interviews

Improving clinical services through employee engagement

Hull & East Yorkshire Hospitals NHS Trust was ‘highly commended’ at the CIPD People Management Awards in the ‘employee engagement’ category for the huge amount of work it has done in just 18 months to turn around negative staff perceptions. NHE spoke to the trust’s director of communications and staff engagement Myles Howell. 

Hull & East Yorkshire Hospitals NHS Trust has embarked on a five-year strategy to “significantly improve” the way it communicates and engages with staff.

When new chief executive Phil Morley came into post in October 2010, he brought with him a strong sense of the importance of organisational development and staff engagement.

He asked trust communications director Myles Howell and improvement and development manager Lucy Vere to lead the work on engagement.

Howell (pictured above) told NHE: “Historically, we’ve not done overly well in the national NHS Staff Survey, and as part of our overall plan to improve on that and improve the care we provide, we embarked on this five-year programme of staff engagement.”

‘What do you think?’

At its most basic, the new strategy involves far more communication with staff – asking them what they think about how the trust is run and how services could be better run.

Howell said: “We invite staff to come and talk to us about the challenges they’re facing and the issues that are preventing us from providing the best possible care. From there, we’ve drilled down into individual areas and looked at how we can create teams that deliver on the things staff have identified as important.”

This began with a series of engagement events with staff. Staff were told about the trust’s visions and values for the future, and then invited to tell managers about the behaviours they thought it most important for all staff to adhere to. This resulted in the creation of five ‘I Will’ statements in June 2011, such as ‘I will look to continually improve the way my service is delivered’. The five were chosen based on a staff vote, after a consultation involving about 800 people.

A reward and recognition scheme, the ‘Golden Hearts’ awards, was launched based on the vision and values in the ‘I Will’ statements. Morley told staff then: “I speak to many staff and I know that many of you don’t consider what you do to be special.

“We set up the Golden Hearts Awards to show you that your efforts are deserving of recognition and that what you do goes above and beyond the call of duty on a regular basis.”

Since May 2012, the trust has been running a formal engagement process called ‘HEY, it’s in our hands’ (HEY as in Hull & East Yorkshire), beginning with ‘big conversation’ events, where staff can tell senior management their thoughts and ask them questions. The first round of events saw about 1,000 staff out of the 7,500 at the trust participate directly, and there have been many more since then, most recently on September 28 this year.

A frank exchange of views

Howell said staff didn’t hold back. “We asked them to tell us what was stopping the trust delivering the kind of care we needed to be delivering: that’s when they gave it to us both barrels!

“The purpose of these events was for us to just stand and listen to what they had to say. They were very frank and keen to point out some of the areas where we really needed to be doing better.

“We got some of the stuff you might expect to get in a large organisation – we’re not communicating well, for example, and that some support services needed to be more responsive and customer-focused.

“If staff rang for HR support or IT support or estate support, it’s important those services recognise that they are there to support the clinical services. It should be that we go out of our way to make sure they get what they need.”

In a blog after those first events, Morley said it was “an incredibly moving experience – difficult for me to hear, difficult for them to say”. He added: “Some staff cried as they told me how undervalued they felt, how frustrated they were at the mountain of policies and procedures we have put in place over the years – all in good faith, but with a cumulative effect that is disabling.”

Link Listeners

Following these initial events, the trust looked at the potential ‘quick wins’ and ‘big wins’ based on what staff had said was stopping them delivering care and getting in their way.

The team set up a network of ‘Link Listeners’ – staff to help the communications process from the frontline to senior management, and vice versa.

Howell said: “Staff said we were just rubbish at communicating. That wasn’t just corporate messages; it was gossip and rumour; when changes were about to happen; we weren’t being timely and weren’t giving them information when they needed it.

“We set up this network so that in every ward and department there’d be a Link Listener who’d meet with the chief executive every month, fire questions at him and he’d answer absolutely every question they’d have for him.

“He’d also give them a briefing on the things that were important that month.

“These staff are at the frontline: they’re not managers, not service leads – they’re the people out there delivering the care.”

Howell admitted that there was some early scepticism about the idea – past experience made that inevitable. But when staff realised that management actually meant it this time, and were genuinely keen to engage, that changed.

He said: “We’ve found, 18 months on, that the Link Listeners have become one of our most powerful communication tools.

“We use them as a sounding board, they’re great for understanding what the general feeling in the organisation is on an issue.”

The executive team take it in turns to carry a special phone – christened the ‘Batphone’ – which allows any of the 130 Link Listeners to get in touch with them at any time.

“They can get them out of bed if they want!” Howell said.

“That was a more gimmicky idea perhaps, but they do ring it. They also have their own email address to send messages to, and their own intranet forum.”

Direct improvements to patient care

The new engagement strategy has not only improved staff perceptions – “every single measure has increased significantly” on the trust’s internal surveys, according to Howell – but it has had more direct impacts on patient care and efficiency service delivery.

