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The impact of a healthy organisational culture on quality and performance

Andrew Foster

KINGS FUND ANNUAL CONFERENCE19th November 2015

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The compassionate face of the NHS

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QUALITY

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Our journey to a culture of Quality

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Quality in WWL 2006

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The WWL Wheel

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Consistent Quality values

• Quality equal to performance and finance

• Nothing is more important than safety

• Speak up if you see harm or risk

• Science of healthcare improvement

• We measure what we do

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MRSA bacteraemia

0

5

10

15

20

25

30

35

40

Cases

None for 420 days

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Clostridium Difficile

9 so far this year

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-

200

400

600

800

1,000

1,200

1,400

1,600

2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15

Deaths Yearly Total

Unadjusted deaths in Hospital

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Unadjusted deaths in Hospital

= 2,347 Deaths

Chart1

2007/08

2008/09

2009/10

2010/11

2011/12

2012/13

2013/14

2014/15

Year

Deaths Yearly Total

1561

1347

1256

1273

1170

1296

1150

1142

Sheet1

Year

2007/081,561

2008/091,347

2009/101,256

2010/111,273

2011/121,170

2012/131,296

2013/141,150

2014/151,142

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And over 8 years

2007-08 2014-15 % changeHSMR (not rebased) 126 57 -55%Deaths in Hospital

1,561 1,142 -27%

MRSA 39 1 -97%C Diff 373 25 -93%Pressure Ulcers (

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Should be a joined up

strategy

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But we’re not as good as we want to be

• SAFE – Nine Never Events in 2 years• EFFECTIVE - HSMR is 90 we want

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Weekly deaths report

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We are still harming patients

• Aspiration pneumonia• GI Haemorrhage• Intestinal obstruction• High risk medications • Patients put NBM/Nutrition• Drug omissions• Rare but dangerous medications• Hospital overload • Patients in wrong ward for main condition• Escalation of deteriorating patient

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Where next?

Quality Champions

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The 280 Quality Champions

*Marion Ashworth Suzanne Holt *Ian Aspinall Nasir Iqbal *Karen Atkinson Emma Baggaley *Anita Baker *Nick Bastow Masem Afzal Denise Glassbrook John Baxendale Rabiya Aseem *Christos Zipitos Andrew Beddeson *Chris Birchall Lorraine Bremner *Leanne Brooks *Dan Buck *Lindsey Bullough *Terry Cawley *Helen Champion *Yvonne Dunn *Amanda Cheesman *Debra Clegg Tahir Chohan *Kath Collins Nicola Compton Jones *Sean Burns

*Shaun Dainty *Gill Davenport *Chris Heaven *Anand Dhanasekaran *Nicola Smith *Janet Duffy *Lucy Farnworth *Helen Flowers *Andrew Foster *Abdul Ashish *Imran Aziz *Kathryn France Ravindra Badge *Jean Prescott *Ruth Gregory *Stephen Gulliford *Amy Halliwell Manzarul Haque *Nicola Hardman *Phil Harris *Christie Hermiston *Susan Heighway *Elaine Hibbs *Christianne Butterworth *Fiona Hindley Victoria Gaskell *Carol Howard *Angela Cross

*Margaret Jolley Alison Jones (gastro) Alison Jones (THQ) *Pauline Jones Nicola Jones *Vineeta Joshi *Dawn Joyce *Maria Katsarou *Mark Keegan Evonn Kennah *Siobhan Kerrigan *Shams Khan Jamie King Nadia Koriba *Arvind Kumar *Pauline Law Christina Barton Fai Lomas *Victoria Loftus Diane Lawrenson *Lucy Lyon *Sonia Macdiarmid Nisar Mahmood Tracey Williams *Vikas Malik *Philip Makin *Micky Malhotra *Tricia McDonnell *Siobhan Buckley

