Developing a patient-centred culture through strong leadership

The Francis report raises the question: has patient care become obscured by the demands of organisational change? A state of continual change has become the norm for the NHS, as it has for many large organisations.

‘In a period of change, non-engagement can bring an organisation to its knees’

These are fast-moving times, and as the different components of the NHS fracture, merge and reform, it is vital we do not allow valuable staff to be cast adrift, and that we continue to attract world-class clinicians and managers.

This means clinicians and managers who care for their patients first and their statistics, benchmarks and action plans second. It is not that these things are not important, only that they are not the most important.

Employees may be feeling distanced and dislocated from a health service they no longer recognise as that which they originally joined. It is crucial to the success of organisational change that these employees can see themselves as part of the NHS brand. A brand that is renowned for quality patient care and innovation.

Surrey and Sussex Healthcare Trust recognised the dangers of disengagement and non-engagement among staff. It realised that the service of the future requires transformational rather than transactional leadership.

It chose to make a significant investment in its people at a time when budgets are increasingly restricted because they felt the alternative would be exponentially more costly.

Super-humans wanted

Non-engaged or “sleepwalking” employees may be relatively harmless, if wastefully expensive, in times of stability. In a period of change, non-engagement can bring an organisation to its knees, while active disengagement deals the death blow. Employee engagement is key to successful organisational change.

‘Change is happening at such a rapid rate that there is no time for trickle-down communications’

What every healthcare trust wants right now are super-human leaders who are simultaneously loyal and questioning, determined and adaptable, thick skinned and sensitive to the overall aim of quality care for their patients. In other words: really valuable people.

Surrey and Sussex believed it already had these people working at the trust, but it needed to maximise their individual potential and, by extension, that of the entire trust.

Healthskills was brought in to assist in developing a workforce, with strong and consistent leadership, that would not merely survive the wind of change but would be able to share in shaping the NHS of the future.

Leaders that would “challenge the process” by being given time to think and reflect about how they could direct teams effectively to improve quality, innovate and empower others to put patient care at the forefront of any decision. 

Specifically, the trust was keen to focus on:

• leading, not just understanding leadership;
• developing shared accountability;
• building proactive engagement with commissioners and partners;
• operating at an accelerated pace of change;
• maintaining high levels of quality and safety through rapid change; and
• driving forward a culture of patient-focused care.

New climate

Surrey and Sussex trust recognised early that leadership happens, and needs to happen, at every level of the trust. Change is happening at such a rapid rate that there is no time for trickle-down communications and a strong culture must ensure staff keep the end result of quality patient care in mind.  

All colleagues need to be operating efficiently in their current working environments while being able to change focus, sometimes dramatically, at a moment’s notice.

‘Whatever the metamorphosis of the NHS, the trust needed to retain the talent and skills that are its lifeblood’

The trust presented Healthskills with a large cohort of over 200 leaders from across the organisation, with representatives of clinical, strategic, managerial, administrative and support staff the gatekeepers to cultural behaviour. 

We designed a bespoke leadership development programme that aimed to inspire them to shape a more flexible and resilient culture, and to take ownership of their organisation.

Our primary aim was to encourage these leaders to challenge their approach to their current roles, and empower others to do the same, while developing a climate of shared accountability and working consistently towards the goal of having a positive impact on all aspects of patient care.

Course attendees participated in one of two programmes in 2011-12, each lasting six months, and were involved in a series of interventions, including:

• leadership master classes;
• 360-degree feedback on leadership behaviour;
• one-to-one coaching to reflect on practice;
• “action learning” to develop work-based projects; and
• a leadership conference featuring participants and board members.

The NHS’s lifeblood

Over the course of the programme we supported Surrey and Sussex trust leaders to re-engage with their roles and encourage more lateral thinking. We facilitated multi-professional project work streams that had an immediate impact on the organisation and fostered unusual working partnerships that created ingenious problem solving.

Surrey and Sussex was convinced that whatever the continuing metamorphosis of the NHS, it needed to retain the talent and skills that are the lifeblood of the organisation. In addition to the qualities it already recognised in its leaders, the partnership with Healthskills encouraged and nurtured those previously underused skills that might be vital in a more strategic and competitive environment.

The trust now benefits from increased sharing of accountability across the workforce and it is building on this via a variety of cross-departmental projects.

New and useful multidisciplinary networks strive towards the common goal of providing high-quality patient care. Professional and departmental barriers are being broken down to enable staff to work more efficiently and effectively.

All become leaders

Surrey and Sussex Healthcare Trust’s story is not unique in today’s NHS. Trusts need to invest in ongoing leadership development and cultural change, alongside the unavoidable strategic and structural changes.

This investment can create a workforce that combines loyalty with flexibility, allowing staff working in disparate organisations to feel part of the wider NHS brand.

We have helped Surrey and Sussex trust ready itself to make the changes required of it in order to sustain and nourish our health service. The staff are justifiably proud of the work they do and are committed to who they do it for.

The Francis report has left us in no doubt that a health service infrastructure focused on targets and statistical outcomes can leave frontline staff feeling disempowered and unable even to see the needs of the patients in front of them.

What we need to do is encourage every NHS colleague to become leaders in their own sphere − responsible and powerful enough to give the very best care to patients. By bridging the gap between strategy and culture we can get the best results for people in the wards and emergency rooms in our hospitals.

Mark Greenfield and Charles Marshall are directors at Healthskills