About the Organisation
Frimley Health NHS Foundation Trust was created on 1st October 2014 by the acquisition of Heatherwood and Wexham Park Hospitals NHS Foundation Trust by Frimley Park Hospital NHS Foundation Trust, the first ever merger of two Foundation Trusts. It runs Heatherwood Hospital in Ascot, Wexham Park Hospital near Slough, Berkshire, England, and Frimley Park Hospital in Frimley, Surrey. It has 4,948 full time equivalent staff. The Patient Trust was launched in 2014 by Howard Kennedy with the purpose of supporting a consistent, quality experience for patients facing serious illness by raising awareness, providing practical support and working in partnership with doctors and patients.
In June 2013, Howard Kennedy received a terminal cancer diagnosis. Reflecting on his experiences as a patient and on a career as a leader of public service system reform, he determined that he would commit the rest of his life to improving the quality and consistency of patient experience. Howard knew that a culture of engagement starts at the top. He knew that leaders shaped culture, where managers responded to it. He set out to develop approaches that would support leaders to strengthen and further enhance the quality of their engagement with patients and the collective support teams offered to patients. This approach was to be about potential and growth, solution focused, not a deficit model. As he worked to develop networks and shape an innovative leadership programme, Howard was told that engaging with consultants was an impossible dream, they were too busy, too focused, too senior to embrace development. Finding, in Frimley Health Trust, an organisation committed to delivering excellent patient experience, he worked in partnership with them to challenge these assumptions. The Patient Encounter Leadership Programme launched in December 2014 with an initial cohort of six senior clinicians, feedback from 359 patients and 102 colleagues and impact beyond.
Rationale & Context
The drive behind the Patient Encounter Leadership Programme (PEL), was Howard’s determination to strengthen the consistency and quality of patient experience. In Claire Marshall, Head of Patient Experience at Frimley Health, Howard found a champion of patient engagement committed to making the biggest positive difference in the hospital trust. This partnership enabled Howard to engage with the hospital board and addressed a number of professional meetings, the first patient in the history of the Trust to do so. Howard’s address was heard by over 200 doctors in total, ranging from newly qualified doctors to consultants. His message was simple, ‘Leadership matters and as leaders you have the power to shape not only the experience of the patients you treat but the experience of all patients throughout the Trust.’ In further developing this theme, Howard outlined three critical factors he had identified during his time leading system reform. That effective leaders demonstrated three common characteristics: 1)Effective leaders never stop learning2)Effective leaders are humble, they walk with care 3)Effective leaders understand the gap between intention and impact and they work to narrow this. In describing these characteristics in greater detail, Howard set out a compelling vision for consistent, quality patient engagement. Supporting this vision was the offer to those who heard his address of the potential to participate in the PEL programme, focused on supporting effective leadership through innovative development.
Planning & Delivery
As Howard engaged with the Hospital Trust it became clear that there was a willingness to embrace new approaches to the development of senior clinicians. In building support for the programme, Howard and Claire Marshall enrolled senior colleagues from within the Trust and outside. One early morning meeting with Kath Evans stands out in the memory, strengthening both the support network and bringing real confidence that the approach was right. In seeking a partner to design and deliver the programme, Howard co-opted former colleagues from system reform days, who were only too happy to contribute time and experience to the cause. Over the course of several months, the design of the PEL programme took shape, with Gareth Cornwall, from the decision point, developing a leadership programme embedding the principles Howard had set out in his address and shaping them into an experiential learning process where consultants could step back and explore their leadership of the patient encounter. In the Autumn of 2014, senior clinicians were invited to apply for the PEL programme, a development programme comprising four days of off-site development, one to one coaching sessions and action learning sets. Within a week, 23 senior clinicians had applied for the 6 places on offer. Following the acquisition of Wexham and Heatherwood Trust by Frimley Park Trust in December 2014, the newly formed Trust, Frimley Health NHS Foundation Trust, endorsed the programme with support and engagement from the Medical Director, Tim Ho and the head of learning and development, Claire Quinn. In Spring 2015, the final cohort was confirmed and the initial cohort embarked on the process of collecting patient and colleague feedback.
