Engaging the board
Brendan McConaghy OD Manager at Belfast Health and Social Care Trust talks about how the board oversaw the design and implementation of a strategy for leadership and culture.
What was the role of the Board in getting underway?
Belfast HSC Trust embarked on a journey to improve the culture in 2017 and the first step was to establish an evidence based baseline for their culture. The aspiration was to create a leadership culture that was better at listening to employees and had more discussion about culture. The first challenge was to understand where they stood now.
The board asked 3 questions of the change team:
how compassionate and empathetic is our trust culture and are we in the top 20% of Trusts?
what are our strengths and areas for development?
what leadership action is needed to support the delivery of the Trust vision?
The board firmly believe that setting this tone from the top is important for the whole leadership of the organisation to engage in a positive culture. The initiative is led by the board - their engagement with the programme, has given them a far better understanding of the culture and behaviour of the Trust.
What was the change team’s approach?
The board asked the Director of Organisation Development to lead a Change Team made up of staff from within the trust. The team used each of the NHSI Culture Tools and generated a really rich data set:
Leadership Behaviours Analysis
Board interviews
Focus Groups
Pulse Surveys
Culture Dashboard
The collective leadership approach is that evidence shows that 5 Cultural Elements are linked to a healthy culture. Looking at the findings for each element allowed the change team, engaging with the wider organisation, to ask whereabouts there were opportunities to strengthen the culture.
What did the change team learn about working collectively?
The Change Team focused on working collectively to gather the data. The collective leadership approach meant sharing responsibility and the change team split into pairs, each pair taking leadership for a different tool. Shared leadership in the change team was important for the report to be collectively owned and the report was richer and more representative. The pairs used the wider change team to quality assure the findings: coming together with the change team every couple of months, before the final version of their reports where discussed at the day long synthesis workshop.
Presenting to the board
The Change Team wanted to promote authetnic staff voice as a cultural value and they chose collectively to change the normal style of a board meeting, present their own posters, holding Q&As with board members in a Data Walk and bringing Employee’s voice to life through voice recording of quotes. The strength of this approach to culture is the robust evidence base the tools provide and they asked Steward Organisation Development to share their observations, in a robust process and the need to continue to invest in leadership development for a more collaborative culture.
What were the outcomes of the process?
As a result the board were encouraged to consider 20 different recommendations covering all 5 of the Cultural Elements with more work to be done to deepen the future leadership behaviours.
The board has chosen to oversee the design and implementation of a strategy for leadership and culture. Rather than taking a tick box approach and simply looking at staff engagement scores and turnover they are asking deeper questions:
what do we need to measure consistently across the organisation which is relevant to our particular context?
what other ways can we find to stay close to the behaviours in the organisation - such as more visits, more face to face meetings?
where are the known ‘hot spots’ where poor behaviours exist and have we a strategy in place to address these?
have we got the leadership in plance to create an organisation which can work collectively with the system?
It is a positive process of learning about how to interrogate culture data and take more interest in culture.
The Trust is now involved in deepening the strategy for the new culture and implementing initiatives to increase the value of appraisals, strengthen team working and develop inclusive and empowering leadership.
Quote from the Joan Peden, Dir OD: ‘the most important thing Change Teams can do is give the feedback to the board about how staff feel about working here. Culture is many things but seeing the values lived is really important and when staff feel the values not being lived they become disillusioned’
What’s next for culture change at Belfast HSC Trust?
Along with some more traditional methods of creating change the Trust is working on the development of a change platform that will be centrally led but locally owned by frontline teams. Staff will be empowered to identify the changes that are needed in their area and will then be supported to start and spread the social movement of positive culture and behaviour change.
Questions change team can ask in preparation for the Board presentation:
· Have we included the voice of external stakeholders?
· Have we really listened to and captured the voice of front-line staff and middle management?
· Have we conducted deep dives into areas of especial concern?
· Have we reviewed patient feedback and patient complaints?
· Have we included a small number of personal anecdotes and personal observations?
· Can we describe the purpose of each tool, the methodology taken and provide a summary of the results for each tool?
· Can we describe the key strengths and weaknesses for each Cultural Element?
· Have we got clear recommendations?
· Are we engaging with the Board in a way which is consistent with the behaviours we want to see in the Trust in the future?
