Leadership & culture in healthcare

Background on the NHS staff survey:The NHS staff survey has operated since 2003 and provides a rich source of comparative data and is recognised as one of the largest workforce surveys in the world. Last year over 630,000 colleagues took time to complete, fulfilling an aspiration of the survey that “we each have a voice that counts”.  The survey is abased around 111 questions, aggregating into 21 sub scores and 9 overall themes and responses are provided by all 215 NHS statutory provider organisations and around 50 other health care organisations.The questions include alignment to the Copenhagen Burnout Inventory and the Health and Safety Executive stress assessment and tools and have also aligned workforce disability and race equality standards into the survey and standardised analysis on the confidence of staff to raise concerns and be confident these are acted upon are derived from the answers.NHS England state there are four main purposes of the survey; 1) consistent survey, 2) ability to compare changes over time, 3) understand variation in staff experience and 4) drive improvement.  The first two are always fulfilled and latter two left entirely to the individual organisations to pursue.   Whilst employers must take primary responsibility to drive improvement in staff experience and support, local, regional and national regulatory/oversight architecture is not using this data forensically to aid them in their responsibilities.  Two areas standout as ripe for using the data effectively.Firstly our regulatory environment must be able to benefit from an evidence based analysis of the culture and views of staff in an organisation they are focusing on. Which inspector would not do their job well if they had analysis, broken down by staff groups cut into themes of safety, team working, compassionate leadership, diversity and inclusion etc.  A healthy working culture takes time to build up and is a good indication that our teams are able to provide great care to local residents.Secondly there is (rightly) a huge focus on health service productivity currently, but issues with productivity will not be solved unless you look under the bonnet. Alongside surveys such as the GMC training survey, we have an abundance of data to identify at team level, the dynamics that stop us being productive and report after report have concluded this will often be issues of leadership, culture, inclusion and safety.  So alongside data from the getting it right first time and the model hospital, why are we not getting into root causes of issues and publishing staff survey data to shine a light on what needs to change at organisational and team level? Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

Jane Tomkinson details the cohesive team that has been built of many years in Liverpool. This is built on:building relationshipsknowing the Trust inside outsingle purposecivilitySome key elements the team has learnt:develop values with staff communicate, communicate, communicateensure the values are visibly present and relevantfocus on the importance of appraisalsno one is more important than anyone elsenever revert to using your job title to make change and command peopleculture is not developed quicklydo not over promiseAt the Countess of Chester there is a huge re-building job to develop trust internally and with the public; ensure teams and services are resilience.  This will take time and must be built on developing trusting teams. Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

The podcast explores the “DCHS” way and how that has set a simple but effective framework for the values, expectations and behaviour within the organisation.Tracy describes how to create psychological safe teams, but teams that challenge themselves, especially with service user and patient views on hope well they are doing.The podcast hears from Tracy’s leadership style and personal impact and advice to people embarking on their leadership career.https://dchs.nhs.ukTwitter: @TracyAllenDCHS  Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

Midlands Partnership University NHS Foundation Trust mission is “Together we are making life better for our communities”. Working across the midlands, it provides physical and mental health services to local communities. The Trust has invested in quality improvement methodologies and competence focusing in small changes - learnt from the Virginia Mason model. Neil has invested much of his time developing a committed, cohesive and established leadership team that devolves responsibility and support to service areas.  The organisation has appointed managing directors for specifics services areas, that lead interesting portfolio of specialist and local services. The ethos has been built on using data well, getting the basics right and learning from best practice. https://www.mpft.nhs.ukTwitter: @NeilCarrNPFT   Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

The Combined Trust has been the professional home for Buki, over 25 years - as an older age psychiatrist and now chief executive.The leadership team were fed up with standards below what was acceptable and poor staff survey results, Combined started on a ‘listening project’; listened to their people and made changes.  This has led to an ongoing engagement culture and approach hard wired with specific levers and understanding how great teams work.Buki explains how they did this, what has changed and gives insight into her leadership approach. Twitter: @combinedNHSwww.Combined.nhs.uk  Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

Trust co-produced simple value statements that all could understand and live at work.  This approach started with a new leadership team facing huge financial challenges.  The Solent approach focused on building leadership capability; quality improvement capacity and knowledge; honest conversations about what was going well/not so well; a visible leadership that celebrated great care with staff.Key components of the Trust wide culture are accountability; engagement with all staff; clear reporting on things that go wrong and ensuing all leaders are accessible and listen. Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

