Whittington Health NHS Trust (partners with care providers). Whittington Health provides general hospital and community services to 500,000 people living in Islington and Haringey as well as other London boroughs including Barnet, Enfield and Camden. As one organisation providing both hospital and community services, they are known as an ‘integrated care organisation’ for which they are a pioneer site. Integrated care means that they bring quality services closer to home and speed up communication between community and hospital services; improving their patients‟ experience particularly for those who need different levels of care. Whittington Health NHS Trust say that partnering with patients, carers, GPs, social care, mental health and other healthcare providers is key to their approach.
Whittington Health, who works to a social care model, has a strong reputation for safe care. For two years they have consistently had one of the lowest death rates in England – one of the key criteria for measuring patient safety. The organisation also has a highly-regarded educational role, teaching more than 600 undergraduate medical students, nurses and therapists throughout the year, and providing a range of educational packages for postgraduate doctors and other healthcare professionals.
The organisation has been a health organisation for a long time and, as with other organisations they were considering the need to invest in a cultural change to embed the learning from recent cases that were in the public domain, e.g. Mid-Staffordshire NHS Trust and Winterbourne View via embedding values-based behaviours and working. This is set in the context of building a health and care workforce that identify, share and develops values based care both to service users and within the “The journey has been challenging” says Kim Hope-Sales, Whittington Health’s Deputy Director for Leadership, Talent & OD, “it takes a long time to embed a cultureand requires leadership signup and ownership at the very top with value-based working embedded and evident at all levels within the organisation. It’s not about recruitment on its own; it requires a whole systems change with elements such as our Organisational Development, Leadership and Development practice needing a review.”
Prior to joining the VBRT pilot, in February 2014, Whittington Health’ s leadership team were already developing their strategic approach and as such were refreshing their values. Taking part in the VBRT pilot enabled them to use the VBRT components to inform their strategic approach. “We knew it was a risk using a pilot toolkit to develop a new approach. However having fully scrutinised the toolkit and having spoken with the NSA and Profiles4Care we gained confidence about its legacy and sustainability”.
Starting the review with a staff engagement survey they knew what challenges they needed to overcome that would inform their change plan. Findings from their survey also enabled them to agree their priorities and approach regarding embedding the VBRT. Since joining the pilot Whittington have embedded the VBRT into their nursing recruitment process and have used the PPQ following shortlisting and the pre-interview stage, at the first, for health care assistants, nurses and linked health and care workers across their integrated care organisation.
They also provided managers with a set of ‘values-based interview questions’ to assist ensuring that interviewees were appointed with their value base at the heart of the decision. The Trust also recognises that to shift an organisation culturally and see real value and evidence of change, changes required are much broader than recruitment alone. They believe that it is one that starts with recruiting the right people, but then it must ensure that it nurtures and develops the values behaviours within its existing workforce via regular 1-1s and at appraisal.
This case study shares their journey to implementing their new ‘Potential & Performance’ appraisal approach that aims to embed values-based reflection and discussion into their standard appraisal policy. Their biggest challenge is how they gain commitment from managers who traditionally sit within a more transactional management role and who are somewhat resistant (and fearful) of change. Ensuring that the key recommendations from the Francis & Winterbourne Reports regarding the need to instil excellent values and leadership behaviours within care, the new appraisal would be based upon these two elements as well as evidencing meeting service objectives.
Having previously been involved in the development of the NSA’s Leadership Qualities Framework (LQF) and their development of LQF assessment tools, Kim Hope Sales sought to have the VBRT as the first element of the appraisal assessment. With the development of the new NHS Health Care Leadership Model (www.leadershipacademy.nhs.uk ) she also wanted to ensure that the Whittington workforce were also self-assessing themselves on their leadership behaviours against this framework. A set of 4 online leadership behavioural self-assessment tools were then bespoke designed for strategic, operational and front line leader, as well as front line staff; aligned against the new NHS leadership model. The workforce would self-assess against their 9 dimensions, and the VBRT would assist in nurturing the culture of self-assessing key values. “Whilst the VBRT was not exactly aligned to the Trust‟s 5 core values: set as ICARE (Innovative, Compassionate, Accountable, Respectful & Excellent), the aim would be that staff would begin to see the expectation that these were required.”
“It has been about building the culture and setting the tone with our workforce that values-based behaviour matter” added Kim. The other key element in driving a values based culture is by having ‘coaching conversations’ between managers and those they manage. The Trust has invested in training up their leadership; starting with those at director, right through to operational management level in these coaching conversations. What will then be realised is a more mature, and required method of managing individuals and teams; one that is based upon an adult-to-adult, strengths based approach, and more importantly, one that has more proactive staff engagement. In time, they will be developing ‘champions’ from those demonstrating values-based working from within their organisation, who will then assist in those areas where values are not as apparent and/or where managers have developmental needs. “We have champions in demonstrating values. We’re just not used to identifying them in an equitable way. The VBRT will enable us to do that”, and for managers, “the discussions will enable managers to see that values-based behaviours are as important as competency based training in care delivery”
Kim states that the use of the VBRT in appraisal discussions has been powerful particularly where managers have developed ‘coaching conversation’ skills that have encouraged the manager to use a facilitative approach to reflective practice. This has enabled staff to reflect and take responsibility for their own behaviours. “We can identify this equitably and also celebrate example role modelling that is far more impacting at the front line than an external ‘expert’ training. It’s all about building capabilities from within”.
Kim suggested a number of improvements to the VBRT and separately, regarding the PPQ. With regard to the PPQ she felt that the language could be more generic; taking it from ‘candidate’ to a more generic term to reflect its potential wider use, e.g. within reflective practice, appraisals and staff development. For the VBRT she suggests Profiles for Care devise a template VBRT business case that OD development leads in organisations can use to show the business value re: investing in it.
It would also be useful to design a ‘roadmap’ for the VBRT re: how it can be used within both recruitment and appraisal processes In order for the VBRT to become more marketable re: usage, Kim also suggested that the back end content/data management system had a solution of automatically sending completers reports immediately back to them. At present, the administration to do this is hugely time consuming; needing a dedicated administrator to manually send reports. The registration element prior to completing the self-assessment also could have ‘drop-down boxes’ with categories of recruitment/appraisal group campaigns, so that when collating the candidate cohorts for vacancies or appraised teams, managers can easily lift reports against given groupings.
With regard to the early signs of impact, this is difficult to determine due to the ‘gradual’ utilisation of the VBRT. Kim feeds back, “Staff engagement and senior leadership endorsement have been crucial in successful adoption. We have had a renewed enthusiasm for appraisal, improved relationships between the manager and line managed, and there are early signs in the cultural shift that focusses on behaviours which works against poor practice and the identification that development is more than just ‘skills’. And finally she adds, “We have an equitable approach to identifying ‘unsung heroes” and those who make a difference in delivering quality care”.
At the point of writing this case study they have implemented the Potential & Performance programme with their more senior leadership levels (director through to operational managers). They are now seeking funding for the coaching conversations training to be rolled out to front line leaders.