Background: Working environments and relationships influence healthcare workers’ satisfaction and intent to stay, as well as service-user outcomes. With staff shortages a global issue, co-creation of effective workplace cultures that are also good places to work is more important than ever. Since our original research in 2011, a growing body of theoretical insights into workplace cultures has shown how complex it can be to develop them. We were curious about what staff felt works or what is needed.

Aim: To develop a guiding theory with and for healthcare practitioners on effective workplace cultures in settings that are also good places to work.

Methods: A three-phase study was used, based on principles of appreciative inquiry and realist evaluation. A blog generated initial interest, followed by a Twitter chat posing provocative questions. A series of Context-Mechanism-Outcome (CMO) configurations emerged and were presented to a new audience during an international conference. Endorsements and additions enabled further refinement of the initial programme theories, which were again presented for reflections during a second Twitter chat. Subsequent analysis resulted in a realist programme theory ready for further testing in practice.

Findings/results: There are four guiding lights for co-creating effective workplace cultures in settings that are also good places to work: collective leadership; living shared values; safe, critical, creative learning environments; and change for good that makes a difference. When each is given adequate attention and all are combined, the ultimate outcomes include: high-performing teams that flourish and provide person- and relationship-centred care that is safe, effective and independent of the agency of specific individuals; and teams that develop effective partnerships within and across boundaries.

Conclusions: Based on the voices of international frontline healthcare staff, we propose the retention of staff committed to providing care valued by staff and service users can be achieved by: collective leadership; living shared values; safe, critical, creative learning environments; and change for good as determined by those providing and experiencing care.

Implications for practice:

• Healthcare managers, leaders and commissioners need to recognise and support microsystem culture development that staff and service users experience as good and safe
• Workplace culture development should be continuous, collaborative, inclusive and participatory, and driven by staff and service-user experiences, not top-down action planning and box ticking
• Responsive and person-centred leadership enables effective workplace cultures and collective leadership

This article by Shaun Cardiff, Kate Sanders, Jonathan Webster and Kim Manley is licensed under a Creative Commons Attribution Non-Commercial 3.0 License.