Case Study

As a service provider to the NHS it’s Serco’s belief that the way our staff provide facilities management (FM) services is just as important as what we provide. Serco Cares is our way of embedding a culture where all our staff are empowered, motivated and clear about their responsibility to positively impact patient, staff and visitor experience.

The programme has been described by a leading change management academic as putting ‘the dignity of the worker at the heart of its design’. It’s innovative, ambitious and challenges thinking around traditional NHS hierarchies. Recognising and appreciating the role of support staff in the patient care journey will benefit patient wellbeing, their experience of being in hospital and contribute to Trusts becoming increasingly caring, safe and efficient.

The principles we advocate are relevant to all support staff, regardless of who they are employed by. The programme is in its third year and will be implemented in all our contracts by the end of 2019.

1. Serco Cares evolved from observations backed up by both desk research and exploratory work at our client’s hospitals:
2. When patients feel positive they get better more quickly.
4. Clinical staff are under increasing time pressure, they may have less time to spend with patients caring for their general wellbeing.
6. Support staff can have as much contact with patients and relatives as some nurses. They can be seen as more approachable when patients don’t want to ‘bother’ busy clinical staff.
8. Clinicians respect the role of support staff and appreciate that they can have knowledge and insights about patients

So:

1. Support staff can make a real difference to how patients are feeling, and a positive mental attitude is linked to recovery/better health outcomes. They can also contribute towards supporting hospital teams in delivering safe and effective care.

The challenge was laid down by Ian Crichton, our Managing Director and ex Chief Executive of NHS National Services, Scotland: How can our staff assist in delivering better health outcomes without impacting on their delivery capability and consequently our quality standards?

Our project mission statement is: ‘To drive noticeable, sustainable improvement in the quality of the service we deliver for patients, families and staff, enabling our customers to deliver better health outcomes’.

Development was led by ExperienceLab, the Serco customer experience experts. UK healthcare is a unique environment when it comes to customer experience and their brief was to bring the best from other sectors but acknowledge and make full use of the uniqueness of health. Comprehensive desk research was followed by spending time in hospitals we work in, talking to stakeholders –nurses, doctors, patients, carers, relatives, our frontline staff, supervisors and managers. They observed staff and took on their varied roles. Development was rooted in co-design and then testing, reviewing and amending at every stage. Over six months ExperienceLab designed and tested the programme content and delivery style.

One of our hospitals was used as a pathfinder contract and the team worked closely with Serco and NHS colleagues there to develop the content and a clear process to implement and promote the philosophy of Serco Cares. It needed to work for all our contracts. Serco Cares comprises 4.5 hours workshops delivered over three sessions, with time back on the shop floor between each session. Workshops are mandatory for all staff, from our Contract Directors, managers and back office functions through to all our frontline staff, regardless of role.

The difference Serco Cares has made to our staff is palpable. For many it represents an investment in them that they have not had before. Workshops are lively, interactive, thought-provoking, fun and nothing like mandatory training as they know it. They are as relevant to long service staff as they are to recent joiners. To date over 3,100 staff have completed the programme. We’ve trained staff at each contract to continue to deliver the workshops to new starters and secure its sustainability. The programme is live in nine sites and we have another six planned for 2019. The expectation is that all our 6,500 staff will attend workshops by the end of 2019.

Quantitative measures of success for a soft skills programme like Serco Cares, in what is a very complex setting, are difficult. We know that the benefits may take time to be realised, but it’s the right thing to do for our staff, our clients and their patients, carers and families. The measures and assessments that we have support this (refer to ‘Impact and results’ poster). The staff engagement scores at the three most mature sites have all increased, as have our client feedback scores.

For our clients we anticipate a positive contribution to their patient experience metrics (such as FFT) and more frequent mentions of our staff in comments left on surveys and Care Opinion posts. The close collaboration between support staff and clinical staff was noted at an inspection at one of our client’s hospitals and held up as an exemplar to be shared. One-team working at ward level and support staff that clearly care and positively impact patient experience will feed into the CQC inspection domains of Safe and Caring.

