embedding equality, diversity & inclusion into nhs governance

Embedding Equality, Diversity & Inclusion into NHS Governance

Final Report

November 2010

Integr8 NHS - Final Report

Embedding Equality, Diversity & Inclusion into NHS Governance

1. Introduction 3

2. Background 5

a. Scope of Intervention 5

b. The Pilot Trusts 7

3. Integr8 NHS methodology and approach 9

4. National Outcomes 12

5. Local Outcomes 14

6. Key learning 22

7. Conclusions and recommendations for the future 24

1. Introduction

In January 2010, the Diversity Practice was commissioned by the NHS Institute for Innovation and

Improvement to support a pilot programme to build Diversity and Inclusion into the Business of NHS

Boards.

The aim of the programme is to co-produce an accelerated development process which will support

Boards to focus on inclusion in a way that engages them in the reality of the challenges they face as

commissioners, providers and employers in the communities they serve. More specifically, the goal

is to support Boards in developing the critical connections between equality, diversity and inclusion

(EDI) and their core business; and identify what they need to do differently to ensure their “business

delivers effectively to all its customers”.

The issue of mainstreaming and embedding EDI continues to be an important aspiration for many

public and private sector organisations. To support NHS Boards in achieving this aspiration the

Diversity Practice has developed Integr8 NHS – a cutting edge approach that practically aligns and

effectively integrates NHS governance, leadership and overarching business models with EDI.

This report outlines the process, learning and outcomes from the application of Integr8 NHS to 3

NHS Trusts: The North West Ambulance Service, Kings College Hospital NHS Foundation Trust, and

the NHS North West Strategic Health Authority. The report is laid out as follows:

1. Firstly, it outlines the background to the project with regards the scope of work required and

the local context of the three Trusts.

2. The next section provides an overview of the Integr8 NHS methodology. A fuller and more

detailed outline of the approach is provided in the Integr8 NHS Toolkit report.

3. We then assess the outcomes from the intervention across all the Trusts and for each one. In

summary, the key point to note is that the intervention has had a significant impact on

issues of governance and leadership of EDI, and either moved the individual Trust further

along on its journey to being an exemplar High Performing Inclusive Organisation, or acted

as a catalyst for the legacy sharing of good EDI practices with other Trusts.

4. We then provide a summary of the key learning from the intervention with regards

governance of EDI across the Trusts and the approach to Board development in this area.

5. Finally, we outline our conclusions and recommendations. Critically, these include

a. A one-off intervention can address some of the EDI issues that the Board may face,

but for sustainable impact further support by way of coaching at Board level and

possibly at sub- committee level as well as external accountability is needed.

b. The timeframe for a project of this nature to fully deliver on its objectives should be

12 to 18 months minimum. This would give sufficient time for measurable outcomes

to become evident.

c. The facilitation of an intervention like this requires expertise in EDI, change

management, and strategic thinking, as well as experience and well-developed skills

in group facilitation at Board level.

2. Background

2.1. The Scope of the Intervention

At the outset the scope of works was very wide. The Diversity Practice was asked:

1. To design and deliver 3 pilot Board D&I Development interventions (co-produced with the

Boards involved), which will focus upon:

using inclusion as strategic lever for improving access and quality in health care and

reducing inequalities in health;

releasing untapped innovation and productivity within the workforce;

generating connection with the populations we serve, and improving prevention.

2. To work with 3 different, interested and willing Boards who are eager to address and are

grappling with the challenges of delivering inclusive health and health care services whilst

being an inclusive employer and providing inclusive leadership. To work with these Boards to

actively address, explore and generate action on a number of key questions including:

How can Boards define and position inclusion as a strategic opportunity?

What’s the compelling case for inclusion and diversity?

How can Boards use the Constitution as an opportunity to ensure comprehensive

services to all and that everyone counts?

How does inclusion deliver improved access and quality in health and health care, and

reduce inequalities in health?

How does inclusion in employment and leadership release innovation and productivity?

How does inclusion improve our engagement and involvement with our populations and

aid prevention?

What measures can Boards use to understand the impact of inclusion and diversity?

How can Boards embed inclusion and diversity into everything they do without losing

sight of it?

3. To engage the Boards in discovery and learning and taking action on how they behave

differently, what they do differently in their business and in their business context to ensure

and assure that their organisations are for example:

- commissioning for inclusion

- delivering inclusive health and health care services

- engaging patients, carers, the general public, local populations inclusively

- leading inclusively

- recruiting for inclusion and diversity

- managing for inclusion and diversity

- harnessing innovation from inclusion and diversity

- harnessing productivity and quality improvement from inclusion and diversity

- improving prevention through inclusion

- accounting for inclusion

The above list provides examples of the individual issues that could have been addressed, subject to

the particular context for each Board, with there being no requirement that all these issues are

tackled.