Impact & Results Achieved
Applying the principles of effective leadership that Howard set out in his address to senior clinicians, the PEL programme is built on three metrics; 1) patient feedback 2) colleague feedback 3) self assessment. At the heart of this is the recognition that feedback drives performance improvement. For the patient feedback measure, the participants undertook the CARE measure, in the process gathering feedback from a total of 359 patients. For the colleague feedback, participants gathered feedback from over 100 colleagues through Hay Group’s 360 Emotional and Social Competence Inventory. For their own self assessment, participants were asked to reflect on their performance, informed by insights from 16PF psychometric profiling. In combination, these measures were selected to provide a robust measure of impact, applying established tools to give participants a real richness of data. At the time of writing this submission, we are in the process of re-running the patient and colleague feedback processes and evidence of impact from these measures will be available in early 2016. Already though, we have evidence of impact from the senior clinicians themselves:
- “The off-site gave me the opportunity to reflect on my work and attitudes towards my patients in comparison to what my colleagues do. I learned from their experiences of patients care and management. I was able to draw inspirations from my colleagues on how best to improve the doctor patient encounter considering our very different specialities.”
- “Following the PEL programme I have been able to take a greater understanding of alternative drivers and behaviours to my interactions with patients and colleagues.”
- “Believing in my own capabilities gives me the power to focus more positively on the challenges that present with very sick angry patients and relatives – who have just been diagnosed – and the challenges from non-co-operating colleagues and cultural differences. I am now more able to control my initial responses and give a more balanced reflection which allows for sustained communication channels which in turn is more likely to impact positively on my working day”
- “I will concentrate on making the patient feel at ease and including the patient in the decision process and wrap up at the end. I will be more open with colleagues to gain their confidence.”
- “I was enlightened by all that we learned and aim to put it into daily practice.”
- “I felt privileged to have been given the opportunity to join the group and gained invaluable experience. Programmes such as this provide dramatic insights into everybody’s working practices and provide a fantastic opportunity to tackle difficult cultural changes that are required within an organisation to allow it to flourish. I do hope that other colleagues of mine are given this opportunity in the future.”
- “Since the sessions I have already seen a vast change in my working and personal life. as the 2 are inter-dependant – I feel empowered to make sensible and positive changes which impact widely – like the ripples on a pond”
- “This programme lifted my mood and made me realise that I am working at suboptimal performance. Gave me an insight into behaviours which I had not noticed. Howard Kennedy’s very sincere efforts of making a difference through this programme made the experience very special. Thanks for a great programme.”
The initial PEL Programme was a pilot programme, an opportunity to learn and develop approaches which will enhance the leadership of the patient experience. In October 2015, based on the success of the initial pilot programme, Frimley Health NHS Foundation Trust commissioned a further programme, due to launch in Spring 2016. This re-commissioning was personally supported by the Chief Executive, Sir Andrew Morris, who recognised the important space the programme provides for senior clinical leaders to reflect on their practice and ‘sharpen the saw’. Howard’s charity, the Patient Trust, is committed to promoting all approaches that support a consistent quality of patient experience. The PEL programme is one element of this approach and in 2016 the Patient Trust will seek to bring in other Hospital Trust partners, alongside Frimley Health. The PEL programme generates significant learning and insight, through the participants themselves and the data that is gathered through the process. In 2016, Frimley Health and the Patient Trust intend to promote lessons learned, supporting a focus on patient experience not only across the host Trust but also through Trusts across the country. The PEN network is an important partner in this.
Awareness building has taken place through the network that has formed as the programme has developed. Interaction and the promotion of consistent, quality patient experience has been highlighted through Howard’s addresses to doctors, through the dissemination of information to Frimley Health Trust’s Health Education Board (HEB) and through the Patient Trust website.
