Cultural change and perpetuation in organisations: evidence from an English emergency ambulance service

Transforming cultures rather than changing structures is a favourite prescription for reforming health care organisations. We explore the relationship between cultures, performance measures, and organisational change by analysing the cultural characteristics of an English ambulance trust to understand how organisational culture is perpetuated. Internal and external factors that impact on culture change programmes, such as historical legacy and sub-cultural dynamics, are identified. The role and identity of ambulance personnel, the conflict between professional culture and managerial objectives, and the roleofperformancemeasurementwere found tobe significant issueswhich promoted resistance to enforced change and impeded planned management action.