4. Within the budget and time constraints to:

Undertake research and gather the appropriate information to present an overview of

the Board’s current D&I position, approach and status, and the business case for

building D&I into the Board’s business and positioning it at the strategic heart of the

organisation

Engage Board members individually and collectively so as to increase their

o knowledge and understanding of D&I, its application at a strategic governance

level, and its relationship to key NHS drivers such as QIPP;

o individual and collective D&I leadership competence and capability;

o governance and oversight of D&I as a strategic lever for improving access and

quality in health care, reducing inequalities in health and attracting and

retaining a talented, motivated and engaged workforce;

o and to provide Board level support for the implementation of the action plans

falling out from the intervention

Develop a model of working, materials, interventions, outcomes from the process which

have the potential to be replicable with other Boards and amenable to inclusion in the

electronic Board Development Platform and adaptable to form part of a wider Quality

Innovation Productivity and Prevention Board development offer

Undertake an evaluation of the Board D&I development intervention, and produce a

brief report highlighting learning from the process and illustrating impact as reported by

the Boards involved

However, as the project evolved, we became more focused on achieving outcomes in the

following areas:

1. Organisational shift – The Board achieves its aspirations and success measures for the

project.

2. Embedding D&I – The Board has a better understanding and a shared point of view of the

critical business relationship between D&I, quality healthcare for all, its strategic priorities

and plan, and national NHS strategic drivers such as World Class Commissioning, and

Quality, Innovation, Productivity and Prevention.

3. Inclusive Leadership – Increased Board member competence and confidence in their

individual and collective ability to take the lead on mainstreaming and embedding D&I in the

organisation, the management of staff, and the delivery of services.

4. Improved Governance – The Board increases its effective governance and oversight of D&I.

5. Organisational benefits – The creation and implementation of a clear action plan and initial

improvements in the diversity of the workforce, the development of an inclusive workplace,

and equality in service provision to patients and the public.

2.2. The Pilot Trusts The three Boards we worked with were:

The North West Ambulance Service Trust (NWAS)

NWAS is the busiest and one of the most diverse ambulance services in the country, providing

services to seven million people in an area of 5,400 square miles. It employs around 5,400 staff,

working out of multiple locations spread throughout the region. It provides services for patients in a

combination of rural and urban communities, in coastal resorts, in affluent areas and in challenging

inner city areas; as well as providing services for a large transient population of tourists, students

and commuters.

The diverse geographical and demographic spread of the region it serves means that issues of

diversity and inclusion are fundamental to the successful achievement of its strategic aims and

objectives, while at the same time being challenging to effectively implement. Nevertheless, NWAS

is “committed to developing a culture and practices which value difference both in employment and

in the delivery of individualised and responsive patient care and to working with patients, carers and

communities to achieve this” (EDI Vision statement).

King’s College Hospital NHS Foundation Trust (KCH)

KCH is one of London’s largest and busiest teaching hospitals, serving a patient population of

700,000 and with a deserved reputation for providing excellent local healthcare to the London

Boroughs of Lambeth and Southwark, and a range of specialist services for patients across South

East England and beyond.

KCH is recognised nationally and internationally for work in liver disease and transplantation,

neurosciences, cardiac services, blood cancers and foetal medicine, and the Trust plays a key role in

the training and education of medical, nursing and dental students.

KCH works closely with other healthcare organisations, such as local Primary Care Trusts and also has

strong academic links with the King’s College London School of Medicine and Dental Institute, and

the Institute of Psychiatry. In addition KCH is part of King’s Health Partners Academic Health Sciences

Centre (AHSC), a pioneering collaboration between King’s College London, and Guy’s and St

Thomas’, King’s College Hospital and South London and Maudsley NHS Foundation Trusts. This

collaborative working is an ongoing strategic priority for KCH.

KCH is recognised as one of the leading NHS Trusts with regards Equality, Diversity and Inclusion

(EDI). It has moved a long way in recent years, significantly improving and embedding good EDI

practices, and in many areas being ahead of comparator Trusts.

