Toxic workplace culture in healthcare: Why issues persist despite complaints
Toxic workplace culture in healthcare rarely appears overnight.
It builds over time. Often in plain sight.
A line from a recent report captures this clearly:
“Concerns were raised as far back as 2017. They made no difference.”
That tells you everything you need to know.
This is not about isolated incidents.
It is about a system.
When concerns change nothing
A recent BBC News report describes bullying, harassment, aggression, and a “toxic culture” within a hospital department. But the most important detail is not the behaviour itself.
It is that the behaviour continued, despite:
Reviews
Complaints
Investigations
On paper, action was taken. In reality, nothing changed.
Why behaviour continues
When harmful behaviour continues over time, there is a pattern, and patterns do not persist by accident.
They persist because the system allows them to.
If behaviour is repeated, despite intervention, it is not just tolerated, it is embedded.
The role of cliques in sustaining toxic culture
The report describes “two main cliques” within the team. Groups engaging in tit-for-tat reporting of each other’s behaviour.
This is a critical detail. Because once cliques form, the dynamic shifts.
You start to see:
Defence of in-group behaviour.
Blame directed at the other group.
Escalation through complaints.
At this point, the issue becomes personalised.
When conflict becomes about sides
In healthy teams, the question is: “What’s happening here?”
In toxic workplace culture in healthcare, the question shifts to: “Whose side are you on?”
That changes everything, because:
Objectivity is lost.
Behaviour is justified within groups.
Accountability becomes selective.
And resolution becomes harder.
Why formal processes often fail
Organisations tend to rely on formal processes:
Investigations
HR procedures
External reviews
These are necessary, but they have limits.
Because they focus on formal accountability, while the real dynamics are often informal.
The informal system that drives behaviour
In teams with a toxic workplace culture in healthcare, behaviour is shaped by:
Who people align with
Who they feel able to challenge
Who they avoid
What feels safe to say
These factors sit outside formal structures.
But they have more influence on day-to-day behaviour.
The critical warning sign: Speaking up feels unsafe
The report also describes staff feeling unsafe and unsupported when raising concerns.
This is the key red flag.
Because once people learn that:
Raising concerns does not lead to change
Or makes their situation worse
They adapt.
What happens when people stop speaking up
When psychological safety is low, people do not stop seeing problems. They stop reporting them.
You begin to see:
Silence in formal settings
Issues raised informally or not at all
Avoidance of conflict
Reliance on trusted individuals rather than systems
The organisation loses visibility of what is really happening.
Why these patterns persist
Toxic workplace culture in healthcare is not sustained because people agree with it.
It is sustained because:
Challenging it feels risky
Speaking up feels ineffective
Behaviour goes unchallenged
Over time, this creates a stable pattern.
Not a healthy one.
But a stable one.
The trap organisations fall into
Organisations often focus on behaviour.
They try to:
Address individual cases
Reinforce expected standards
Apply formal processes
These actions are visible. They are measurable. But they do not address the underlying system.
What actually needs to be addressed
To shift toxic workplace culture in healthcare, you have to look deeper, at:
1. Informal Power
Who holds influence?
Whose behaviour is protected?
2. Group Dynamics
Are there cliques or alliances?
How do these shape behaviour?
3. Psychological Safety
Do people feel safe to speak?
What happens when they do?
4. Organisational Response
Do concerns lead to meaningful change?
Or do they reinforce silence?
When culture overrides process
Formal processes can only go so far.
If the culture does not support change:
Investigations will not shift behaviour
Policies will not change norms
Complaints will not stop patterns
Because people take their cues from what actually happens.
Not what is written down.
Final thought
When concerns are raised for years and nothing changes, the issue is not awareness.
It is not process.
It is culture.
If behaviour continues, it is because something in the system allows it.
Until that system is addressed, the pattern will repeat.
No matter how many investigations take place.
Nicole Williams is an occupational and coaching psychologist specialising in culture repair, team dynamics and psychologically safe workplaces.
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