The new ‘Pioneer’ teams, for example, were set up to tackle specific areas that staff raised concerns about.

Each team would be set up as a ‘task and finish’ group to focus on one specific issue, and were each championed by an executive director.

Staff around the trust were asked to do everything they could to co-operate and help the Pioneer teams achieve their objective.

One was length of hospital stay following a hip fracture – which correlates closely with mortality rates.

Howell said: “Keep that length of stay down, and the patient is less likely to develop a pressure ulcer, less likely to develop an infection – they need to get up and about.

Over the course of 12 weeks, the Pioneer team reduced the average length of stay from 19 days to 14 days. This is something they’d been trying to do for 10 years, but with the power of executive support, and the rest of the trust behind them, they did it in 12 weeks.

“It meant, in real terms, that orthopaedic patients were 28% less likely to die while in hospital, 40% less likely to develop a pressure ulcer, 53% less likely to have a slip, trip or fall – so a genuine, direct benefit to patient care.

“There’s people alive today who wouldn’t have been, and that’s thanks to the Pioneer team.

“That change has been sustained and has got better in fact, they’ve continued to work on it, length of stay is now under 14 days and it’s gone from strength to strength.”

Bringing everyone together

There have been 30 Pioneer teams set up so far, whose successes include a massive increase in the number of referrals into the cancer survivorship team, and an initiative with the community midwife that saved 600 hours of staff time and £22,000 by ensuring equipment was all delivered to one place rather than midwives driving around to find it.

All it took was a proper conversation between the midwives, the transport teams and the stores team to come up with a solution, which could be put in place “almost instantaneously”.

The fact that the midwives now get to spend 600 extra hours with the women they care for shows “just how inefficient the old system was”, Howell said.

“The real power in it has been bringing everyone together, and the realisation of benefits as a direct result of that.”

As well as the Pioneers, the trust has introduced a network of ‘change agents’, 25 people who’ve been on specialist training to facilitate other teams around the organisation to implement change and new ideas on their own. 

The trust is determined to improve leadership, mirroring the changes in the wider NHS, again in response to staff feedback. With budget cutbacks, new demands on efficiency and service delivery, and people asked to work in new ways, staff want creative and effective managers to lead the change.

Howell said: “We’re looking at all of our recruitment processes in a different way, making sure the values of the people coming in match ours, match the type of people we want – not just the right qualifications but the ‘right type of person’.”

Great Leaders

Most recently, the trust has set up its ‘Great Leaders’ programme.

Howell said: “The teams nominated who they wanted to come, and we selected some people we knew were the right people in the right areas, to undergo an extensive programme of development and training, to help them be the kind of leaders the staff said they wanted.

“We want to reduce command and control and make this a more engaging organisation with a better atmosphere, and allow staff to be more involved.”

The CIPD People Management Awards judges were impressed by the trust’s work on employee engagement, Howell said, adding: “They thought we’d come a really long way in such a short amount of time.”

Not every employee engagement idea has been successful – the trust attracted a lot of negative publicity in the summer when a video was leaked showing Morley dressed as Superman promoting ‘Workout at Work’ day, with some staff branding it insensitive or foolish.

Reflecting on the incident, Howell told us: “It was done with all good intentions.

“Some people liked it, some people didn’t like it, but I think for us the intention behind it was the right intention, and Workout at Work day has probably never had more coverage.

“You could say that element of it was a success. Would we repeat it? I think it’s something we’d have to have a conversation about…”

But generally, Howell said, employee engagement has been very positive for the trust. “We’re looking at this as the beginning of a longer term strategy, something that five or six years down the line we’ll really reap the benefits of.

“We’re not expecting overnight results but we’ve been really encouraged by what we’ve seen so far.”

Pioneer Teams – improvements to patient outcomes

•  A 70% increase in referrals in to the cancer survivorship service

•  The creation of an IBD biologic unit in the gastroenterology ward

•  Access to remote paperless working for all neurology nurses

•  Hip fracture patients are now 28% less likely to die whilst in hospital

•  One lift in HRI is now isolated for patient use only to improve privacy and dignity

•  Six out of seven anaesthetic rooms in HRI theatres have been remodelled

•  Patient therapy sessions to be scheduled through the Cayder boards

•  Ocular Plastics has gone from being the worst to the best performing ophthalmology service

•  A standardised bereavement service has been developed for the relatives of deceased patients

•  Freed up almost 20 hours a week for community midwives to spend with their patients

•  Implemented significant changes to the catering services being provided to staff

•  Telephone calls reduced by up to 30% on our pilot wards

•  Improved recovery for breast care patients

•  Four beds ring-fenced for neuro patients in ICU, resulting in fewer delays for patients

•  Significant progress made towards reducing the amount of paper pathology results (Source: Trust presentation)