Organisational culture

Participants frequently linked their experiences of progression, representation and retention to the cultures of the organisations in which they worked. While experiences varied across NHS organisations, many respondents described workplace cultures as having a significant influence on whether staff felt included, supported and able to progress. The findings suggest that organisational culture is shaped not only by formal policies and strategies, but also by leadership behaviours, organisational responses and the actions taken when concerns are raised.  

Organisational culture has long been recognised as one of the most influential factors shaping staff experience, workplace inclusion and organisational performance within the NHS. Previous research has highlighted how organisational cultures can either reinforce or reduce inequalities through leadership behaviours, workplace norms, decision-making processes and responses to discrimination. The NHS Race and Health Observatory (2024), Workforce Race Equality Standard (WRES, 2025) and Green Park Race Inclusion reports have all highlighted the importance of creating cultures where equity, inclusion and accountability are embedded within everyday practice rather than treated as standalone initiatives.

The literature review highlighted examples of positive practice. Across the NHS, organisations have introduced targeted leadership development, reciprocal mentoring and fellowship programmes to support the progression of ethnic minority staff. National initiatives, including the NHS Leadership Academy’s Stepping Up and Ready Now programmes, demonstrate how structured leadership development can strengthen progression into senior roles. Regional fellowship programmes and leadership development initiatives for aspiring BME nursing and midwifery leaders provide further examples of practical approaches being implemented across the NHS.

Survey findings

Survey responses highlighted mixed perceptions regarding organisational approaches to race equality. Some respondents described positive organisational experiences where meaningful anti-racism work had been implemented. This included structural work, cultural work and zero tolerance to racism. 

 

Structural work	Cultural work	Zero tolerance
“We have set up an anti-racism committee.”	“For Black History Week, I was happy to share my culture with food to the team.”	“We have a zero tolerance to racism reporting tool and circle group.”
“Race, equality and inclusion (REIN) introduced in my organisation. The Bridges Talent Management Programme is a leadership and management training programme for employees in band 2-5.”	“The trust organised events to celebrate ethnicity and race like Diwali, Indonesian event, Black History Month, Filipino event. This is Me programme also rolled out.”	“We have a zero-tolerance policy and ethos within the organisation and a freedom to speak up guardian.”
“Patient and Carer Race Equality Framework (PCREF) – to eliminate unacceptable racial disparity.”	“Cultural awareness training.”	“Zero tolerance for bullying and discrimination. Regular webinars for managers and staff.”

However, other participants described organisational approaches to anti-racism as inconsistent or lacking visible impact. The findings suggested that participants reported more positive experiences where anti-racism was embedded within organisational practice and supported by leadership. In contrast, where action was perceived as tokenistic or inconsistent, participants continued to describe experiences of exclusion and inequity. 

Participants frequently described concerns regarding leadership understanding of racism and race inequality. Many respondents reported low confidence that senior leaders fully understood the experiences of ethnic minority staff working within the NHS. Similar concerns were evident across different staff groups and leadership levels. 

Survey responses also suggested that organisational culture influences whether staff feel psychologically safe to discuss racism or raise concerns. Some respondents described positive experiences where concerns were addressed appropriately and inclusion was actively promoted. However, others described cultures where racism was minimised, poorly understood or not consistently challenged. 

Participants frequently distinguished between activity and impact. While many organisations were described as undertaking race equality initiatives, respondents often questioned whether these activities had resulted in meaningful improvements in workplace experiences, progression opportunities or leadership diversity. 
Interview findings

The interviews provided additional insight into how organisational culture influences leadership experiences. 

A recurring theme across all interviews was the importance of organisational action. While participants acknowledged that awareness of race equality issues had increased significantly in recent years, many questioned whether this awareness had translated into meaningful change. Several interviewees described NHS organisations as being strong at collecting data and identifying problems but less effective at implementing sustained action. 

Participants also reflected on the role of leadership in shaping organisational culture. Leadership behaviours were frequently described as setting the tone for inclusion, psychological safety and accountability. Interviewees suggested that race equality was most likely to improve where leaders actively championed inclusion, challenged inequity and accepted responsibility for organisational change. 

Another recurring theme was the distinction between representation and cultural change. Participants acknowledged the importance of increasing diversity within leadership but argued that representation alone was insufficient if organisational cultures remained unchanged. Several interviewees suggested that race equality initiatives often focused on supporting individuals to navigate systems rather than addressing the systems themselves. 

Psychological safety also emerged as a significant issue. Participants frequently described the importance of creating environments where staff felt able to discuss racism, challenge inequity and raise concerns without fear of negative consequences. The absence of psychological safety was often linked to silence, disengagement and reduced trust in organisational processes. 

These findings are consistent with wider evidence suggesting that sustainable progress requires race equality to be viewed as a core organisational responsibility rather than an isolated workforce initiative. 

Summary 

The findings suggest that organisational culture provides the foundation upon which experiences of progression, representation and retention are built. While participants recognised examples of positive practice and increasing organisational commitment to race equality, many continued to report concerns regarding accountability, leadership behaviours, psychological safety and the translation of intention into action. 

Organisational culture was frequently described as the factor that determined whether race equality initiatives were experienced as meaningful or symbolic. Improving representation alone is unlikely to achieve sustained change unless it is accompanied by organisational cultures that actively promote inclusion, equity, accountability and belonging. 

The examples of positive practice identified within this report demonstrate that many NHS organisations are already taking meaningful steps to improve race equality. The challenge is now to ensure that effective approaches are shared, evaluated and implemented more consistently across the NHS.