About the trust
Aintree University Hospitals NHS Foundation trust is a large, complex organisation providing acute healthcare to a population of 330,000 in North Merseyside and surrounding areas. The trust covers an area of 33 square miles which is largely urban, with significant areas of commerce including docklands.
Background
The project built on the trust’s successful strategic level partnership forum cascading partnership behaviour to a unit/departmental level in order to meet current and future organisational development, whilst at the same time improving the overall quality of patient services.
Four pilot areas were identified where partnership working had proved challenging in the past and where planned changes to service provision was necessary. The trust identified that shop steward and management capacity/desire existed (or could be speedily mobilised) in these areas which could be used to develop partnership approaches to meet the challenges. They were also identified as areas from which wider lessons in improving patient care could be extrapolated:
1. Elective Care Centre: In 2010, 184 staff were transferring from Walton Hospital to a new purpose-built centre involving not only a change in location and working environment for staff, but also requiring different working arrangements.
2. Theatres: Improving productivity to increase efficiency in this area had been identified as a trust priority.
3. Hotel Services: Domestic staff were bought back in-house in 2008. The trust acknowledged that these members of staff were key workers given their contact with patients and their role in controlling infection; however cultural issues of reintegration into the direct labour force remained.
4. Outpatients: The trust had plans to move from a paper-based patient record system to an electronic one and staff faced a period of significant change and likely redeployment as a result.
Project delivery
An external partner was chosen to undertake an initial diagnostic report to develop and implement the partnership training and development programme for the pilot areas, undertake continuous learning and make proposals for a trust-wide rollout.
Workshops and interviews for key players and individual coaching for partnership champions were held to reinforce partnership working.
A training programme for managers and shop stewards was developed within the targeted areas built on learning from existing good practice adapted to each individual area to cover:
- how partnership working works
- the processes involved including consultation and information sharing
- behaviours including developing trust, mutual understanding and the ‘no surprises’ culture
- training and capacity building
- promoting employee engagement in service design and delivery
We used the trust’s well-established communications channels to facilitate ongoing and transparent feedback to hospital staff from the pilot schemes (both paper and e-communications) and encouraged two-way communication between staff and managers through a ‘social partnership development’ site on the trust’s intranet.
We produced a report based on the strengths and successes of the existing partnership arrangements to identify learning points which was widely disseminated throughout the trust to enhance trust-wide confidence in the approach.
We developed partnership arrangements with an employee engagement focus in the four pilot areas. A survey of managers and TU colleagues provided evaluation material to establish awareness of, support for and remaining challenges to partnership working.
Project outputs
By embedding the principles of partnership working at an operational level we have been able to change working practices, reduce redundancies and improve patient care:
- Managers and staff worked together to avoid redundancies of permanent staff following a major reorganisation of theatre arrangements
- A smooth transition bringing domestic services in-house helped Aintree achieve a vast reduction in infection levels
- Staff were involved at an early stage in the change process resulting from the closure of Walton Hospital. At the same time they were consulted on the future design of patient pathways which has lead to improved patient care.
Top tips
1. Be flexible:
Staff groups within the four pilot areas were all different and at different stages of development and partnership awareness. The project had to be flexible in order to be able to deliver its key messages in the right way, and to the right audience. By identifying areas where partnership working was already embedded it was possible to see potential barriers.
2. Be prepared:
- Consult at the right time when there is still room to influence
- Produce high quality communication for everyone
Partnership working can fall foul of unknown threats, for example where key people move or TU colleagues are not re-elected. Understand the problems that this can cause and develop processes to help mitigate them.
3. Be inclusive:
- Share with staff the processes involved in how strategic decisions are made
- Create an informed employee voice that contributes by challenging constructively and suggesting solutions
- Develop a closer working relationship between line managers and staff by giving them consultations tools.
We believe that staff need to be informed and empowered but equally they need to accept that with this comes responsibility. They should be able to contribute ideas and have the confidence to challenge constructively where they feel this is necessary. Managers have to accept this way of working and be open and honest with staff. By working in this way the team at Aintree found that far from being part of the problem, the staff were a major part of the solution.
Further information and contact information:
Debbie Fryer
debbie.fryer@aintree.nhs.uk
0151 529 2226
Peter Ballard Staff side chair
Peter.ballard@aintree.nhs.uk
0151 529 2495