national case study engaging and empowering staff for ... · waiting times, reducing length of stay...

National Case Study

Engaging and empowering staff for better patient outcomes

Breaking paradigms, creating ambition, raising the bar

@ Optimise Limited - all rights reserved

“LiA is a powerful force for cultural change” says Chief Executive, Alwen Williams

“We know that to be compassionate to our patients, we need to be compassionate to our staff.

Following a period of significant change at Barts Health NHS Trust, I joined as Chief Executive in June 2015 and decided to adopt Listening into Action (LiA) as themain vehicle to engage staff on a widespread basis around changes that matter to patients and to themselves. This links directly to our ‘Safe and Compassionate’improvement plan, and is all about making demonstrable improvements to patient care while, at the same time, unblocking the way for staff so they can get onand do their jobs.

Barts Health is one of the biggest NHS Trusts in the country with around 16,000 staff, so getting traction around a fundamental shift in ways of working andleading is no small challenge. And yet the results and impact we have seen within even the first 10 months speak for themselves. As a new way of working whichcentres on engaging with staff, listening to staff, and empowering our frontline clinical teams to work together across all of our sites to bring aboutimprovements in patient care, the difference that LiA is making is clear.

Being on this journey is helping to galvanise and connect leaders across all of our sites, especially as we work together on linking the engagement effort to themost important aspects of patient care. At the outset, more than 2000 staff were involved in an initial round of catalysing LiA Big Conversations which Ipersonally led, to talk about what gets in their way and to surface great ideas for action. This is driving change at all levels to ‘unblock the way’ for our staff.

At the same time, we mobilised 40 clinical teams who pioneered adoption of the LiA 7 Steps over an initial 20 weeks to improve patient care in their own areas.This has led to a wealth of stories and outcomes such as a one stop breast clinic, improvements in Cardiology services, cutting waiting times in Trauma andOrthopaedics, and halving the number of unstable patients admitted to our Observation Unit to reduce cardiac arrests. The stories and outcomes from the first40 teams has quickly ‘fuelled’ the spread to 80 more, and we will be picking up the pace over the next few months.

In terms of staff, our LiA Pulse Check - completed by almost 3000 staff in September and then again in May - shows an unprecedented


improvement in how engaged and valued people feel. Our results are up on all 15 questions.

And this is just the beginning! I am very confident that we will continue to make significant improvements to the quality of services wedeliver to our patients here at Barts Health. But we will only achieve that through the dedication and commitment of all our staff. LiA isa powerful force for cultural change.”

“LiA has been a transformative experience at Barts Health”


Professor Charles Knight, Consultant Cardiologist and Managing Director, St Bartholomew's Hospital

“LiA has been a transformative experience at St Bartholomew’s. We’ve seen real results for patients being delivered – halving outpatient waiting times, reducing length of stay and surgical infections, and the development of patient welcome packs amongst many other examples. At the same time, staff experience has objectively improved and morale boosted. We’re excited about the LiA journey ahead!”

Denise McEneaney, Head of Midwifery, Whipps Cross Hospital

“LiA feels more like a movement than a strategy. I almost spontaneously clapped recently listening to some staff explain to colleagues how the planned improvement they were about to start was about making positive changes together, no ‘just moaning’ allowed and how they needed to include senior and junior staff and service users together. I didn’t have to say much except that I would support the team.”

Tim Peachey, Consultant in Anaesthesia and Deputy Chief Executive

“For me the most obvious benefit arising from the LiA approach is the change in culture in the organisation where staff now enjoy being involved in improvement activities, celebrate their achievements and spread their message with pride. Our workforce is now much more engaged and determined to succeed.”

Tom Smith, Intensive Care and Anaesthetics Consultant

“Staff now recognise that before they felt frustrated, they were worried about patients on their ward, they didn’t know how to access help or what extra resources were available to them, and through LiA they’re now seeing that their voice is being heard - that we’ve changed the way we respond – and we’ve listened to their concerns.”

