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

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Happy New Year!

Dear Colleague,

Happy New Year!

I hope that whatever you were doing you managed to spend some well-deserved restful time with family and friends. My thanks to all of you who were working over the holiday period.  It was great to see many of you celebrating together in your departmental teams; some spectacular feasts on display!

So what will 2019 bring? Here are some thoughts as to what might be coming our way.

Firstly, Brexit. No matter what your personal views, there is no doubt this will continue to dominate the political and economic agendas, and as the NHS is intrinsically linked to both of these, it will be really important for us to be prepared for all eventual scenarios. We received refreshed national guidance just before Christmas and many of you will be working hard to ensure we have everything in place. A Brexit contingency group chaired by the Chief Operating Officer, Natalie Fox, has been established to lead and coordinate activities, working with partners across the county. We have been running workshops to support all our EU staff (8% of our workforce) and will be supporting all settled status costs – if there are any questions about any of this please do not hesitate to get in touch.

The NHS Long Term Plan was delayed in publication, but should be coming out in early January. This will outline the priorities for the NHS over the next 10 years off the back of increased funding (3.4% growth over the next five years) announced by the government last summer. Following its publication, we as a Trust will look at how we align our priorities to those outlined in this national plan. These are likely to focus (but not exclusively!) on the following:

• Frailty, with investment in community-based integrated services
• Faster adoption of technology, especially in outpatients, such as electronic records and telephone/video conferencing appointments
• Solving the healthcare workforce gaps i.e. looking at ways we can attract and train more people to come and work for the health service
• Prevention – helping people to stay fit and healthy and prevent them from becoming ill in the first place – something the NHS lags behind on compared with developed healthcare systems in other parts of the world

Finally, over the next three months we will be setting our organisational plan for the next year and beyond. In parallel with our ongoing road to financial recovery, we will be looking to continue to develop the Trust as a great place to work; supporting innovation to enable us to continue to meet rising demand; and making significant headway in plans for the upgrade of both our digital and building infrastructure.

Plenty of challenges and plenty to be excited about. I look forward to doing it all with you and to seeing lots of you in the coming weeks at the all-staff sessions. As ever, do get in touch on the details below with any comments or questions.

Neil

07920 071 814
Neil.macdonald4@nhs.net
@NMacdonaldBHT

The CQC is coming!

Dear Colleague,

It’s been nearly three years since they were last here, so we are overdue a formal inspection – although we do see them every 3 months or so to update them on where we are. Some of you have also presented to them at these sessions so they have a fair idea of our successes and challenges over recent months.

It is likely they will be here at the start of February. This is undoubtedly one of our more demanding times of the year – don’t worry, they are assessing on us how we care for our patients in a range of different circumstances, not on how busy we are. There will be an announced inspection on any number of our core services (which cover almost all the things we do) followed by an unannounced inspection at a date shortly afterwards.

Four messages from me:

1. Often their judgements are not directly about the care provided, but the evidence we record  that proves how we monitor this care. They have asked for a huge amount of information. A big ‘thank you’ from me to all who were involved in pulling this together – it was a massive amount of work at short notice. We will continue to get these requests over the next few weeks, so if someone asks you for some information in this regard, please do all you can to support them.
2. One of the most important bits of feedback we can give is what you, our staff, think about the care we provide. Everyone who wants to talk to the CQC will be given the opportunity to do so– look out for the messages inviting you to attend focus groups over the coming weeks. The more of you who get involved, the better informed the inspectors will be.
3. Sometimes it is the attention to detail that can let us down. All the work we do to showcase our fantastic care can be let down if we don’t get the basics right. For example, if we don’t fill in documentation properly or miss following agreed policies. Don’t let this catch you out!
4. Finally – I’ve visited a number of Trusts since taking over, and I have no doubt that we provide comparable care to those organisations with much higher ratings. A lot of what we do is genuinely outstanding. This is a fantastic opportunity to showcase our people and our services, and as a result attract more great people to work here – seize the opportunity!

I am really looking forward to the process as I know we’ll show the CQC why we’re proud to be BHT. If you want to get in touch to share thoughts or get involved, you can contact me as always on the details below.

