Staff Survey. For: Information Assurance Discussion and input Decision/approval. None

Transcription

1 Staff Survey Name of meeting: Trust Board Item: 7.6 Date of meeting: 30 th July 2014 Enclosure: H Purpose of the Report / Paper: To provide the Board with an update on work done to date in response to the staff survey and further action planned For: Information Assurance Discussion and input Decision/approval Sponsor (Executive Lead): Author: Author Contact Details: Kate Grimes, Chief Executive Kate Grimes and Terry Roberts, Director of Workforce Kate.grimes@kingstonhospital.nhs.uk Terry.roberts@kingstonhospital.nhs.uk Risk Implications - Link to Assurance Framework or Corporate Risk Register: Link to Relevant Corporate Objective: None Strategic Objective 2: To have a committed, skilled and highly engaged workforce who feel valued, supported and developed and who work together to care for our patients Document Previously Considered By: Monday meeting July 2014 Recommendations: The Board is asked to note the update provided on work in place and planned to address issues raised in the staff survey. 1

2 Staff Survey 1. Background In March 2014 the Trust Board received the results of the 2013 staff survey. The Trust had maintained its position from the previous year, but had not made further improvements. Table 1 below summarises the main strengths and weaknesses of our staff survey results. Whilst an action plan around specific areas for improvement was agreed, the Trust Board agreed that they would like to see further thought given to how the Trust could be more ambitious in this area. The executive team have now had an opportunity to discuss this with support from the newly appointed Director of Workforce. Table 1 Strengths Weaknesses 2. Existing work on staff engagement The Trust already has a strong reputation for its work on staff engagement. The Chief Executive has been invited to speak on a number of national platforms on the work the Trust is doing in this area in 2014 and the Trust has featured as case studies in two research 2

3 initiatives The IPA Report Meeting the challenge: Successful Employee Engagement in the NHS published in April 2014 and a collaboration between Bath University and the CIPD on building trust in organisations due to be launched in September The IPA case study is shown at appendix 1. Analysis of the staff survey results demonstrate that there are some real areas of strength in the Trust as well as areas for improvement. For example, the Trust is in the top 20% nationally for staff reporting good communication between senior management and staff. The key area that the executive team believe will make the biggest difference to overall staff experience of working in the Trust is to further strengthen line management. Looking at many of the average scores the Trust achieved this year, improvement in people management skills by line mangers would make a significant impact. Much of this work is already underway. Examples of work at Kingston that have been cited as examples of good practice include the use of a questionnaire that enables each line manager to receive feedback from their direct reports on their people management skills. The Trust is now in the second year of running this process and a number of other Trusts are beginning to copy this approach. This will enable us to share our results with other to see if similar patterns emerge. We are also using this to inform some further development commissioned this year eg. around the approach each manager takes to one to one s and appraisals with their staff. Another example of good practice is the trusts coaching culture strategy, which has recently been approved at EMC. Again, much of this work is already underway with many staff already trained in using a coaching style. The Trust has embedded values and leaders are visible around the trust. Initiatives such as board members training as dining companions helps to support this visibility and ensures that Board members are able to role model the Trust values. The Trust is also looking to learn from others. Andrew Foster, CEO from Wrightington, Wigan and Leigh, who beat the Trust to an HPMA award recently, ran a seminar on what they have been doing to build staff engagement on 15 th July and there are some ideas from that the trust plans to implement. 3. Proposed way forward The Trust has a clear programme of work to strengthen employee engagement. However, this is not brought together into a formal employee engagement strategy and plan. It is therefore proposed that the programme is brought together and formalised in this way. A draft plan is under development. It will be focused under four headings: 1. Leadership that builds trust 2. Exceptional people management by line managers 3. Mechanisms to empower staff to solve their own problems 3