Lee Parker, Consultant Orthopaedic Foot and Ankle Surgeon

“Patients are happier, there are fewer complaints and we spend less time on the phone explaining to patients what the inefficiencies are and answering complaints. Patients are seen quicker, my surgical conversion rate is higher, there are fewer patients out in the community waiting for appointments, and the clinic staff are happier as well.“

Zaliwe Chabala, Service Manager for Trauma and Orthopaedics

“Clinic turnaround time has improved, our patients are much happier, and our clinicians are much happier as well.”

Matt Guinane, Consultant Gastroenterologist

“One of the things about adopting it as a culture and a methodology for delivering change is that it keeps us all focused on the simplicity of what is required to deliver change. The challenge for us all is to have this embedded as the fundamental way we go about doing things and how we change things in this hospital and in Barts Health as a whole.”

Michael Pantlin, Director of Human Resources, Barts Health

“For the first time we have found a key to unlock widespread staff-led change across our large and diverse organisation. The energy, pace and engagement has led to a growing sense of ownership for improvements at all levels towards issues which really matter to staff and patients.”

Sebastian Dawson-Bowling, Consultant Orthopaedic Surgeon

“One of the things that Listening into Action allowed us to do is to formalise a structure of better communication channels between the teams across the different sites and to break down those artificial barriers that we have traditionally had between the different teams. People understand that really there is one mission in terms of the type of patient care we’re looking to provide."

Lucy Morrissey, General Manager

“As a manager, I know it’s really important to listen to staff’s views. In the hospital setting we have a range of different professionals, all of whom bring a different perspective on the patient pathway. We’ve been able to use LiA as a framework to really understand staff’s views and how we can improve the patient pathway.”

Darren Barnes, Senior Cardiology Nurse, St Bartholomew’s Hospital

“Listening into Action really does what it says on the tin. It has allowed us as leaders to listen to frontline staff of all disciplines about what needs unblocking in the organisation and gives staff permission and courage to make changes and improvements. By sustaining and spreading this new way of working, the future at St Bartholomew’s Hospital is looking increasingly better for our staff and our patients.”

Helen Byrne, Director of Operations, Whipps Cross Hospital

“There has been excellent clinical involvement so I think loads of positives from our LiA opportunity. We have embraced the concept and the tools and it’s working really well.”

“For the first time we have found a key to unlock widespread staff-led change”


Some of our stories have already been published nationally in ‘The Best Medicine: 100 Powerful Stories of Staff-Led Change from the 5th Biggest Employer in the World’


http://www.listeningintoaction.co.uk/

Better for organisationBetter for staffBetter for patients

Delivering demonstrably better outcomes for our patients, staff and our Trust (here are just a few examples from many)

160 days harm free care on surgical wards with ‘I want great care’ scores up from

60% to over 90%

Increased early morning discharges and 50%

reduction in length of stay for complex patients in

specialist medicine

Every Cardiology and Surgical patient seen every

day by a consultant, reducing length of stay by

1.5 days

40% reduction in Surgical Site Infection rates with a

follow-up Wound Clinic run by Band 4 Healthcare

Worker

7 day Pharmacy service in Oncology means patients get home faster, reducing

length of stay by 1 day

Halving number of unstable patients admitted to Observation Unit means

fewer cardiac arrests

Cystic fibrosis patients –often teenagers – given ID

cards so they can come and go freely from the ward

‘One stop’ Breast Service up and running with

significant involvement from patients to get it right

Cardiology Day Care Team show the biggest national improvement ever in their

LiA Team Pulse Check –100% feeling valued!

