Culture and Leadership programmeBuilding a culture of continuous improvement: the

importance of compassionate and inclusive leadership

Adam Sewell-Jones

Executive Director of Improvement

NHS Improvement

Developing People - Improving Care

Developing People – Improving Care sets out five conditions

3

Patient mortality

• 5% more staff working in real teams associated with 3.3% drop in mortality rate (p = .006)

• For an “average” acute hospital, this represents around 40 deaths per year

90

92

94

96

98

100

102

104

106

108

110

Low (< 35%) Moderate (35-40%) High (> 40%)

Extent of real team working

Mo

rtali

ty r

ati

o

Lyubovnikova, J., West, M. A., Dawson, J. F., & Carter, M. R. (2015) 24-Karat or fool’s gold? Consequences of real team and co-acting group membership in healthcare organizations, European Journal of Work and Organizational Psychology, 24:6, 929-950

Sickness and absence

One standard deviation increase in overall staff engagement = 0.9% drop in agency spend = savings of £1.7 million for the average trust

Source: Employee engagement, sickness absence and agency spend in NHS trusts

Team working:

• Reduced hospitalisation and costs

• Increased effectiveness and innovation

• Increase well-being of team members

• Inter-disciplinary teams deliver higher quality patient care and implement more innovations

• Lower patient mortality

• Reduced error rates

• Reduced turnover and sickness absence

• Increased staff engagement

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Culture and Leadership Programme

7

Leadership for improvement now being included as a core component of the work...

8

We have designed a programme to be delivered in three phases

Diagnostics to identify

the culture of our

organisation

Development of

collective leadership

strategies

Implementation of

collective leadership

strategies

https://improvement.nhs.uk/resources/culture-and-leadership/

Trusts using the programme

• 38 trusts are in one of the three stages of the programme

• A further 24 have expressed an interest in beginning the programme

• Well over a third of the trusts listed above are in category 3 or 4 of the single oversight framework, with seven being in special measures.

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Support offerNew partnership with local Leadership Academies to support trusts in categories 3 + 4 of NHS Improvements single oversight framework, in which they will:

• Work with the Executive sponsor

• Help build the change team

• Train the change team

• Facilitate the synthesis work shop

• Help support strategy development and implementation as a ‘critical friend’.

NHS Improvement will continue to:

• Produce the cultural outcomes dashboard

• Produce the patient experience tool

• Support the leadership behaviour survey tool

• Work with the Leadership Academy and the Trust to support successful delivery of the programme

10

Interactive session – App & Sli.Do

Asking a question for the Q&A sessions:

• Choose the = symbol in the top left of the app, this will bring up a menu –choose ‘Live polling and Q&A’

• Select ‘Theatre 1’• Type your question and click ‘Ask’

App Download: search for ‘NHS EXPO’ In the app store

Our Cultural Toolkit Journey

Abigail PawlowskiLeadership & Management DevelopmentPrincess Alexandra HospitalsAbigail.Pawlowski@pah.nhs.uk

336,601 101,152

General & Acute Beds

379

Outpatient Appointments

ED Attendances

Babies delivered

4,241

40,588

Elective Admissions

28,988

Non-Elective

Admissions

Nurses & MidwivesEmployed

Deficit

1,009 £209,74k

£26,715kIncome

Trust ratings in October 2016

Trust ratings in March 2018

Service ratings in October 2016 Service ratings in March 2018

Our ambition:To deliver truly outstanding healthcare to our local community

Our mission:Putting quality first will be our approach in everything we do

Our Strategy:Your future, our hospital, underpinned by our Five P plans

Ambition, strategy & values

Challenges & Barriers

Working with NHSI Team

✓Critical friend✓Objective perspective✓ Experience and expertise✓Connections✓ Encouragement

Top Tips✓Named Executive lead from day 1✓ Take the time to carefully consider how you choose (and how you will use)

the Change Team✓Avoid losing momentum✓Build in governance✓Build your networks✓Develop your Change Team

The way we do things around here….Culture Change and Leadership Development at

Royal Cornwall Hospitals NHS Trust

Ruth EvansAssociate Director of HR & ODRoyal Cornwall Hospitals NHS Trustruth.evans16@nhs.net

Who we are………

➢Main provider of acute and specialist services for the population of Cornwall and the Isles of Scilly

➢Population of approximately 450,000 which more than doubles in busy holiday periods

➢We deliver care from three main hospital sites in Truro, Penzance and Hayle as well as providing outpatient, maternity and clinical imaging services from community hospitals across Cornwall and the Isles of Scilly.