What we are doing is relevant to all organisations that have a mix of technical/clinical and support staff, regardless of who employs them. We hope to spearhead a significant shift in thinking, behaviours and attitudes about and among support staff. Through Serco Cares we encourage our staff to adopt a different way of thinking about their role and the impact they have, not just focusing on the delivery of their core tasks but the ‘how’ as well as the ‘what’.

We aim to replace: ‘I’m just a porter / domestic / housekeeper’ with: ‘I’m part of the patient care journey’. This is beautifully summed up by one of our porters when he was interviewed about his role for an article in the HSJ: “It’s not medical, it’s not surgical, but it is care …… I may not have [clinical] qualifications …. but I’m making sure the patient is OK.”

Working in healthcare is different to other sectors. Staff, whether they are clinical or in support roles, are caring for people who don’t choose to be patients, carers or visitors, so Serco Cares needed to take account of this. It’s far more than customer care training and goes to the heart of what it means to work in a hospital. Most employees, regardless of their role, care and genuinely want to make a difference. Serco Cares connects with the emotional side of working in a hospital and celebrates the impact that caring has. Everybody has a contribution to make and should be encouraged to do so. For our experienced staff it’s about recognising and appreciating the small acts of kindness that make a difference to people every day.

For our less confident staff the programme aims to upskill, empower and give them confidence to make a difference. We encourage staff to personally relate to content through sharing their experiences and encouraging delegates to see things through the eyes of a patient. Our workforce is multi-national and multicultural, some of our people have been in their roles for many years, others have just transferred over to us from previous companies. The style and format suits the needs of the range of delegates that attend. We’re not prescriptive in specifying what people have to say and how they have to say it, over the course of the workshops we ask them to adopt the principles of Serco Cares and make them their own. Increased value and recognition also improves staff satisfaction and engagement. The direct and positive link between staff satisfaction and patient satisfaction/positive health outcomes is being increasingly discussed.

In addition, happy staff that feel valued are more likely to deliver greater consistency and high-quality effort. Finally, and arguably most importantly, Serco Cares goes beyond implementing a customer care-type programme. We’re working hard to promote collaboration with clinicians from ward to Board to support them in providing timely, high quality, safe and effective patient care. We’re encouraging our staff to tell nursing staff when they have a concern about a patient or pass on requests patients make of them. Patients aren’t interested in who someone works for, they see a person in uniform and anticipate that they will be able to help. Working as one team on the wards makes communication easier and more efficient.

1. Healthcare is a unique environment with an emotional pull that many other sectors don’t have
2. Don’t underestimate the knowledge support staff hold about the wellbeing of patients
3. Value and recognise the contribution of the whole team; aim to break down hierarchies and recognise that everyone can have a positive impact on patient wellbeing and experience regardless of their role
4. Cultural and attitudinal change at all levels is a way to overcome some barriers to efficient hospital service
5. Support and active involvement of senior leaders is essential
6. It takes time for benefits to be realised; it may not be easy to demonstrate cause and effect but acknowledging and embracing the contribution support staff can make is the right thing to do
7. A hearts and minds change programme needs to have a dedicated team of trainers with the appropriate skills and who continually peer review delivery to maintain quality
8. Workshops are the first step, activities need to continue to keep momentum going and demonstrate success

Realising the benefits of Serco Cares is as much about approach as it is about content. It depends firstly on recognition of the role support staff have in delivering care. Unwavering involvement and support of senior management is essential, as is detailed planning and comms in the lead up to implementation, focussed administration during implementation itself and a commitment to subsequent embedding of the ethos. It requires trainers skilled in delivering attitudinal and behavioural change programmes that avoid conventional teaching and focus on taking delegates on a journey of discovery and realisation. We are rightly proud to have Serco Cares as part of our proposition to our existing and new clients and to take an active part in the debate around the contribution support staff have in delivering a positive patient experience and the benefits that brings.

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