LiA Conversations in wards, clinics, theatres, teams engage teams around

making changes together

Vacancy rate down from over 50% last year to 16%

this year

New Junior Doctors’ Forum for training and quality

improvement work

New Grand Rounds –consultant-led junior

doctor scenario-based teaching sessions

98% of medical records now available at Outpatient clinics

Intensive care nursing team Top 3 in Nursing Times Award for ‘Best Student

Placement’

New Doctors’ Mess for rest and relaxation makes

everyone feel more valued

Estates leading lots of small changes that make a big

difference - heating adjustment, toilet painted,

new carpet…

5 minute ‘plan the day’ huddles for student and mentors in Theatres and

Sycamore Ward

‘Request to Recruit’ approval down to 3 days and 40% jobs now filled from our own workforce

through ‘Grow Your Own’

120 LiA Clinical Teams follow LiA 7 Magical Steps

to improve patient care within 20 weeks

Patient clothing cupboard sponsored by M&S means

emergency pathway patients have clothes to go

home in

Outpatient waiting times halved in Cardiomyopathy

100+ days with no pressure ulcers based on staff and patients’ ‘Tree of Ideas’

Feeling a shift – working ‘the LiA way’ is starting to

bring our values to life

50% reduction in Theatre cancellations for non-

clinical reasons

60 wasted time slots saved per week as Trauma and

Orthopaedic specialty slots allocated to the right

patient

Barts Cancer Centre becomes first London

Hospital to win Macmillan Environmental Award

Expansion of the Patient Forum enables widespread

engagement in the co-design of our services

STOP PRESS! Trust-wide LiA Pulse Check – huge shift in improving staff experience #NHSBartsHealth across all

15 questions

LiA locked in with ‘Safe and Compassionate’

Improvement Plan

Managing Director breaks contract to remove fees

from local cash machine in one of poorest boroughs in

London

Visible leadership - senior leaders in front of staff in a way they have never been before, leading 28 LiA Big

Conversations so far

More than 2000 of our staff help to shape change

at our LiA Big Conversations

More than 40 LiA Clinical Teams impact patient care and inspire others within

20 weeks

Rotation set up between Theatres, Neurosciences and Paediatrics to enable

retention of staff – inspired by staff


Making our Transport services better for patients and staff through a revised

contract

A transformational shift in staff morale and motivation is already evidenced in our LiA Pulse Check®2015-2016

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Sept 2015 49% 37% 36% 21% 32% 50% 41% 42% 58% 27% 52% 50% 27% 28% 33%

May 2016 58% 48% 45% 29% 41% 59% 49% 52% 63% 37% 61% 56% 37% 34% 41%

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LiA Pulse Check® Questions

LiA Pulse Check® Results – Barts Health (weighted average)*

Sept 2015 May 2016Notes:Responses: 2934 in 2015, 2883 in 2016

@ Optimise Limited All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner. LiA Pulse Check® and results for use by NHS Trusts and organisations under license only

9%1. I feel happy and supported

working in my team/department/service

+

2. Our organisational culture encourages me to contribute

to changes that affect my team/department/service

11%+

3. Managers and leaders seek my views about how we

can improve our services9%+

4. Day-to-day issues and frustrations that get in our way are quickly identified

and resolved

8%+

5. I feel that our organisation communicates clearly with

staff about its priorities and goals

9%+

9%6. I believe we are providing

high quality services to our patients/service users

+

7. I feel valued for the contribution I make and the

work I do8%+

8. I would recommend our Trust to my family and

friends10%+

9. I understand how my role contributes to the wider

organisational vision5%+

10. Communication between senior management and staff

is effective10%+

11. I feel that the quality and safety of patient care is our

organisation's top priority

12. I feel able to prioritise patient care over other work

13. Our organisational structures and processes

support and enable me to do my job well

14. Our work environment, facilities and systems enable

me to do my job well

15. This organisation supports me to develop and

grow in my role

9%+

6%

10%+

6%+

6%+

+

Responses: 2934 in 2015, 2883 in 2016


A transformational shift in staff morale and motivation is already evidenced in our LiA Pulse Check® 2015-2016 - percentage point shifts

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Sept 2015 49% 40% 39% 22% 34% 56% 41% 45% 58% 34% 56% 54% 31% 33% 35%

