and beliefs

Medical:  Personal contract between doctor and patient, clinical freedom, scientific basis for treatment, member of profession, not employee of Trust
Managerial: Loyalty to Trust, resources limited by centrally-controlled budgets, financial prudence, adherence to central policy
Nursing:  Patient advocacy, care more than cure, nurturing, comfort, self-sacrifice, hygiene

Level 3 Basic assumptions

Medical:  Hippocratic Oath, patient confidentiality, sanctity of life, responsibility to patient
Managerial:  Responsibility to Trust/NHS for public money expenditure, health gain of population more important than individuals
Nursing:  Primacy of the individual, patient dignity

By analysing the sub-cultures using Schein’s model, it may be possible to identify common themes within each.  Appealing to common values may allow greater acceptance of change initiatives.  Moreover, those parts of the change initiative which fit with a particular subgroup can be emphasised most for that situation.  In other words, inasmuch as the senior management is a part of the culture, they may be able shape aspects of it to suit their agenda.

I’ll give some specifics in next posts!


This is a great word a learnt recently!  It means that sense of peer-to-peer understanding that we get when communicating with someone we don’t necessarily know, but with whom we share some common bond, e.g. professional status.  So, a doctor speaking to another doctor will always get a fair hearing on a controversial subject, whereas a manager or politician may not. 

It doesn’t mean that your peer will agree with you unthinkingly, but you will at least get a ‘foot in the door’ to make your pitch.  If you don’t have homophily with your audience, you should consider ‘buying it in’; in other words, bring someone with you who does, and let them do the talking.

Bear in mind that homophily works best the closer the bond.  Thus, a doctor-doctor bond is fine, but a GP-GP bond works better than a GP-Consultant one.

Homophily is crucial for clinical engagement with controversial subjects and sceptics!