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Embedding Equality, Diversity & Inclusion into NHS Governance
Board Development Toolkit
November 2010
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Integr8 NHS – Board Development Toolkit
Embedding Equality, Diversity & Inclusion into NHS Governance
1. Overview of Integr8 NHS Toolkit 3
1.1. Approach 3
1.2. Target Outcomes 4
1.3. Methodology 4
1.4. Timeline 6
2. Board Engagement 7
2.1. Programme Set up 7
2.2. Scoping Meeting 7
2.3. Full Board Meeting 8
3. EDSnap Audit 9
3.1. EDSnap Audit Report 10
4. Strategic Inclusive Leadership Review 11
4.1. Background 11
4.2. Completing the Factor 8TM DLAT 12
5. Board Development Workshop 13
5.1. Example of Workshop Agenda Template 13
6. Taking Action 15
6.1. We Implement 15
6.2. Evaluate and Review 15
Appendix:
1. Scoping Meeting Agenda Template
2. Integr8 NHS Board Overview Report
3. EDSnap Document Request Checklist
4. Sample Summary page – Factor 8 Assessment Report
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1. Overview of Integr8 NHS Toolkit
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”.
This report outlines the Integr8 NHS Board Development Toolkit for Embedding Equality, Diversity
and Inclusion into NHS Board Governance.
1.1 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.
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1.2 Target Outcomes
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.
1.3 Methodology
The Integr8 NHS methodology is an 8 step process for embedding equality, diversity and inclusion
into NHS governance.
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Foundation
The initial steps in the process are focused on project set up, engagement and ownership with the
Board; analysis of the 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 EDSnap
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 will be 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 communities. 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.
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 a facilitated Board workshop, examines what it means to lead
effectively on D&I and develops a common framework of inclusive leadership competencies,
behaviours and values for Board members.
vi. We Govern – the final session of a facilitated Board 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.
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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
the consultants attend meetings with the Trust to coach and facilitate the Board in executing
the plan.
viii. Evaluation & Review – an overall final review and evaluation of the success of the
Intervention
1.4 Timeline
In an ideal context the Integr8 NHS process would be undertaken over a 12 to 18 month timeframe.
This is primarily to give time for the intervention to translate into sustainable and impactful
outcomes. However, where necessary it can be condensed into a shorter timeframe. An indicative
timeline and reflection of investment required from the average Board member is shown below:
The rest of the Toolkit breaks down each of the major steps and provides guidance as to how to
undertake this Board D&I Development intervention, along with examples and other materials.
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2. Board Engagement
2.1 Programme Set Up
1. Invitation to participate: A letter is sent from NHSI to selected Boards to invite them to
participate in the Programme. Alongside the letter, an outline of the Integr8 NHS
methodology and terms of engagement letter are also sent.
2. Provider communication with Board Chief Executive /Chair: Following the invitation letter
there is an introductory conference call with the Chief Executive of the Trust. The purpose of
the call is to:
a) Introduce the Provider to the Chief Executive
b) Outline the aims, objectives and process for Integr8 NHS, as outlined in the
methodology document previously sent to Chief Executive
c) Determine readiness and commitment of Chief Executive and the Board to undertake
Integr8 NHS in a timely and productive manner
d) Establish parameters for scoping meeting including agenda, participants, and timing
e) Agree on operational points of contact and communication
2.2 Scoping Meeting The objectives of this initial meeting are to clarify expectations and define the scope of the
programme, gain insight to Board readiness and raise Provider awareness of the specific context and
issues that need to be taken into account. Working with a key group of stakeholders the Provider co-
creates a programme agenda and plan of events that fits with the priorities and needs of the Board.
The actions that are taken are as follows:
a) Participants at the scoping meeting to include key individuals critical to successful
implementation of the project, and likely including:
i. Chief Executive
ii. Chair of the Board
iii. One or two other Board members e.g. Diversity Champion
iv. Equality and Diversity Lead
v. Director of Human Resources
vi. Secretary to the Board
b) A Scoping Meeting Pack is to be sent out beforehand and this is to include:
i. Agenda template and key questions for discussion – A sample template is
provided in Appendix 1.
ii. Information request for overview of Board, pen picture of members, roles and
responsibilities, how it is structured etc, over and above what is publicly
available on the website
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iii. Document supply request template to show the documents/information
required for the EDSnap Audit
c) At the scoping meeting, participants discuss and agree the Integr8 NHS process as it will
be applied in the context of the specific Board, including:
i. Providing options for where more flexibility may be required
ii. Identifying the critical issues that will be the focus of attention, discussion and
actions for the Board
iii. Identifying which Board members should participate in the EDSnap interviews
iv. Developing a communications plan for sharing/updating information with the
full Board following the scoping meeting and for the project as a whole.
