About the trust
Robert Jones & Agnes Hunt Orthopaedic and District Hospital Trust is a specialist hospital providing elective orthopaedic surgery and musculoskeletal medical services with specific additional areas of expertise including spinal disorders and metabolic disorders affecting muscular development. The Trust has a turnover of £78.8 million and employs nearly 1,000 whole time equivalent staff.
Background to the project
Like many trusts, RJAH had experienced periods of major organisational change. Whilst achieving the overall aims of the change procedure, the impact of changes on staff were not being addressed consistently. The trust believed that change could be smoother and even more beneficial if staff side views were taken into consideration earlier in the change process.
As a result, the trust began a project to review its approach to managing organisational change by improving partnership working between managers and staff side organisations. The Associate Director of Human Resources and the Staff Side Chair sponsored the project, with approval from the Chief Executive.
Whilst partnership working is everyone’s responsibility, improvements need to be lead, co-ordinated, and championed within an organisation. The project team identified the HR department as an obvious place for leadership as they could make the connections between partnership working and service change, communication, management style, leadership style and service improvement techniques.
A review of previous service change projects found there was a lack of appropriate tools with which to measure and evaluate those projects. A ‘toolkit’ was therefore developed which included practical approaches to measuring partnership through change and provided basic principles to be used in gathering and measuring qualitative data.
The principles for effective measurement and evaluation include the following:
- Provides evidence to inform decisions, rather than relying on individual perception or hearsay
- Acts as a control to demonstrate that monitoring is in place (a principle of effective management)
- Develops a ‘baseline’ or start point from which to measure the impact of change
- Helps identify what has changed as a result of actions taken
- Leads to more effective targeting of where actions and/or additional resources are needed
- Demonstrates the impact of the actions taken
- Provides a business case (or otherwise) for further activity.
To measure the current state of partnership working at the RJAH the project gathered baseline information from staff and managers who had been involved in recent service changes. Feedback was gathered via a questionnaire survey and focus group activity. This enabled the Trust to determine the current level of satisfaction with partnership working during service change.
Project delivery
The project included five steps to delivery:
Step one:
- review and learn from experiences of service change implemented in the trust over the previous twelve months
Step two:
- deliver a workshop with managers, trade unions and representatives from buddy NHS trust to share learning and develop a draft protocol and toolkit for partnership working during service change
Step three:
- pilot the protocol and toolkit during the implementation of a service change within the trust
- review and evaluate the effectiveness of draft protocol/toolkit, with support of representatives from buddy trust and learning from pilot evaluation
Step four:
- revise protocol/toolkit
- deliver second workshop to share outcomes and learning with participants involved in first workshop
- write up outcomes and final protocol/toolkit
- produce a booklet to explain the protocols and tools for distribution around the trust
Step five:
- present findings to the social partnership forum
- seek funding for the distribution of the booklet across the NHS
- utilise NHS employers website to assist with distribution and accessing
- share outcomes with rest of the NHS
- deliver national workshop
Having identified the key themes for improvement, the next stage targeted improvements to bring about a positive change.
We held a workshop to help define partnership working. The workshop was challenging but provided a helpful forum for both management and staff side to express their views, to raise issues and concerns about partnership working and to established a shared understanding on which to build future relationships.
Project outputs
The project enabled us to produce a suite of guidance material giving us a firm foundation on which to move forward. The guidance will assist in making more productive use of the time spent by all involved in implementing service change:
The Partnership Agreement adopted a set of six partnership principles:
1. Shared commitment to success - securing and promoting the long term success of the trust
2. Recognition of Interests - promoting the interests of staff, patients/clients, other stakeholders and the community at large
3. Commitment to Employment - ensuring the trust meets patient expectations by having staff with the right skills in the right place at the right cost
4. Quality of Working Life - understanding that staff work best for patients when they can strike a healthy balance between work and other aspects of their life outside work.
5. Openness - ensuring staff are managed fairly and professionally
6. Adding value - continually seeking to improve the service provided in quality, effectiveness and efficiency.
Top tips
- Communicate at all levels
- Keep to targets
- Build on the experience of others
- Listen to all staff in areas where service change/review is happening
- Keep in mind the purpose of the project – working at all times for the benefit of the patient towards even better patient care
Further information and contact information:
Ruth Tyrrell, Joint Project Manager
Ruth.tyrrell@rjah.nhs.uk
01691 404639
Jan Brassington, Joint Project Manager
Jan.brassington@rjah.nhs.uk
01691 404639
Anne Roberts, Project Facilitator
Anne.roberts@rjah.nhs.uk
01691 404639