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28.05.19

Mid Yorks Hospitals NHS Trust: Our improvement journey

Source: NHE May/June 2019

Chief executive of the Mid Yorkshire Hospitals NHS Trust, Martin Barkley, writes for NHE to guide us through his trust’s improvement journey.

It’s arguably a hackneyed phrase in the NHS, but Mid Yorkshire really has been on a significant journey in the last few years. Dogged by a previously problematic reputation, I believe the trust now has a realistic ambition of achieving a CQC rating of ‘Outstanding’ within the next three years. Not only would this mean patients and the public can have greater confidence in the quality of the services provided by their local trust, it would be a just recognition of the hard work and dedication of our workforce.

Mid Yorkshire serves a catchment population of 550,000 people. We have more than 8,000 staff, provide community services in Wakefield and have three hospital sites, two of which opened less than 10 years ago as part of the same PFI scheme. The trust has an income of £540m and reported deficits of £19m after receipt of Provider Support Funding.

For many years the trust has had a troubled reputation in respect of its performance, both financial and non-financial, and as a place to work. Change was already underway when I became chief executive. A significant reconfiguration of acute services between our three hospital sites was completed in September 2017, with the main hospital, Pinderfields, being the ‘hot site’. The purpose of the reconfiguration was to improve the quality of services, ensure sustainability of services through improved deployment of scarce clinical staff, and to achieve a reduction in running costs. The reconfiguration has achieved these objectives, most notably a reduction in mortality rates, improved staffing, and financial savings of £6m per annum.

However, staff morale was low. Our aim as an executive team was to establish a culture where staff feel valued, respected and engaged, and are enabled to do their work to a high standard and to enjoy it; a culture where continuous quality improvement is the norm.

In May 2016, we began a series of ‘Big Conversations’ events with myself, which were attended by 450 staff. We focused on three things: listening to staff about what needed to improve; securing their views on what the ambition of the trust should be; and securing their views on the behaviours that we should expect and indeed require of each other to bring the trust’s four values to life and make them a reality.

Through this interactive process we reached a consensus that the trust’s ambition should be “to achieve an excellent patient experience each and every time.” In addition, each of our four values is now defined by clear statements of eight behaviours. The values and behaviours are fundamental to how we work with each other, the patients and our partner organisations. As a continuation of this, six months ago we started a monthly three-day development programme for staff on Band 7 and above who are in formal management or leadership positions, on the basis that our managers are crucial in embedding our behaviours and values across the trust.

The board also made an important decision for the trust to adopt a systemic approach to quality improvement by way of the North East Transformation System (NETS), which is very heavily based on the Virginia Mason Production System. Branded the MY Quality Improvement System, since its introduction in September 2016 nearly 500 staff have been trained or taken part in improvement events, typically week-long rapid process improvement workshops.

The rationale for adopting this method – and what made it a particularly suitable approach for Mid Yorkshire given the previous status of staff morale and engagement – was not only because of its effectiveness in improving quality, but also because it is a brilliant way of empowering staff.

Its underpinning philosophy is that it is the staff who know best what needs to improve and how; it is a very sustainable way of securing improvement and has already resulted in a number of significant changes to patient pathways or processes, with dramatic improvements for patient as well as staff experience. The next step is to introduce ‘World Class Management’ including ‘Standard Work for Leaders’ and ‘Everyday Lean Management’ by further investing in the skills and knowledge of the trust’s managers and leaders to work in this way of continuous improvement.

Through improving our reputation as a place to work we have managed to grow the workforce by some 300 people, helping to reduce the gap between demand and capacity, as well as helping to reduce spend on agency staff.

This represents only a snapshot of the many areas of work underway to further improve our performance and ways of working – as well as our reputation. Our most recent CQC inspection took us to the top end of ‘Requires Improvement’ (in fact, we have doubled the number of ‘Good’ ratings in our hospital services since 2014) and our staff FFT results show improvement, with 60% recommending the trust as a place to work and 70% as a place to receive treatment.

Whilst indicating there remains a great deal more to do to be in the top decile, these numbers are encouraging evidence of the improvement made to date and the fact that, as a trust, we remain absolutely dedicated to accomplishing our ambitions of achieving an excellent patient experience each and every time, being an excellent employer, and a CQC rating of ‘Outstanding’.

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