In this situation, what could Sally do to actively change the culture?

Eastern Medical Center (EMC) struggled with its quality indicators, consistently ranking in the bottom quartile of its corporation’s quality measures.
A number of interventions—training, motivational talks by respected authorities, and financial incentives—were offered. A consulting firm, brought in to work with the quality improvement employees, noted that the organization’s culture did not support quality. However, the consultants’
proposed interventions were too expensive to implement, far exceeding the medical center’s budget, so nothing more was done. As expected, no change occurred in the dismal quality outcomes.