May 2016 55% 48% 45% 26% 41% 63% 46% 54% 59% 37% 60% 51% 35% 36% 38%

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LiA Pulse Check® questions

LiA Pulse Check® Results 2015-16St Bartholomew's Hospital

Sept 2015 May 2016Responses: 853 in 2015, 594 in 2016


A transformational shift in staff morale and motivation is already evidenced in our LiA Pulse Check® 2015-2016 - St Bartholomew’s Hospital results

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Sept 2015 54% 40% 36% 30% 35% 56% 45% 47% 60% 31% 57% 61% 36% 36% 41%

May 2016 62% 54% 44% 36% 47% 67% 54% 54% 68% 47% 66% 70% 48% 45% 48%

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LiA Pulse Check® Results 2015-16Newham University Hospital



A transformational shift in staff morale and motivation is already evidenced in our LiA Pulse Check® 2015-2016 - Newham University Hospital results

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Sept 2015 49% 34% 35% 16% 29% 48% 39% 40% 55% 22% 45% 46% 21% 23% 29%

May 2016 52% 42% 42% 25% 31% 55% 48% 49% 59% 28% 57% 52% 27% 25% 31%

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LiA Pulse Check® Results 2015-16Royal London and Mile End Hospitals



A transformational shift in staff morale and motivation is already evidenced in our LiA Pulse Check® 2015-2016 - Royal London and Mile End Hospitals results

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Sept 2015 49% 38% 35% 20% 33% 47% 43% 39% 60% 27% 53% 51% 29% 25% 34%

May 2016 60% 46% 45% 31% 41% 56% 50% 51% 63% 38% 62% 55% 37% 33% 41%

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LiA Pulse Check® Results 2015-16Whipps Cross University Hospital



A transformational shift in staff morale and motivation is already evidenced in our LiA Pulse Check® 2015-2016 - Whipps Cross University Hospital results

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Sept 2015 44% 29% 38% 18% 22% 32% 37% 32% 62% 15% 51% 24% 16% 9% 24%

May 2016 59% 48% 50% 26% 42% 52% 47% 50% 69% 34% 60% 47% 34% 30% 44%

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LiA Pulse Check® Results 2015-16Corporate Teams



A transformational shift in staff morale and motivation is already evidenced in our LiA Pulse Check® 2015-2016 - Corporate Teams results

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Trust 2015 54% 40% 36% 30% 35% 56% 45% 47% 60% 31% 57% 61% 36% 36% 41%

CDCT Team 2016 94% 78% 83% 78% 78% 100% 100% 94% 94% 100% 94% 94% 78% 83% 83%

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LiA Pulse Check questions

LiA Pulse Check® ResultsCardiology Day Care Team, St Bartholomew’s Hospital

Trust 2015 CDCT Team 2016Responses: 20Followed full 20 week cycle following LiA 7 Steps


A transformational shift in staff morale and motivation is already evidenced in our LiA Pulse Check® 2015-2016 – example to show the impact on a team vs Trust baseline

Building leadership capacity and capability to ‘change the way we do change‘ – LiA Leadership Scorecard results have already shifted from ‘mostly red’ to ‘mostly blue or green’ within the first 10 months

@ Optimise Limited All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner

Barts Health NHS Trust - Leadership Scorecard September 2015 (65 responses) Respondents: Leadership Teamcross all sites

