Steve Dunn: How we achieved our outstanding rating

We became the smallest acute hospital to receive an outstanding rating from the CQC in March, which was an amazing achievement. But how have we done it at such a difficult time, what role did leadership play, and what can others learn from our journey?

When I arrived at West Suffolk Hospital in 2014, I found a hospital delivering high quality, efficient care, with a concerning, but comparatively small deficit, and comparatively strong staff survey results.

I found we had a passionate workforce who cared deeply for the hospital and the community we serve. Our doctors and nurses routinely go the extra mile for patients, and think nothing of organising weddings on the ward or ordering birthday cakes for patients.

I was aware that there was no overarching strategic vision for where the trust was going. So, I set an ambition for us to be an outstanding hospital

Our staff are supported by amazing volunteers and great working with partners such as our outstanding local GPs, community services and our local authorities.

I was, however, also aware that, despite all the positives, this was not being communicated to stakeholders, either locally or nationally. And, crucially, there was no overarching strategic vision for where the trust was going.

I wanted a single goal everyone could understand and get behind across the whole workforce. So, I set an ambition for us to be an outstanding hospital as rated by the CQC, and one of the leading integrated health systems in the country.

My experience in senior roles at the Department of Health and the NHS Trust Development Authority meant I was confident about engaging with our local and national stakeholders.  

Leadership

Developing my style inside the hospital was always going to be the bigger challenge. I’d never worked in a hospital and I knew I had much to learn.

First, I wanted to establish what excellent leadership looked like. I am fortunate to have a great team around me at the trust. But, I also reached out for advice to some of the sectors’ leading chief executives, including Andrew Morris, Sir David Dalton and Andrew Foster, in order to help me develop my leadership skills and style.

I would advise anyone in the job to do the same. Senior people have been kind and receptive to me reaching out. The best leaders always are. And I’ve already found myself doing the same for other chief executives in more recent years.

As well as developing my own leadership style, I wanted to ensure that we put in place a new leadership framework to grow our own talent

As well as developing my own leadership style, I wanted to ensure that we put in place a new leadership framework to grow our own talent.

We have a set of leadership behaviours and have set up regular leadership summits for senior and junior management, such as the West Suffolk 2030 leaders programme open to consultant medical staff, and band 7 and above staff.  

We also have a regular “Five o’clock club” – a leadership and quality improvement forum, open to anyone who wants to come along. Roy Lilley designed our logo and gave the inaugural talk. We have a coaching and mentoring offer across the trust, and we have bought corporate access to the HSJ for everyone who works for us.

Staff engagement

Equally important was developing the right culture across the rest of the workforce and really harnessing – and rewarding – the passion and dedication of our staff. We try to value our staff by listening to them and thanking them.

Over the last few extremely busy winters, we have said thank you by giving all our staff free coffees, chocolate and fresh fruit. We have also given out free ice-lollies when the weather is unbearably hot. We can’t afford air conditioning, but it’s the little things that show your staff you care!

Full staff engagement of course involves far more than nice gestures. As a leadership team, we have gone out and done lots of back to the floor (I am sure you might have noticed if you follow me on Twitter!).

We also believe in more thanks than spanks. For every one negative comment, you need to say five to seven positive things before the positive gets through

I have followed the med reg overnight, shadowed all our allied health professionals, cleaned toilets with housekeeping, changed and cleaned beds as a healthcare assistant. I have been out in the community providing social care and shadowing the respiratory team, worked in pharmacy and cooked the special in our in-house kitchens. And I have been all over as a radiology and general porter, often at our busiest times.

This gave me a huge insight into the daily challenges staff face and helped me understand how hard they really do work, and how much they really care. It also means that me and other members of the leadership team are accessible and approachable.

We also believe in more thanks than spanks. For every one negative comment, you need to say five to seven positive things before the positive gets through.

And happy staff do amazing things. We came top for staff engagement in the latest NHS staff survey when compared to the rest of the NHS, with staff saying that they would recommend the care to friends and family and recommend us as a place to receive care. And on the model hospital, we benchmark as the third most efficient hospital in the NHS.

Learning from feedback

Our first CQC inspection in March 2016 identified this foundation. It also provided a focus for us to tighten up on the basics and get the checking of resus trolleys, fluids, drugs, fridge temperatures right. It also highlighted that we needed to get better at our understanding of the deprivation of liberty safeguards and resuscitation status of our patients.

We went live with a new Cerner electronic patient record system, locally called e-Care in May 2016. Despite the inevitable teething issues, the #WestSuffolkWay meant that we were seen by NHS England as a digital exemplar, and are the smallest hospital to be given the opportunity and funding to finish the job.

The project is far from complete but already we have used e-Care to improve our recording of resuscitation status and address some previous CQC concerns. And we have massively reduced some of the long waiting times which emerged after e-Care.

Our first CQC inspection in March 2016 provided a focus for us to tighten up on the basics

Since our first inspection, we have also taken the CQC feedback and improved our palliative care, and are working closely with the local on-site hospice than ever before sharing consultants and expertise. We have put in place, with our clinical directors and new consultant in public health, an exemplar learning from deaths framework.

Of course, being outstanding does not mean we are perfect. Despite all our efforts we had a horrible winter, with year on year increases greater that predicted.

It is tough. It is relentless. We don’t always get it right. But we are doing our bit and transforming and integrating care. Our staff are going the extra mile. Ordinary people in small hospitals and small systems can do extraordinary things. But even outstanding, efficient hospitals do need more staff and resources to maintain national standards.