Evidence exists that the UK National Health Service has had, over many years, persistent problems of negative and intimidating behaviour towards staff from other employees. The evidence also suggests the organisational responses to negative behaviour can be inadequate. A conceptual model of organisational dysfunction was proposed to assist in explaining those responses and the overall culture in the NHS. Through research this model has been tested. Based upon the findings, an extended and developed model of organisational dysfunction is presented. A (...) qualitative approach was taken to research the organisational responses to negative behaviour, and the reasons and motivations for those responses. Forty-three interviews and six focus groups were conducted. There seem to be “islands” and “pockets” with a positive culture; however, the generalised evidence suggests the NHS is systemically and institutionally deaf, bullying, defensive and dishonest, exhibiting a resistance to ‘knowing’, denial and “wilful blindness”; a dysfunctional, perverse and troubled organisation. Totalitarian and Kafkaesque characteristics are identified. The NHS could also be described as a coercive bureaucracy and under certain definitions, a corrupt entity. The NHS appears to be an organisation with a heart of darkness; a “self perpetuating dysfunctional system”. There may be widespread “learned helplessness”. It seems to be a “good news factory”, rejecting and hiding any “bad news”; retreating from reality. The NHS appears to have “lost its way” and its focus/purpose as an institution. The dysfunctional organisational behaviours manifest in the NHS need to be addressed urgently as there is a detrimental, sometimes devastating, impact on the wellbeing of both staff and patients. The NHS needs to embrace an identity of being a listening, learning and honest organisation, with a culture of respect. (shrink)