I feel very privileged to have a role in which people open up to me about their experiences in the organisation. It’s very humbling. I get to speak to so many people from all different walks of life. That’s why the Culture and Leadership Programme felt like the perfect match for me: I’ve always been interested in organisational culture and people’s stories. That’s why I offered to run it. Today it’s pretty much my full-time job.
I began recruiting staff to join our change team in January 2019. I only had 20 places and I got over 50 applicants! They included 20 clinical staff ranging from healthcare support workers to a consultant anaesthetist. That breadth meant our members could offer really different perspectives. NHS England and NHS Improvement supported us through the process, using a coaching approach, while the external consultants have supported us at a more strategic level.
I’ve learnt to trust the process. When I first saw the programme content, I worried the process was way too lengthy and detailed. But once I got started, I realised that its value is not just in the outcomes, but in the journey itself. If you want to see profound cultural change, you have to take the time to gather people’s experiences. That’s how you find out what’s actually happening in the organisation.
You have to be open to what you find, too. If you’re really, truly listening to the stories coming out of your staff experiences, you may have your assumptions proved wrong!
For example, we had scored poorly on equality, diversity and inclusion issues in past Staff Surveys so we assumed our attention would need to focus on discrimination. Instead, the key problem was about fairness – that is, a lack of transparency around the recruitment process, with lots of staff having a perception that our recruitment processes weren’t fair.
When we started analysing the data, we found that the proportion of ethnic minority people getting promoted was higher than other groups (70% versus 60% ethnic minority colleagues across the organisation). So our task is to shift perceptions and communicate all the good work that happens at North Middlesex.
We’re doing that by communicating more clearly and strategically through various channels, including newsletters and workshops. We are also gathering staff stories, with colleagues sharing where they’ve come from and how the organisation has helped them develop. For example, we have the third-best NHS apprenticeship programme in London and most of our apprentices are from ethnic minority communities – but we’d never shared that. Of course, we don’t always get things right, but when we do, we need to make sure our people hear about it.
Another area of focus was encouraging people to speak up when they saw poor behaviour. It was quite evident from day 1 that many of our colleagues were unwilling to do this. This was for two reasons. The first was that some felt they’d tried to speak up before and nobody had listened. Here, our task has been to communicate, very explicitly that today, when people speak out, North Mid listens and takes action. We can do this by sharing messages such as ‘You told us and we have therefore done…’.
The second reason was the legacy of past experiences. Some staff have been through very negative experiences, usually five or more years ago, and although things have changed, these stories are still widely known. Here, our task is to genuinely enable people to come to terms with those experiences and move forward, trusting that things have changed – almost like a rebuilding ‘trust and healing’ process.
Compassionate, inclusive leadership
The need for compassionate, inclusive leadership emerged as we looked at all the stories of bullying, harassment incivility in the organization. We spoke to more than 1,500 of our colleagues about this issue and found that these behaviours have affected more than 50% of the organization. Staff shared really powerful stories about the microaggressions – the little moments of incivility – and explained how they affected their working lives. We’re currently looking at ways to capture snippets of these stories to share with colleagues and we’ve redesigned all our leadership programs to focus on inclusive, compassionate leadership so that a new atmosphere of trust, healing and understanding runs throughout all our teams.
We started to see changes in people’s behaviours and corresponding impact on patients’ experience. For example, as staff felt more respected themselves, they became more likely to refer to patients by name rather than referring to ‘the patient in bed 15’.
Later in 2019 we became the ninth most improved organisation in the National NHS Staff Survey, with improvements in seven out of the 11 themes. Then COVD struck. We were the second most affected hospital, so when it came to the transformation programme we had to take our foot off the pedal. And by the time of the 2020 Staff Survey, all that progress had slipped back.
Initially, I was devastated. But on the positive side, our performance remained constant. And having created those improvements once, we know how to do it again. If anything this just proves that what we were doing was working – and that we need to keep up the momentum to maintain the results. The board is more supportive of the programme than ever before and I feel confident that our staff experience will be back up in no time at all.
We’re on stage 3 of the Culture and Leadership programme itself but the work will be ongoing. Our Continuous Improvement Team is linking it to our ongoing improvement work. This isn’t a project with an end goal so much as a new way of being, for us all.
We’ve redesigned all our leadership programs to focus on inclusive, compassionate leadership so that a new atmosphere of trust, healing and understanding runs throughout all our teams.
Trust: North Middlesex University Hospital
Stage at time of writing: Design
North Middlesex University Hospital is one of London’s busiest hospitals, providing acute care and community services for the 350,000 people living in Enfield, Haringey and beyond.