OUR LEADERSHIP DEVELOPMENT JOURNEY NORTHAMPTONSHIRE

HEALTHCARE NHS FOUNDATION TRUST

#weareNHFT

OUR TRUST

• An Foundation Trust since 2009

• A diverse range of community and mental health services for adults and children

• 3,500 staff

• £192m income 2016/17

• #weareNHFT

Where we were… (3 years ago)

• Positively moving forward on our journey towards a quality culture

Continuing challenges were:

• Leadership Strategy had limited impact on Trust performance and outcomes

• Lack of real buy in

• Greater breadth and Depth of engagement required

• Financially challenged

• Challenging WRES indictors

New focus…

Lets do something new and different…

• Distributed leadership was at the core

• Desire from the Board for action

Why distributed leadership?

• Learning from the Francis Report

• Why Leadership Matters 1 • Leaders make improvements in service and outcomes • Leaders promote professional cultures that support

teamwork, continuous improvement and patient engagement

• High performance requires distributed leadership including clinical champions

The NHS needs people to think of themselves as leaders not because they are personally exceptional, senior or inspirational to others, but because they can see what needs doing and can work with others to do it1

Our action

• Chief Executive as champion of new leadership approach

• Project lead - new Director of HR & OD

• New leadership Strategy supported by Trust Board

How did we make it happen

Leadership Matters conferences

• Regular conferences with leaders from across the organisation

• Engaging, informative and uplifting

• Shaping our future, learning together

• Conversations, relationships, results

We developed our leadership behaviours • Shaped by our leaders – they reflected on a time when they

were well led, how did it make them feel, how it impacted, how they performed as a result

• Summarised into list of behaviours • Focus groups and director interviews further developed the

behaviours into exceptional, desirable, expected and what they are not.

• Launched behaviours and began to embed into the Trust • Recruitment and Selection • Performance Management • Learning and Development • Reward and Recognition

Our leadership behaviours

We developed our Leadership Matters programme

• We reviewed our existing leadership programs both for content and delivery method

• Redesigned delivery based on whole brain learning theory – reasoning, sound, vision and physicality, this enables staff to: • Retain information for longer • Recall information easier • Take in new information faster • Enjoy the learning process more

• Turned information sharing into learning • Embedded Leadership behaviours into programme • Mandatory for all leaders

Empowering our leaders to take responsibility, embrace change, work together and be authentic

Our Leadership Matters programme

Foundations Engaging

Managing Sickness Courageous conversations

Recruitment and selection Resilience

Disciplinary, capability and grievances Negotiating for Influence

Quality performance and innovation Making things happen

Appraisal Leader as Coach

Leading change and transition Distributed and system leadership

Personal effectiveness

Talent management and development

• Identification of a Trust Senior Leadership Team

• Commencing programme to identify our talent

• Hold talent conversations in conjunction with appraisal

• Identify ways to enhance individuals potential

• Centrally support, coordinate and develop talent

• Constantly review Leadership Matters to ensure it meets organisational needs

• Coaching support for leaders to maximise potential

Our appraisal process

How we behave towards each other … How we behave as leaders … How we perform individually …

Appraisal Process

Conversations

Diversity Network Leads To address the Diversity challenges the Trust has created a Diversity Network • Involves Chairs of all our networks BME, Disabilities,

and LGBT • Led by CEO, supported by Director of HR and OD

and Director of Nursing • Joint agreed action plan • Initiatives - Career development Training, Auditing

Disciplinary and focus groups • Next Leadership Conference focused on Diversity

Communications Focussed communications to encourage change, empowerment, accountability and evolution

Our approach? • Similar to Bill Quirke’s communications escalator below • Established the first three stages, then focus on the last two for transformational change

• Quality awards • Open and honest CEO updates –

regular/as needed • New staff intranet (Staff Room) • Video • BIG conversation webinars • Learning lessons webinars • Freedom to speak up comms • Manager communications

MN2K Manager empowerment Leadership behaviours conferences

• Distributed leadership • Leadership matters • Ownership of our intranet

• Executive & SLT accountability Service visits Induction Board to ward

MOVING TO GOOD AND BEYOND

Our project to underpin our post CQC visit activity and embed the quality and safety journey within NHFT

• Collective objective: quality improvement, developing and sharing lessons

• Directors and Deputy Directors work together with service teams to review and resolve quality issues and celebrate good practice

• Has strengthened ward to board visibility and includes NED’s

• Helped the develop some of the key internal Trust communications and quality initiatives

• Regular meetings with representation from all clinical and corporate areas

• Will continue after our next CQC visit

Quality Awards

• Fully sponsored annual Awards since 2015

• Three rounds and annual ceremony

• Over 150 nominations • Hundreds of staff involved • All awards presented as a

surprise, videoed and shared across our channels

• Positive impact on morale and a ‘buzz’ around the Trust, that is growing each year

Service Users and Carers as Leaders

Patient Involvement and IMRoC developments Development of our alignment with the IMRoC project and patient involvement in care planning

FUTURE DEVELOPMENT: Continue to increase patient involvement and embed principles of this valuable project across the Trust. Carer Awareness Training Developed and designed collaboratively by the Involvement team and the L&D team. Carers have played an active role in the facilitation of the training sharing their experiences of being a carer, this has been supported by Northant’s carers who have also supported the delivery and have provided advice and guidance regarding support available for carers FUTURE DEVELOPMENT: development of the Carer Ambassador role across the Trust.

