Context and Objectives
A major healthcare provider approached us to address significant workplace culture challenges impacting staff
well-being and performance.
An anonymous staff survey and focus group feedback indicated increasing stress, dissatisfaction, and concerns around leadership engagement, workplace toxicity, and psychological safety.
The organisation specifically chose to collaborate with Zuhra due to our unique Culture Quotient (CQ) survey methodology and the expert reputation of Dr Susan Hetrick in diagnosing and transforming workplace cultures.
The goal was to deeply understand these challenges using our proven measurement framework and recommend actionable improvements.
Methodology
We utilised a robust mixed-method approach, combining qualitative and quantitative research methods:
- Senior Leader Interviews: Conducted 24 confidential interviews with senior stakeholders.
- Focus Groups: Facilitated 15 structured focus groups across various locations, involving 97 staff members from diverse roles.
- Comprehensive Culture Quotient (CQ) Survey: Distributed to 1,195 employees, achieving a 53% response rate, leveraging Zuhra’s proprietary Culture Quotient measurement tool to gain deep insights into workplace dynamics.
Key Findings
- Leadership Disconnect: Many employees perceived senior management as disengaged, unapproachable, and unresponsive to staff concerns.
- Workplace Toxicity: Reports of bullying, harassment, favouritism, and unrealistic performance pressures were prevalent, significantly impacting morale and psychological safety.
- High Levels of Stress and Burnout: Excessive workloads and resource shortages contributed to widespread feelings of burnout and emotional exhaustion.
- Strong Peer Support: Despite challenges, many employees valued their immediate teams, citing strong peer relationships as essential support.
Deeper Cultural Assessment
To complement our mixed-method analysis, we applied Dr Susan Hetrick’s 4-Stage Model of Organisational Culture — a strategic diagnostic tool designed to resonate with executive decision-makers seeking clarity on cultural health and performance.
This model frames organisational culture as a staged continuum, ranging from Healthy and Aligned to Pervasively Toxic. It is built around two critical diagnostic dimensions:
Cognitive Dissonance: The extent of the gap between an organisation’s stated values and the observable behaviours of its leadership.
Normalization of Deviance: The degree to which unethical, bullying, or dysfunctional behaviours have become accepted as normal practice.
In our case study, both dimensions were clearly evident: staff consistently reported a credibility gap in leadership, alongside signs that toxic behaviours had become ingrained and unchallenged. Based on this evidence, we located the organisation within the “Pervasive Toxicity” quadrant of the model — indicating significant dysfunction, but also a clear window of opportunity for cultural reversal with the right leadership focus.
Importantly, this model is not theoretical in nature. It is grounded in empirical research and cross-sector application, aligning with established frameworks such as Schein’s cultural levels and Edmondson’s theory of psychological safety. Its strength lies in translating cultural dysfunction — often seen as intangible — into clear stages with observable indicators, enabling both diagnosis and action.
For senior leaders, the model offers three distinct forms of value:
1. Clarity Amid Complexity
By deconstructing culture into progressive stages and diagnostic dimensions, the model provides a tangible structure to assess cultural health and prioritise action.
2. Risk Management and Strategic Insight
Cultural dysfunction often correlates with operational failure — from poor retention to reputational crises. This model supports proactive leadership by exposing cultural risks before they escalate.
3. Leadership Accountability and Action
Rather than framing toxicity as inevitable, the model encourages ownership. It provides leaders with a framework for measurable improvement, showing that change is both achievable and evidence-based.
Our approach delivers more than just a diagnostic — it provides a clear and actionable roadmap for cultural renewal.
Recommended Interventions
- Enhance Leadership Engagement: Structured initiatives to improve leadership visibility, accountability, and empathetic engagement with frontline staff.
- Establish Psychological Safety: Implement clear anti-bullying policies, confidential reporting systems, and training programs to promote a safer, more inclusive environment.
- Strengthen Communication: Regular, transparent communication channels between leadership and staff through town halls and feedback loops.
- Promote Staff Well-being: Initiatives to reduce excessive workloads, including increased staffing levels, peer support programs, and targeted well-being resources.
- Career Development Opportunities: Transparent, merit-based career pathways, supported by structured mentoring and protected professional development time.
Impact and Conclusion
Our comprehensive analysis and recommendations provided the organisation with a clear, actionable path towards cultural transformation. The proposed interventions were designed to rebuild trust, improve staff morale, reduce turnover, and ultimately enhance the quality of service delivery.
This project highlights the critical role of proactive leadership, robust measurement frameworks, and systematic culture management in sustaining healthy and effective workplaces, particularly within complex organisational environments.
These themes are further explored in Toxic Organizational Cultures and Leadership: How to Build and Sustain a Healthy Workplace by Dr Susan Hetrick, which offers valuable insight into the underlying dynamics and practical tools for cultural change.
