interviews

The countess way

The Countess of Chester Hospital NHS FT has been shortlisted for two prestigious HR awards by the Chartered Institute of Personnel & Development (CIPD). NHE discussed the trust’s successes with its director of human resources and organisational development, Susan Young.

The Countess of Chester Hospital NHS Foundation Trust is the only NHS organisation to be shortlisted twice in the upcoming People Management Awards, run by the CIPD.

It is up for the award for Change Management, and the new award for Corporate Responsibility, against some top names in both the public and private sectors.

The trust runs the 600-bed district general hospital and has nearly 4,000 staff serving around 450,000 patients a year, and also runs a 64-bed intermediate care services unit at Ellesmere Port Hospital.

The change management shortlisting reflects the hospital trust’s ‘The Countess Way’ change programme.

Susan Young, the trust’s director of HR and organisational development, told NHE that the change programme was launched to improve outcomes for patients while trying to save £20m over three years.

“That’s not unusual in the NHS,” she said. “We have an increasing demand for services at a time when we’ve got a limited ability to control some of that demand.

“We were a pretty successful trust, but there was always that feeling that we could be better, and needed to do more to sustain performance in a more competitive environment – that we were going to have to get sharper if we’re going to survive in that environment.

“We got some early warning signs that we had to do something, such as in staff survey results: there was a feeling that we don’t want to be one of those market leaders that takes its eye off the ball.”

The Countess Way

The Countess Way, she said, could be summed as ‘the way we do things around here’ – and embedding those ideas in day-to-day working. The transformation programmes are being delivered with help from Unipart Expert Practices.

She added: “It’s very much linked in with our organisational strategy, and our vision for the organisation, which is to have care at its best. To do that, we need people at their best, and the way we deliver that is through The Countess Way programme. It’s all about embedding the features of the change programme into day-today working.

“When it started, it was a two to three year programme, but I think we now see it as a continuous programme of improvement.

“Sometimes, when things are done and delivered, they become ‘business as usual’: but then we will pick up new things to become part of the Countess Way. A lot of the programme so far has focused on ‘big’ organisational change: restructuring ourselves in line with patient need, in urgent and planned care.

“Then we did some specific pathway work in certain areas: we’ve looked at emergency respiratory, and the elective orthopaedic pathway, Lean working generally across the wards, organisational change and development of our leaders. But now some of those things, like the Lean working on the wards, and stock control, have become just business as usual, and we’ve started to pick up new things.

“So the big one, coming into the programme now, is about transforming our patient administration pathway.

“It’s about making the whole administrative process much quicker and smoother, and also making it more efficient.

“We know we process far more transactions than we need to, because of the number of changes to appointments, which leads to a lot of re-work, dissatisfaction for the patient, frustration for our staff, and potentially unfilled slots in theatres if we get it all wrong.”

Statistics produced before the programme began showed that nearly half of all outpatients and two-thirds of inpatients have appointments or treatment changed or cancelled, and fewer than one in five patients will have no changes made to their appointment or treatment dates at all. Most complaints, up to 70%, were due to ‘process delays’ and poor communication.

Partnership working and other successes

The hospital is also affected by external factors, of course, such as the changes to commissioning structures. In the last NHE, we interviewed Dr Huw Charles-Jones, who chairs the West Cheshire CCG, about the need to reduce emergency admissions among elderly people, and shifting them to care in the community, such as the very successful ‘Hospital at Home’ initiative.

Young said: “The pathway work is affected by changes externally, because obviously the way services will be commissioned will be different, and we will need to have new alliances in terms of people we work with.

“One of the big issues for us is patients who come to us who are also dealt with in other parts of the system: we work very closely with our partners, for example in the mental health trust, which has responsibility for community services. We’re doing some joint working with them, and all the same sorts of principles we apply to our own internal change programmes, we’ll apply in the way we work with our partners as well.”

The hospital has a good reputation, and is one of only five trusts to have been named one of the country’s top 40 hospitals in the 40Top awards every year since they were launched 12 years ago. Dr Virginia Clough, who recently retired as the trust’s medical director, said at the time of the awards: “In a difficult period of change and financial pressure we have still been recognised nationally as a top performing hospital which is a testament to the commitment and hard work of all our staff. We have now held this award for 12 years – an amazing achievement.”

It also recently won the NHS Bariatric tender for Cheshire, Warrington, Wirral and part of Greater Manchester.

Not about cost-cutting

Speaking about the CIPD shortlisting, Young said: “I think there’s something different about what we do here.

“One of the key things is that this isn’t just about cost-cutting. A lot of these sorts of programmes do tend to focus on the cost-cutting aspect of things. But if we invest in our people, at a time when others are cutting back – and particularly if we concentrate on developing our leaders – and focus on the quality of what we deliver to our patients, then the theory is that the savings will drop out by themselves.

“Ours has been a holistic approach based on getting the people right and getting the processes right: and you can’t do one without the other. We’ve significantly invested in our leaders, and in ensuring clinicians and managers work together on the same leadership development programme, discussing the same things: values, behaviours, staff engagement.”

Individual and community needs

The trust is also up for the corporate responsibility award, primarily for its equality and diversity work.

Young explained: “Everybody’s got issues with the communities they work in, and ours are perhaps not quite so obvious here in Chester, but we have got some quite significant parts of our patient population who we believe need a stronger focus. For example, we’ve got quite a significant traveller community, so we’ve done a lot of work on how we can get those patients handheld records they can take with them as they travel around.

“We’ve also got a very significant ageing population. The demographics here are really quite a challenge for us: many patients have dementia, which has been a particular focus for us. “We’re keen to learn from our mistakes, and empower our staff to come up with the ideas about how we can do things better – focusing on the service and the patient, not cost-cutting.”

The CIPD submission focused on work the trust has done to improve care for patients with dementia, instigated following a complaint about its handling of one patient. The initiative, called ‘This Is Me’, has involved specialist staff training and the creation of patient portfolios about the type of person they were before they began suffering from dementia. Patients with dementia have a forget-me-not flower behind their beds.

“That was an idea that came from the staff, in response to a complaint initially – it means the staff know that patient is someone they need to deal with in a slightly different way.

“It is all about focusing on patients’ needs, both individual needs and communities, and learning from mistakes and getting better.”

Alzheimer’s Society director of external affairs Andrew Chidgey visited the hospital over the summer to see the work, and has said he is impressed with what has been done.

Following the shortlisting, the trust made a formal presentation to the CIPD judges on September 6, which will inform the final result.

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