*Rob Nelson *Ursula McMahon *Carrie McManus *Linda Morton Sieu Ming Ng *Deborah Waywell *Silas Nicholls Chris Ellison *Jackie Ogden *Marius Paraoan *Mike Parks *Hitesh Patel Ellen Gandy *Sean Jackson *Louise Piscina *Joanne Wright *Gill Lyon Sheena Wright *Andrea Rostron Kim Barton *Angela Bibby *Peta Stross *Ram Sundar *Sarah Short *Vicky Bolton Helen Salvini *Cath Bridge *Clare Thomas Caroline Harrison

*David Evans Chris Broadbent Mruthunjaya Hulgur *Fiona Noden Janice Fellows *Kathryn Ashton *Pam Green Mary Fleming *Steve Izzat *Jane Dean Clare Magrath Carolyn Dereszkiewicz Farag El Habishi *Sharon Lythgoe *Emma Howarth Gillian Edwards Alex Chialton Gail Taylor *Janet Harter *Andy Savage Helen Wilding *Simone McCracken Geoff Conway *Emma Cooke *Joanne Grimes Gill Rowland Gemma White *Janice Cavadino

Fares Koussa Jane Davies *Sandra Newton *Laura Pickering *Ann Clayton Caroline Greenhalgh Nyuk Cho Lee Alam Imran Sadasivam Loganathan Rachel Fitzsimmons Paula Madden *Marie Malone Jacki Mansfield *Kohei Matsumoto *Alison McKenzie *Victoria McKinnell *Jayne Moakes *Michelle Murray *Jacob Oommen *Caroline Parry Baskaran Ranganathan Lynn Schofield Anne Sheen *Sarah Simm Nathan Sinclair Sandra Slater Booth

Carol Crook *Christine Swann Donna Talbot *Marie Cunliffe *Cheryl Dagnall *Janet Harter *Jackie Hylton Tracey Butler Ahmed Ismail *Chris Jackson Karen Jackson *Val Thorpe Deborah Travis Andrew Twist *Tara Broughton *Kim Whiteside *Angela Winterton Helen Titu Roland Turner *Alison Unsworth Donna Yates *Helen Hand Joanne Unsworth Kayleigh Webster Judith Whelan Ruth Wiggins *Diane Wilkinson *Jon Lenney

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60 Quality Champion Projects• Efficiency of Bone Bank Service• Customer Care focus in Estates• Frenulotomy Clinic for Babies• Breast Feeding of Premature Babies• Safeguarding12–16 yr olds in A&E• Immobile Patients with possible DVT• Preventing Dehydration in Nursing Homes• Ambulatory Assessment Discharge• Reducing Falls in Hospital• Training in Dysphagia Screening• Discharge of Vulnerable Adults• Communication on Rainbow Ward• Nutritional supplements in #NOF• Speedy Transfer to Side Rooms• Patient Weights• Reducing Harm From Urinary Catheters• Improving Appointment Letters• Reducing Deaths from Sepsis• Shared Decision Making in Maternity• Preventing Readmissions (Urology)• Improving Experience on Ward 5• Treating Infections in Newborn Babies• Improving Patient Information in ENT• Improving Experience in Audiology• Improving Hourly Rounding• Improving the Birth Environment• Improving patient satisfaction on one medical ward• Improving Discharge• Preventing repeat attendances at A&E• Increasing Patient Satisfaction with the bedside whiteboards

• Addressing Inpatient Stay for Stroke• Preparation of Patient Bed Spaces• Timely & Effective Discharge• Prevention of Periop Hypothermia• Improving Audiology Patient Pathway• Reducing NBM Medication Omissions• Improving Patient Worries & Concerns• Sustaining the Safer Surgery Checklist• Avoiding Readmissions in Oncology• Preventing Harm From Post Operative Delirium• Privacy & Dignity in Theatre• Nurse Led Discharge in Surgery• Preventing Falls• Rapid Discharge at End of Life• Improving Hydration• Reducing LoS in #NOF• Reducing Medication Omissions• Reducing Pressure Ulcers• Improving one stop clinic letters • Pain Management in ECC Majors• Musculoskeletal Checklist• Transportation of Blood Samples• MDT Intervention & Stroke Patients Dependence Levels• Cataract Patients’ Pathway• Preventing Respiratory Admissions from Care Homes• Improving Medical Handover• Prevention of Hospital Acquired Pneumonia• Back to Basics: Time to Care• Supporting Carers of Patients with Dementia• Safer Anaesthesia Outside of the Operating Theatre

