Case type: Governance, organisational culture and internal control Organisation: University Hospitals Birmingham NHS Foundation Trust (UHB) Jurisdiction: United Kingdom Key review period: 2022–2023 Primary reviews: Patient Safety Review led by Professor Mike Bewick; Independent Organisational Culture Review conducted by thevaluecircle FGL focus: Tone at the top, psychological safety, speaking-up arrangements and board risk intelligence Case snapshot Organisational culture is sometimes treated as separate from internal control. The UHB reviews demonstrate why that distinction can be misleading. In 2023, independent reviews of University Hospitals Birmingham identified significant concerns involving leadership, staff experience, speaking-up arrangements and organisational culture. The central governance issue was not simply whether policies and reporting channels existed, but whether staff trusted those systems enough to use them. Importantly, th...