Jane Lewington, Chief Executive at United Lincolnshire Hospitals NHS Trust, reflects on their first year of LiA adoption:
"The Trust has had a very challenging year, especially as we were put into special measures in July 2013 following the Keogh review. At that time, a cultural survey identified an absence of trust and engagement between staff and the Board. People did not feel pride in the Trust and had lost hope that things could be better.
I knew we had to do something radically different and LiA has been a key part of that. A year on, LiA has started to have a major impact, with staff working together to lead change within the organisation. Staff who have connected with LiA in whatever way are feeling more energised and I believe there is a growing sense of pride within the Trust. The change is starting to be visible.
When we started out, it was clear that it was only through my active, personal leadership as Chief Executive that staff would start to believe in my commitment to engage and empower them to lead change in their own areas. For it is staff who best understand the barriers to delivering good quality care, to make changes for the benefit of patients and to improve team morale.
LiA is proving to be a powerful way to engage with our staff. So far we have connected with over 1500 staff around what really matters to them and what gets in their way, and this has led to 45 teams so far working on their priorities to improve services for patients and staff.
In the first 12 months, we have engaged staff in a number of different ways:
- 800+ staff have taken part in a Trust-wide LiA Conversation
- 300+ staff attended team-based LiA Conversations
- 200 senior staff have been part of an LiA master class
- 140 staff have attended a 'Pass It On' event where inspiring stories and local evidence 'fuels' the spread
- 100 junior doctors attended an LiA conversation specifically about optimising their role.
It was really important to have pace and momentum, but also a focus on sustainability from the beginning. Our ongoing Quick Wins have been key in terms of fast responses to what our staff say and building belief that we mean business. For example:
- Stopping a very unpopular vacancy control process that was hindering staff rather than helping them
- Moving yellow clinical waste bins to a new location that better suits our clinical staff
- Launching a 'Smile Campaign' to encourage the right behaviours and boost morale
- Photo boards so that staff, patients and families can see who does what
- Face-to-Face Wednesdays to reduce emails and encourage people to talk to each other
- Physiotherapy self-referral for staff to improve wellbeing
- Removing firewalls to enable access to social media
- Use of tablet devices
- Moving a blood gas analyser into A&E (the porters had been trying to get sorted for 5 years!)
- Fixed 60+ 'eyesores' across our estate to make the environment better for patients.
More than 40 of our frontline teams are now pioneering adoption of LiA in their own areas. The first of these started last summer and they have achieved some great things. I never fail to be amazed at the ingenuity and determination shown by these teams - all they really needed was a process to work with and the full backing of the Trust so they had 'permission to act' and help to unblock the way. Some of their early successes included:
- Improved case notes – the printing of blood test results has been stopped, resulting in massive paper savings (400 sheets per day just at Grantham hospital) and 7–10 hours of clinical time saved every day
- Hip fracture management – Lincoln County hospital has achieved a 20% improvement in hitting the 36 hour target from admission to theatre, this target now stands at 96%
- Acute Care Practitioners (ACPs) in A&E - 10 ACPs are now working in A&E, improving quality and safety and saving £200,000
- The recruitment process – time to recruit new staff has been reduced from 10 weeks to six.
In March 2014 we ran our second LiA Staff Pulse Check to gauge how staff were feeling in the Trust. This was first carried out at the start of our LiA journey in July 2013. Over 1,700 staff completed the survey, which showed some impressive improvements in how staff felt about working in ULHT, including how valued they feel, and the extent to which our culture encourages staff to make positive changes.
I have been blown away by the commitment, enthusiasm and passion of our staff in driving forward so many improvements in the care we provide, and feel really humbled that they are trusting me and our clinical leaders to support them in doing so."