Strengthening and improving: working with leaders at Cambridge University Hospitals NHS Foundation Trust

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The King’s Fund is working with Cambridge University Hospitals NHS Foundation Trust (CUH) on a leadership development programme, helping the trust to develop its culture and support its leaders to deliver a long-term improvement strategy. 

CUH provides general, specialist, women's and maternity care at Addenbrooke's Hospital and the Rosie Hospital. The trust is a university teaching hospital with a worldwide reputation, and also a leading national centre for specialist treatment; a government-designated comprehensive biomedical research centre; and one of the five academic health science centres in the UK.  

The trust has faced a number of challenges in recent years. In September 2015, it was rated ‘inadequate’ by the Care Quality Commission (CQC) and placed in special measures. Joan Milne, Associate Director of Leadership and Organisational Development at CUH, recalls the tough times: ‘Being rated inadequate got to everyone; it had an impact on morale and confidence and really rocked us.’ 

The trust put in place a robust quality improvement programme and, in January 2017, was taken out of special measures and rated ‘good’ by the CQC. The trust’s focus then moved to a long-term organisational strategy, with an emphasis on improvement and sustainability. The strategy is underpinned by a major culture change programme, CUH Together, aligning the trust’s vision, values, strategy, ways of working and focus on continuous improvement. 

Looking to the future

Joan explains what informed the development of CUH Together: ‘We talked to staff, partners and patients about what it’s like to make changes in the organisation. That gave us a clear idea of what it was like to work and be a leader here. The next step was to ask: “If things were better in the future, what would that look like?”. Building on our values, CUH Together is the result of those conversations and sets out new ways of working: choose to improve; make good and timely decisions; be trusted and accountable; pull together as a team; be open and learn from our mistakes.’ 

‘We were looking for an organisation that had the capability and capacity to deliver a leadership programme that would support the delivery of an ambitious vision and strategy,’ says Joan. ‘The King’s Fund absolutely demonstrated that; the calibre of its people, experience and reputation all spoke to what we were looking for. They had engaged with medical leaders and other leaders in health care and understood the challenges of that environment, in particular the complex leadership challenges.’ 

The leadership development programme is split into three parts. The King’s Fund was appointed to deliver the first two phases, which focus on engaging leaders in the change journey and strengthening leadership capability. The third phase, which looks at systems and processes, will be run by the Cambridge Judge Business School.  

Helping smart people to learn

David Naylor, Senior Consultant in the Leadership and Organisational Development team at The King’s Fund, is leading the programme. The trust faces the issue of how to enable smart people to learn. Based on the work of Chris Argyris, the theory is that it can be harder for highly skilled professionals to face what they don’t know how to do. The risk of that is that they frame challenges in terms that they feel they can resolve or deal with. And that can sometimes make it hard for people to say, “these fixes aren’t working, there’s a gap between our intentions – delivering safe, effective, high-quality and cost-effective care – and what’s actually happening in practice”.’  

For David, the programme was only going to be a success if the team from the Fund worked together with CUH to understand how they could explore and close that gap. That meant participants bringing lived experience of being a leader at CUH. ‘It’s in the combination of us bringing our policy knowledge and leadership development expertise, and participants bringing their lived experience, that makes it work.’ 

Leaders – including operational staff, clinicians and corporate staff – were split into groups of 25. This, alongside the modular structure of the programme, was very important to Joan: ‘This phase of the programme was about knowing yourself and trusting the people around you. The small groups have meant a real richness of learning, and we have appreciated breaking into even smaller application groups; these give people the opportunity to work through some of those challenges and get to know, and get support from, colleagues.’ 

Time to reflect

As well as working in small groups, the Fund stressed the importance of slowing down to learn ‘These leaders are doing long hours and are under enormous pressure and sometimes those underlying gaps between what people want to do and what’s happening in practice are covered over by people by working really, really hard,’ says David. Joan describes the impact of that: ‘Slowing down can be a shock in a busy acute trust, where you go from one incident to the next.’ But it was important to disrupt that drive to work flat out, as David explains: ‘We know that one of the ways people avoid learning is by working at pace, so our job was to slow people down; the participants got that and came to value it.’  

Throughout the programme, the Fund’s flexibility and focus on evaluation were appreciated by Joan. ‘While The King’s Fund was very responsive to our initial specification, we’ve developed it further so the ability to flex and be responsive has been fantastic and really valued. And I like that the Fund insist on evaluating; we build on each programme, every session we have, we evaluate and ask, “what could be even better?” I know that the team flex on the day without losing sight of the overall objective of the session.’ 

With the full programme due to finish in July 2019, Joan has been impressed with the progress that has been made so far. ‘We needed our leaders to have the space to learn about themselves, and those around them, and focus on improvement,’ says Joan. ‘And The King’s Fund really understood that – they saw where we were and where we wanted to be and understood how to help us get there.’