Positivity and kindness at every level
Jacqui Skeel, Associate Director for OD at the Isle of Wight Trust talks about starting to create more norms around empathy and more positive leadership behaviours
The NHS needs leadership cultures that retain and motivate staff like never before. To be a ‘go to’ trust NHS organisations need to build new competencies into their leadership, and develop consistent leadership behaviours at scale and at every level.
What was the role of the Chief Executive?
Partly inspired by her experience at Mid Staffordshire Hospital, the Chief Executive at the Isle of Wight NHS Trust was clear about the kind of culture she wanted to see for safe, engaging and effective organisation. A culture diagnostic using the NHSI Kings Fund tools showed the areas where changing the culture was a priority.
Without a more compassionate culture the low levels of staff engagement would probably have persisted. The most successful healthcare organisations have higher levels of staff engagement and a significant influence on staff engagement is whether people feel a sense of identity with the team or organisation they belong to. Positivity, kindness and procedural justice (having the same access to opportunities as other people) are all linked to this.
What was the approach to developing leadership?
To infuse compassion throughout the organisation meant creating a strategy for leadership development and making sure the senior leadership team knew why the new culture was needed to support the strategy for better care for patients. Doing this at scale meant devising some core leadership models and creating an architecture for delivering this at different levels.
The leadership development was backed up by organisational changes to ‘hard wire’ the new behaviours: This way consistency is created across the organisation: behaviours (being supportive, listening, being appreciative and positive) were included for discussion at appraisal; the vision was refreshed and HR processes including induction and recruitment have taken a more values-led approach. Tackling bullying was particularly led by setting up ‘Anti Bullying Advisors’ who also supported the work of the freedom to speak up. It was important to staff that they were called anti bullying advisors.
To create a consistent approach to leadership the change team asked these 3 questions in the order that they’re written:
1. Based on the diagnostic stage what do we need our leaders to be able to do to build a healthy culture? Having worked with the culture tools and engaged 800 staff a great deal was known about the existing culture and what staff most needed leaders to do. Compassion came out as the number 1 priority as commitment to the organisation was low. Staff engagement scores were low whilst intention to leave was high. Teamwork and promoting innovation and learning were also important but not the priority.
2. Which leaders do we need to develop so we have consistency across the organisation? Senior leaders, team leaders, middle managers, medical leaders and nurse leaders on the wards were all identified.
3. What components do we want to put at the core of our leadership development for all leaders so we have a compassionate culture? buddying, reflection / action learning, teamwork, resilience and self awareness, listening, delivering high quality appraisals, creating meaning and purpose by living the values, have formed the basis of the new approach to leadership development.
The approach is more complex to manage but creates a shared narrative and begins to change the conversations.
What did the Trust do to create a different leadership culture?
Staff engagement is improving. The key measures monitored for the 6 months to date are: appraisal compliance, absence related to stress anxiety and depression, monthly staff survey of whether staff recommend it as a place to work. On all these measures have improved over the 6 months to date an recommendation as a place to work has increased from 28% to 56%.
Isle of Wight NHS Trust is the only integrated acute, community, mental health and ambulance health care provider in England. Established in April 2012, the Trust provides a full range of health services to an isolated offshore population of 140,000. The work to build a compassionate culture included:
· 200 Middle leaders, the senior leadership team, team leaders and medical leaders on the front line and nurse leaders, all attended a comprehensive leadership development that offers something for every single member of staff
· Medical, Senior and middle leaders are also going through a human factors training programme. This is making the difference to behaviour awareness and team working.
· Resilience, listening, empathy, team building, compassionate leadership and Trust have been discussed at senior leader workshops
· Moments were created across them all for quiet reflection using journals, reflective writing, creating learning buddies and sets
· Creating a shared mind-set including a shared direction and commitment to the unfolding journey, meant the Chief Executive repeatedly communicating her vision, attending the start of every development programme and monthly induction for new starters
· Fostering a greater sense of community and support by buddying people up
· Leadership conference attended by just short of 300 staff and partners
· Changes to values based recruitment are planned
· A phased approach – the next phase includes teamworking
· A governance structure for culture which included a steering group Chaired by the Chief Executive, new KPIs, monthly reporting to a board using a culture dashboard
Taking this thorough approach to culture is demanding but means that it is not left to chance.