1 = Strongly Disagree; 2 = Disagree; 3 = Neutral; 4 = Agree; 5 = Strongly Agree

Navigation 1 2 3 4 5 Total

1 Different change initiatives are integrated in the minds of management 3.0

2 Different change initiatives are integrated in the minds of employees 2.4

3 Management prioritises the use of resources 2.9

4 Change initiatives work together (left hand knows what the right hand is doing) 2.0

5 Costs and benefits of all projects are managed as a whole 2.3

12.6

Leadership 1 2 3 4 5 Total

1 Serve as effective role models for desired behaviour 3.2

2 Are strong sponsors of change 3.4

3 Hold managers and supervisors accountable for contribution to successful change 3.0

4 Provide coaching and counselling related to change leadership 2.5

5 Effectively communicate about change (reasons for, benefits, strategies) 2.8

14.9

Ownership - People affected by change: 1 2 3 4 5 Total

1 Are involved in the process in a meaningful way 2.5

2 Believe their ideas and concerns are being heard and responded to 2.5

3 Understand the need for change 3.0

4 Believe the change is positive for the organisation 3.0

5 Receive effective communication (timely, relevant, honest) 2.7

13.7

Enablement 1 2 3 4 5 Total

1 Organisational processes are redesigned to eliminate non-value added activities 2.2

2 Organisation structures are designed to fit future needs 2.9

3 Competencies for the 'new' organisation are being identified 2.8

4 Training supports new skill and behavioural requirements 2.6

5 Performance management and reward systems are redesigned to fit the new organisation 2.3

12.8

Barts Health NHS Trust - Leadership Scorecard September 2016 (156 responses) Respondents: Leadership Teamcross all sites

1 = Strongly Disagree; 2 = Disagree; 3 = Neutral; 4 = Agree; 5 = Strongly Agree

Navigation 1 2 3 4 5 Total

1 Different change initiatives are integrated in the minds of management 3.5

2 Different change initiatives are integrated in the minds of employees 2.6

3 Management prioritises the use of resources 3.2

4 Change initiatives work together (left hand knows what the right hand is doing) 2.6

5 Costs and benefits of all projects are managed as a whole 2.7

14.6

Leadership 1 2 3 4 5 Total

1 Serve as effective role models for desired behaviour 3.6

2 Are strong sponsors of change 3.7

3 Hold managers and supervisors accountable for contribution to successful change 3.5

4 Provide coaching and counselling related to change leadership 2.9

5 Effectively communicate about change (reasons for, benefits, strategies) 3.1

16.8

Ownership - People affected by change: 1 2 3 4 5 Total

1 Are involved in the process in a meaningful way 3.1

2 Believe their ideas and concerns are being heard and responded to 2.9

3 Understand the need for change 3.3

4 Believe the change is positive for the organisation 3.3

5 Receive effective communication (timely, relevant, honest) 3.0

15.6

Enablement 1 2 3 4 5 Total

1 Organisational processes are redesigned to eliminate non-value added activities 2.8

2 Organisation structures are designed to fit future needs 3.0

3 Competencies for the 'new' organisation are being identified 3.0

4 Training supports new skill and behavioural requirements 3.0

5 Performance management and reward systems are redesigned to fit the new organisation 2.7

14.5

For more information about Listening into Action (LiA)

Hannah ForbesFounding Director of Optimise Limited and joint architect of Listening into Action (LiA)®

[email protected] 812644

Gordon ForbesFounding Director of Optimise Limited and joint architect of Listening into Action (LiA)®

[email protected] 812311

Quotes from LiA Trusts

“A powerful force for cultural change”Alwen Williams, CEO at Barts Health NHS Trust

“Our staff feel energised and empowered by the LiA approach”Judith Graham, Queen’s Nurse and Advanced Nurse Consultant

“This is real staff engagement. It feels different. It feels punchy. It feels great.”Dr Esther Waterhouse, Consultant in Palliative Medicine

“The LiA ‘Pass It On’ events have the best days in my NHS career” John Goulston, CEO at Croydon Health Services

“LiA is clever in its simplicity. Follow the formula, involve everyone, share your successes and enjoy the culture shift. What’s not to like?”

Tom Johnson, Radiologist

“LiA is helping us to make significant improvements for patients and staff at Europe’s oldest hospital”

Charles Knight, Consultant Cardiologist and Managing Director of St Bartholomew’s Hospital

“LiA really has developed me into the person and the nurse I am today” Sarah Watkins, Ward Sister

“Magic Dust”John Adler, first NHS CEO to adopt Listening into Action (LiA)®


mailto:[email protected]

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