Culture change, leadership and the grass-roots workforce.

The NHS is arguably entering its most challenging era. It is being asked to do more for less and, in parallel, a cultural shift in response to its described weaknesses has been prescribed. The definition of culture, the form this change should take and the mechanism to achieve it are not well understood. The complexity of modern healthcare requires that we evolve our approach to the workforce and enhance our understanding of the styles of leadership that are required in order to bring about this cultural change. Identification of leaders within the workforce and dissemination of a purposeful and strategic quality improvement agenda, in part defined by the general workforce, are important components in establishing the change that the organisation currently requires. We are implementing this approach locally by identifying and developing grassroots networks linked to a portfolio of safety and quality projects.