Pulling from the evidence base and experience of experts, such as Michael West, Anita plots the changes made in Cambridgeshire Community Services NHS Trust.  A simple narrative and approach starts with engaging and listening to staff; simplifying how the organisation operates;  reducing tiers of management; simply objective setting process and develop a positive and supportive culture.Cambridgeshire Community Services NHS Trust Is also the Trust that is led by the podcast host, Matthew Winn - hence Anita, as deputy chief executive is talking about the culture and leadership in the organisation. https://www.cambscommunityservices.nhs.ukTwitter: @pisanianitaLinkedIn: Anita Pisani Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

The new Chair of the Trust challenged the executive to improve the culture and ways of working that properly engaged staff on the back of a succession of poor staff survey results.The team used the leadership into action methodology; created an internal improvement academy; engaged; listed; acted; be honest when things go wrong and developed a vibrant leadership culture.Poor behaviour was tackled and a set of shared and owned values implemented.Hal shares how he developed as a leader and sustains his approach.  Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

Graham has an unusually route to becoming a healthcare CEO - via the retail and charity sectors into the NHS becoming a finance director and support of a great to CEO to mentor and encourage him in his career. Surrey and Borders Partnership NHS Foundation Trust was formed from three mental health organisations - the culture puts kindness, curiosity and inquisitiveness at its core.Balance is always to test things out and push the boundaries and avoid the orgnaisation stifling invocation. We need to encourage testing a new approaches, that ensure when things go wrong will have low consequences. Role modelling by executive teams is crucial and leadership development, backed up by QI methodology is key. Being a CEO is highly personal - getting it right for our local residents and patients is the main reason to do the job.https://www.sabp.nhs.ukTwitter: graham_warehamLinkedin: https://www.linkedin.com/in/graham-wareham-b15ba113?utm_source=share&utm_campaign=share_via&utm_content=profile&utm_medium=ios_app  Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

Having spent 34 years in the NHS, starting in nursing role, moving into clinical leadership and then managerial role, Mairead became the chief executive of Kent community trust 18 months ago.  Although inheriting a stable and well run organisation, there was still much to do and improve.with a focus on data and staff engagement/involvement, Kent community are making chnages to their culture and the way care is delivered. Listening events, staff forums and a drive for compassion leadership and teams has seen turnover rates improve. Mairead Discusses her leadership style, who has inspired her, an approach to continually learn and be challenged to improve.Kent Community Health NHS Foundation Trusttwitter: NHSKentCHFTLinkedIn: http://linkedin.com/in/mairead-mccormick-209a4680 Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

Formed in 2001 in bringing together mental health and physical health services and staff, the Trust has developed and flourished.  There has been continuity and stability in leadership meaning that long term planning and purpose is clear within the organisation. Taking over as CEO in 2011, Julian has focused on accountability, building trust and developing/maintaining a healthy work place culture.With challenge from non-executive directors in 2012 the executive team embarked on involving staff, getting the basics right and responding to what staff were saying needed changing/developing.Since this point many initiatives and approaches have  improved quality, staff involvement, leadership and driven increasing amount of innovation.Julian described his career starting in the probation sector and his impact as a leader And the increasing need to look at solutions in other industries that we can adapt into healthcare.https://www.berkshirehealthcare.nhs.uk  Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

After starting her professional life as a scientist, Birju has spent 21 years at Northumbria FT in various roles and within the last year has been appointed permanent chief executive.The Trust has a long pedigree in leadership development, manager and clinicians working as a single team, values based recruitment, and involving/engaging staff with real time data.Describing her development and support she has received over the years, Birju describes her passion and mission to lead the organisation into the next 10 years - firmly focused on the needs of local residents, their staff and partnerships with local authorities and other health care providers.Twitter: @BirjuBartoliLinkedIn: http://linkedin.com/in/birju-bartoli-02291a107www.Northumbria.nhs.uk Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

Michael West is a Professor of organisational psychology and a senior fellow at the Kings Fund. In the podcast Michael discusses how the NHS staff survey is the longest running staff survey worldwide across all sectors. Designed in 2003, it has 20 years of data and feedback from 600K people per year. The evidence shows the best predictor of NHS organisational performance is staff engagement - specifically the involvement of staff in decision making (also predicts performance, quality and financial outcomes). Inclusive and supportive staff leadership is one of the most important factors, where leaders listen and are empathetic.Michael discusses the themes of an appreciative culture; the fundamental importance of team working and the data showing staff workload and burnout being the biggest negative factors and predictor of good  patient outcomes.  The importance of using staff survey data intelligently is shown that if you want to understand what will be happening in an individual organisation in the near further - look at engagement; burnout and team working scores. They will predict what outcomes are going to be achieved.Summarising the themes from the series one episodes with NHS chief executives, Matthew and Michael, discussed how good organisations have a clear DNA - based around vision; values; totally linked into objectives and priorities for all. Leaders must be present - not just visible -don't have an agenda and make sure you Listen with fascination. This has a ripple effect as others will mirror this approach.Michale ends the episode with a reflection that leadership is not a cloak you put on —its authenticity; humility to learn; nurturing our capacity to empathise; compassion is thought; lean into the difficult; being compassionate helps others and helps ourselves; be self compassionate and support others.The summary of conversations with CEOs can be found here: https://www.linkedin.com/posts/matthew-winn-b750b67a_leadershipandcultureinhealthcare-activity-7201477667332726784-4BzQ?utm_source=share&utm_medium=member_ios Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