The NHS North West Strategic Health Authority (NHS NW)

NHS NW is one of the largest SHA in the country and the NHS is the largest employer, commissioner,

procurer and service provider in the region. Comprising 64 NHS organisations and employing

222,000 people it covers the biggest geographical area of any SHA in the country. The SHA oversees

the provision of services for approximately seven million people living in a combination of rural

and urban communities, in coastal resorts, in affluent areas and in challenging inner city areas;

as well as for a large transient population of tourists, students and commuters.

The SHA recognises that issues of diversity and inclusion are integral to creating a world class health

service that delivers better health and workforce outcomes for all people. The diverse geographical

and demographic spread of the region it serves and the complex needs of its patient population

means that this will be a challenge to achieve, but it has made a significant commitment to and

investment in equality and diversity, so that equality underpins our transformation into a quality

health care system (Business Plan 09/10)

Included in the E&D vision is for NHS North West to be acknowledged and recognised as a leader of

equality and diversity in the workplace and more importantly in the commissioning and delivery of

high-quality health care services for all.

3. Integr8 NHS Methodology and Approach

The issue of mainstreaming and embedding EDI continues to be an important aspiration for many

public and private sector organisations. To support NHS Boards in achieving this aspiration the

Diversity Practice has developed Integr8 NHS – a cutting edge approach that practically aligns and

effectively integrates NHS governance, leadership and overarching business models with EDI.

Integr8 NHS builds on the National Standards, Local Action Planning Framework, World Class

Commissioning, Integrated Governance and CQC Standards as the core foundation for embedding

and mainstreaming EDI into NHS governance policy and practice.

Working within the Cadbury, Turnbull and Higgs standards for corporate governance, risk control

and role and responsibilities of boards, Integr8 NHS seeks to increase each Board’s ability to more

effectively monitor, scrutinise and constructively challenge from the perspective of EDI the strategic

levers and drivers for quality, innovation and improvement, and to deliver inclusive health and

health care services whilst being an inclusive employer and providing inclusive leadership.

The overall approach is built on the principles of:

collaborative partnership – to create robust processes that take account of individual

Board contexts, and ensure interactions with each Board maximise engagement and

time with the need for flexibility;

appreciative enquiry – to build on the good practices already in place; inclusive action

that seeks out and incorporates the perspectives of the diverse staff, patients and

community representatives;

a“whole system” perspective – in order to create change strategies and implementation

plans that take account of the complex adaptive nature of the NHS. Above all, the

approach seeks to ensure that there is an alignment between the key NHS strategic

drivers, governance & leadership, and diversity & inclusion.

The Integr8 NHS methodology is an 8 step process for embedding equality, diversity and inclusion

into NHS governance.1

Foundation

The initial steps in the process are focused on project set up, engagement and ownership with the

Board; analysis of current situation and aspirations; and individual inclusive leadership support to

each board member.

i. Board Engagement – Initial consultation with Chief Executive/Chair, followed by

engagement with the full Board to introduce and take ownership of the Integr8 NHS

development process.

ii. EDSnap Audit - an Equality, Diversity and Inclusion Snapshot audit to determine the current

positioning, integration and impact of D&I on the Board and the organisation, comprising of

documentary review, short interviews with a few Board members, and an online survey of a

small sample of key staff, patient and community representatives. The output from this step

is a 40 page EDSnap audit report, outlining where the Trust is on its EDI journey from

“compliance” to “delivering outcomes” to “being an exemplar high performing inclusive

organisation”, and indicating areas where the Trust or the Board could benefit from further

development or intervention.

iii. Strategic inclusive leadership review – each Board member receives a personal, confidential

session with an executive leadership coach, to support and develop their inclusive leadership

commitment and understanding. A unique aspect of the review is the use of the Factor 8

Different Leaders Assessment Tool. This is an innovative, cutting edge 360 online tool which

provides an assessment of the leadership competences critical for leading a diverse

workplace serving diverse patients and clients. Through the individual 34 page report they

receive and the executive coaching, each Board member has the opportunity to develop a

personal action plan to grow their competence and confidence as inclusive leaders.

Board Development Workshop

Using the output from the foundation steps, a Board Development Workshop is then held. The next

3 steps in the Integr8 NHS process are applied during the workshop. An example of the output from

the NWAS Board Development Workshop is provided as Appendix 1.

1 A fuller outline of the Integr8 NHS is provided in the Toolkit Report

iv. E-QIPP – the first part of a facilitated Board workshop, develops the vision for EDI, the

business case for building D&I into the Board’s business, and examines the critical

connection between D&I and achieving QIPP.

v. I-Lead – the second part of the workshop examines what it means to lead effectively on D&I

and develops a common framework of inclusive leadership competences, behaviours and

values for Board members.

vi. We Govern – the final session the workshop, builds effective mechanisms for Board

leadership and oversight of D&I, for example through identifying and developing a Board

level Diversity Scorecard to track progress against pre-determined success measures.

