CULTURE, WORKFORCE AND THE PRIDE WAY

Deborah Tarrant, Director of People and Organisational Development Alf Theodorou, Kaizen Promotion Office Director

WHY ARE WE HERE

We will cover: • A brief background on our organisation • Our culture and the journey we are on • How our relationship with Virginia Mason Institute supports our

cultural journey • Our plans for developing our workforce

OUR CULTURE – WHAT WAS IT LIKE AND WHERE ARE WE HEADING

• Early reflections – listening to our patients, people and partners • OD Strategy and framework – diagnostics, priorities and process • Engagement and communications • Patient safety and improvement work • The PRIDE Way • Evaluation – metrics to ensure interventions are effective and

outcomes delivered • Next steps of our journey

WHAT DO WE MEAN BY CULTURE

• The way we do things around here

“A pattern of shared basic assumptions that the group learned as it solved its problems…[and] had worked well enough to be considered valid and, therefore, to be

taught to new members as the correct way to perceive, think, and feel in relation to those problems…Leadership and culture are two sides of the same coin.”

(Organisational Culture and Leadership. Schein: 1992)

2014/15 2015/2016 2016/2017 2017/2020

Stability

Unlocking our potential

Resilience

Delivering our potential

Transformation

Continuing

service redesign

Year 1 Year 3 Year 2

Today we are here

CONTEXT - OUR CONTINUING JOURNEY

Sustainable

New models of delivery

Year 4+

Our vision is to provide outstanding healthcare to our community, delivered with PRIDE

OUR VISION AND VALUES

OUR VISION IS TO PROVIDE OUTSTANDING HEALTHCARE TO OUR COMMUNITY, DELIVERED WITH PRIDE

• Our improvement plan integrated into the day to day running of our services • Underpinned by our values

Operational plan

Improvement plan

Strategic

development

Operational plan

Updated clinical strategy

Improvement Plan

Safe

Effective

Caring

Responsive

Well led

Quality (clinically effective, safe,

positive experience)

Workforce

Substantive Agency

Performance

Finance Income Expenditure

Partnerships

JOINED UP PLANNING

Virginia Mason Institute • Non profit organisation

specialising in health care transformation

• In 2002, Virginia Mason created the Virginia Mason Production System (VMPS) based on the principles of the Toyota Production System

• VMI founded in 2008 in response to a demand from healthcare organisations worldwide to understand and apply lean methods

VIRGINIA MASON INSTITUTE

Partnership with NHS Improvement • Five NHS trusts will benefit from

the mentoring from VMI as part of an ambitious improvement programme. They are: UHCW, SaTH, SaSH, LTH and BHRUT.

• As part of the initiative aiming to make the NHS one of the world’s greatest learning organisations, clinicians and leaders from VMI will teach NHS staff, including doctors and nurses the principles and systems that made it so successful.

VIRGINIA MASON INSTITUTE

• The 5 year engagement with VMI offers our Trust an opportunity to implement an evidence-based quality improvement culture and methodology to the benefit of our patients, visitors and staff.

• The PRIDE Way will become our change management approach and a fundamental part of our organisation’s culture.

• This is not an initiative; it is a fundamental change in the way we work.

• The Kaizen Promotion Office sits at the centre of implementation of the method.

• Patient first • Respect for people • Kaizen – continuous

incremental improvements

THE PRIDE WAY

VALUE STREAM SURVEY NOV 2015

316 respondents • Diagnostics Processes 30% • The first 24 hours 39%

Respondents group (Q2)

Select future value streams (Q3)

VALUE STREAMS

The First 24 hours Within the first 24 hours of emergency admission our frail, elderly patients receive the right assessments and treatments Sponsor Development Session: 10th May Rapid Process Improvement Week #1: 11th – 15th July Diagnostic Processes The way we communicate results of investigations between clinical teams and with patients Sponsor Development Session: 7th June Rapid Process Improvement Week #1: 15th – 19th August

Developing the

Organisation

VMI Service Improve

ment Patient

Exp.

Staff Exp.

EDI

PRIDE

Communication

Team Work

Profess

ional Practice

Education,

Training and

Development

Workforce

Leadership

Partnership Working

Planning

Governance

Safety

Quality

Productivity

Schwartz Rounds

Strategy Development

Health & Wellbeing

Senior Team Brief

Patient Safety

Summits

OD PROGRAMME 2016/17

OD PROGRAMME 2016/17

HEADLINES

Why change anything? What are the risks of not changing? What would success look like?

