Implementing national health reform - is organisational culture the key?

In a famous quote attributed to Peter Drucker ‘culture eats strategy for breakfast’. The impact of local health organisation culture on the implementation of national health reforms has been noted in a range of studies (Davies 2002; Franco et al. 2002; Ormrod 2003). This classic ‘top-down versus bottom-up’ disjunction (Sabatier 1986) reflects the competing perspectives on health policy held by different actors in the policy subsystem (Palmer and Short 2010).

This paper reports on the application of the Cameron and Quinn (2011) Competing Values instruments to front line health care management (Scott et al. 2003). In the context of the Tasmanian Department of Health and Human Services, the Competing Values results suggest that the top-down, economic focus of the Australian National Health Reform Agreement (Council of Australian Governments 2011) is antithetical to the professional culture and orientation of local health service providers.

The implications are that a change management approach to local organisational culture is required for the successful implementation of national health reform. Preparatory work undertaken in this area by the Chief Executive Officer, and other senior staff, within the Southern Tasmanian Health Organisation is outlined.

Tasmania is not unique in these matters. This paper will be of interest to other jurisdictions, policy-makers and policy implementers.