Taking Action

The final steps involve drawing up and implementing actions from the Board development workshop

and reviewing the Integr8 NHS process.

vii. We Implement – all the agreed actions are consolidated into an implementation plan, and

Diversity Practice consultants attended meetings with the Trust to coach and support the

Board in executing the plan. An example of the NWAS Dashboard Report that was put to the

Board for approval is provided as Appendix 2.

viii. Evaluation & Review – as this was a pilot, there was a requirement for ongoing evaluation,

sharing of learning and good practices at each step of the process, as well as an overall final

review, evaluation and refinement of the Board D&I Development Toolkit.

4. National Outcomes

The Board D&I development intervention, through the Integr8 NHS process, has had a significant

impact on the Trusts and moved all of them further along on their journey to becoming exemplar

high performing inclusive organisations. To quote NWAS, “The development intervention has been

very powerful in enabling the Board to critically evaluate its leadership and behaviours and has

facilitated a prioritisation of key changes which are required to achieve a step change in delivery.”

In looking across the Trusts there are a number of national outcomes that can be drawn. The

intervention has resulted in:

1. Vision and Change: The refinement or clarification of the respective visions for EDI, a shared

understanding of the vision across the Board, and a greater momentum for further change

and focused attention to EDI.

2. Governance & Planning: The development of new approaches to integrate and embed EDI

into strategic governance and business planning, with more explicit links to strategic NHS

priorities.

3. D&I Committee: The role of the Board Equality and Diversity Committee/Steering Group has

been re-examined, strengthened and clarified, with the intent of making it a better agent of

change, monitor of EDI performance, and vehicle for prioritisation of issues.

4. Equality Impact Assessment: A more critical evaluation of equality impact assessments, to

shift them from being just another process to being a more effective mechanism for the

Board to use to mainstream and embed creative thinking and analysis of EDI.

5. Inclusive Leadership: The reinforcement and enhancement of EDI knowledge and good

behaviours among Board members, by creating a shared frame of reference around strategic

inclusive leadership, resulting in greater confidence around EDI.

6. Collective EDI Leadership: There has been progress in terms of the prioritisation of EDI

issues, and greater understanding and application of collective Board leadership of EDI has

been developed.

7. Outcomes Driven Focus: A greater emphasis has been placed on an outcomes based

approach to EDI, not just a focus on processes.

8. Workplace changes: The Boards have set in train a greater degree of engagement with

managers and the workforce on EDI, for example through renewed or refocused Staff

Engagement/Diversity Groups, diversity training programmes for Managers, and/or more

extensive yet tailored communication with staff.

9. External Groups: Increased discussion, communication, involvement and accountability to

local communities and diverse groups regarding service provision and development.

10. Individual Learning: The development of personal actions by Board members to further

enhance their confidence and competence as inclusive leaders.

5. Local Outcomes

5.1. Results of the EDSnap Audit

5.1.1. Areas of Good Practice

All three of the Trusts had moved a long way in recent years with regards D&I, significantly

improving and embedding good EDI practices, and in many areas being ahead of comparator

organisations. What is particularly noteworthy is that three Boards are firmly committed to EDI and

actively promoting and taking on the EDI agenda. There is an expressed desire for continuous

improvement in this area – to be an exemplar EDI organisation. Among the areas of good practice

we noted are:

A values-driven leadership approach that views equality, diversity and inclusion as

integral to organisational culture and behaviour, and to the successful attainment and

delivery of high quality health care services for all; and therefore, not a separate bolted-

on activity operating in an ineffectual silo manner.

The development of an open and inclusive culture in many parts of the organisations

The growing engagement with diverse communities to address issues of access to

services, employment opportunities, and patient experiences

Initiatives to tailor patient care and service delivery to meet the needs of diverse groups

and address health inequalities

The growing representation of women managers at higher levels of the organisations

The development and use of an EDI infrastructure of strategy, policies, Diversity

Steering Group/Committee, and structures for senior management accountability

The widespread use of equality impact assessments

The communication to staff of EDI issues and messages

The explicit setting of targets by NWAS to address the under-representation of diverse

groups in the workplace

The work being done by KCH around “Living Kings Values” by KCH, the embedding of

EDI within this, and the expectation and ambition to use this to bring about both a

change in behaviours and in the organisational culture of KCH.