Moving Ahead Project – Diversity in Action

• Diversity focussed

• Responding to feedback

• Using data to inform best practice

• Prioritising quality improvement

• Community engagement and leadership

• Co-production

– Governor involvement

– Patient assurance

– Learning together

Focus on Outcomes

The purpose of our leadership strategy has been to;

“Empower our leaders to take responsibility,

embrace change, work together and be authentic”

→ To deliver outcomes that improve quality.

→ Our outcomes are described in the next section

Our achievements – CIP delivery

-

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

8,000,000

9,000,000

Target 4.5%,£7,897,000

Total planned delivery£7,872,253

Delivered £7,449,102 Directorate schemes£124,094

Non Pay expenditure£192,483

Trust wide projects£106,573

2016/2017 Cost Improvement plan of delivery

• Total delivered at 31 January 2017 £7.449m (94%) of £7.9m target (increase of £0.314m since December 2016) • Further £0.447m to deliver the 2016/2017 target – projected to be £25k short of target

Our achievements – agency spend

NHFT Totals

24

-Oct

-16

31

-Oct

-16

7-N

ov-

16

14

-No

v-1

6

21

-No

v-1

6

28

-No

v-1

6

5-D

ec-

16

12

-De

c-1

6

19

-De

c-1

6

26

-De

c-1

6

2-J

an-1

7

9-J

an-1

7

Totals

Off framework 0 0 0 5 0 0 0 0 0 0 0 1

Price cap met 262 291 249 269 268 293 304 260 191 126 174 211

Price cap broken 267 242 250 281 291 308 312 332 289 165 185 277

Total Shifts 529 533 499 550 559 601 616 592 480 291 359 488

% Price cap broken of Total 50% 45% 50% 51% 52% 51% 51% 56% 60% 57% 52% 57%

Our achievements – RCN recognition

National case study by RCN: Reps making a difference Recognised nationally for successfully addressing our cultural challenges of low morale, high sickness and disciplinary ab in an effective partnership with our union reps. Results • Trust became an accredited Living Wage employer in 2015. • Disciplinary/grievance cases decreased. • Sickness absences reduced. • Lower spend on bank/agency workers. • Increased investment in staff training and development. • More focus on staff health and wellbeing. • In 2014 signed a joint Trust/RCN/Unison Learning Agreement

IMPROVING WORKPLACE CULTURE

Our achievements – improvements in WRES

Areas within the WRES that have improved in 2016: • Relative likelihood of staff accessing non mandatory training and

CPD • Percentage of staff experiencing bullying, harassment or abuse from

patients, relatives or public in last 12 months • Percentage of staff experiencing harassment, bullying or abuse from

staff in the last 12 months • Percentage believing that the Trust provides equal opportunities for

career progressing or promotion • In the last 12 months have you personally experienced

discrimination at work from manager, team leader or other colleague

Encouraged by improvements but still challenges to overcome

Our achievements – our openness and transparency Percentage of staff able to contribute towards improvements at work

72.46

Fairness and effectiveness of procedures for reporting errors, near misses and incidents

3.78

Staff confidence and security in reporting unsafe clinical practice

3.72

Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months

18.42

Our Achievements –

• 61,000 reviews to date

• Trust Friends and Family test to date - 94.21%

• Trust average five star to date - 4.7

• FFT plus detailed quantitative and qualitative feedback on what matters to patients and carers

• Embedded into Quality Framework, assurance and performance processes

• Aimed at changing staff culture and really understanding what matters to patients and carers

• Reviews are published, as are responses

Our achievements – financial control

• Our control total for 2016/2017 is £1.340 million.

• We are currently on track to deliver this.

Our achievements – CQC initial feedback Initial Feedback from the CQC following our recent inspection – Awaiting our report:

• Staff were engaged with the Trusts agenda • Some dynamic and innovative practice • Several examples of going above and beyond • Vision and Values permeated throughout the Trust • Visibility and approachability of the majority of Board

members • Staff felt senior leaders understood and valued staff roles • Despite the amount of change majority of staff were on

board • Culture of the Trust was praised with people saying they had

been supported to progress and develop • Flexibility in training styles and times

Our achievements – Leadership Matters feedback

Our achievements – staff engagement

WHAT OUR STAFF SAY

NHS ANNUAL STAFF SURVEY 2015 Top five ranking scores 1. Staff experiencing harassment, bullying or

abuse from patients, relatives or the public

2. Staff agreeing that their role makes a difference

3. Effective use of patient / service user feedback

4. Staff motivation at work

5. Staff reporting good communication between senior management and staff

Our NHS England Staff Survey report outlines that our staff engagement score is above average for Trusts of our type

What next…

• Build on our current work

• Continue to develop innovation

• The future leadership focus is “Collaboration - Through Partnerships”

• First for Wellbeing partnership with County Council and University

• 360 – MCP partnership with GP’s

• STP – “System Leadership”