Croydon Health Services NHS Trust has become the first NHS Trust in the country to be awarded the Listening into Action Kite-Mark for its commitment to the engagement and empowerment of its staff.
The announcement of the accreditation for 2015 is in recognition of the significant and sustained progress in how staff feels working at the Trust and the positive impact this has had on the quality and safety of care in South West London.
Under CEO - John Goulston - and his team, the Trust is now entering its third year of commitment to LiA, a new way of working in the NHS that puts frontline staff at the centre of improvements around the quality and safety of patient care and the patient experience. LiA is fast becoming ‘the way things are done around here,’ making Croydon a better place to work for its staff.
Accreditation is recognised and awarded based on five specific criteria that must be met before the kite-mark is given:
- There must have been a demonstrable shift in the leadership and culture at the Trust, led by the CEO’s personal commitment and role-modelling to the evidence-based, radical but proven, change approach
- Staff feedback in the annual National Staff Survey and the LiA Pulse Check must show a sustained improvement, year-on-year, in staff morale and motivation
- There must be a plethora of patient improvements, evidenced in published accounts of better outcomes for patients around the quality and safety of care, and the patient experience
- External recognition of the impact LiA has had at the Trust must be clear and a matter of public record
- The Trust must have followed the LiA process in all material parts during the course of the year LiA was adopted.
As the first NHS Trust to extend its involvement in the LiA network to year 3, John Goulston recognises that the shift in culture required to sustain and embed LiA in the Service won’t happen in just 12 months. Instead it requires a continual focus from the CEO and the senior team to challenge existing conventions - and a mind-set of ‘but we’ve always done it that way’ - to deliver new solutions to old problems. That commitment starts with the Executive Leadership team and the CEO, leading by example. The evidence of this shift at CHS is clear below.
CHS LiA results and Impact: staff
National Staff Survey results have improved from 2012 when CHS first adopted LiA. In 2011-2012, Trust staff responses to the Picker Institute’s 38 Key Findings around the NHS Constitution put CHS in the bottom quartile of performers in the acute sector by some distance. Within two years, the NSS results have been transformed and in 2013-2014, CHS was 54th out of 141 Acute Trusts on the league table for staff engagement in NHS England. In 2014-2015, although the trend is down slightly, CHS still ranks 60th out of 135 Acute Trusts for their results.
In terms of LiA Pulse Check results, CHS staff has confirmed how much better things are working at the Trust today from where they were in 2011-2012:
- Our organisational culture encourages me to contribute to changes that affect my team/department/service (up 14%)
- Managers and leaders seek my views about how we can improve our services (up 15%)
- I believe we are providing high quality services to our patients/service users (up 23%)
- I feel valued for the contribution I make and the work I do (up 27%)
- Communication between senior management and staff is effective (up 13%).
This positive shift is given more credence by some encouraging workforce trends: a 2% reduction in staff turnover from 2011/2012 to December 2014, and a 0.34% reduction in Trust wide sickness levels for the same period. The Trust is witnessing more interview candidates keen to learn ‘the LiA way’, and there is increasing buy-in from union representatives and managers to LiA as a key approach to improving the work environment for staff.
All great positive change for staff.
CHS LiA results and Impact: patients
But ultimately, this feel-good factor for staff – under the mantra of happy staff, happy patients – needs to translate into demonstrable, measurable, visible improvements for patients.