The extensive and innovative diversity monitoring of patients at KCH

The NHS NW has a clear, well articulated and outcome focused strategic plan for EDI

that has been derived from careful and detailed analysis of its local context, and includes

objectives, performance measures and actions to be taken, and is outcomes focused i.e.

results and impact as opposed to activity and process.

The NHS NW Equality Performance Improvement Toolkit is an excellent example of an

SHA leading the way in terms of establishing standards of good practice and working

collaboratively with NHS organisations to raise E&D standards.

Examples of recent achievements from one or more of the 3 Trusts include:

The provision of mandatory equality and diversity awareness training, with specific sessions

on disability issues, for all staff

The inclusion of equality and diversity requirements within all personal development plans

Through the Electronic Staff Record, the production of monthly staff profiling according to

equality target grouping

The production of an Equality Impact Assessment Toolkit for the assessment of all policies

Systems have been put in place to ensure that E&D is mainstreamed throughout business

plans, the assurance framework and master control plan.

A system has been set up to ensure that all policies undergo EIA before being submitted for

Board approval.

Staff induction programme has been reviewed and induction pack includes E&D issues

A Deaf Access training programme for nurses has been re-commissioned and other disability

awareness programmes are ongoing.

Participation in DoH national Pacesetters Programme; the Programme tackles health and

workplace inequalities.

Staff access to 24/7 independently run Harassment & Bullying Helpline

Work experience programme and placements for people with disabilities

Establishment of staff led diversity networks – Cultural Diversity Group, Deaf & Disability

Workforce Group and Lesbian, Gay, Bisexual & Transgender Forum.

Delivery of a range of recruitment initiatives including pre-recruitment training, community

based training events, and targeted positive action initiatives.

Recruitment of workforce to reflect its diverse community – 46% from BME backgrounds

and proportion of middle/senior managers from BME increased from 25% in 2002 to 44% in

2009.

5.1.2. Areas for further Development

1. EDI Vision, Strategy and Business Case:

Clarity of purpose and direction of travel, along with a shared ownership of its strategic rationale

are critical factors in successfully embedding good EDI practices and behaviours into any

organisation and achieving the desired performance improvement. To some extent all the

Boards would benefit from:

a) A restatement and collective acknowledgement of the EDI vision and priorities, and an

explicit linkage being made to organisational and NHS strategic objectives.

b) Strategies that will deliver more stretch, challenge and the step change required to

improve access to services, reduce health inequalities and increase the diversity of the

workplace.

c) Further communication of the strategic and business imperative, rationale and

benefits of EDI to the staff. This communication needs to take place through channels

and language that the staff will actively engage with and take on board.

2. Board Monitoring and Scrutiny of EDI:

The embedding and mainstreaming of EDI does not eliminate the need for specific focused

governance anymore than this is the case for other strategic priorities such as finance or safety.

While the use of a specialist equality and diversity NED and the intent to equality impact assess

all policies and Board papers are to be commended, further robust and more frequent scrutiny

of EDI as part of the full Board agenda should be implemented, in line with other relevant

strategic priorities. There can be an over-reliance on a single Board specialist and a risk that EIAs

become “just another process” rather than a tool for effective scrutiny and action. Generally, the

Boards could benefit from:

a) Consideration being given to further strengthening the collective engagement and

leadership by all members of the Board, and to the breadth and depth of Board

involvement in the Diversity Steering Group/Committees and their terms of reference.

b) EDI being a standing item on the Board’s agenda supported by adequate time for

discussion, debate and decisive action.

c) Effective, outcomes-driven challenge of the EDI agenda being encouraged and

undertaken by more than just a few Board members. The collective leadership ability to

make the connection between EDI and the core business functions of the Trust is

imperative.

3. EDI Scorecard:

Another area for further refinement is for Boards to centrally capture the totality of their

strategic approach to EDI, the objectives and measurable results and outcomes, in a way that

allows them to regularly track and monitor. What is required is an effective overarching

monitoring framework that allows for both local ownership and action in addition to central

oversight and scrutiny, and that can be used as a means to drive and sustain the required

changes in behaviours.