v. Determining the schedule of dates/meetings for the Integr8 NHS steps
2.3 Full Board Meeting The first meeting(s) with the Board will set the scene for the rest of the programme. The aim is to
get the Board to collectively take ownership of the Integr8 NHS programme and the process. A
report of the Intergr8 NHS aims, objectives, process and desired outcomes will be circulated prior to
the meeting. An example of such a report is provided in Appendix 2. An overview of this will be
presented and used as a platform for discussing and agreeing the specific development agenda.
The objectives for the Board Meeting are to:
a) Establish a shared understanding of the purpose and scope of the programme and to shape
and refine the proposed plan
b) Explore what will work with regards the implementation of the programme, what are the
barriers and how can they be addressed, and communicate the underlying principles and
rules of engagement
c) Engage Board members in an exploration of the role of D&I as a strategic lever for achieving
the goals of Quality, Innovation, Productivity and Prevention (QIPP) as laid out in the Next
Stage Review vision
d) Explain to Board members the Strategic Inclusive Leadership review and the use of the
Factor 8 Different Leaders Assessment Tool
e) Identify how success will be measured and the programme evaluated
It is highly likely this is scheduled as an agenda item at one of the Board meetings and therefore the
time allocated may be quite short - 15 to 20 minutes, in which case item c) may be deferred to the
Board Development Workshop
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3. EDSnap Audit
The Integr8 NHS EDSnap Audit seeks to gather information on the current status with regards the
positioning, integration and impact of EDI for each individual Trust. Broadly, this includes:
An understanding of the Board’s perception, engagement and leadership of EDI
An analysis of policies, programmes, and outcomes relevant to the workforce and workplace
A review of health care service delivery, access to health care and engagement with diverse
stakeholders and communities
The EDSnap Audit is not intended to be a comprehensive audit of all EDI activities and issues at the
Trust or to identify what is “right or wrong” from an EDI perspective. Rather, the objective is to
make a quick assessment of where the Trust is on its EDI journey and capture the direction of
travel from compliance - to process - to delivering outcomes - to being exemplar. It is to provide a
snapshot of the current situation, and a high level understanding for a baseline assessment of where
they are today.
There are three elements to the EDSnap information gathering process:
1. Documentary Review – an analysis of existing information and data. To ensure that we use a
quick and systematic approach to gathering head-line data and relevant information we
have developed a Document Request Checklist, which is attached in Appendix 3. This
checklist provides an indication of the minimum types of information required to conduct
the EDSnap audit.
2. Telephone interviews – the purpose of the interviews is to provide an initial assessment of
Board members understanding of EDI, the Board’s engagement with EDI from a governance
and leadership perspective, and to establish their views and perceptions on what needs to
be different for EDI to be integrated into the way the Board does business, the associated
behaviours and measures of success.
The objective should be to interview 6 Board members, the Chair and 2 other Non-Exec
Directors, and the Chief Executive and 2 other Executive members of the Board. In addition,
other significant individuals could also be interviewed, for example the Equality & Diversity
Manager and the Heads of diversity staff representative groups.
3. The Integr8 NHS EDSnap online survey is intended to gather the views of a cross section of
stakeholders with regards to EDI at the Trust. More specifically, the objectives are:
To examine EDI issues critical to the Trust, and stakeholder views on the extent to which
they are being addressed, outstanding challenges and barriers, and how they can be
overcome
To explore perceptions of the significance placed on EDI by the organisation and assess
Board and Senior Management leadership of the EDI agenda
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To gain an understanding of the impact that current EDI practices are having on the
workforce, the workplace, service delivery, and in ensuring equality of health outcomes
to all communities
The request to participate in the survey is sent to a small sample of staff, patients and community
representatives for completion. The survey is completed online, unless it is absolutely necessary to
use hard copies of the questionnaire, for example where staff may not have access to the internet in
the normal course of their work. The intention is to gather 100 plus completed surveys.
