Quality

I was delighted to spend some time last week with the recent graduates of the regional Quality Service Improvement and Redesign programme as part of World Quality Day.

It made me think; what should we be thinking about when measuring quality? What does good look like? These are the 5 things that I’ve tried to use as a way of testing quality;

1. What does your data say?
   The use of data is really important, especially if it is benchmarked with other sources or comparable areas.
2. What do your patients say?
   Often things that we don’t expect are the most important part of the patient experience.  IF we don’t know what is important to them, we can’t claim to have a quality service.
3. What do staff say?
   You cannot understand what quality looks like unless you have an environment in which your staff can come and tell you. This should be all staff, not just the most senior.
4. What does it feel like when you are there?
   In any area of service, nothing is more important than experiencing what the patients see; how it is run; how do staff interact; is it clean and so forth.
5. What’s the culture?
   Are people wanting to improve and do better? Are people respectful to each other? Successful change stories have a legacy of team members continuing to demonstrate these behaviours.

One of the leadership traits I find most important (and is not talked about often enough) is to be curious. My challenge to all of you is to be more curious about whether we are delivering quality services that are always improving.

Please get in touch if you would like to discuss any of this further, or to share your thoughts about quality – I’d be really interested to hear from you. From my diary below you can see what I’ve been up to in the last fortnight.

Neil
@NMacdonaldBHT
07920 071814
neil.macdonald4@nhs.net

Abbreviations: BOB ICS: Buckinghamshire, Oxfordshire & Berkshire West Integrated Care System; Bucks ICP: Buckinghamshire Integrated Care Partnership; EMC: Executive Management Committee; HASC: Health & Adult Social Care Select Committee; QI: quality improvement

 

Black history month

I was delighted to attend the celebration for Black History Month in Stoke Mandeville Hospital last week. I am a proud ally and member of the BAME Network at BHT. This is because I firmly believe in the value and importance of establishing an inclusive environment in the Trust, so that all staff can be their full and best selves at work, and do not suffer discrimination for any reason; ethnicity being one of them.

I was struck by the stark statistics Yvonne Coghill, Director of the NHS Workforce Race Equality Standard (WRES), presented at our National Inclusion Conference in September. For example:

In the last 12 months have you personally experienced discrimination at work? 2019
(Source: NHS Staff survey website)

A Freedom to Speak Up report into whistleblowing in the NHS by Sir Robert Francis QC shows similar findings:

• More BME staff are unsatisfied with the outcome of workplace investigations than white staff (40%:27%)
• BME staff are more likely to be victimised by management than white staff (21%:12.5%)
• BME staff are less likely to be praised by management after raising a concern than white staff (3%:7.2%)
• BME staff are more likely than white staff to not raise a concern for fear of victimisation (24%:13%)

In National Inclusion Week 2019, I committed to making the progression of equality and inclusivity part of each individual executive’s annual objectives. This includes my own.

Please do get in touch if you would like to discuss any of this further. From my diary below you can see what I’ve been up to in the last fortnight.

Neil
@NMacdonaldBHT
07920 071814
neil.macdonald4@nhs.net

21st	22nd	23rd	24th	25th
SMHR interview answering questions from staff and the public   1:1 with Lou Patten, CCG AO   Burns Symposium   Call with NHSI about winter performance	Presented CARE awards   1:1 with Trust Chair, Hattie Llewellyn-Davis   Reciprocal mentoring 1:1   1:1 with Nick Braisby, BNU Vice-Chancellor and Chief Executive	Visit with estates team to Haleacre (AMH) to discuss renovations   Trust Board Seminar in AMH – Trust Board in Private; patient experience session with Julia Holding, NHSE & NHSI Head of Experience of Care	South East regional leadership summit in London with NHSI	Flu vaccination campaign in SMH with peer vaccinators – 80 vaccinations!   CEO Brief   EMC – medical workforce discussion; Charitable Funds proposal; corporate objectives progress; Feedback Friday; flu vaccination; IPC report
28th	29th	30th	31st	1st November
Meeting with Junior Doctors forum representatives   1:1 with Chief Nurse candidate   Bucks ICP assurance meeting with NHSI	Meeting with Bucks ICS MD and CCG AO   CQC Executive Reviewer induction   BAME network Black History lunch   Meeting with Cisco to discuss digital plans   Finance & Business Performance Committee	Financial Recovery Board   Meeting with BOB ICS procurement leads   1:1s with consultant candidates   New Executive Director objective-setting meetings   BOB ICS Acute Collaboration Workstream call	National CEOs meeting in Leeds with NHS Leadership Academy

