Royal Bolton Hospital NHS Foundation Trust 

Partnership working

Under the leadership of a forward thinking director of workforce and organisational development, the Royal Bolton Hospital has been steadily building strong partnership working, based upon the principle of ultimately improving patient care.

The trust currently employs  3,600 staff and has a highly effective staff side structure, with relationships that enable staff side representation at all levels of decision making. In order to be a truly successful organisation, the trust recognised that it was also vital for all staff to feel more involved in the decisions that affect them on a day-to-day basis, ultimately ensuring the best possible care for our patients.

Staff side have been key contributors in developing our understanding of different methodologies to address staff morale and improve communication and attitude.  In partnership we have created a basis for mutual understanding and respect, leading to greater transparency and shared communications and decision making. 

The trust has successfully developed a Bolton Improving Care System (BICS) using ‘lean thinking’ techniques, which help to reduce wasteful processes and add value for patients and staff. In addition, we have a bespoke supporting leadership development programme involving managers and health professionals.  In October 2008, the hospital achieved  foundation trust status, allowing more freedom to develop our services for the benefit of patients and give the public a much greater say in how we do this through our membership scheme.

In April 2011 the trust and the provider services from Bolton PCT will become an integrated care organisation.  We will continue to build on the engagement foundations that we have established to promote organisational effectiveness for the future delivery of high quality and safe services to our service users.

Background to the project

The trust reviewed its workforce strategy, which was produced in 2007, following a number of focus groups with staff to identify what is preventing them achieving ‘joy and pride’ in work, which is a key aim of the trust.  The review fed into the outcome of the staff survey results from 2008 and the Best Companies Survey (Sunday Times Top 100) from 2007, identifying key themes that emerged. Using this data and qualitative information from our internal communications, we identified a need to change the culture of the organisation from a ‘tell’ culture to a ‘listening and involving’ one. These findings had strong correlations with the issues that staff side were dealing with on a regular basis.

In 2009, in complete partnership with staff side, the trust embarked on a project to embed a culture of engagement that would make Bolton Hospital a great place to work. The aim of the project was to introduce an engagement methodology into the trust through a series of listening events with staff, in order to really understand what working life is like for staff and what their ideas and thoughts were to support ongoing improvements.

Project delivery

We began with a position paper and presentation to the board of directors, who overwhelmingly agreed to support a programme of cultural change.

The project was led internally from existing resources by the head of organisational effectiveness and staff engagement, with part-time administration support and a budget of £40,000 secured from a successful bid to the Social Partnership Forum.

The methodology involved the use of ‘appreciative inquiry’, which uses a positive approach towards identifying what great days at work look like and what is required to create and sustain these days.

We carried out a considerable amount of research to find best practice, both in the NHS and the private sector, on staff engagement, involvement, participation and staff ownership. Staff side colleagues made a number of visits to NHS trusts who have worked on similar projects, including Birmingham Children’s Hospital, Heart of England, James Cook and Sandwell and West Birmingham.

The project involved a series of staff 'listening' events titled the ‘Small’ and ‘Big’ conversations. 

From each of the events it was anticipated that we would identify:

• the values held by staff and the development of a set of trust values
• quick wins for our staff – the things that we can resolve quickly to demonstrate to staff that we are listening
• longer term actions that would link to other trust initatives and support mechanisms (i.e BICS)
• how the methodology could be cascaded within the trust to encourage staff conversations and continually look at what is good.

The small conversations were delivered to each divisional/directorate board and key decision making group, including the Joint Consultative Committees, in order to raise awareness about engagement as a culture, what it would entail and how we would go about achieving it.

Around 250 staff took part in the small conversations, which consisted of a short presentation and an exercise to elicit staff values using three questions:

• Why do you work in the NHS?
• Why do you work at Bolton?
• What do you need in order to give your best at work?

Following the small conversations, a series of six big conversations were held for staff at all levels. Staff were selected randomly from the ESR database and received a personal invitation to the events from the chief executive and the director of workforce and organisational development. 

The big conversations were held at a large, off-site venue and were supported by SPF funding. The events were delivered in partnership with staff side and covered an overview of the importance of engagement and a vision for what the trust is trying to create. At each event, priorities for action were identified and staff had opportunities to put their names forward to be involved in working on these. ‘Just do it’ actions were also identified and, in some instances, staff who wanted to get involved were linked immediately into existing action groups.