Leadership is the most significant driver of culture and therefore the first priority to making the required change

The potential for a lack of leadership capability to undermine improvement is an existing corporate risk

o Increased staff engagement scores

o Improved patient FFT scores

o Improved retention of talent (>regretted attrition, < internal promotion)

o Improved operational performance

o Improved safety-related measures (SHMI / £claims)

o Improved productivity (pay spend v activity and income)

The organisation’s performance is largely dependant of the management of the performance of its people and we must improve our performance

We are not sighted on people-performance rating or performance management and cannot be assured that poor performance is addressed or that high performance is recognised

We have several very challenged teams and long-standing, high demand for intensive OD support

We are unable to meet this demand to improve team performance and where we do make provision it is at a high premium and not necessarily sustainable. Team functionality is strongly associated with safety outcomes as well as workforce related indicators

The Staff Survey and a recent cultural audit report a significant challenge to the dignity of our people at work

We have a duty of care to meet. The current findings also pose a risk to our reputation and to retention – both relating to our objective of becoming an employer of choice

The majority of our resources are managed at the point of interface with our patients by the ‘front-line’ leadership tier however we don’t currently mirror the organisations new MDT leadership structure at this level

Front-line leadership has the most direct influence on both patient and staff related outcomes and so any sustainable gains in leadership or resource management are ultimately dependant on this structure

ROI

OD PROGRAMME RATIONALE

Workstream DELIVERY 16/17

• Support the delivery of a COMPACT to set a clear and consistent expectation of leaders • Launch comprehensive leadership programme • Develop a complimentary coaching/mentoring network and action learning programme

• Continue to implement a quality PPR system with capability maps and resultant reports + plans as outputs

• Develop internal capacity for OD support to teams; identifying and working with the highest priority areas directly and commissioning external expertise where required and with clear outcomes

• Publish our annual workforce E&D report & develop consultative networks to co-design responsive action plans • Lead a refresh of the PRIDE behaviours alongside the introduction of tools for all in courageous conversations • Launch and implement a new Dignity at Work policy & restorative justice approach

Structures • Further support the development of the team leadership level, specifically identifying the Team Consultant and drawing

this new role in to leadership development alongside Senior Charge Nurses and Service Managers

OD PROGRAMME DELIVERABLES 2016/17

COMPACT WITH OUR PEOPLE

• Standards and expectations • Respect for people

Helping people make it easy to do the right thing

COMPACT DEVELOPMENT Timeline Activity Communications

April

Externally facilitated session amongst the Exec Briefing Communication to all leaders introducing the process and addressing likely questions/concerns Externally facilitated session between the Exec and the Triumvirates

Preparatory workshop for facilitators and launch to all line-managers

Collation of all existing feedback on expectations of leaders and of all people: from induction sessions, meet the chief sessions, the existing PRIDE behavioural descriptors, the ‘BHRUT Manager/Person’ model 2015 etc

May

Session at STB (or similar forum) facilitated (or hosted) by the Exec Communication throughout the organisation with

feedback captured in the main atrium and through

PEG as well as through an online form for our people

Divisional Teams hold facilitated sessions with their wider leadership committees

Corporate directors hold facilitated sessions with their SMTs

May - June

Divisions define the sessions required to reach front-line people and commission facilitation via their POD BP

Corporate directorates define the sessions required to reach all of their people and commission facilitation via their POD BP

End of June Town Hall type event hosted by the Executive and Divisional/Corporate SMTs to finalise and test the priorities emerging

in order to produce a final version Open event invite across the

organisation

July Final version submitted to CTM, TEC, PCC (and Board?) ahead of widespread organisational communication through all channels and with mapping

through recruitment, appraisal etc

CULTURAL ASSESSMENT

• With the support of Michael West/Aston and in collaboration with colleagues across all 5 participating Trusts we will undertaking cultural assessments using the Aston OD Tool

• We will also survey our Medical workforce using the Medical Engagement Score.

• This process will survey staff participating in The PRIDE Way related activity and a wider cohort of people across our organisation

• Approximately 850 people will be surveyed with data collection likely to start in July 2016

• It is planned to carry out a follow up survey in 30 – 36 month’s time in order to assess the cultural impact of The PRIDE Way

IT’S THE LITTLE THINGS

CELEBRATE SUCCESSES

FINAL THOUGHTS

• Embedding change management involves significant cultural change • Staff need to be engaged and empowered • Traditional silos will need breaking down • It is a journey and takes time • Success needs structure and in the short term celebrate success

THANK YOU FOR LISTENING