3.1 The EDSnap Audit Report Having gathered the data, it is then analysed and reviewed under four broad areas for assessment:
1. Board Governance of EDI
2. Patients, Communities and service delivery
3. General Leadership and Management around EDI
4. Workforce and workplace
Within each area an assessment should be made against a set of EDI good practice statements as a
baseline for comparison. The Diversity Practice has created a proprietary set of good practice
statements representing what an “Exemplar EDI Organisation” or “High Performing Inclusive
Organisation” would have in place and be achieving. The good practices are drawn from a range of
published guidelines/frameworks for good EDI Standards including the Department of Health
“Equality and Human Rights in the NHS, a guide for NHS Boards”; The Local Government Equality
Standards; Care Quality Commission Standards; and the Diversity Works for London Diversity Gold
Standards.
A critical output from the Integr8 NHS process is the production of the extensive EDSnap report
outlining areas of good practice and recommendations for areas requiring further development
and intervention. As a stand alone report it provides a basis for further action on the part of the
Trust, and additionally it feeds into the content for the Board Development Workshop.
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4. Strategic Inclusive Leadership Review
A key step in the Integr8 NHS process is the Strategic Inclusive Leadership Review. The objective is
for each Board member to receive 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 will be 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.
Additionally, the use of the Tool allows for a collective representation of the strengths and areas for
development of the Board as a whole with regards inclusive leadership, and the development of a
language and framework for inclusive leadership behaviours and competencies.
4.1 Background By way of background, the Factor 8™ Leadership Framework emerged from a groundbreaking study,
Different Women, Different Places (2007) the first research of its kind to focus on the career and
leadership strategies of successful black and minority ethnic (BME) women in the United Kingdom
and Europe. The framework draws on the fundamental premise that diversity is a distinctive
leadership strength that must be leveraged by individuals, teams and organisations for competitive
advantage.
From early 2008, The Diversity Practice started to use the Factor 8™ framework in a variety of
consulting, coaching and learning & development interventions. Since then, over 2000 people have
experienced Factor 8™ as a learning tool across the public, private and not-for profit sectors, in the
UK, US and Europe. It has been validated training courses by the Institute of Leadership and
Management. The evidence has built up to show that Factor 8™ contributes to the success of a
broad group of leaders. The term “Different Leaders” is used to encompass all those individuals,
regardless of their gender, race, ethnicity, or other dimension of diversity, who draw on diversity as
an authentic strength to maximise leadership impact and deliver results.
Factor 8™ and the Different Leaders Assessment Tool have been used to support the leadership
development of BME individuals, managers of diverse teams, and senior management of large
complex organisations. It has also provided a framework for whole system organisational dialogue
and change, and successfully contributed to the development of high performing inclusive
organisations across a variety of industry sectors.
In addition to providing individuals with the opportunity to self assess against the eight Factors,
it also gives managers of diverse individuals and teams the opportunity to 'step into the shoes' of
Different Leaders and provides a common language and appreciative model for engaging in dialogue
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that focuses on the value of difference and those leadership behaviours that create high performing
cultures.
The Factor 8™ DLAT has been used by a wide cross section of organisations including Kings College
Hospital, North West Ambulance Service, NHS North West Strategic Health Authority, NHS Yorkshire
and Humber Strategic Health Authority and Senior Leaders from Trusts across the region. Outside of
the NHS it has been used with organisations as varied as Imperial College, Oxford University,
PricewaterhouseCoopers, Ernst & Young, Kent County Council, Bank of America Merrill Lynch, and
the National School of Government to name a few.
4.2 Completing the Factor 8™ DLAT The Factor 8™ DLAT is available online through the Diversity Practice Ltd at
www.factor8assessment.com. Once set up, the Board member and between 4 and 10 observers are
required to submit a completed online questionnaire. Selection of observers should be based on
inviting as broad a spectrum as possible – peers, subordinates, current/former managers and need
to know the individual well, have seen them in action and can be trusted to provide objective
feedback. For the purposes of this particular review, at least 2 observers should be colleagues on the
NHS Trust Board on which the member is currently serving. The questionnaire takes about 20
minutes to complete.
Completion of the 360 version of the Tool provides a comprehensive report on the extent to which
individual Board members display the characteristics of an inclusive Leader.
The results from this questionnaire are then reviewed and discussed as part of the Inclusive
Leadership Review, a one to one confidential Executive Coaching session to be held with each Board
member prior to the Development Workshop. The objective is to highlight the learning from the
Factor 8™ DLAT, areas of strength and for development, the application of the learning in a Board
and Trust context, and creation of a personal development action plan.
An example of a summary page from an individual Factor 8™ DLAT report and a team chart is
provided in Appendix 4.
Note, only certified Factor 8™ DLAT coaches are licensed to use the Tool and conduct the review. A
list of these coaches is available by contacting the Diversity Practice at www.diversitypractice.com
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5. Board Development Workshop
The Board Development day marks the half way point in the Integr8 NHS process and is a key
milestone in the journey the Board has embarked upon. The overall aim is to use the facilitated
workshop to further build or embed EDI into the business of the Board and the organisation.
