Delivering on Ambition: A Healthcare Culture Transformation Case Study

Posted by: Adam Oliver
June 16, 2026

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When leaders think about culture transformation, there is often an assumption that something must be wrong.

Performance is declining. Engagement is low. Teams are disconnected.

But some of the most valuable culture work happens in organisations that are already successful.

The challenge sometimes not fixing a broken culture. It is understanding whether culture is fully aligned to the organisation’s ambitions.

That was the question facing BMJ.

As a global healthcare knowledge provider with a mission to drive positive change, BMJ had a culture that was collaborative, purpose-led and harmonious. It was a positive place to work, with strong values and a clear sense of purpose.

When Chris Jones joined as CEO in 2020 with a mandate to drive business performance, he recognised the role culture would play in achieving that objective.

Rather than relying on instinct, he wanted a detailed understanding of the existing culture and where focused intervention could create the greatest impact.

Understanding the Existing Culture

Using Coode’s culture management platform, Culture15, we conducted a full cultural diagnostic supported by leadership interviews and focus groups.

The aim was to understand BMJ’s cultural profile, alongside the potential blockers and enablers influencing strategic execution.

The findings revealed a culture with many strengths. BMJ was highly collaborative, purpose-led and harmonious. These qualities had helped create a positive working environment and supported the organisation’s broader mission.

At the same time, the diagnostic identified an important opportunity. The culture lacked the ambition and decisiveness needed to push performance to the next level.

This is a challenge many organisations face.

The behaviours that help create a positive culture are not always the same behaviours required to accelerate strategic execution. The task is not choosing one over the other. It is finding the right balance between them.

For BMJ, the challenge was clear: how do you strengthen ambition and decisiveness without losing the collaboration and purpose that already define the organisation?

Aligning Leadership Around a Shared Agenda

Culture transformation begins with leadership.

Before organisations can align around a target culture, leadership teams need to align around what that culture looks like and why it matters.

Using the insights from the diagnostic, we worked with BMJ to define a clear target culture and create alignment around the behaviours required to support future success.

A significant part of this work focused on the Executive Team.

Over a structured nine-month programme, the team developed a collective agenda, shared beliefs and common ways of working. The objective was not simply greater agreement. It was greater alignment around the culture required to deliver the organisation’s ambitions.

As leadership alignment strengthened, so did the organisation’s ability to create consistency around expectations and behaviours.

Turning Culture Into Everyday Behaviour

Culture cannot be changed through leadership teams alone.

If culture is ultimately expressed through behaviour, then transformation requires people across the organisation to understand what is changing and why.

To support this, BMJ strengthened leadership and role-modelling capabilities across a wider leadership population of more than 100 leaders. Behavioural activation workshops helped engage employees across the organisation, while institutional practices were aligned to reinforce the desired culture. A Culture Steering Group was established to steward progress, surface feedback and maintain momentum throughout the transformation.

Importantly, Culture15 continuously measured the culture.

Too often, culture is discussed as something organisations can feel but struggle to quantify. Ongoing measurement allowed BMJ to track progress, understand where behaviours were changing and maintain focus on the outcomes it wanted to achieve.

The Results

The results demonstrated the value of aligning culture, leadership and strategy.

Organisational ambition increased by more than 50%, alongside a reduction in the culture gap across key behaviours. The Executive Team became more aligned and more willing to challenge one another regularly. Business performance improved and the organisation demonstrated greater resilience as it emerged from the uncertainty of the pandemic.

As Chris Jones reflected:

“Since we started working with Coode, not only is business performance accelerating, but we’re also seeing increases in our rates of product development and innovation.”

What Leaders Can Learn

One of the most common misconceptions about culture is that transformation requires organisations to become something different.

BMJ’s experience demonstrates a more effective approach.

The goal was never to replace a collaborative, purpose-led culture. The goal was to ensure that culture could better support the organisation’s ambitions.

Culture transformation is often most successful when it builds on existing strengths rather than attempting to reinvent them. For BMJ, strengthening ambition and decisiveness did not come at the expense of purpose. Instead, it helped create greater alignment between culture and strategy.

And when culture and strategy work together, organisations are in a far better position to deliver on what they set out to achieve.

What’s next

Liked this? Next, learn how to separate leadership friction from deeper cultural friction.

Prefer your content in audio form?

Listen to the BMJ’s Chris Jones in conversation with Charlie Coode, discussing his own leadership journey.

Potential, realised

At Coode, we look at strategy through a human lens because success depends on how people work together. When leadership teams achieve real alignment in how they lead, they unlock performance that may have been present all along but not yet fully realised.