Written evidence from NHS Improvement (LFM 19)

 

Public Administration and Constitutional Affairs Committee

Follow up to the PHSO report: Learning from Mistakes inquiry

 

 

Culture change in the NHS

 

Q62 Chair: How does NHS Improvement change the behaviour and attitude of an organisation with over a million people working in it?

 

Helen Buckingham: The fact that we exist is a start, because we were formed from two bodies, plus the teams from NHS England, that did not have this remit and focus before and did not have the consistency. Now that we do exist, we are working very closely with the CQC and NHS England and the other appropriate bodies so that we have a consistency of approach, because that was definitely something that was missing previously. We not only exist but we exist within a very explicit remit about improvement support, so although we have regulatory powers, the trick is in the name. We are here to enable organisations to do a better job for patients and their families and to do it in a way that is supportive and holds people to account when that is appropriate but very largely supports people to do what they need to do. An offer to the Committee that if it would help to provide evidence in writing on the cultural toolkits and the leadership framework that I mentioned, we would be happy to do that.

 

Q63 Chair: By all means, please furnish us with that.

 

 

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NHS Improvement’s approach to culture change in the NHS

 

  1. NHS Improvement believes that culture and leadership are fundamental to safe, effective and patient-centred care. 

 

  1. NHS Improvement’s culture programme aims to provide practical support and resources to help trusts.  The ambition of our work in this area is to turn ‘culture’ from something that is talked about but may feel intangible to something that people can get hold of, work with and feel they can make a difference on. 

 

 


Practical aspects of our culture programme

  1. The following content forms the basis of our introduction to trust boards.  This is available as a supporting resource within the culture toolkit.  We are encouraging leaders to use it through promotion at meetings, events and conferences, for example, Human Resources Director (HRD) networks, the King’s Fund annual conference and the Healthcare Finance Management Association (HFMA) conference.

 

  1. Backing from the board is essential for culture change and there should be:

 

 

 

  1. We believe that leadership is the most powerful influence on the culture of an organisation.  Therefore leadership behaviours are particularly important in shaping an organisation.  Professor Michael West says that “every interaction, by every leader, every day, influences the culture of the organisation”.  

 

  1. If leaders start to get this right, it encourages leadership at every level through better team working, innovation and ultimately better patient care.

 

  1. Culture drives outcomes.  Below are some of the key pieces of evidence that underpin the five cultural elements.

 

Vision and Values

  1. Evidence suggests that there is a link between chief executives with a clearly communicated strategic vision, long term goals and organisational plans for patient safety and staff wellbeing and good patient safety performance.  Trusts with good patient safety performance tended to mention national patient safety alert actions more frequently than poorer performing organisations. Their leaders prioritised safety over other organisational goals, and demonstrated this to all staff through their behaviours.

 

Goals and performance:

  1. Evidence has found that patient satisfaction was highest where staff had clear purpose and there were clear goals at every level of the organisation. Where this happens, communication between patients and staff members is good and patients feel engaged in decisions about their care. The same study also showed a relationship between the percentage of staff receiving appraisals and improved levels of patient mortality. Moreover, good appraisal and good financial performance were closely correlated. As well as being an indicator of outcomes, appraisals are associated with higher levels of staff engagement which drives performance at individual, team and organisational levels.

 

Support and compassion

  1. It has been found that for staff to treat patients with respect, care and compassion, all staff, especially leaders must treat their colleagues with care respect, and compassion. The higher the levels of satisfaction and commitment that staff report, the higher the levels of satisfaction that patients report.

 

  1. Compassion in an organisational context can be understood as having four components: attending, understanding, empathising and helping.  In the context of an interaction between a health care professional and a patient, compassion involves:
  1.       paying attention to the other and noticing his or her suffering – attending and being present
  2.       understanding what is causing the other’s distress, by making an appraisal of the cause – understanding
  3.       having an empathic response, a felt relation with the other’s distress - empathising
  4.       taking intelligent (thoughtful and appropriate) action to help relieve the other’s suffering – helping.

 

Learning and Innovation

  1. The National Advisory Group on the Safety of Patients in England recommended that the NHS should become a ‘learning organisation’, with its leadership creating and supporting learning capability and through this introduce change at scale.

 

  1. Within collective leadership cultures in healthcare, all staff focus on continual learning and through this, on the improvement of patient care.

 

  1. A Chartered Institute of Personnel and Development (CIPD) study suggested that engaged employees are more likely to seek out new ways of working and turn their ideas into useful applications.

 

Teamwork

  1. Where there is genuine team working “staff demonstrate enthusiastic co-operation, work across professional boundaries, and work interdependently to provide high quality care for patients”. Leadership is crucial in creating an environment where real teamwork can flourish.

 

  1. The NHSI Culture and Leadership programme is at the end of the diagnostic phase.  As we move in to phase 2 we will be more than happy to share the learning from our pilot trust, but also other organisations who have done work in this area.

 

Pilot programme

  1. To ensure our programme has lasting value for trusts, we have been working with the following three pilot NHS trusts over the past 12 months to develop, design and test all aspects of NHSI’s developing resources:

 

 

  1. These pilots are engaged in a two year programme, through the following phases

 

  1. It is important to note that culture change has to be embedded over time, so this programme is designed to put important building blocks in place for continuous improvement through, for example:

 

 

  1. Our ambition for trusts can be summarised as:

 

 

November 2016