➢ Long history of poor colleague experience scores – internal and external survey activity

➢ Annual cycles of action planning based on assumed priorities – which often changed annually

➢ Colleagues fatigued by the continuous introduction of different initiatives

➢ A toolkit available that mapped out a way to develop a journey to long term sustainable change

Drivers for Change

A systematic, evidence based approach to sustainable change

3 Phase Approach

➢Discover the cultural issues that need addressing➢Design the strategies for developing collective leadership➢Deliver the strategies

Discovery

➢Patient Experience Dashboards

➢ Staff Experience Dashboards, including the recent 2017 Staff Survey Results

➢Board Interviews

➢Staff Focus Groups

➢Medical Engagement Scale (2016 and 2018 data)

➢GMC Survey (2017)

The Synthesis Workshop

What did we discover…?

What we did next?

➢ Checked out the key messages with our colleagues through workshops

➢ The culture change and leadership development programme is a key part of our Quality Improvement Programme

➢ Focus on leadership development, values and behaviours, and introduced ImproveWell as a way empowering staff to get involved

➢ Next – we will continue to ‘grow’ our small team of change agents; ensure the organisational design is right to sustain the change needed; focus on language and behaviour to match the change we want to see.

Have we made a difference?

Indicator Change since 2018

staff survey% colleagues recommending the Trust as a

place to work

9% improvement

% colleagues recommending the Trust as a

place to receive care or treatment

16% improvement

% colleagues saying that managers act on

feedback

3% improvement

Things we have learned along the way…..➢The NHS Improvement Team has a development team to support with this

work!

➢Being in special measures can add a level of pressure to expedite this work –Executive Sponsorship and Board buy-in is critical

➢A single Quality Improvement Programme – the only game in town!

➢Resourcing the activity is important, not just in physical resource – consistent language and behaviours that match will convince colleagues something is different

➢Join a community of practice – learn from others – you are not alone

Culture and Leadership Programme

“The Portsmouth Story”

Dr John KnightonMedical Director Portsmouth Hospitals NHS Trust @JohnKPHT

Content

•Portsmouth context

•Why adopted

•Progress and experience

•Challenges and barriers

•Support

•What we’ve learned

Portsmouth Hospitals NHS Trust

• Population 675,000 plus regional Renal services• 3 Acute sites merged to one in 2009• £250M PFI partial rebuild on main site• 1000 beds; 7600 staff• ED 150,000 attendances• Busiest maternity department on South Coast • Training reputation• Research

Portsmouth 2014-2017

• Mortality was rising (HSMR & SHMI) & unexplained• Access, flow & safety in the Emergency Department• Serious safety concerns in urgent medical pathway• ED 4 hour performance 136/137 Trusts• “Lack of medical engagement” • Staff Survey concerns over bullying• Financial difficulties - growing deficit• Board Instability• Ineffective governance and organisational structure

Why?

Well Led Inspection May 2017➢ Staff, patient and regulator feedback

▪ Culture of specialism▪ Staff perceived a culture of bullying ▪ Staff not listened to or supported to speak up▪ Processes for raising concerns not open and free from blame▪ A culture not supportive to patient safety, quality or care▪ No current vision or strategy▪ Disconnect from ward to board particularly in relation to governance and risks

➢ New CEO July 2017 Exec appointments July 17 – Jan 18➢ Challenged Provider Improvement Director July 2017➢ Organisational restructure➢ New Strategy, vision and values

Progress to date

•Recruit a number of ‘change agents’

•Undertake a cultural audit and diagnostic to identify the gaps between what we have and what we need to deliver against the CQC cultural measures

0-6 months

Discover

•Develop a clear and unique Leadership Strategy to deliver the Trust priorities for the next 3-5 years to improve patient care, performance and finances

•Talent, organisation design, leadership culture and development

6-18 months

Design•Deliver and embed a number of programme and interventions to ensure:

•Staff feel supported and developed

•Patients are receiving safe care

•The organisation is continually improving

18-36 months

Deliver

March 2018• Workshop with the Board• Launch first biannual leadership

summit with Professor Michael West

April 2018• Recruit Change Agents

May – September 2018 • Undertake cultural audit

October 2018• Feedback to the Board

Change Agents• 15 Agents representing a range of professions and levels• Commitment - x2 days per month

