We know that culture change programmes can create the conditions for health & care organisations to be more “change ready”, but what does it take for a culture change programme to become the way we work organisation-wide? Natalie Wilson & colleagues have published a scoping review in @JBI_EI on embedding organisation-wide culture change programmes in health & care. They screened 7,922 studies but only included 17. One is a review I co-authored with Cynthia Willis & colleagues in 2016, so I read this with particular interest. The authors separate 3 phases. “Implementing” gets interventions into practice. “Sustaining” keeps the programme & its outcomes going, usually 2 to 6 years after implementation. They also describe a middle phase, “embedding”, when change becomes part of the everyday routines of individuals & teams & part of organisational systems. The evidence for “embedding is particularly lacking. 10 factors emerged. “Education & training” & “measurement, monitoring & feedback of outcomes” appeared in every study. “Processes & structures”, “leadership”, “resources” & “cultural alignment” appeared in 16. “Shared, defined accountability” in 15. “An adaptable programme” in 11, “stakeholder engagement” in 8, “alignment with the external environment” in 7. There is a tension in the design of culture change interventions. Should we initiate a programme that seeks to change culture "directly" through values, attitudes & messages? Or should we seek to change culture "indirectly" by redesigning the daily work, norms of collaboration & routines? It doesn’t say so explicitly, but the conclusions of this article are in the latter camp (as am I generally). Five implications for leaders of change: 1) Build the change into daily work: Integrating new practices into existing tasks & duties, aligning them with current processes & accounting for the effect on workload. 2) Write it into the organisation’s routines. Reporting systems, governance, people processes, policies & monitoring are where a programme becomes business as usual. 7 studies pointed to defining roles & responsibilities in organisational policy. 3) Support embedding as its own phase. 9 studies named a dedicated budget as a key factor, alongside people & time to do the work. 4) Put new practices into induction & refresher training, so it survives turnover of people. 5) Share leadership across professions & levels, keep it steady & feed outcomes back so people see what the change achieves. This review shows us how thin the evidence base on organisation-wide culture change interventions in health & care is. All 9 empirical studies focused on nursing. Patients took part in 2. Administrative & corporate colleagues are missing from the research. Culture appears as both the goal & a condition for success. The studies measured whether the programme became embedded, not whether the culture shifted. This knowledge is much needed & there is work to do. Link: ovid.com/jnls/ijebh/fulltext….