Relevance to Other Groups
As the programme develops and learning emerges, we believe opportunities will emerge to share approaches and learning with other groups focused on patient experience. We believe the PEN network will be a valuable disseminator of this learning.
What Makes This Initiative Stand Out?
The PEL Programme stands out for a number of reasons. Firstly, at the very heart of the programme is the inspiration provided by Howard Kennedy in choosing to respond to the greatest adversity with such positive intentions and actions. The programme is inspired and shaped by a patient working closely in conjunction with a hospital trust to deliver innovation and sustainable change. Secondly, the programme is aimed at consultants, recognising the influence they have beyond their immediate group of patients. By promoting consistency and quality of patient experience with this senior group we aim to shape a broader culture of engagement across the service. Thirdly, the programme seeks to build long term mastery. The programme takes a holistic approach to development, supporting participants to reflect and be mindful of mastering the balance of patient care, professional interaction and self. It is when this balance is managed that the senior clinicians themselves say that they can deliver the most consistent quality of patient care. By focusing on potential and grounding this in reflection, dialogue and feedback the programme seeks to embed performance in capability and behaviour, overcoming the common failings of ‘quick fix’ approaches.
Key Learning Points
- We’re all human and recognising our weaknesses allows us to better understand our strengths
- Feedback is critical to development and performance enhancement
- Adopting a solutions focus approach allows people to move away from blame and look towards positive shared outcomes
- Partnership between patients and professionals can deliver real benefits
- Nothing is written – one person can make a difference and leadership is about being that person At the core of the programme is the promotion of a quality conversation with patients and about patient care.
PEN is 6 today!
PEN is 6 years old – and like many 6 year olds we are growing more independent, flexing new-found skills and abilities although appearing a little gawky and uncoordinated at times; we want it all and sometimes have difficulty making choices and on occasion, perhaps, we are a little bit too rigid and demanding ….and of course we are worried about the monsters under the bed!
Growing and independent
But joking aside we have indeed grown significantly over our first 6 years to a network of almost 8,000 likeminded people wanting to improve the experience of care for all involved; we have developed new resources and approaches to support teams who wish to implement change (these can be found on our website under Resources); and because we know our website is still a little bit gawky and difficult to navigate we plan to re-launch this over the coming months!
We want it all
Yes – we want it all! We want to ensure we support organisations to recognise, share and celebrate their good work and then help them get better at measuring, embedding and sustaining this – and of course we want to do it now! This year saw our best ever PENNAwards with more categories, more entries, more judges, more finalists and ultimately more brilliant examples of what is working well.
We need your feedback
We are though still growing and developing and to help us be a little less rigid and demanding please let us know how it is going – we love to hear your views but a word of warning, be kind with your feedback – as a 6 year old, we can be hurt by criticism, but we always listen and take on board your views.
There are monsters under the bed
As a not for profit organisation we are self-funding and every now and then there really are monsters under the bed but together we can vanquish those monsters and make the world a better place. We would be delighted to work with you, to welcome more associate or partner members, to support you on your own experience improvement journeys – just let us know how we can help.
Our last 12 months
Here are just some of the areas we have had the privilege to work in over the last 12 months:
- CYP Experience
- Maternity Experience
- Learning Disabilities
- Complaints and Compliments
- MRI and Mammography
- Leadership – board reviews
- Strategy/ values development
- Benchmarking organisations
- Winning Principles for Patient Experience
We have been delighted to work alongside NHS Improving Quality, the Picker Institute, NHS England, West Midlands SCN and CHANGE People amongst so many others with a very special thank you to Andrew Hasler, Phil Stylianides, Catherine Carter and of course Kath Evans.
What’s ours is yours
We now have over 500 case studies and will be making sure these are fully accessible on our new website, together with a series of best practice webinars, videos of the our category winners and others, plus articles and news items from our monthly newsletter.