4. Patients, Communities and Service Delivery

Whilst all the Boards had strategies and initiatives to engage with their patient populations,

communities and tailor service delivery, there is nevertheless more that can be done and

suggested areas for further development include:

a) More regular and visible prioritisation by the Board of the effectiveness of service

delivery to diverse patient groups, the outcomes from tackling health inequalities, and

the success of tailored care.

b) A greater use and leverage of the diversity within the workforce and community

volunteers to support a better understanding of patient needs and the communities

they come from, and to ultimately help improve the quality of patient care and health

outcomes.

c) Establishing an overall mechanism for centrally capturing the outcomes from initiatives

to address health inequalities and the tailoring of service delivery, to better improve

leadership and governance in this area and the communication with staff and

stakeholders.

d) More effective collection and use of patient monitoring and satisfaction data, to

provide a better understanding of how diverse groups access services, what their patient

experience is, where health inequalities exist and to determine what the tailored

healthcare requirements of diverse groups are.

e) Undertaking further research, for example to better understand, evidence and address

the implications of culture, spiritual belief, or sexual orientation on health care needs

and provision.

5. Workforce Representation

Two of the Trusts are finding it challenging to increase the representation of people from a BME

background and those with a disability, and of women in senior management. Whilst steps have

been taken to address this and some progress has been made there is still more to be done. The

Boards could consider:

a) Setting specific objectives for Executive Directors that are then held accountable for

their achievement of diverse staff profiles.

b) Introducing diverse recruitment panels – formally identifying and recruiting individuals

from diverse groups to participate in the selection process as a way of bringing a

different viewpoint to recruitment and appointment decisions.

c) Implementing diversity recruitment training, with a specific focus on unconscious bias,

for all staff including HR and line managers involved in the recruitment, selection and

appointment process.

6. Managers modelling of good EDI behaviours and practices:

Whilst it is clear that there is generally some training provision for staff and managers around

EDI, our findings suggest that this is not translating into perceptions of a consistent modelling of

good EDI behaviours and practices by managers. We suggest the following;

a) If not recently undertaken, a review of the impact and transfer of learning to the

workplace from the EDI learning interventions.

b) A potential redesign/introduction of EDI management skills development

programmes, with a focus on leading diverse teams, engaging with diverse

communities, and championing diversity and inclusion.

c) To increase understanding of what good EDI management is in practice, the

organisation should articulate the specific behaviours that underpin its corporate

values statement.

d) Consideration is given to how the organisation visibly reinforces and rewards managers

and work areas that are consistently displaying good EDI behaviours and practices that

deliver improved service.

e) Senior Managers have EDI objectives built into their performance plans.

5.2. Outcomes from the Integr8 NHS process Comments received from the Boards include: “The work of Integr8 with the Board has led to demonstrable increase in the

understanding and application of EDI issues. There is now a common approach to

becoming effortlessly inclusive”.

“The development intervention has been very powerful in enabling the Board to critically

evaluate its leadership and behaviours and has facilitated a prioritisation of key changes

which are required to achieve a step change in delivery. As a result the board anticipates

that they will see an improvement in its D&I performance over a longer period of time as

objectives are delivered.”

Some of the specific outcomes from the Integr8 NHS process for the different boards include:

Strategic Priorities

1. One Board developed a shared understanding of its vision for EDI, around the theme of

“Caring, Fair and Inclusive” and has agreed an action which starts the process of developing

a deeper understanding of the practical application of the vision, supported by simple

messages, a revised value statement and a strategy with clear outcome based objectives.

For another Board, The Development Workshop enabled the Executive Team to have critical

discussions about the EDI Vision and the road to exemplar. This enabled the Board to

further embed their shared vision to become “effortlessly inclusive” and to tie this in with

the values of the Trust.

2. Identification of objectives to improve the integration of EDI into strategic governance,

business planning and scorecard. This combined with work on the EDI strategy, next year’s

business planning cycle and performance measurement is expected to improve the

underlying links between strategic planning and EDI.

3. One Board has already identified the gaps in available patient data and put plans in place

for 2010-11 to start to improve the availability and analysis of patient data.

4. The intervention has had an important impact in raising awareness of the need to

integrate EDI into leadership and management. Many of the objectives identified as a

result of the intervention are focused on improving sustainable engagement with the

agenda. These include steps to integrate EDI into core business planning processes, training

interventions for managers and a review of the strategy and values of the Trust to ensure

simplicity of message. These are to be promoted through Trust events and FT consultation.

These steps should improve engagement with the agenda, particularly from middle

managers and leaders and should over time improve the Trusts performance in this area.

