whether talk of ªcultural transformationº is merely a convenient metaphor or is, instead, shorthand for a more tangible raft of speci®c changes. If the latter, then it would seem essential to have some clear idea about the meaning of organisational culture, the extent to which this culture can be managed within health care, and the nature of the organisational cultures which underpin quality improvement activity in health care. This paper draws on a wide social science literature to open this debate. It explains some of the current conceptualisations of organisational culture and explores the implications of these for health systems (such as the NHS) or healthcare providers (such as hospitals and primary care networks) that are seeking organisational transformation.