Thank you for your support. We have had a wonderful year – our best yet, and are grateful for everyone’s support.
So with a final word from AA Milne
“But now I am six, I’m as clever as clever.
So I think I’ll be six now for ever and ever.”
All the best
Staff Engagement the WWL Way
Wrightington, Wigan and Leigh NHS Foundation Trust is a major acute trust serving the people of Wigan and Leigh. Innovative and forward thinking, the trust is dedicated to providing the best possible healthcare for the local population in the Wigan Borough and surrounding areas. The Trust aims to continuously provide safe and good quality care to all patients. Over £220 million is spent each year on a diverse range of reputable general and specialist acute services.
The Trust has three hospital sites, a state-of-the-art outpatient’s centre, a dedicated Ophthalmology centre and offices located at Buckingham Row in Wigan town centre. The Trust employs approximately 5000 staff.
The “WWL Way” is a vision for understanding, implementing and embedding sustainable staff engagement in Wrightington, Wigan and Leigh NHS Foundation Trust (WWL). It has grown out of a long history of successful staff engagement initiatives that have delivered positive outcomes to staff and patient care, and has developed into an evidence-based measurable pathway model and robust strategy for staff engagement.
Our long term objective is to embed a sustainable positive organisational culture, through strong leadership and by giving staff at all levels the information, tools and encouragement they need to self-sufficiently enhance engagement throughout WWL. Our forward-thinking approach to staff engagement has already received national attention because of our “gold standard example of a systemic and sustainable programme to improve staff engagement and satisfaction” (HPMA). We believe our approach has the transferability to make a huge impact on the wider NHS.
The WWL Way has created a framework to continuously measure and improve engagement, identifying specifically the factors that are enabling engagement at Trust level or at a team level. Not only that, it directs staff and the Trust towards the right tools to address specific staff engagement needs, creating a bespoke solution as opposed to “one size fits all”. In addition, strong leadership and staff side sponsorship and consistent communication has ensured the WWL Way has become “the way we do things” and an authentic approach as opposed to a tick box exercise. The difference the WWL Way has made to patient care, quality and experience has been extremely encouraging.
Our staff engagement journey evolved over 15 years and included the following three distinct initiatives:
- Staff Involvement Delivers (SID) – a partnership between Human Resources and Staff Side. “Conversations with” Directors events allowed staff to raise issues important to them and “walkabouts” gave Directors the opportunity to integrate with staff at the front line.
- Listening into Action (LiA) – In 2011 we undertook the NHS national staff survey, resulting in scores below average on 55.3% staff engagement measures and only above average on 21% of measures. LiA further energised staff engagement, giving a greater focus on making quick-win and bigger system changes, aligned to the needs of staff. LiA encouraged staff to run their own listening events and local level changes.
- Our partnership with Unipart – Lean ways of working through team communication cells, visual management tools and a strong emphasis on metrics and devolved problem-solving.
Practical application of these tools can be observed at the following link: http://www.youtube.com/watch?v=lTNZCdfMKV4
We needed a joined up approach where all initiatives were accessible as tools to all staff, and used in the appropriate places. We also needed to understand how these tools were influencing the cultural conditions at WWL e.g. what was the cause and effect? By knowing this we could understand and regularly measure their impact, to create a continuous improvement approach to staff engagement.
Developing “the WWL Way”
In mid-2013 we combined the three initiatives to create our own unique brand of staff engagement – “the WWL Way”. We created a new “Staff Engagement Pathway” model underpinned by research/theory – a framework for understanding staff engagement more deeply, by gauging levels of staff engagement, and identifying several factors that help us better understand what enables improved staff engagement. The framework focuses on nine staff engagement enablers as well as staff engagement feelings and behaviours.