Abbreviations: AMH: Amersham Hospital; AO: accountable officer; BOB ICS: Buckinghamshire, Oxfordshire & Berkshire West Integrated Care System; BNU: Bucks New University; Bucks ICP: Buckinghamshire Integrated Care Partnership; CCG: Clinical Commissioning Group; CQC: Care Quality Commission; EMC: Executive Management Committee; IPC: infection prevention control; MD: Managing Director; NHSE: NHS England; NHSI: NHS Improvement

Freedom to speak up month

I’m not a prolific TV watcher, but over recent weeks greatly enjoyed the HBO series on the Chernobyl disaster. It provided some extraordinary detail and revelations on a dismal man-made event that caused suffering to an almost incomprehensible number of people. It was an impactful watch and thinking about it afterwards, I reflected that there were lessons in the story that may be relevant for us.

First, the actions of the leaders and engineers in the control room. At all times when conducting the test which led to the reactor explosion the engineers knew what they were being asked to do was likely to lead to a problem with the core.

They carried on after being overruled by the chief engineer, who wouldn’t accept he was wrong. A culture of hierarchy, fear of blame and an inability to challenge authority led to safety being compromised through not listening to those speaking up.

Secondly, as the disaster unfolded, there was complete blindness from anyone in authority to recognise the scale of the problem. At all levels of the Soviet hierarchy there was a refusal to believe what had occurred and those who brought bad news were ridiculed. Through a leadership structure that wouldn’t accept failure and discouraged people speaking the truth, critical delays in enforcing an appropriate exclusion zone caused harm to many thousands.

Something to think about as we celebrate October’s Freedom to Speak Up Month and the healthy culture we are trying to create in the Trust.

Please do contact me if you want to discuss anything further; thanks to all of you that have already done so.  See also my diary below so you can see what I’ve been up to in the last fortnight.

Neil

@NMacdonaldBHT

07920 071814

neil.macdonald4@nhs.net

 

7th	8th	9th	10th	11th
Corporate induction Welcomed October’s cohort of new joiners to the Trust BHT Way Workshop with Trust leaders on building personal wellbeing and resilience Meeting with local MP	NHS Providers Annual Conference to glean important updates for us from senior colleagues in the NHS to inform our strategic planning		Bucks ICP Senior Leaders Event Presented the strategic vision for the ICP and its way of working Team 1:1s Mentoring an external director	EMC – corporate objectives progress, flu vaccination plan, CQC action plan, urgent care, CARE awards Charity lunch for SportsAid with Chairman of Buckinghamshire County Council Night shift Visit overnight to all parts of Stoke Mandeville Hospital (except the pathology labs where their security was too high!)
14th	15th	16th	17th	18th
Meeting with Buckinghamshire & Oxfordshire CCG Accountable Officer Pledges in support of  Malnutrition Week and AHPs Day Team 1:1s   Meeting with Guardian Meeting with Unison	Board Strategy Day Assessment of future regulatory, policy and population challenges	Reviewed forecast with Director of Finance   Financial Recovery Board   Bucks Provider Collaborative Board   Health and Wellbeing Board briefing session on the BOB ICS LTP	Meeting with Bucks County Council Chief Executive   Team 1:1s   Meeting with senior colleagues in BOB ICS to discuss elective care waiting times	System Efficiency Group – financial and performance issues in Bucks ICP Visit from Ted Baker, CQC Chief Inspector EMC corporate objectives progress, urgent care, budget setting, financial transformation, forecast   Meeting with Grant Thornton (Trust auditors)

Abbreviations: AHPs: Allied Health Professionals; BOB ICS: Buckinghamshire, Oxfordshire & Berkshire West Integrated Care System; Bucks ICP: Buckinghamshire Integrated Care Partnership; CCG: Clinical Commissioning Group; CQC: Care Quality Commission; EMC: Executive Management Committee; LTP: Long Term Plan

The Gift of Feedback

I hope all of you would recognise that one of the key priorities of the Trust over the last two years has been, and continues to be, staff engagement.