The evidence from CHS is over-whelming:
- Knowing How We are Doing (KHWD) scorecards – based on the 5 CQC patient-centric care domains of safe, caring, responsive, well-led and effective – with current performance are published monthly so staff can see how they are doing at ward level, transforming transparency for patients and providing a focus for weekly ward team meetings
- A Multi-agency Pressure Ulcer LiA taskforce team delivered a 40% reduction in all pressure ulcers within 3 months, with a 55% reduction in PUs in nursing homes and a 13% reduction in grade 3 PUs over the period
- New ways of working in Outpatient departments has resulted in greater availability and accessibility of patient records/notes, positively impacting time spent with patients, less churn at the reception desk, better patient information in a timely fashion, and text/voicemail reminder service for patients TCI: this has seen a 3-4% reduction in DNAs over the period, a 12.0% improvement over the 3 months period ending 31/12/14 to 82% in the Outpatients’ Friends and Family Test scores, and the improved availability of patient notes 24/48 hours before the clinic
- Transformation of patient discharge process under the ‘Home for Lunch’ LiA team and the LiA Discharge Medication Team: 94% prescriptions for TTOs are written the day before EDD on the LiA ward, with meds now with patients by 10am on the day. This together with other LiA work on discharges has led to a 50% increase in the number of patients able to go home by lunchtime
- A new process of every complainant being assigned a named co-ordinator has seen a 17% ‘like-for-like’ reduction in patient complaints from 2013 to 2014
- Creation of the first Dementia Friendly Zone in an A&E department in the UK
- Introduction of a ‘Pass It On Card’ to improve the referral process for patients leaving hospital and continuing their care in the community.
The patient environment at CHS has also been transformed with a whole slew of refurbishments and estates fixes to improve the patient experience, a source of many patient complaints over the years.
Patients are not only benefitting from staff working the LiA way; they are also being given the opportunity to influence the service they received, with the Trust using LiA in December 2014 to invite patients living with cancer to share their experiences about the service they received to ensure it is centred around them going forward. More patient-LiA events are planned for the year ahead.
CHS LiA results and Impact: Trust Performance
All of these schemes have contributed to an improving financial situation at the Trust. CQUIN income received from LiA improvements totalled £610,000 in 2014 and more than £1,000,000 has been saved from discharge delay improvements.
The Trust’s leadership commitment to maintaining LiA is clear from their commitment to visible Wednesdays, a CHS-wide movement to provoke a step-change in how senior leaders engage and interact with staff, being more visible, accessible and supportive to staff across the Trust on a weekly basis. This level of commitment to ‘getting out of our Exec Suite and from behind computer screens’ has been recognised by external agencies. As one the first NHS Trusts to undergo the new CQC Inspection regime in late 2013, the inspection team recognised the extent to which the working environment and culture was shifting due to the leadership team’s efforts:
‘Patients, staff and stakeholders had many positive messages for us about the improvements that are happening and how this is leading to changes in the care and treatment given to patients. We were told how the Chief Executive and his senior managers are accessible and open,’
‘The main approach to improvement is called ‘Listening into Action’. This is where groups of staff come together to identify how services can improve. This is proving to be very successful. This has already led to lots of “quick win” initiatives which are improving the delivery of services. Staff said how they can see the changes happening and welcome being part of this process,’
‘We noticed a very positive atmosphere in the trust. Staff said how much they enjoyed working there. Junior doctors and student nurses told us that they had been made very welcome and would like to work at the trust in the future.’
What Accreditation means for CHS
In accrediting CHS, we hope that it will inspire John and his team to ‘raise the bar’ in the year ahead and that the tipping point is reached so there is ‘no going back’. Everyone at the Trust has their part to play in this for staff engagement and empowerment is not the domain of a ‘staff engagement manager’, but everyone’s day job with responsibility for staff. Staff engagement is not ‘the soft stuff,’ it’s what delivers ‘the hard stuff’ around quality and safety of care, improving the patient experience, and about frontline teams and their support colleagues working smarter together.
CHS has proved this over the past two years and deserve their recognition. Congratulations to all involved in this sustained improvement in culture and leadership at Croydon.
Our hope in awarding the kite-mark is that it will inspire CHS leaders to do more, inspire staff at the Trust to want to stay, and encourage other NHS staff looking to move to an environment where they will be valued and supported to do their best for their patients, to look to Croydon based on their track record since 2012.
The kite-mark is for 2015 and will be available for CHS to use on all websites, literature and publications.
Any other Trust interested in how to attain an LiA kite-mark should contact Gordon Forbes on 07734 812311 or via email at firstname.lastname@example.org