Our validated ‘WWL Way’ quarterly diagnostic survey and extensive engagement toolkit are now used together both at Trust and Team level, to measure, track and continuously improve the enablers of staff engagement and ultimately our organisation’s performance.
Our Staff Engagement Pioneer Teams 26 week Programme allows teams to use the survey to identify their specific engagement needs. Our new “WWL Way toolkit” integrates our initial trio of initiatives into eight staff engagement tools. It offers a choice of solutions to apply locally, avoiding a “one size fits all” approach. The Programme helps teams feel empowered to engage in, and offer up, service improvements through their own initiative.
Who Made it Happen?
- Chief Executive and Directors – Acted as “Engagement Sponsors”, there to build excitement, be authentic, harness the WWL community and emphasise the significance of staff engagement.
- Staff Side – worked in partnership to bring honesty and openness to staff engagement and also encourage and mobilise staff engagement activity at all levels.
- Staff Engagement Team – Develop and Deliver the WWL pathway framework, diagnostics, staff engagement toolkit and Trust Wide Engagement Activities.
- Staff Engagement Champions – Advocates and sponsors of staff engagement activities, guiding and supporting staff engagement teams at every step.
The following video explains more: http://www.youtube.com/watch?v=Zrq0m2nY1Q4&feature=youtu.be
Impact & Results
In 2012 we saw major improvements in our national staff survey results. Above average scores increased by 64% from 2011, and increased again by another 15% in 2013. During this period we saw significant reductions in sickness absence (down from 4.62% in April 2012 to 4.17% in Dec 2013) and expenditure of temporary staffing (down from £15 million in 2011/2012 to £12 million in 2012/2013).
In 2014 we have seen continued improvement in our Trust-wide engagement scores as a result of a range of organisational activities aimed at addressing development needs identified through our quarterly staff engagement survey. We have seen significant improvement in two particular engagement enablers: Trust (staff feeling trusted and empowered) and Working Relationships (staff feeling supported). These improvements have been supported by proactive work to develop our leadership skills, extending the use of communication cells and listening to staff. As a result we have seen significant improvements in staff advocacy (staff recommending the Trust as a place to work and a place to be treated) which has risen by 14% since January 14. We have also ranked 22nd out of 241 Trusts in the 2014 Staff Friends and Family test results (released November 14), compared to 54th place in 2013.
We have seen a 7% overall improvement in engagement collectively amongst teams, one of which improved by 25% over six months. This was all measured and achieved through our staff engagement pathway framework, and the hard work of our own staff to take ownership and action.
Staff engagement has also enabled us to achieve Quality and Safety Improvement between 2007/08 and 2013/14:
- Reducing mortality rates (HSRM) – 126 to 87
- (annual actual deaths in hospital falling by 30% in the same period)
- C-DIFF incidences – 373 to 26
- MRSA reduction – 39 to 1
Staff engagement has also influenced our patient experience:
- Top 25% in the annual patient survey.
- Friends and Family Test: Consistently the highest scoring A&E Department in Greater Manchester, Second in Greater Manchester for our inpatient quality.
- WWL received recent national notoriety when our bereavement staff went the extra mile to enable a dying patient to see her horse for the last time. This was an example of engaged staff going above and beyond to enhance patient experience and deliver compassionate care.
Key Learning Points
- Buy-in. We ensured strong visibility and promotion of our staff engagement the WWL Way and its initiatives –gaining senior leaders’ commitment and sponsorship, and acting “at scale”.
- We established a partnership approach between staff side and management, working together towards mutual staff engagement goals.
- We acted and communicated quickly following listening events, providing regular feedback through a “You Said – We Did” approach.
- We acknowledged that staff engagement can be enabled in many ways, from how we recognise and value staff, to the way we involve staff in decisions, to the way we build motivation and morale.
- Every Day Enactment. We always ask the question “have we asked our staff?” We are seeing a cultural shift from our leadership, in that they are beginning to make more informed and collaborative decisions with greater staff involvement.