Broadly, there are 3 critical areas that need to be covered:
1. E-QIPP – to develop the vision for EDI, the business case for building D&I into the Board’s
business, and examine the critical connection between D&I and achieving QIPP;
2. I-Lead – to explore and examine what it means to lead effectively on D&I and develop a
common framework of inclusive leadership competences, behaviours and values for Board
members, building on the results of the Factor 8 Different Leaders Assessment Tool and the
Inclusive Leadership Review;
3. We Govern – to build 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.
Ideally, a full day is required to do justice to the issues that need to be addressed. In practice, most
Board’s are only prepared to offer half a day for the workshop. Therefore, more detailed preparation
and dialogue with key Board members – or the team leading the intervention – is required to ensure
that the maximum use is made of the time and the sought after outcomes are generated.
A successful workshop requires skilled facilitators with in-depth knowledge and understanding of
EDI, change management skills, an appreciation for working systemically and expertise in working
with Boards and Senior Managers.
Prior to the workshop, all Board members should receive a copy of the EDSnap Audit Report.
5.1 Example of Workshop Agenda Template Aims and Objectives
1. Restatement of the vision for EDI; gaining agreement and shared ownership of the vision
and the road to exemplar
2. Connecting EDI to the Board’s strategic agenda and priorities; and clearly articulating the EDI
business case
3. Use the EDSnap findings and Factor 8 Leadership review to identify key areas of focus to
become more effective as a Board in terms of strategic leadership and governance of EDI
4. Acknowledge what is working and agree steps to sustain and accelerate progress
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5. Explore how EDI can be fully integrated into the Trust’s Scorecard or Strategic Performance
Measures, and identify solutions to eliminate the barriers to progress on EDI
Integr8 NHS Agenda
Board Development Workshop 3.5 hours
Time Activity
Framework
13.00 EDI Vision and the road to exemplar: where are we now and where are we going?
Introduction & foundation for the Workshop
What is our collective vision for EDI?
How does EDI at the Trust connect to the broader NHS strategic agendas?
The EDSnap Audit and what it tells us
Where are we on the road to being exemplar?
14.30 Strategic Leadership: you as a Board
What does Strategic Leadership in EDI look like?
What’s really working for us as a Board and how we lead on EDI?
How do we sustain and move this forward?
What are the barriers to progress and how do we eliminate them?
15.30 Priorities for Action, Collective commitment & Next steps
What do we need to focus our attention on?
How do we ensure EDI is fully integrated into the Strategy and Balanced Scorecard?
What actions are we committing to undertake as a way forward?
How will we track and monitor our progress?
How will we hold each other to account?
16.30 End
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6. Taking Action 6.1 We Implement Following the Board Development Workshop, the Provider and the Board will consolidate the
actions agreed from the previous sessions and create an implementation plan. The role of the
Provider at this point in the process is to act as an expert coach to the Board or the working group
responsible for taking forward the output from the Board Development Workshop and the Integr8
NHS process.
In addition, drawing on action learning methodology and appreciative inquiry, their role will be to
facilitate and sustain the ongoing learning of the Board and to assist in addressing any issues that
might arise as they take action and put the changes and improvements in place.
The Board will then be required to approve the implementation plan and take responsibility for the
ongoing monitoring of the agreed actions. It will be important for the Board to also give thought to
the organisation in the context of its wider social system and that any changes are considered in the
light of the complexity of the NHS and the various relationships that exist across the system.
Additionally, a communication plan will need to be devised to ensure that relevant staff and patient
or community representatives affected by any of the changes are kept informed.
6.2 Evaluation and Review The evaluation and review focuses on the effectiveness of the methodology and suggestions for
improvement; on the impact of the programme in terms of personal learning and development of
the Board members; and the effect of the changes on the leadership and governance of the Board.
In the spirit of action learning and a solutions focused mindset, progress against agreed key success
indicators are reviewed at each stage in the programme. This will ensure that the learning of “what
works” is captured and embedded into working practice as the Board progresses on its D&I journey.
The final evaluation takes the form of a short semi structured questionnaire sent to the Chief
Executive/Chairman and other Board members for completion and analysis before the final review
meeting. This meeting is to feedback the data from the evaluation and provide an opportunity for
collective reflection and recommendations on the value and contribution the programme has made
to the ability of the Board to build D&I into its business practice.