4 4. Lived values These headings reflect the evidence around the mechanisms and keys to increasing staff engagement. The staff survey has demonstrated that particular focus and energy should be placed on actions to improve people management by line managers so the programme will be strengthened in this area for 2014/15. These four headings also relate to two areas where we could have had better results. Leadership that builds trust, exceptional people management, empowering staff to solve their problems and lived values will go some way to reducing the number of staff that report that they have personally experienced discrimination or experienced bullying and harassment. However, specific action also needs to be taken to understand why staff are experiencing discrimination or bullying and harassment. The Equality and Diversity Committee will lead on getting a better understanding of these issues and developing action plans to improve in these areas. There are a couple of other areas that staff have told us need improving under the staff survey. These are hand washing and procedures for reporting errors and near misses. Plans for improving staff perception of a lack of available hand washing have been developed which include a hand hy-genius campaign focused on different elements of hand hygiene. Signage has also been improved over the last year. Regent wing was the main areas of concern reported by non-clinical staff. Water Heaters were installed locally; subsequently additional requests were identified in Occupational Health. These will be installed by the end of July Further work needs to be undertaken to ensure there are no other areas of concern. Duncan Burton, Director of Nursing & Patient Experience will take responsibility for the plan in clinical areas and Sarah Tedford, Deputy Chief Executive in non-clinical areas. With regard to reporting of incidents and near misses, the Trust is proud to have a high level of staff saying they have witnessed errors and near misses as it believes that this demonstrates a strong safety culture. Staff are trained and encourage to notice things that could or have gone wrong in order to enable action to prevent them occurring in the future. However, on closer examination of the questions, there are two areas that require improvement. The first is to ensure staff are aware of trust wide incidents and the second is to ensure staff are aware of actions taken after incidents. Duncan Burton and Sarah Tedford will lead on developing plans to improve both these areas. A summary of the proposed actions is shown below. 4

5 Summary of proposed actions WHAT WHO BY WHEN 1. Formalise staff engagement strategy and plan for 2014/15 2. Recruit individual to support implementation of the 2014/15 plan 3. Establish workforce steering group to oversee delivery 4. Develop and implement mechanisms to ensure staff are aware of Trust-wide incidents 5. Develop and implement mechanisms to ensure staff are aware of actions taken after incidents 6. Understand reasons staff report lack of hand washing materials in clinical areas and develop plan 7. Understand reasons staff report lack of hand washing materials in non clinical areas and develop plan 8. Develop mechanisms to monitor impact of this plan and communicate results widely. 9. Understand the reasons staff report Bullying and Harassment and develop mechanisms to address 10. Re establish Equality and diversity Committee in order to develop action plan to address perceived discrimination issues Kate Grimes Mid-August 2014 Kate Grimes & Terry Roberts Interview due on 31 st July 2014 Terry Roberts September 2014 Duncan Burton August 2014 Sarah Tedford September 2014 Duncan Burton August 2014 Sarah Tedford August 2014 Terry Roberts August 2014 Terry Roberts October 2014 Terry Roberts September Monitoring mechanisms The success of this plan will be measured on inputs and outputs. The delivery of actions within this plan will be monitored by the workforce steering group. The impact will be measured by: 1. Staff Friends & Family Test (FFT) Scores 2. Annual engagement score 3. Regular pulse surveys in each service line Recommendations: The Board is asked to note the update provided on work in place and planned to address issues raised in the staff survey. 5

6 Appendix 1 Kingston Hospital NHS Foundation Trust Kingston Hospital NHS Foundation Trust is a single site, medium sized district general hospital, located in Kingston-upon-Thames. The trust employees over 2,500 members of staff and provides a variety of diagnostic and treatment services to around 320,000 people in the local area. Employee engagement is seen as vital to patient care, and is therefore a high priority at the trust. Kate Grimes, Chief Executive at Kingston, described how they make the really clear link to patient care; our job is to improve patient care and this is the right way to do it. Having been towards the bottom end of acute trusts, Kingston has managed to increase employee engagement significantly in the last few years. Leaders at the trust align this increase to the sustained improvement in performance at the trust. Leadership and trust Kate Grimes identifies four key factors in underpinning employee engagement at Kingston. The first of these is strong leadership that builds trust. This is bolstered by the stability of the leadership team. Kate has been Chief Executive for five years and she believes this has helped build employees trust in her and the organisation more widely. She highlighted the fact that the average tenure of a Chief Executive is relatively short at around two years. Having stability and experience at the top can be an asset; I think you need to have been there for a while to do that otherwise people don t trust you. Senior leaders at the trust are perceived to be highly visible, approachable and in-touch with employees. One member of staff described how managers have become more visible and transparent. Everybody knows what s going on, whereas before it was we re the execs and we re going to get on with it, now it s much more transparent. Another said in my last trust, we barely ever saw the Chief Exec. Whereas here we see Kate all the time. This is supported by regular communication between the senior leader team and the front line. Kate does a weekly to keep people updated, and aims to be informal, engaging and personal in style rather than corporate. There is an effective team brief in place and the senior team do regular open forums and walkabouts to speak with staff face-to-face. Kate sees senior leaders as playing an important role in setting the strategic narrative for the organisation. She explained how leaders must ensure that all staff understand this so they can see it, own it and feel it. They can say this is the trust vision and this is the part I m playing in that. Kingston performs very well in this area. In addition to highly positive feedback from employees, the trust comes in the top quintile in terms of communication between senior managers and staff. It also performs higher than the average for acute trusts in terms of recognition of senior managers, their commitment to patient care, and the extent to which leaders involve staff in decision-making, and act on feedback. 6

