Creating a culture of high-quality care in health services requires an understanding of the key elements of culture and consideration of how such elements can be nurtured. This paper draws on extensive research within the United Kingdom National Health Service (NHS) to describe the importance of visions of high-quality care that are not just promulgated by leaders, but also enacted at every level of a health-care system. It is also necessary to set clear challenging objectives to improve quality at all levels. The research shows that a key determinant of health care is the extent to which staff are managed effectively by promoting their satisfaction and commitment via supportive, compassionate, respectful, and appreciative supervisory leadership, along with appropriately designed human resource management practices. Staff engagement is higher in positive, optimistic, and supportive work-place climates and where there are high levels of trust in leadership. Teamwork is fundamental to high-quality care, but requires well-defined teams with clear objectives, interdependent working, and regular reviews of team performance.
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