Neil

07920 071 814
Neil.macdonald4@nhs.net
@NMacdonaldBHT

Our financial position

I am sorry there has been a gap of a few weeks in between my blogs. Since September we have launched the monthly CEO Brief and made it open to all staff. It has been great to see so many of you there – please come along if you can. They are also filmed so you can catch up here: CEO brief videos

I would like to update you around our financial position – which is not where it needs to be. There are a number of reasons for this: increasing demand on our services; the volume of medications we are using; our backlog of maintenance in estates; and the number of temporary staff we are having to use, amongst others. The Trust’s historic debts and borrowings also cause us financial pressures, as do our PFIs – the buildings which are run on our behalf by private companies.

It is without doubt that we have a far greater challenge this year than in previous years, and will require all your help to fix it. I would urge you all to be aware of this and take this into account as you deliver your services. Remember, as well as providing safe and compassionate care we also have a duty to look after taxpayers’ money and spend it wisely.

I am, however, actively seeking to change the tone about how we talk about our finances. When we reflect on messages about money, to date (and probably every year we’ve been talking about the issue) they are almost entirely negative in tone – ‘keep within budget’, ‘don’t spend on this’, ‘we can’t afford that’ and so on. It is right that we have to manage our money properly, but I believe that people are motivated by reward and positive change far more than by restrictions and central control.

As we go into next year I would therefore like to discuss with you, and ask you all to think about, how we can change this. We will definitely be thinking about incentives and how we can use good financial management, or more efficient ways of working, to provide reward and investment for staff and patients at department level, so we can directly link good practice to improvements in patient care and staff wellbeing.

If you have any ideas around this, please get in touch with me directly. This is critical to creating a culture where success breeds success.

Finally, I leave you with the example of Kelly, one of our domestics from our Brookside clinic, whom I met last week. If the non-clinical waste bins in her area aren’t more than half full, she deliberately empties them without always changing the bin liner, because she is conscious of the cost of replacing these. It is small steps such as this that together will achieve the bigger goal of financial stability as well as better care for our patients.

As always, it would be great to hear from you.

 

Neil

07920 071 814

Neil.macdonald4@nhs.net

@NMacdonaldBHT

Dealing with current and future gaps in our nursing workforce

Dear Colleague,

I hope you are all well and, where possible, enjoying the summer weather and trying to get some time off. This unusually hot summer has put some additional stress on us in terms of demand for our services. Some parts of the Trust are also really challenging to keep cool; I’m really grateful for all you have done to look after each other and our patients.

I set out in my opening blog a set of priorities, one of which focused on a desire to ensure we were able to deal with the current and future gaps in the nursing workforce. That is not to say by any means that vacancies in other professions don’t cause us significant challenges, but the nursing workforce is by far the largest body of staff. Future projections for those entering nurse training nationally are worrying. We don’t have the number of nurses we would like at this moment, and with 1 in 9 posts vacant in England, this is unlikely to resolve quickly. So how do we adapt for a world where there aren’t enough nurses and we know that more qualified nurses = better patient outcomes?

My personal thoughts as to what we need to focus on:

• How is this organisation a great place to be a nurse? Yes, being competitive on pay within the bounds of agenda for change is important, but what can we offer that is different? Access to different specialty rotations, opportunities for personal development, pathways into specialist roles and working for a Trust that has been recognised nationally for some of the innovative work we do here – we do good things, but we need to do more. Most importantly, how do we make nursing more enjoyable here: developing professional autonomy and an environment where nursing can thrive?
• We will have to get better at managing the future supply of nursing: this will involve working with numerous educational providers and developing partnerships that bring nursing education directly into the county and our own organisation.
• New roles – we need to accept that with not enough nurses coming through the universities we will need to look at different training routes (driven via apprenticeships) and the vocational training of higher banded support staff.
• Some of the solutions will come through redesigning the team structures that serve wards, departments or localities. This means looking at all the clinical and non clinical professions that will be needed to work together to provide the most appropriate care. This includes therapists, technicians, clerks, pharmacists and psychologists, for example, who will all have roles to play. It is critical that these teams are designed at ward / theatre / locality level involving all members of the multi-disciplinary team around the needs of our patients. Some areas, such as the National Spinal Injuries Centre, are already forging ahead with some innovative new models.

