“Ultimately, you need the whole organisation to understand what the issues are, what needs to change – and how changing things for staff leads to changes for patients.”

I joined the trust four years ago, on the day that it was placed into special measures on the back of a really damning CQC report. I had headed up large-scale change at Mid Staffordshire NHS Trust and although I recognised some of the problems, I knew that making far‑reaching changes like this would require some structure too. That’s why we joined as one of the first pilot trusts for the NHS England and NHS Improvement Culture and Leadership programme.

I’m not scared of rolling my sleeves up, and I know what my values are. I know my strengths and I know where I need to develop. So it made total sense that we would need really good talent around us to make things work.

That’s where the programme really helped – it wasn’t formulaic, it’s more about providing a framework through which you explore and resolve your own problems. The programme team were hugely effective at coaching us through the process and at our end, we put the very best people we had in place. We were particularly supported by Dr Katy Steward, who was the main external consultant through the process.

Compassionate leadership

The task we faced was really serious: we had eight areas that were inadequate for safety. I knew our focus had to be on providing nurturing, compassionate leadership and the programme supported my vision, highlighting the value of connection, empathy and empowering people. By single-mindedly keeping people and staff indicators as our driving point, and doing everything from a perspective of making this a better place for them, we started to see results.

The Discovery stage is an essential diagnostic, which highlights the areas for priority. But it was also an opportunity to share my vision with the rest of the leadership team and beyond. Through being involved in the listening exercise, people could see for themselves the value of the programme. It takes courage to listen to feedback as what you hear isn’t always easy – but by going through that process for themselves, working through solutions and then seeing the impact of their work, people became inspired by the programme.

Ultimately, you need the whole organisation to understand what the issues are, what needs to change – and how changing things for staff leads to changes for patients.

The Design stage involved drawing up localised quality improvement action plans around the eight area of focus that we identified. To move from ideas into action, we developed some core leadership models and set out clearly how we would develop leadership skills throughout the organisation. As we moved into the Delivery phase, we found that you can put broken things right quite quickly, but that to sustain these changes, staff need to embrace different ways of doing things. That meant unlocking their potential and empowering them to take a lead.

Changing safety behaviours through leadership

In one example, some surgical staff weren’t following the WHO safety checklists, but the data highlighted that this was a systems failure. We used a three-day human factors training to help each team member understand their role within the wider system.

I attended that human factors training about six or seven times. The programme emphasised the importance of managers – including senior management – providing that hands-on leadership. So in this case, I sat with the groups, gave them insights into why we were there, and made sure those people took the lessons back to the theatre. And we had great results: compliance with the list changed dramatically and quickly.

It takes courage to listen to feedback as what you hear isn’t always easy.

Strengthening relationships

Another area we worked on is bullying and building relationships between people and line managers. We’ve run a host of positive interventions to set our standards and reinforce values. Activities included building new staff networks and recording video messages from leaders at the height of the COVID-19 pandemic. We’ve also replaced appraisals with a wellbeing check-in, to show staff that we care and we’ve launched a ‘Your voice’ programme, led by the executive team, with monthly ‘You said, we did’ updates.

Through all these changes, having the external support of the programme team and Katy was invaluable in providing a framework for our process and different insights and perspectives.

What’s changed?

We have seen statistically significant improvements in our NHS Staff Survey 2020 performance including a record 60% response rate. This includes improvements in creating a safe environment by tackling bullying and harassment, staff recommending the organisation as a place to work, higher levels of staff engagement, and positive action on health and wellbeing. We’re not out of the woods, as we’re overdue a CQC inspection, so we’re still a ‘requires improvement’ trust – but I know the data is showing us to be a good trust.

Longer-term work

The Culture and Leadership Programme has enabled me to develop myself in new ways too. I have different discussions that I might not feel comfortable with having with my peer group and I understand more about the organisation a whole. We’ve got a ‘culture champion’ lanyard and the logo is on my email signature too. It’s nice to have that different string to my bow.

Real faith in the trust

Even though I’d been through this process before, the Culture and Leadership Programme was an extremely valuable tool and a good basis for our improvement work. Having someone to come in to facilitate and support with seminars can be really influential for the board and leadership team and it’s very motivational for the change team.

Through the programme, staff designed our values: Compassion, Accountable, Respect, Everyone counts (CARE).

Now the programme is over, the work is ongoing to embed these into our longer-term development work all underpinned by the key ingredient: compassionate leadership.

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