Suzie Bailey – Director of Leadership and Improvement at NHS Improvement – and Julia Fernando of The King’s Fund talk about the joint two-year programme underway to help trusts develop a culture that enables high-quality, compassionate care.
This presentation was recorded at The King’s Fund Annual Conference 2016 on 9 November 2016.
Suzie: Culture and leadership are so fundamental to the NHS but to the delivery of healthcare. There was a fantastic multi-method study done on culture and behaviour in the NHS which published in 2013. It’s a very powerful piece of research which highlighted the fact that within, even high performing organisations, there can be dark spots that need attending to. And it talked about the importance of having an inspiring vision of collective behaviours, of listening and involving staff at all levels. Many of you will be familiar with Michael’s work. He’s published and researched extensively on leadership in healthcare and he is particularly drawn on the fantastic data that is available from the NHS staff survey.
And from this, it’s very evident that whilst there are many influences in culture, leadership is the most malleable influence. It’s the thing that we can do something about. We actually have to have an organisational approach to it. It’s something we have to practice, and it’s something we have to be strategic about. And it does require very high levels of dialogue, debate and discussion.
I’m pleased to say that the executive team at Monitor, which is where I used to work, recognised that actually despite all of the great programmes that we’re involved in, if we weren’t going to do something on culture and leadership that we were actually missing the point.
And so I’m standing in front of you today because there was a commitment to really increase the dialogue around culture and leadership and that’s really what we’re trying to do, but also to do some very specific work in co-production with people within the health system around what it actually takes to improve culture and to improve leadership. So we’re working Northumbria, working with Central Manchester and with East London Mental Health Trust. So we embarked on a programme of work to learn with these three organisations and the work that we’re doing is based on these five cultural elements, so working on vision and values, on goals and performance and performance is a really important part of culture. Support and compassion. Support and compassion not just for the people we care for, but for each other. Learning and innovation. How the NHS or how any system can be a learning culture. So actually that we continually learn. And the fifth one, which I think we spent quite a lot of time talking about in the programme, is around teamwork. Teamwork doesn’t just happen.
Michael has a great phrase, pseudo teams, and when I think of some of the teams that I have worked with in the past, and probably some of the teams I’m working with today, some of those are pseudo teams. We are a team in name, but we are not practising the art of teamwork, and what we’re learning with the providers that we’re working with is actually that you need to spend time with high levels of dialogue in order to develop highly effective teams.
So what we’ve designed is a two year programme to be delivered in three phases, and the first phase was to develop some diagnostics, co-produce those diagnostics and drawing on the evidence base that is available and also testing things out from the learning, from the organisations that I’ve described. And on the NHS improvement website now, you will see the first set of tools that we published in September. Obviously putting a toolkit out there and putting guidance and putting case studies doesn’t actually do the work for you. So we absolutely understand that these tools only go so far, but we hope that by making them open source, and by testing them out in real organisations, that they will be of use to you.
And we’re now moving into phase 2, which is really around the development of the collective leadership strategies. Later into next year, we’ll move into the final phase which is really the study phase which is the acting on, so the implementation of those studies and what are we learning, and we hope that many other organisations will join us in that journey.
Julia: And this was a project that was aiming to translate years of theory and research around culture and leadership in the NHS into practise, and I’ve since seen the work blossom and grow. At present my role in this work is in evaluation, so evaluation at every sense of the word, so capturing the knowledge and learning as we go through this work, and building the theory of change, trying to understand what culture change does look like when we monitor it over time. And also ensuring that the tools, the methods and the processes that we’re co-designing together, are at the most, are of the most high quality and are maximally effective for use in the NHS.
My learning so far is that culture change is hard, but that doesn’t come as a surprise and I think that’s not unique to the NHS but the imperative of good effective leadership and I feel it’s more salient than ever before.
And culture change, so culture being the values, the norms and the beliefs, it begins and it ends with leadership. A leadership that’s clearly articulated and has a clearly articulated direction and is able to nurture commitment, throughout all levels of the organisation, through compassionate interactions, and this work that we’ve been doing is already beginning to see some positive changes and efforts that have gone into this are already producing things that we are beginning to capture through the evaluation work that we’re doing.