Reading through these case studies some clear and striking themes emerge.
It comes as no surprise that the key attributes for improvement highlighted by Professor Ted Baker – good leadership, effective staff engagement and a strong organisational culture that embraces learning – run through the narratives presented here.
They also demonstrate how these priorities can be deployed in different ways, in widely varying situations, to good effect.
For the chief executive at Dorset Healthcare University NHS Foundation Trust, Eugine Yafele, a central element of good leadership is about being visible and approachable. Beyond this commitment to face-to-face contact, the trust now produces videos after board meetings to demystify decisions and the way they have been taken. Similarly, Carolyn Regan at West London NHS trust places a premium on walkabouts – even at 3am – so whatever their shifts, staff can see her “living the values”.
The power of effective staff engagement is captured eloquently by Dame Marianne Griffiths, chief executive at Brighton and Sussex University Hospitals NHS Trust, who speaks of having “taken the rocks from out of their shoes”. Daily 15 minute huddles have helped to harness staff expertise in identifying and solving problems. Similarly, the trust leadership at North Tees and Hartlepool NHS Foundation Trust acknowledges that “the people at the frontline are our experts”. This approach, encouraging staff to challenge the way things are done, has helped to reduce duplication by different services, and to improve patient flow through the system.
Again, at Kingston Hospital NHS Foundation Trust, we see a sustained focus on listening to staff, taking their views seriously and acting on them. The chief executive, Jo Farrar, insists there is no “magic formula” to staff engagement, but we see here and elsewhere that when it is done well the impact is transformative.
Staff engagement is closely linked to a strong organisational culture that embraces learning. The priority given to “Quality Friday” and clinical governance learning sessions at Chelsea and Westminster Hospital NHS Foundation Trust reflects a strong emphasis on learning in order to improve care for patients. The trust’s adaptation of the Dragon’s Den formula has evidently helped to motivate staff, drive innovation and deliver improved care, as demonstrated by nurses working to improve mouth care on the stroke ward.
The “Break the rules” week at Cornwall Partnership reflects the same willingness to empower staff in finding better ways of working and delivering care, which in this example has enabled them to refine and clarify the roles of district nurses. And as staff are trusted with a greater say, and more responsibility, engagement scores have improved alongside tangible ‘wins’ for patients.
This is also borne out in the approach to end-of-life care taken by South Western Ambulance Service NHS Foundation Trust, backed by a programme of training for staff that is helping to ease anxiety and distress at a critical time for patients and carers, avoiding unnecessary admissions and supporting a good death.
There are further important themes that run through these success stories. One is a willingness to act on the data, even if that entails difficult decisions. We see this in Hounslow and Richmond Community Healthcare NHS Trust where, after examining the patient profile, the trust closed one of its rehab wards. Alongside this it developed a more rigorous admissions policy and has since dramatically cut the average length of stay.
At London Ambulance Service NHS Trust, as part of the quality improvement approach, all initiatives accepted as a “pioneering service” are given close support and are also carefully monitored, to ensure resources are well directed. This approach quickly demonstrated the success of the mental health car – supporting staff to work more effectively, easing pressures on hospitals and – most important – helping patients to access the most appropriate care.
There are other qualities evident in these case studies: resilience, commitment, determination and resourcefulness. One of the most striking though is courage. Trust leaders carry great responsibilities as major employers running complex organisations, overseeing huge budgets of public money, and accountable for the quality and safety of care for countless patients and service users. Seemingly small decisions can have huge ramifications.
Placing faith in staff, encouraging ideas, supporting and refining them, acknowledging and learning from mistakes – that takes bravery. As Robert Woolley from University Hospitals Bristol NHS Foundation Trust says, “We’ve made mistakes, but we own it. It’s ours”.