In 2017, NHS Staff Survey results revealed Chesterfield Royal Hospital NHS Foundation Trust as rated a 'worst performer' for the second year running with 26/32 negative scores. The trust embarked on a successful mission to engage, improve and change culture and the 2020 survey results showed they had scored above the national average in nine of the survey's eleven themes.
Key benefits and outcomes
- Increased response rate to NHS Staff Survey from 33 per cent to 71 per cent from 2016 to 2019.
- Improved responses to the survey, putting the trust above average in nine out of eleven categories.
- Improvement programmes put in place to enhance staff engagement and upskill managers.
What the organisation faced
In 2016, Chesterfield Royal Hospital NHS Foundation Trust was classed as a worst performer in the national NHS Staff Survey. 22 out of the survey's 32 key findings were in the ‘below average’ or ‘worst performing’ category and only 33 per cent of staff had opted to have their say.
In 2017, the response rate increased to 63 per cent, thanks to a concerted effort to promote the survey. However, the results deteriorated even further, with 26 key findings dropping to the lowest possible level.
These results were at odds with patient feedback. Care, treatment and patient experience were highly regarded, but only 58 per cent of staff said they would recommend the trust as a place to work. In particular, staff feedback from the survey indicated widespread dissatisfaction with leadership, the ability to get involved in decisions about the trust and its future, and the lack of opportunity to get involved with improvement, or indeed to be given the go-ahead to get on and just do it.
The board's vision to provide 'the best possible care to our patients' coupled with 'a great place to work for all our people' was at risk - potentially impacting their ability to attract, recruit and retain staff. As North Derbyshire's largest employer, the overall culture of the organisation, and how people perceived it, needed to be positive to enable a reputation of somewhere that valued and appreciated its staff and the individual part each of them play in the trust's success.
What the organisation did
The board determined that a strategy to engage and involve staff, where they were actively encouraged to lead and bring improvement ideas to life, would improve the culture of the organisation and in turn contribute to sustained improvement in quality of patient care. It was agreed that in response to staff concern, any such strategy should adopt a long-term, consistent approach - accepting that the preference to move from one quick-fix attempt to another had not paid any dividend. The board signed up to this mission on the understanding that it would likely take five to ten years to see any significant improvement.
The organisation developed a people strategy, the first version in 2016 and refreshed in 2019, on the themes of: build, lead, engage, learn. This aligned to the trust’s strategic aims and values. Success was measured through a framework of workstreams. Each theme in the strategy was underpinned by detailed plans, priorities, actions and outcome measures - all overseen by relevant working groups and committees.
Chesterfield also adopted the Listening into Action (LiA) culture change programme and in 2018 investment the Royal Academy of Improvement - blending the methodologies of LiA with quality service improvement and redesign (QSIR) to further improve how the trust put staff at the heart of transformation.
To support its leaders, a new framework was established called Leading the Chesterfield Way. This framework improved how the trust supported and developed leaders at all levels, whether they were starting out in their leadership career, or were a leader with many years’ experience. Based on the NHS Healthcare Leadership Model, it set out the behaviours and characteristics that the trust expected from its leaders. As well as providing a leadership structure, the framework was also designed to support individual development through appraisal, career progression and personal development plans.
Results and benefits
The trust started to see the impact of its approach. In the 2019 NHS Staff Survey results, the response rate was 71 per cent and the trust was above national average in nine out of eleven themes the survey now includes. In addition, 70 per cent of staff would now recommend the trust as a good place to work.
Improvements are celebrated, which inspires other staff to join the journey. Over 50 improvement teams and 1400 staff have been involved so far through LiA and the Royal Academy of Improvement and more than 80 staff are now QSIR trained.
More than 2500 staff and teams have bene recognised in the internal Applause Recognition Awards with other colleagues, patients and visitors submitting the awards. While over 200 senior leaders and middle leaders in the trust have been through the Leading the Chesterfield Way development programme.
The majority of patient feedback is positive in all areas. Maternity services and inpatient and day-case services scored above the trust ambition for the friends and family test (FFT) in October and November 2019, which means that inpatients and day-case units are now scoring in the top 10 per cent of all trusts.
The trust had to build confidence that its leadership was committed to improving staff engagement and to increased involvement of staff. This included overcoming a legacy of scepticism about the short-term approach to previous initiatives which had been adopted as quick fixes but then not followed through. Staff needed to believe that the Chesterfield Way was real and different.
The organisation had to ensure that it supported all its leaders, especially immediate supervisors, to support the new approach with investment in training to support leaders at all levels.
- Board support is essential for long-term change.
- Recognise that significant improvements take time.
- Improved staff involvement produces tangible savings and improvement in services.
- Improved staff experience feeds into improved patient experience.