7 Line managers and coaching In addition to senior managers setting the tone for engagement and building trust, line managers are seen as having a crucial role in employee engagement. Recently the trust has introduced a feedback questionnaire for line managers. This is built in to the appraisal process of everyone with line management responsibility. Direct reports are asked to score their line manager on a number of areas, based on the key things that evidence shows make for good people management. This is aggregated along with free-text comments on the areas employees would like to see their managers do more of. This process is seen as important in both setting out what the trust sees as good people management, and providing feedback to managers on how they re doing. This is then used to inform objective setting, personal development and training needs. It also enables senior managers to identify areas of strength in terms of people management across the organisation, and where there might be issues. As Kate explained, it s already had a benefit, particularly in terms of some people who ve never had feedback before or never even seen themselves as a people manager. There is a really strong emphasis on coaching at Kingston, where Kate Grimes is aiming to create a coaching culture across the organisation. This is based both on the evidence linking coaching approaches to engagement, and on Kate s personal experience of training as a coach, something which she found changed her approach and greatly enhanced her management skills. The board has now also been through coaching training, as have many middle managers and senior clinicians, and the trust has a coaching strategy, setting out how this will be rolled out. They have a specialist coach on site one day a week for staff to work with. This is all seen as fundamental to the approach to line management at the organisation. Kate wants to build a culture where, instead of managers telling their direct reports what they want to do, they help their reports work out what they want to do for themselves. Enabling staff Key to employee engagement at Kingston is a strong focus on enabling and involving staff. This is central to the culture at the trust. David Grantham, Director of Workforce and OD explained the theory behind this; we know that staff are the people in our organisation who on a day to day level see what s going right and what s going wrong. They often have the bright ideas that will save us money and improve the patient experience. Kate Grimes echoed this, explaining it was the role of the senior leadership team to create an environment where employees can take the lead; they aim to give staff freedom and enable them to solve their own problems. In addition to the culture of enablement, there has been an effort to ensure the organisational structure at the trust supports this. Kate Grimes described how she had been trying for some time to reconfigure the organisation so that, instead of the centre leading on things, their role is to support and facilitate the clinical service managers to manage their own service. Last year, the organisation was split into 18 service lines, reflecting meaningful services groups. These service lines are given their own budget, so they know what they can spend and the income they need to earn. They manage their own performance and reporting. Each service line is lead by a clinical director, supported by a manager and a nurse. This ensures there is a strong element of clinical leadership, which is seen as particularly important. A whole layer of central management was removed in the process; we ve only got the executive team and the 18 service lines. 7

8 This is seen as having had a transformative impact. Kate Grimes explained that the trust is leading the way in terms of service line management for a district general hospital. I think it s going to have a massive impact. She believes staff are feeling more engaged and motivated with a greater sense of ownership over their service and that this is driving more entrepreneurial and innovative behaviour. In addition to devolving power to service lines, the trust has also made efforts to involve employees in decision-making more widely. David Grantham explained how, in terms of managing the financial pressures on the organisation, they have changed our approach to that from being very top-down and salami-slicing to actually sharing the nature of the problem very explicitly with staff and actually involving staff and saying we need your help to do this. Living the values A final factor seen as important in driving employee engagement at Kingston is having a strong set of organisational values, and ensuring they are lived. The trust values - Caring, Safe, Responsible and Value Each Other were developed in 2011 through an extensive process of consultation with staff. David Grantham emphasised how the process had been very much bottom-up; the ownership of the whole culture needs to be shared across the whole organisation. If you just set the culture and values from the top, people aren t going to engage in it. There has been a great deal of work to embed the values in the organisation. Extensive visual branding around the trust highlights the values to patients and acts as a reminder to staff. They are also integrated into a number of HR practices. There are monthly staff awards, where employees who are nominated by colleagues for having gone beyond the call of duty in demonstrating one of the trust values, are recognised and rewarded by the Chief Executive. The values have been built in to the recruitment process and they now form a central part of appraisals. Employees are assessed on a two-dimensional scale, taking in to account both performance against objectives, and living our values everyday. As David Grantham explained, it gives people the idea that it s not just what we do but the way we do it. This seems to have had a significant impact. Employees gave positive feedback on the appraisals and the staff survey has shown an improvement in the number of employees saying they ve had well-structure appraisals, a figure that now ranks in the top quintile for acute trusts. Highlighting this change, David Grantham said he attributed this to integrating the values into the appraisal process. 8