There are many reasons for this. The culture of an organisation is its most important feature; if we exhibit the values that we promote, staff, patients and the public will have a better experience of the Trust. We know that happier staff are healthier, and healthcare employees who are more engaged with, and rewarded by, their jobs are more likely to provide higher quality care.

An engaged workforce will also give us the answers to the challenges we face as we journey from ‘Good’ to ‘Outstanding’. I was given a really important reminder of this last week. Whilst on the wards at Stoke Mandeville with the Chief Nurse, a chance encounter with one of the ward sisters prompted us to think differently about some creative solutions to one of our patient flow problems. I am a strong believer that problems are never solved in the Board room; solutions will always come from those who face the challenges directly.

Feedback is a gift; my view is that you should always say ‘thank you’ for receiving it, even if the message is one you don’t want to hear! Time is also our most valuable commodity and spending it finding solutions to clinical or administrative challenges is an effective use of it. In a world where we often have too much to do, I think perhaps understandably this is easy to forget.

Leadership is not defined by doing great things, but by creating the environment within which great things happen. This is the environment we should all be trying to create at BHT.

As always, delighted to hear any comments or your thoughts.

Best wishes

Neil

@NMacdonaldBHT

07920 071814

neil.macdonald4@nhs.net

Objectives

We have published our objectives for the next two years following workshops with some of the teams and a great ‘BHT Way’ session we held with many of you at the end of April. These are the priorities you and the Board have agreed to focus on as we pursue our journey from CQC-rated ‘good’ to ‘outstanding’ and the safest healthcare system in the country.

We continue to focus on goals that meet the triple aims of improving our quality, people and money and setting as a priority a small number of important objectives that together would meet these. We felt it was important to do fewer things, and do them really well, so it was an interesting experience persuading the Board to agree only three! These are:

Improving our culture. I am convinced that this is the building block of getting to greatness and there are many things that go into this. Using patients to co-produce service change; making it easy to ‘get things done’ in the organisation; all staff being able to use Quality Improvement to make changes; and involving all staff in contributing to our financial challenge – these are all critical parts of building these improvements. I would especially draw your attention to the ‘Small Change, Big Difference’ campaign being led by Tina Kenny which is already starting to gain some momentum.

New solutions to workforce. Healthcare is a people business and we need to tackle the local shortages. We will do this through innovating new roles and building stronger multi-professional working, whilst also developing new partnerships in education and training. How we tackle inequalities in our workforce is also critically important: to represent our communities we must be inclusive and representative. Making this Trust a really great place to work is the other part of this puzzle, to support and enable our staff to be their best selves at work.

Tackling inequalities and variation. As the largest healthcare provider in the county, and its biggest employer, we must play our role in reducing the stark inequalities that exist between our communities. Alongside this we must look to tackle variation that happens in our clinical services and support this by developing clear strategies for dealing with moving us forward digitally, whilst ensuring our buildings are fit for future use. Our next BHT Way is designed to help us explore this objective together in more detail.

So, a bit to do! I find these goals exciting and hope you all can get behind them. I am looking forward to seeing you as part of my forthcoming all-staff sessions in July, and discussing your team’s contribution to our Trust objectives and our organisation’s journey to ‘outstanding’.

As ever, do get in touch on the details below with any comments or questions.

Neil

07920 071 814

Neil.macdonald4@nhs.net

@NMacdonaldBHT

 

Reflections

It’s the time of year when I have all the statutory accounts in front of me to sign: our financial and quality accounts and our annual report. These are compulsory reports where we tell the public how we have spent their money and how well we have looked after them. They are externally audited and a lot of work goes in to producing them, so my thanks to all involved who put significant hours in getting them ready. It seems fitting at this point to reflect on how 2018/19 has been.

In terms of the quality of care we provide, I only have admiration for what you have all achieved in the face of ever increasing demand for our services. Across the board we have seen improvements in how patients have rated us in their experience of care, and we know there are multiple examples where our outcomes are comparable with the best in the region and country. Reading back through my CEO reports to the Board over the year, there are countless examples of awards, recognition and outstanding practice; to achieve this in the face of the triple challenges of demand increases with workforce and financial restraints is all the more remarkable.