What do the leaders of national organisations do to support great culture and leadership in health care delivery? This series sets out to understand more. Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

Henrietta discusses how she works across regulatory and accountable organisations to promote patient safety by putting patients first, as well as the importance of listening to patients’ views.During the episode Henrietta discussed people who have inspired her; the roles she has undertaken that have prepared her for this role and the impact she is/will be making in safety of patients. https://www.patientsafetycommissioner.org.uk/ Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

Purpose of the CQC is register health and care providers (50% private and 50% independent providers); provide public assurance through inspection and promote improvements in care. Much of the statutory role is about compliance against the 34 quality statements, but increasingly the CQC are conveners, using their insight and data.The organisation has a wealth of data and developed greater data processing and insight capability over the past five years.The high level themes about care and health and bright into the ‘state of care’ reports that shines a light on particular aspects of the health and care sectors.Increasingly over the past five years, Ian has led the organisation to be proactive, using the emerging concerns protocol , that brings national organisations together to tackle and support providers that have quality and leadership issues.Ian describes his leadership roles across many sectors, his leadership style and hopes for the future. Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

Following careers in provider leadership and the Care Quality Commission, Andrea has led the NMC for the past five and half years. As the regulatory body for nurses and midwives, there are 848,000 on the professional register.The NMC protects the public through the standards of registering professional to have a licence to practice; regulates the standards of professional education to terrain our clinicians and quality assures the programmes that are provided in educational institutions. The organisation has changed alto of the past 5 years - 20% of the register are people that trained outside of the UK; users and professionals are involved as a critical eye and friend in how the organisation works and the use of data/insights is far more prevalent. By far the largest number of referrals received about clinicians are from the general public, not employers. The NMC has worked hard to ensure they are able to advise and support employees, not be the first reaction to something that could have gone wrong for a registrant. Andrea described the hard road in making cultural change in any organisation, including the NMC and reflects on her personal impact as a leader.She leaves the organisation with unfinished business due to her needing urgent and pressing treatment from the NHS that will take some time to recover from. We all wish Andrea well in her recovery. Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

The General Medical Council is an independent regulator, established in Statute. Charlie has been its leader for seven years. It keeps the register of practicing professionals; undertakes fitness practice assessments; sets training and education requirements for medical schools and increasingly supports organisations to proactive support Drs in employment.Data and insight is a key plank of the organisational approach. using the national trainee survey it has detailed information of organisations supporting trainees at departmental level. Strategically it is becoming more important to be sharing that information with other national regulators, to enable better insight and drive targeted action. There are now higher numbers of doctors coming onto the register who were trained outside of the UK, than trained in the country and this has meant the GMC has had to adapt to this reality. They have also developed support for employers on caring and supporting for those who were trained outside the UK to ensure their assimilation and transition into UK healthcare is successful and that cultural and non UK training issues do not drive referrals into the fitness to practice process. Charlie describes what keeps him resilient as a leader. Learning and depending on a team is crucial; balance in work and home life; regular exercise with dogs and competitive table tennis to keep him sharp! Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

The office of the National Guardian was set up following the recommendation of Robert Francis in his seminal review work. The National Guardian and the office covers England and is hosted within the Care Quality Commission. It has/continues to develop processes and cultural improvement to support people speak up about care and quality in healthcare organisations. There are over 1000 guardians country wide with nearly every type of organisation possessing a NHS contract having a guardian in their fold or access to joint guardian arrangements.Feedback from people who have spoken up or who would have wanted to is that there is fear; concern about individual detriment and a sense of futility - what will actually change and therefor what is the point?A role of the National Guardian is to speak truth to power and shine a light in areas where staff and data say there are problems - such as the recent report into the culture in ambulance providers. Looking forward Jayne is eager that culture within organisations is viewed as important as finance or performance dynamics. As more sectors embrace the Guardian approach (police/fire) there is an opportunity to embed this speaking up culture throughout the public sector and ensure we avoid the silences that incur in far too many places. Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

The five podcasts in series 2 has given an insight into national leaders and their organisations. The episode is a summary of the themes coming out of these conversations and Matthew’s thoughts on what are the main challenges for national regularly body’s looking forward. Matthew Winn, podcast host and an experienced leader in healthcare in the UK.