Culture is about how things are done. It was one line in a preliminary report on a health crisis in NSW that always stuck with me.

In 2016, NSW Health experienced a scandal when news broke that a doctor purposefully underdosed over 100 head and neck cancer patients, rather than dosing calculated on individual body size and kidney function.

At the time, I was working for the Health Minister responsible, and this crisis and others spiralled into a growing lack of confidence in the NSW Health and negative media stories.

We mishandled this and other health crises it at a Ministerial level but that is not the lesson I have taken from this. It is the quote from Proffessor David Currow - culture is the way things are done.

The hospital's alleged response to the crisis revealed a culture characterised by ambiguity and media management. Emails disclosed under an S052 order illuminated a default towards self-protection over problem-solving. While perhaps offering short-term media management benefits, this approach flowed through to the patients and proved inadequate in addressing the core issue and ultimately led to a larger crisis.

A culture prioritising defensiveness and damage control over patient welfare (or customer centricity) and open communication can never deliver quality consistently - and led to an environment that allowed the under-dosing to take place.

My experience during the under-dosing scandal offered a stark lesson on the importance of culture within organisations. When the undercurrent culture fosters ambiguity and self-protection over problem-solving, it is not just staff who suffer; patients do too.

The under-dosing scandal was not just a reflection of misguided priorities, but also a testament to the courage of individuals within the system. It was brought to light by a courageous whistle-blower, an employee who exemplified a culture opposite to that of self-protection. Their brave action underlines the importance of fostering a culture that encourages transparency above all else.

In the aftermath of the scandal, the simplicity of Professor Currow's quote rings louder. Culture is how things are done, and these 'things' profoundly impact staff morale. The lessons from this scandal should guide us in cultivating a culture that prioritises problem-solving over short-term management, openness over ambiguity, and customer centricity (or patient welfare) over everything else.