It’s a different picture on the money. We ended the year with a £31.6m deficit, which is significant. As a result, our regulators have altered our ‘segmentation’, meaning that we are now under a much greater degree of scrutiny and it is more important than ever that we meet our target this year. As well as keeping patients safe, we have a legal duty to ensure we make the best use of taxpayers’ money. There is more work to do here during the course of the year which I will talk about in a later blog; this is critical for us to get right if we are to raise the money to invest in our digital transformation and estate.

Like most places in the country, we still have significant challenges in finding and retaining the numbers of staff we need. This remains a high priority for the Board and we are starting to make some progress in tackling these issues. For example, I am delighted that we have agreed with Bucks New University the start of nurse training in Aylesbury from September – the first time nurses have been trained in this county for many years. Our staff engagement scores continue to increase – we are now well above average in many areas, with some pleasing improvements in developing a safety culture.

So in summary, there was much to be proud of last year, and there are some important areas of focus for the year ahead. We await the publication of our CQC reports in a few weeks. What we do know from their verbal feedback to us is that the culture of this organisation is compassionate and caring. To me that’s undoubtedly the most important thing.

As ever, do get in touch on the details below with any comments or questions.

Neil

07920 071814

neil.macdonald4@nhs.net

@NMacdonaldBHT

 

Building a climate of respect

Dear Colleague,

Towards the end of last year, colleagues and I recorded a video with some thoughts as to how we could strengthen a climate of respect in the organisation. You can watch it here: Building a Climate of Respect (7 minute video).

It is one of the NHS’s idiosyncrasies that it sees disproportionately much higher levels of workplace bullying than other sectors nationally. We at BHT are not immune to this; whilst we’ve made good progress in creating a more supportive culture, according to our staff survey 11% of you have witnessed bullying, harassment or abuse from a manager, and 16% by a fellow colleague. If you pause and think about it, these are extraordinary numbers. “Building a Climate of Respect” has been produced as a direct result of listening to your concerns and the feedback in our staff survey. We must all recognise the importance of respecting each other in the workplace now and in the future.

I am sure many of you have met Tracey Underhill, our Freedom to Speak Up Guardian (FTSUG). She does a fantastic job, and I am always happy to see that her work load is ever increasing. Just as trusts that report more incidents are safer, I’m sure trusts that ‘speak up’ more are better places to work (and therefore provide better patient care).  In fact, this is supported by evidence collated by the National Guardian Office, which shows an apparent correlation between how well staff are supported by managers and leaders to speak up and the trust’s overall Care Quality Commission ratings. If you haven’t met Tracey, involved her with your team or department, or if you have a concern that you are worried about sharing, then she will always be delighted to hear from you.  She has a wealth of expertise on what good and not so good practice looks like when managing relationships, teams and so forth.  You can contact her on 01296 316027 or via tracey.underhill@nhs.net .

There is also a new dedicated information resource guide for all staff in any role which has been developed to support you; it can be accessed here: Building A Climate of Respect Resource Guide. It contains useful information about how to identify, better manage and deal with the impact of bullying and poor behaviours that we know can sometimes arise. If you know of other helpful resources to share that can help us to further develop the guide then please let Tracey know.

The “Building a Climate of Respect” video sets out some expectations about what sort of behaviours should be expected in the Trust. Changing culture is never going to be something achieved overnight, but we have a collective responsibility to make this a great place to work. Perhaps the following are food for thought:

• People are much more likely to change behaviour through reward / praise rather than punishment / criticism.
• Try smiling and saying hello to a colleague you haven’t met before – you will be amazed at the impact this can have. Manners are just as important when speaking with colleagues as they are with our patients.
• Every now and then read back your emails to yourself – it is so easy due to time pressures to create a tone that is rushed and not as respectful as it could be.
• If people cannot do something, it is more than likely it is because they haven’t got the right training, tools or environment, not because they do not want to.

Imagine the collective change we could create if we all took the time to think about how we interacted with colleagues and made a small change.

As always, please get in touch with any thoughts or questions.

 

Neil

07920 071814

neil.macdonald4@nhs.net

@NMacdonaldBHT