Why culture – not strategy – determines success in care delivery
By Andrew Crawshaw, Chief Executive Officer, Millbrook Healthcare
In health and social care, we spend a great deal of time talking about strategy.
Five-year plans. Transformation programmes. Operating models. Digital roadmaps.
All of these are important. But in my experience, they are not what ultimately determines whether an organisation succeeds.
Culture does.
Strategy sets direction. Culture determines delivery.
A good strategy defines where you are going and how you intend to get there. It provides clarity and alignment, particularly in complex, multi-service organisations like those operating across community health and social care.
But strategy, on its own, does not deliver outcomes.
Delivery happens in thousands of everyday interactions – between frontline colleagues and service users, between depot teams and central functions, between providers and commissioners. It is in these moments that culture is not just visible; it is decisive.
You can have the most sophisticated strategy in the sector and the most developed systems and operational practices. If your culture does not support it, the strategy will not be delivered.
What culture really means in care
Culture is often misunderstood as something intangible – a set of values on a wall, or a set of statements in an annual report.
In reality, culture is simply “how things get done” when no one is watching.
In care delivery, that translates into very practical behaviours:
- Do colleagues take personal accountability for outcomes?
- Do they speak up when something is not right?
- Do they prioritise the needs of service users?
- Do teams work collaboratively across organisational boundaries?
“Doing the right thing”, as in the examples above, is simple when times are easy. The test of a culture is whether we stick to our values when it is difficult.
- Do colleagues take personal accountability for outcomes, even if a failure is your failure?
- Do you speak up when something is not right, even if everyone else disagrees?
- Do you prioritise the needs of service users, even when it is inconvenient?
- Does your team work collaboratively across organisational boundaries, even though that “other team” are a pain to work with?
At Millbrook Healthcare, we have four key values that define our culture.
CARING
We care about our service users, their safety and their families who are often going through difficult times. We take care of our colleagues and treat everyone fairly and with respect.
ACCOUNTABLE
We take responsibility for our actions and the services we provide. People can rely on us to do what we say we will do. We are trusted to do our work well because outcomes matter and people’s safety, independence and well-being depend on us.
COLLABORATIVE
We understand that the best outcomes come from listening to, and working in collaboration with, our service users, customers and colleagues. We work in a transparent and innovative way to build strong, effective partnerships.
SOCIALLY RESPONSIBLE
We look after the interests of society, the environment and our local communities. We promote environmental sustainability, advance diversity and inclusion and maintain ethical supply chains.
Why culture matters more in health and social care
In many industries, performance can be standardised, automated, or controlled through systems. Health and social care are different.
Most of the care we deliver is in people’s homes. It often involves vulnerable individuals and families going through difficult times. It requires judgement, compassion, and responsiveness – often in situations that cannot be scripted.
You cannot write a process for every scenario. You cannot supervise every interaction. You cannot rely on systems alone to ensure quality.
What you can rely on is culture – if it is strong enough.
The link between culture and quality
There is a direct relationship between culture and quality of care.
Where culture is strong:
- Colleagues take ownership of problems rather than passing them on.
- Issues are identified and resolved earlier.
- Service users receive a more consistent and responsive experience.
- Teams focus on outcomes, not just activity.
Where culture is weak, the opposite is true – and no amount of strategic intent can compensate for it.
This is why we place such emphasis on personal accountability, collaboration, and acting on issues when they arise. We focus on actions and outcomes, not just words, and expect colleagues to call out when something is not right.
These are cultural behaviours, not strategic initiatives – but they are what drive performance.
Culture as a competitive advantage
In an increasingly competitive and financially constrained market, culture is often forgotten as a source of advantage.
That is a mistake.
Many providers can deliver a service model. Many can invest in powerful systems and technologies. But culture – the collective behaviours of an organisation – is far harder to replicate.
It is also far more powerful.
A strong, values-led culture enables organisations to:
- Deliver consistently high-quality services.
- Attract and retain skilled colleagues.
- Build trusted relationships with commissioners.
- Adapt more quickly to change.
In our experience, it is this combination that defines long-term success, not the strategy document itself.
Closing thought
In health and social care, we are not delivering products. We are supporting people – often at the most vulnerable moments in their lives.
That requires a culture where people care, where they take ownership, and where they are committed to doing the right thing – even when it is difficult.
Strategy matters. But culture is what makes it real.