It’s a daunting problem but one which everyone is facing; and one for which I know we have the skills and experience to tackle together. Carolyn is leading this programme and will require all of your support: if you want to help and advise us on this journey please do get in touch, we want to hear from as many people as possible.

Once again, thank you for all that you do. Please do contact me if you want to discuss anything further; thanks to all of you that have already done so.

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

BHT’s safety culture

In my last blog I outlined some personal priorities. As a reminder:

• Developing a safety culture
• Hearing the patient voice
• Getting things done
• Transparency of decision making
• Financial sustainability and dealing with the growth in demand for care
• Developing the nursing workforce

I would like to discuss with you each of these in a little more detail over the coming weeks, both so you get to hear what the senior team are going to be spending their time on, but also so I can learn from all of you how we should be developing these.

Starting with developing a safety culture, I want to outline the three areas that I think are important next steps for us here:

Firstly, becoming an organisation that learns. Learning from successes and mistakes is critical to ensure they are repeated or avoided in the future. I want us to make it easier to transfer this information around the organisation beyond our traditional methods – think about what it might mean in your teams or departments.

This doesn’t only apply to clinical care either: it is equally important for management decisions, and we should be brave enough to seek feedback, celebrate when something goes well, and learn when it doesn’t.

Secondly – we need to continue to develop our culture. People who want to tell us things that are uncomfortable should be welcomed and taken seriously. If you can spare the time, watch this film from Mersey Care on how they did this, it is superb. https://www.youtube.com/watch?v=bu9yhdOegm8

Thirdly, we need to understand the complex reasons why things don’t always go well, and design systems that reduce risk, especially from human factors. This is relevant in all parts of the organisation, so I am keen to support training and development in this area – the Board will be undergoing specific training later this year, and we are looking at how we can make this available to all staff. Please get in touch if you would like support in your area.

There are some great IT programmes being rolled out shortly that will help develop our safety culture. The Board last week approved the roll out of e-observations across the organisation (hopefully by Christmas), and if you haven’t yet seen the Careflow system we are also deploying, take a look at this link (http://www.careflowconnect.com/). Dr Jeremy Drake, one of our consultant anaesthetists is leading on this so please do contact him if you wish to learn more.

Finally – the CQC have a useful checklist for all to use when assessing organisations / departments for safety. I’d encourage you to take a look:

As always, please do contact me with any thoughts or comments, and thanks to those who have already done so.

Neil

@NMacdonaldBHT
Neil.macdonald4@nhs.net
07920 071 814

My personal priorities

In my last blog I promised I would set out some personal priorities as CEO (in line with our existing strategy) that I have been talking through with the board and with some of you already – so here goes!

In no particular order of priority….

Developing a patient safety culture. We have really moved forward in the Trust in the 5 years I have been here about recognising and being open when we don’t get things right and sometimes cause risk to both patients and staff. But the absence of harm does not always mean the presence of safety. Our next stage is how we measure and celebrate safety and create a culture that supports learning – excellence reporting is a great example.

Getting things done. We need to make the organisation ‘work’ better and make it easier to do stuff  – rapidly spreading improvements, using quality improvement methodology to solve issues and move beyond ‘business case’ culture. This is reversing learned behaviours over some time, so we won’t always get it right, but we should call it out when it happens.

Making decision making more transparent. We should be continue to develop as an open organisation and publish how we make decisions, so you can all see and comment on the choices we make. You’ll see this start to come through the daily staff bulletins.

Transforming the nursing workforce. I’m sorry if you’re not a nurse and you feel aggrieved that I haven’t singled out your profession – but the nurses are our largest part workforce, and we haven’t got enough of them. We need to make this a great place to be a nurse, but also recognise we need to create ward and community teams that embrace different skills and professions to generate true team working – we all have a role to play in this.

Sustainability. Our largest collective challenge is the unsustainable growth in emergency demand, from both a financial and quality view. Through supporting primary care, strengthening our community services, and getting the patients to the right part of our hospitals quickly, we will solve this.

The patient voice. Do we hear it enough? Great organisations design service changes in partnership with patients, and get better results. The development of the community hubs is a great example of this.

I hope this gives a sense of my personal priorities, and what I will be focusing on: I’ll be discussing these further with you through a series of staff events in the coming weeks. Would be great to hear your views.

Neil