5. The development intervention enabled one Board to crystallise its understanding of the

links between EDI and its strategic priorities. The development of its scorecard, which

embodies the strategic priorities of the Trust, has provided a powerful opportunity to

mainstream EDI into these strategic priorities. The planned actions to further clarify the EDI

elements within the scorecard should further enhance the understanding of the core

business case. For a second Board, as a result of the work with Integr8, Board members are

more aware of how their EDI vision and objectives are linked to strategic NHS Priorities.

Effective Governance

6. Two of the Boards recognised that the role and influence of their E&D Steering

Group/Committee could be strengthened and also that there needs to be clarity on the

EDI responsibilities of all Board Committees. A review of the current governance

arrangements has been included in one of the Board’s agreed action plan.

7. For one Board, the Development Workshop led to a more consistent approach in terms of

application and commitment from Board level downwards. The Trust’s Workforce

Diversity Group reviewed its terms of reference and has re-named itself Staff Engagement

Group. The membership of this group cuts across all areas of the organisation and includes

representation from the different staff diversity groups.

8. It is anticipated that changes to governance and planning arrangements will naturally lead

to appropriate EDI risks being identified. At present the Risk Register and Board Assurance

documentation are being reviewed.

9. Following the intervention all the Boards are keen to ensure that an EDI focus becomes

better embedded in normal business, although they continue to recognise the value of

specific EDI agenda items where appropriate. Actions identified to embed EDI into business

planning & scorecard and to strengthen governance should help to raise the profile of EDI

issues on the agenda and to improve the understanding of the Board in challenging and

maintaining a focus on EDI.

10. The intervention has helped to raise awareness with the Boards of their role in critically

evaluating EIAs. In addition the actions identified to improve governance and the visibility

of EDI in strategic drivers, is expected to improve engagement with the EDI agenda through

normal business.

Priority actions

11. The intervention has raised the profile of D&I in the workforce and with the Board; in

addition actions to improve workforce understanding through simple messages and values

will help to improve inclusion and diversity. The Boards will also continue to focus on

different workplace inclusion initiatives, including engagement with staff over internal

communications, development of staff networks and positive action initiatives to improve

representation at all levels.

12. Work continues to develop Organisational Values and associated values both to address

workforce D&I issues and to enhance patient experience.

13. The intervention has helped to raise the commitment and profile of existing plans to

impact assess service delivery, implement patient diversity monitoring and specific

initiatives to deliver improvements for specific patient groups.

14. One Trust’s 3 Diversity Groups (Deaf & Disability, Cultural Diversity, and LGBT) have

revised their terms of reference to become forums that work with front-line staff to

increase inclusion and diversity.

Leadership

15. EDI knowledge and understanding has been enhanced further through the development

intervention. Also, a greater understanding of collective leadership has been developed

and a commitment to increase the visibility of EDI on the Board agenda.

16. In addition, the Board Development workshop has given more confidence to members

around EDI that has enabled them to start asking more difficult questions about EDI issues.

17. One Board has recognised the need to refresh its focus on EDI issues and to move to more

outcome based approach to delivery. The actions identified to improve governance and to

create a clearer strategic approach are intended to create a sustainable approach to EDI.

18. The development received has reinforced good D&I behaviours on the Board. The

intervention has also helped to improve the working of the Board because it has contributed

to a greater understanding of the value of difference, leading to a positive recognition of the

benefits of celebrating inclusiveness in delivering services but also in maximising Board

effectiveness.

19. Board members have identified individual and collective strengths and areas for

development as inclusive leaders. Board Members were also able to use these insights to

develop personal actions to enhance their confidence and competence as inclusive leaders.

Organisational Shift

20. An initial set of objectives has been identified which are mainly focused on addressing the

gaps in strategic leadership and governance. These objectives include the need to

establish a clear strategy and values. The process for developing these will review all the

available data, consultation feedback and the outcomes of the development intervention to

provide clear outcome based objectives for the Trust to take forward.

21. The Transformation Team are now embarking on a change programme that will further

embed Kings Values and will define a set of behaviours, the “Kings Way”. These

behaviours will be modelled across the Trust, from Board level downwards.

22. There has been a tangible increased discussion, communication and involvement with the

local community and other diverse groups regarding service developments.

23. Many of the objectives and priorities which have emerged from the intervention were

known already but the intervention has helped to crystallise these and also to identify

some of the key issues of EDI leadership for the Trust.

24. For the NHS NW the focus is on legacy. The preliminary proposal is to use the NHS

NorthWest regional E&D forum to disseminate key learning from their approach to

embedding EDI into the work of the Board and across the NHS system. The intention is to

ensure that progress, knowledge and skills gained from leading on the EDI agenda are

captured and preserved as the transition to the new NHS model of GP consortia emerges.

