culture assessment tool to give the organisation a more detailed understanding of its culture.Since the beginning of 2015, The King’s Fund has been working with Lancashire Care NHS Foundation Trust (LCFT), using our
Julia Fernando, Senior Analyst at The King’s Fund, asked Professor Heather Tierney-Moore OBE, Chief Executive, LCFT, what made the organisation decide to embark on this work, what it found, and where it may lead.
Why was LCFT interested in finding out more about its culture?
When I first came to Lancashire Care NHS Foundation Trust seven years ago, I was struck by a strong need for a positive culture change across the organisation. Building on the work I had been doing before I joined the organisation in trying to understand the importance of the right leadership culture and its link to compassionate care, I set myself the ambition to create a culture of compassion in LCFT.
Before I joined LCFT, I was involved in a piece of work with a Scottish health board that was concerned about some significant failures in patient care. I remember board members were asking ‘What’s gone wrong? Have they [practitioners] lost all their compassion?
Many people were offering overly simplistic explanations. They assumed that the lack of compassion resulted from poor training. So we decided to carry out a major piece of work to explore the conditions that allowed compassion to thrive, with the aim of extending best practice, working with the local university.
We learned that the culture and leadership of teams was the main predictor or inhibitor of compassionate care. People may say ‘Well of course that’s the case’ but back then it wasn’t so self-evident.
What led you to work with The King’s Fund?
For a number of years, LCFT had been doing a lot of work to define and embed its values. The trust had been exposing leaders to tools that could help them develop their values and create a positive and appreciative culture.
However, when we got our staff survey results they were very disappointing, in that they did not reflect the extent of the culture change, or the level of staff engagement we were hoping for. Despite the work we had been doing, something was stopping us getting the traction we needed to make what we wanted to happen, happen.
I was aware of the work that Professor Michael West had been doing at The King’s Fund on collective leadership and it really resonated with me. My colleagues and I thought it could be an opportunity to build on what we’d already been doing as an organisation. The chance to discover our culture in an evidence-based way, with someone who’d done the research, was very attractive.
Were the results what you expected?
Our strength in compassion and values was very pleasing and reassuring. That was where I started from and that was where we had focused our energy, and using the culture assessment tool highlighted the value of the work we had been doing.
We were also able to identify other areas of culture that we had focused on less. I realised that if, in the future, we focus on these too, we will see improvement in these areas, particularly if they become part of a shared vision.
When we saw the findings of the culture assessment tool it felt blindingly obvious! I had just needed someone to hold up a mirror and reflect it back. The vision the organisation had made a shedload of sense to me, but it clearly did not resonate with staff. And it really made me think, what is our vision?
A vision needs to be something that gets people up in the morning. You can think that because you are busy doing lots of things well, the other parts will take care of themselves. That’s not the case. By showing us the variation in our culture it also made us think: other than our values, what else binds us together?
The nature of our services are so diverse – someone working in forensic services may not feel connected to organisational values in the same way as someone working on smoking cessation or working in schools.
What’s next for you on your journey towards a culture that delivers high-quality, continually improving, compassionate care?
We’re working as a team to improve how we define our vision, ensuring it is focused on quality but is also something that gets people in their gut rather than just their intellect. We’re also now able to use our existing approaches to help us create next steps based on the findings of this project. In this way it’s not just another corporate-based thing devised in a darkened room. These results are actionable.
But for us at LCFT, this is just the beginning. We’re now moving into a new phase of our programme of work on collective leadership, which will move from discovering our culture into developing ways of changing it. The culture assessment tool has helped us get started on that journey.
This article was originally published in The King's Fund's Insight magazine, autumn 2015.