I don’t think creating a culture of continual management improvement is complex but it takes more commitment than most organizations seem to have. To build a culture that supports customer focused continuous improvement a management system needs to reinforce consistent behavior over the long term.
There is far too much saying certain things (customers are valued, people are our most important assets, etc.) but not backing those claims up with management systems that would be needed to operationalize those beliefs. Failing to do this just results in surface changes that have no depth or commitment and will shift with the winds (no culture change).
It is very difficult to create a culture that supports customer focused continuous improvement that doesn’t understand the failings of: extrinsic motivation and arbitrary numerical goals.
An understanding of variation and how to properly use data to aid improvement is also critical (otherwise huge amount of waste are generated on all sorts of fruitless efforts to explain common cause variation leaving far to little time to actually for on quality). An appreciation of the long term is necessary, which means reducing time spent on trivially urgent matters so focus can be given to important but not urgent matters.
And a respect for people is needed: a real respect, not just claims – which nearly every organization makes. The huge egos of most USA senior executives result in them taking huge amounts from the company to such an extent that they are inherently dis-respectful. The hero culture they profess with their pay package makes it extremely difficult for anyone to take them seriously when they claim to care about a culture that values the stakeholders of the organization.