6. Key Learning

1. Benefits to Participating Trusts

a. Improved Governance: There is a renewed focus on vision, mission, and strategic

planning for EDI, and a focus on capturing EDI objectives, activities, measures and

outcomes into easy to track, monitor and scrutinise Board level scorecards to improve

collective governance.

b. Inclusive Leadership: The use of the Factor 8 Different Leaders Assessment Tool and the

supporting coaching is leading to heightened awareness and understanding of Inclusive

Leadership both at individual and collective board member level, and the development

of personal action plans to increase competence and confidence.

c. Exemplar High Performing Inclusive Organisation benchmark: Providing Board

members with a shared frame of reference for where they are now and where they are

trying to get to has accentuated a sense of collective ownership, purpose and direction

for EDI, and catalysed momentum for further change.

d. Changing behaviours: Recognition and emphasis on living the value of inclusion, has led

to further focus on embedding behaviours, going beyond strategy, process and structure

to deliver meaningful EDI outcomes and improved performance.

2. Project Lessons

a. OD & Change methodology: Adopting a change strategy approach to EDI and the

Integr8 NHS process has greater resonance and more impact. In other words, it is

important to get the Boards to view the intervention not just as an opportunity to learn

more about EDI, but as part of a change process to propel the Trust further along the

journey to exemplar EDI status.

b. Align to local context: The approach to EDI is a function of the local context, so Integr8

NHS is flexed to align with Board culture and specific needs of each Trust. This was

particularly evident with NHS NW where the emphasis rightly shifted to legacy learning

and embedding of good practices.

c. Focus on the role of the Board: while ultimately the aim is to see improvements in

workforce, workplace diversity and inclusion issues and in patient care and community

connection, for this intervention to be successful the focus needs to be on the Board of

itself, governance of EDI issues such as strategy, performance monitoring, effective

scrutiny and constructive challenge. It is by “stepping up its game” as the ultimate

leaders of EDI in the Trust, that the organisation will achieve the broader goals it has set

itself.

d. Project Duration: There needs to be an appropriate and adequate timeframe

established for the implementation of the project and the delivery of its outcomes.

There was a sense at times when we and the Trusts felt that we were going through

parts of the project too quickly to have the maximum potential impact. A project of this

nature particularly needs more time post the development workshop and Board

agreement to the action plans, for meaningful implementation before review of the

outputs.

3. EDI Themes

a. Culture Change Challenge: Translating EDI policies, processes and structures into

sustained behavioural and cultural change in the organisation is the biggest challenge

that organisations face. It requires consistent and sustained focus on the part of the

Boards to ensuring that this is achieved.

b. Effective Scrutiny: The breadth and depth of effective leadership and scrutiny of EDI by

the Boards is variable.

c. EDI Leadership: There is a tendency on the Boards for EDI to be de facto the preserve of

a few members.

d. Process Driven: There is an over-reliance on processes such as Equality Impact

Assessments and Single Equality Schemes, rather than robust challenge and innovative

thinking by the Board.

7. Conclusions and recommendations for the future

The Integr8 NHS process has proven to be a powerful vehicle for enabling a Board to take stock

of where they are on the journey to becoming an exemplar high performing inclusive

organisation. The process provided Board members with personal and collective insight into how

to become even more effective at embedding EDI into governance and ensuring clear linkages

between EDI and the vision and business strategy for their organisation. With the passage of

time and a sustained effort on the part of the participating organisations we expect to see

progress in the way they for example:

- commission for inclusion

- deliver inclusive health and health care services

- engage patients, carers, the general public, local populations inclusively

- lead inclusively

- recruit for inclusion and diversity

- manage for inclusion and diversity

- harness innovation from inclusion and diversity

- harness productivity and quality improvement from inclusion and diversity

- improve prevention through inclusion

However for this approach to fully deliver the desired outcomes our views are that:

1. A one-off intervention can address some of the EDI issues that the Board may face, but for

sustainable impact further support by way of coaching at Board level and possibly at sub-

committee level as well as external accountability is needed.

2. The timeframe for a project of this nature to fully deliver on its objectives should be 12 to 18

months minimum. This would give sufficient time for measurable outcomes to become

evident.

3. The facilitation of an intervention like this requires expertise in EDI, change management,

strategic thinking as well as experience and well-developed skills in group facilitation at

Board level.

embedding equality, diversity & inclusion into nhs governance

Documents