Benchmarking and assessment:• CQC well led domain 8 x Key Lines of Enquiry root of investigation• Desk top data collection and analysis• Co-designed Discovery Questions• Focus groups, attending meetings, trolley dash• Gathering data, intelligence and stories

Challenges and barriers

Staff The Board

Collaboration, Learning & Support

✓ Committed to change✓ Understanding what good looks like✓ Shared learning✓ Mentorship and development✓ Other Trusts✓ External Organisations✓ NHSI Improvement Director

Learning and Tips

1. Culture change takes time, needs a plan2. Clear understanding, commitment and leadership from the board3. Board must be visible to the change team4. Receptive to support and advice from critical friends: NHSI support5. Problem sense not comfort seek (Prof. M West)6. Be prepared to really listen and hear some difficult messages (not jump into

action)7. Stick with it – many distractions8. Change team recruitment crucial – communication and support to release9. Look for and celebrate the green shoots

@JohnKPHT

Facilitated by Adam Sewell-Jones, Executive Director of Improvement, NHS Improvement

With:

• Abi Pawlowski– Princess Alexandra Hospital

• Ruth Evans – Associate Director HR & OD, Royal Cornwall Hospital

• Dr John Knighton – Medical Director, Portsmouth Hospitals

• Michael Watson – Culture & Leadership Programme Lead, NHS Improvement

Question & Answer Panel Session

Closing Remarks

Adam Sewell-Jones

Executive Director of Improvement, NHS Improvement

Contact DetailsName Email Trust

Abi Pawlowski Abigail.Pawlowski@pah.nhs.uk Princess Alexandra Hospital, Harlow

Ruth Evans ruth.evans16@nhs.net Royal Cornwall Hospital

Dr John Knighton john.knighton@porthosp.nhs.uk Portsmouth Hospitals

Michael Watson michael.watson9@nhs.net NHS Improvement

Culture & Leadership Team

NHSI.Culture@nhs.net NHS Improvement

Building a culture of continuous improvement:

Compassionate, inclusive, and effective leaders at every level

Stephen Hart

Managing Director NHS Leadership Academy

@stephen_hart1

Compassionate and effective leaders at every level:Leadership development at scale and reach

The right number of leaders, with the knowledge, skills, attitudes, and behaviours

necessary to create cultures of compassion and inclusion across the NHS.

Snr System Ldrs

CE and equivalent

Executive directors (ESM)

Mid-Level Leaders (B8a-9)

Team Leaders (B6/7)

Leaders (All)

30

350

1200

46500

265000

1.5 million

The Rosalind Franklin programmeFor mid-level leaders

Who is it for?

Mid-level (Band 8) clinical and non-clinical leaders across health and care.

Why has the programme been developed?

In response to system need and request. Research identified a gap for mid-level leadership

development across the system including a significant primary care audience that was not

linked to a Masters qualification.

What elements are at the heart of the programme design?

• Accessibility

• Inclusion

• Value for money

• Adaptable to local contexts and needs - geographically (e.g. STP, ACS), workforce

(e.g. emergency medicine) or organisational (e.g. Large trust, ALB).

What is the programme structure?

The programme is delivered over nine months via a mix of online learning (Leadership

Academy digital campus), face to face workshops, small group work and applied learning.

Programme will be nationally designed and supported, with local organisations and systems

supported to deliver.

Building a culture of continuous improvement:

Compassionate, inclusive, and effective leaders at every level

Stephen Hart

Managing Director NHS Leadership Academy

@stephen_hart1

Jo Vigor

DPIC National Programme Director

NHS Improvement

Developing People, Improving Care

“In the two years since Developing People- Improving Care was launched, how far have we come and how far do we still have to go”

• Tracie Jolliffe (Leadership Academy)

• Adam Sewell-Jones (NHS Improvement)

• Suzie Bailey (Kings Fund)

• Steve Hart (Leadership Academy)

Panel

Facilitated by Jo Vigor, DPIC National Programme Director, NHS Improvement

With:

• Tracie Jolliffe (Leadership Academy)

• Adam Sewell-Jones (NHS Improvement)

• Suzie Bailey (Kings Fund)

• Steve Hart (Leadership Academy)

Question & Answer Panel Session

Closing Remarks

Jo Vigor

DPIC National Programme Director

NHS Improvement