Environment

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STAFF ENGAGEMENT

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Hard wired into our strategy

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2012 - Time for a change of gear

• Poor 2011 Staff Survey Results

• Need to meet economic challenge

• Invitation to join Listening Into Action

• Beginning of experimentation with Unipart

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Staff… 2012 2013

feel happy working in their area/team/department 54% 76%

feel involved in changes that affect their work area 33% 59%

feel senior managers encourage staff to suggest new ideas

32% 64%

feel day-to-day frustrations are quickly resolved 17% 51%

feel we communicate clearly about what we try to achieve

31% 64%

believe we provide the very best services to patients 40% 69%

are satisfied with how much the Trust values their work

20% 55%

feel proud to work in their area/team/department 61% 79%

understand the link between their role and the wider vision

47% 73%

feel communication from management is effective 22% 57%

The results – Staff impact

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Temporary Spend April 2012 – September 2013

The results – HR metrics

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• 5th out of 50 in NHS North Quality Dashboard

• 5th out of 50 in NHS North Performance Table

• 1st out of 23 in NHS NW A&E Performance Table

• Achieved Financial budget £4.1m surplus and

FRR 4 for third year in a row

• HSJ Award for Staff Engagement

Result – Organisational success 2013

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But that was only the start

• How do we

– Get from Good to Great?

– Understand Cause and Effect’

– Tailor to the needs of an individual department?

• Our experts produced an academic and

practical framework of culture analysis

and ‘repair’ tools

9 WWL Enablers of Engagement

Influence

Clarity

Work Relationships

Perceived Fairness

Recognition

Personal Development

Mindset

Resources

Trust

Staff Feel Engaged

Energy

Focus

Dedication

Staff Behave Engaged

Advocacy

Persistence

Discretionary Effort

Adaptability

Direct and Indirect Impacts on Patient

Care

In-role/extra-role performance

Turnover

Departmental/Divisional performance

Safety

Staff health and well-being

Absenteeism

Patient Satisfaction

How it works

A typical department

Wonderful Ward 524/06/2014 28/01/2015

• Big improvement• Some results doubled• Improved staff morale• Excellent team work• No complaints in 7 months• Positive comments from patients

“there is the feeling that caring for patients is always the priority and any concerns of staff are always listened to”

“excellent team work which has engaged the ward”

“I have had amazing support, not only from management but also everyone else involved”

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Our staff survey results

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Organisational results 2014/15

• Top 2% for People measures • Top 10% for Quality and Finance• Top 5% for Performance • 20 National Awards including

– HSJ Provider Trust of the Year– HSJ Patient Safety Award– HSJ Social Responsibility Award– HPMA Staff Engagement Award– HSJ/Nursing Times Best Place to Work in the NHS –

Runner-up

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What have I learnt?

• Chief Executives have few direct powers• But they do have their hands on big levers

– Recruitment of senior staff (setting the culture)– Choosing what to prioritise– Speaking for the Trust– Setting an example of management style

• Staff ‘alignment’; Quality is a unifying motivator• Staff are very values driven• Staff engagement releases huge discretionary

effort

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Any Questions ?

Slide Number 1The compassionate face of the NHSSlide Number 3Our journey to a culture of QualityQuality in WWL 2006Slide Number 6Consistent Quality values MRSA bacteraemiaClostridium DifficileUnadjusted deaths in HospitalUnadjusted deaths in HospitalAnd over 8 yearsSlide Number 13But we’re not as good as we want to beSlide Number 15We are still harming patientsWhere next? The 280 Quality Champions60 Quality Champion ProjectsSlide Number 20Hard wired into our strategy2012 - Time for a change of gearThe results – Staff impactThe results – HR metricsResult – Organisational success 2013But that was only the startHow it worksA typical departmentWonderful Ward 5Our staff survey resultsOrganisational results 2014/15What have I learnt?Slide Number 33