04 / 11 / 2010
What we did and why
How we did it
Results and next step
Tips for other trusts
St George's Healthcare NHS Trust is a large teaching hospital, with around 6,000 staff and more than 500,000 patients every year. The trust shares its main site in Tooting with St George's, University of London, which trains medical students and carries out advanced medical research.
The trust runs the Wolfson Neurorehabilitation Centre in Wimbledon, which cares for patients with acquired neurological conditions, such as stroke and spinal injuries. St George's has also recently integrated with Wandsworth Community Services, which includes Queen Mary’s Hospital Roehampton.
Disappointing staff survey results showed rising stress levels in staff, a rise in bullying between colleagues and increasingly unhappy patients. As a result, a project was developed in partnership with NHS trade unions to increase customer awareness among non-clinical staff, ultimately leading to high-level customer service to colleagues and patients/carers.
This would involve training porters, healthcare assistants, security staff, receptionists and clinic coordinators to become champions of excellent service.
The overall focus and frame for the activity is based on the ‘service chain’ of:
1. Staff to patient service
2. Staff service to each other
We began by:
• identifying what good/great service looks like and what behaviours support this
• building consistency and standards inside a flexible framework
• creating and improving people processes so they are simple and fit for purpose
• addressing and resolving key issues that impact the workforce.
Secondly, we wanted to:
• build a service that is personal to everyone – colleagues and patients/carers
• tap into the creativity of the trust-wide population, partners and patients
• create a culture of self-improvement.
We employed a consultancy to help develop ideas, a brand, and a training model, in conjunction with staff. The staff who undertook the training would become ‘service partners’.
A series of interactive workshops were complemented with exploration, listening and observation, in order to gain information from patients and staff about problems in the hospital and ideas for improvement. We carried this out collaboratively with a cross-section of the workforce, trade union representatives and patients/carers.
Using the information gained, we identified five ‘service attitudes’ that could be used as tools to encourage the trust’s values of kindness, excellence, respectfulness and responsibility. These five attitudes became the central themes for the training:
• I choose the right attitude, we are all saving lives
• I listen and share
• I show I care
• I am a professional
• I make a difference.
The pilot scheme focused on three departments: estates and facilities, outpatients, and theatres. These were chosen because they showed above average scores on bullying and harassment in the staff survey and provided a good cross-section of patient-facing roles.
The departments’ managers nominated 40 staff who already give good service and have good communication skills, so that we could train them to become role models for excellent behaviour within the team.
Their training involved:
• a ‘service safari’ in London to sample good and bad service in museums, restaurants and shops
• a two-day training course where participants drew on their service experience and discussed how they could bring better service in to the hospital.
The detailed focus of the project involved:
• Capturing patients’ comments and identifying opportunities to deliver the best staff-to-patient service experience, as well as identifying blocks to giving good service such as equipment failure or inefficient systems.
• Identifying examples of the best staff-to-staff service experience, for example how would staff wish to be treated and did they feel the current services met this aspiration?
• Identifying priority areas for trust issues to focus on. For example, where specifically in the staff experience does bullying occur and what is the underlying cause?
• Recruiting volunteers from across the workforce to provide them with additional role modeling and colleague coaching skills.
In pilot areas we see better team working. Service partners are taking on more responsibility and are more confident in dealing with difficult situations with both colleagues and patients. In particular, a number of porters have expressed a greater willingness in giving great service to patients.
Cultural changes take a long time but we anticipate improvements in absence and retention figures over the next 12 months, plus improvements to the relevant staff survey scores.
Our targets on key performance measures in the pilot areas are:
Indicators to be below 4 per cent by Sept 2010
Indicators to be below 12 per cent by Sept 2010. However, we will need to explore reasons for leaving to ensure that we understand exactly what our activities are impacting.
Staff morale (via staff survey)
To see a statistically significant improvement to below 20 per cent.
We will be holding an event with service partners to share the latest staff survey results and ask for their input in to the action plan.
We are planning to train around 30 to 40 people to deliver the One Team training and aim to reach 6,000 staff within two years. Eventually we hope to offer the training model to other trusts.
We will continue to share the learning from our project and will report back further results after the next NHS Staff Survey is published in May 2011.
• Include everybody from the start of the programme.
• Listen to concerns and act upon them before giving your own view.
• Communicate concerns to staff and listen to their ideas for creating solutions.
• Create a vision together so you have a clear and shared goal to work towards.
• Always ask for staff views, never make assumptions.
• Ensure every meeting has a clear purpose and a clear outcome.
St George's Healthcare NHS Trust
Staff side secretary
St George's Healthcare NHS Trust
Director of transformation