A total of 278 staff took part in the events. Evaluations of the events showed 2 per cent rated them as ‘fair’, 43 per cent ‘good’ and 55 per cent ‘excellent’.

To support the project, a range of communication networks were established:

• A Best Employer Group, with representatives from every division, directorate and specialist area becoming ‘engagement champions’.
• A comprehensive intranet site with links to key internal and external information, including literature, conversation outputs, presentations and reports.
• Communications via the trust team brief, newsletters and presentations to various forums.

Project outputs

The aims of the project and its outputs are:

Project aims	Project Outputs
Begin to establish a culture of engagement	Presentation to the board of directors, divisional/directorate boards and key decision-making groups. Presentations to key leaders, Social Partnership Forum and national and regional events. Development of an engagement spectrum to support regular measurement of engagement, with an average score of 3.5 recorded on a five point scale (correlating with staff survey scores).
Undertake a series of listening events	Delivery of a series of small and big conversations to identify trust values, top priorities and ‘Just do it’ actions. Development of seven major work streams for longer term actions.
Development of seven major top priority work streams	Work stream titles: Values Leadersip and management Communications Recognition and well-being Staffing and skill mix Team working Appraisal All groups are established and working on key actions
Development of staff engagement action plans	Action plans for corporate and divisional/directorate levels incorporating findings from NHS staff survey and national in-patient survey.
Development of ‘Engaging manager/leader programme	Programme commenced in October 2010 to support engagement behaviour and use of engagement methodology.
Use of engagement methodology in the wider organisation	Roll-out of the engagement methodology into departments in partnership with staff side.
Use of engagement methodology to support transformation and integration	Series of small and big conversations to be delivered with PCT provider colleagues to support Transforming Community Services and integration strategies. Conversation event planned with trust governors.

Added value

Insights from the project process and outcomes have proved invaluable in terms of:

• the impact that the methodology has as motivational tool towards achieving engagement and discretionary effort
• the importance in delivering on actions  
• the importance of supporting managers to develop engaging behaviours
• the importance of working in partnership.

Evidence to support effectiveness

While we are able to demonstrate achievement of the project aims, we have determined that improvements in the forthcoming 2010 NHS staff survey will be a key measure.  In the meantime, the Bolton engagement spectrum will be used to measure engagement on a monthly basis.

Across the divisions, a series of engagement case studies are being identified. The case studies focus on areas that need to improve levels of engagement, known to impact on productivity and morale. The first of the case studies have shown that using appreciative enquiry methodologies, engagement levels, productivity and morale have significantly risen within a six week period. Managers in the areas are supported by the organisational development team and measures of ongoing improvements are put in place. 

Four core values have been identified and will be launched following a further series of conversations to be held with PCT provider colleagues, as a result of integration plans. The values will be used to support policy, performance, behaviour and recruitment.

Taking the project forward

A project plan is in place for 2010-11 and a further plan to reflect integration will be developed for 2011-12.

Key outputs are:

• launch of the trust values
• roll-out of engagement methodology and associated key measures of effectiveness. For example sickness absence, engagement/satisfaction scores, survey results, productivity, employee relations issues, patient complaints
• roll out of the engaging manager/leader programme
• visitor days for organisations who wish to learn from our experiences 
• sharing learning internally and externally.

Top tips

1. Have a clear vision.
2. Take time to research best practice – know your stuff!
3. Work up as much detail in your plan as possible.
4. Work as collaboratively as you can.
5. Communication, communicate, communicate.
6. Don’t be put off by a small majority who may want to thwart your best efforts.

Staff feedback

"A very informative event, much better than I thought it would be."

"We've enjoyed it and it has been very positive."

"A lot more relaxing than I thought it would be and I'm sure that we'll all get something out of it."

Contact

Nicky Ingham – director of workforce and organisational development
Nicky.ingham@rbh.nhs.uk

John Murphy – staff side chair
John.murphy@rbh.nhs.uk

Sue Whittam – head of organisational effectiveness and staff engagement
Sue.Whittam@rbh.nhs.uk