Central Manchester University Hospitals NHS Foundation Trust: one trust's experience of the culture programme

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Helen Farrington, Associate Director of OD and Training, talks about her trust's experience of the diagnostic phase of the culture programme.

How have you felt about the culture programme so far?

The Culture Programme has been a fascinating journey so far. The programme has helped us carve out time to talk about the ‘way we do thing around here’ which we all agree is important, but in the hectic day to day is not always prioritised. Carrying out the comprehensive diagnostic phase has given us some real concrete and comprehensive information that will ensure our interventions are more accurately designed and targeted. This will in turn ensure we are making a real difference to our staff and our patients. Although the programme has been time consuming it has been worthwhile!

Would you have any tips for other trusts doing the diagnostic phase?

Don’t underestimate the amount of data produced particularly from the diagnostics where the method for obtaining information is mostly face to face. This data is extremely rich and informative but requires dedicated time and the ability to analyse it. Previously we focused on the quantitative methods – primarily the national Staff Survey– to understand our culture, but this meant we only gained a superficial understanding.

Extend the invitation for people to be involved in the work widely. We asked our directors to identify a number of capable and motivated people as change leaders to help design and lead on the delivery of the programme. There were no set criteria for getting involved, just an enthusiastic commitment to the programme and a willingness and capacity to get involved. Initially we had 30 volunteers from around the trust and from a range of roles and bands. We kept the whole group involved but we had a core group of 16 who have led on this phase of the work programme. The real benefits of developing the change team in this way have been the fact that we have both capitalised on people’s interest and curiosity in culture and also started to build OD capability in roles who ordinarily would not have been exposed to this. The team has also acted as a real catalyst for communicating and spreading the key messages from the programme.

Assign roles and responsibilities. In terms of roles, we identified a pair of leads for each diagnostic which helped to ensure ownership and that the diagnostic was designed and implemented effectively. We did end up running most of the diagnostics concurrently however our culture corner meetings, half an hour every two weeks, helped to keep us on track and address any issues that arose through this phase of the programme.

Keep communicating about the programme and its progress. We decided to create a brand for our culture and leadership programme to make sure staff understand the aims and could see its impact from the diagnostics through to implementation of the leadership strategy. We linked this to the overall Central Manchester branding – particularly the use of a heart which symbolises our Values. Once the programme was ready to go live with staff, we had a video to describe the programme, regular updates in our newsletter and posters. We also presented data and results in a format that was already recognised by leaders in the organisation helps ensure the data is held in the same regard / importance as operational data.

Engage with your board early on

At the onset we identified two Executive Director sponsors – the Chief Nurse and the Executive Director of HR and Corporate Services. They helped spread the word to other Executive Director colleagues and could update them regularly. This really helped to get buy in and support from the entire Board, which was demonstrated in their willingness to take their part in the Board Interview piece of the diagnostic.  The Organisational Development and Training team led the project but worked closely with our corporate Nursing team.

How have the diagnostic resources helped you to identify areas for improvement?

The diagnostic has helped to showcase real cultural strengths, alongside clearer areas for improvement. For example, organisational leadership encourages pride, positivity and strong identity and the diagnostic has brought to the attention of the Board that there is a real appetite from staff to share the vision of the future of the organisation and a desire to work collectively to make it happen. Staff are eager for more autonomy and involvement in decision making, and would welcome a reduction in hierarchy and silo working, which links with a key driver of the culture programme of collective leadership.

What surprised you most about what you found during the diagnostic phase?

We were surprised at the appetite across the Trust to have cultural conversations and the energy of those who joined the change team despite extreme operational pressures. Staff were prepared to be open and honest when giving their views which means we have a true perspective of what life is like.  

What are your hopes for the next phase?

For the next phase, we are hoping that we can bring together all our findings to effectively inform and prioritise our leadership and cultural strategy going forward, giving credibility and evidence to support future interventions. We are hopeful that we can build on the energy from phase one and keep involved those who were new to OD, so they can continue to develop their skills and constantly bring their clinical and operational experience to the process. This will help to ensure our strategies and plans are ambitious and innovative but also pragmatic and possible to implement successfully.

Were the resources easy to use?

The resources were easy to use. Our challenge was giving enabling people to take part and step away from their incredibly busy clinical environments. In order to reach out to staff and make the offer of involvement widely we adapted our approach, and together with focus groups we also offered ‘marketplace’ drop in events at various times and locations with facilitators to support conversations. This enabled people to contribute to the programme and give their feedback at a time that suited them, without compromising on quality of the data we collated.

The survey asks people to take time to think about their own behaviour as well as those of their leaders. We found that the survey was already encouraging behaviours in people as well as being a diagnostic about staff experience of the leadership they receive.

We chose to use internal employees to conduct our board interviews. We selected this approach because we felt it would strengthen our work to build a model of collective leadership to further improve staff engagement and motivation. Before undertaking the interviews our change team, who had self-selected for the board interviews and focus groups, underwent an afternoon of interview training. This included discussion of the purpose of the board interviews, confidentiality, notetaking techniques and how to probe effectively.  Participants had a chance to practice their newly learnt skills through mock interviews, helping to bring it all to life. The training helped bring the team together, but it also provided some excellent transferable skills in interviewing and a thorough introduction to the diagnostics. Having a number of team members undertaking the interviews meant they were not only able to spread the workload, but also learn together and reflect on the process as a whole. Everyone really enjoyed taking part and commented on how it had positively changed their views of our board. Part of our overall OD plan is to build OD capability across the trust and this process really helped make that happen. Importantly, the board were very receptive to taking part and it was felt they were open and honest in their responses. Like the survey, this in itself may end up having a positive impact on the culture and leadership of the organisation.

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