East London NHS Foundation Trust: one trust's experience of the culture programme

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Sandra Drewett, Director of Human Resources and Organisation Development for East London NHS Foundation Trust, talks about her trust's experience of the diagnostic phase of the culture programme.

How have you felt about the culture programme so far?

I’ve felt excited, energised and thoughtful and I’ve also been anxious because of the amount of work involved and the capacity and capability of the organisation to do it. Logistically it has been quite challenging, particularly at the beginning, but that has got much better. A lot of this is to be expected because we’re one of the pilot trusts.

I’m confident that other trusts using these resources in future will find the process a lot easier!

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

  • spend some time thinking about the likely capacity and capability that a project like this requires 
  • design a structure that ensures change team members are able to communicate with each other clearly and regularly
  • give a lot of thought to the size, composition and diversity of the change team

It’s really important that you give the team the time and space to be able to do the work properly. Each of the tools are quite different and so having someone with oversight over all of them is also essential (eg a project manager or someone similar). At the same time it’s important to remember that changing an organisation’s culture cannot be the responsibility of an individual person or manager, it’s a collective effort that’s required so getting that balance right will be crucial. 

Engage with your board early on

Think about whether it’s the right time for your organisation to do something like this. The system as a whole is under pressure – we all know that, but there are local factors which also need to be considered before committing to a project like this. For example we had a CQC inspection at the same time as when we were running the tools, which perhaps made things more stressful than they could have been. 

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

  1. We’ve been able to identify more ‘dark and light spots’ in our organisation that we would otherwise have been unaware of
  2. We’ve got a much clearer idea of where in the organisation people have experienced positive leadership (and where we could do better) 
  3. The diagnostics are an intervention in themselves - they’ve highlighted the importance of leadership and the key cultural elements which underpin it and  have helped to start that conversation which is still going on
  4. Getting a clearer idea about the experiences of Black, Asian, and minority ethnic (BAME) staff (this was already a priority for us, but we now have much more information as a result of using the tools)
  5. Improving our processes around leadership (how we recruit, train and then develop them) - the leadership workforce analysis has been particularly useful in this aspect 

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

The experience and perception of leadership is very dependent on where you sit within the organisation. Band 2 staff for example are far more positive about leadership than other members of staff who are closer to senior leadership. We haven’t unpacked that fully yet, but we’re still doing some analysis.

There was also a larger perception gap than expected (ie the difference between how people perceived themselves compared to other members of staff was much larger than we thought).

There was more convergence among the board members than I expected. A lot of them identified the same themes and had the same thoughts about what the organisation needs to do to improve its culture. That’s a very positive thing! 

What are your hopes for the next phase?

That we will be able to develop a culture at East London that not only promotes, encourages and develops collective leadership, but also cultures of continuous, meaningful and developmental feedback. We also want to make sure our teams work better together.

We’re going to map our current development activities against the 5 cultural elements and we’re going to review the composition of the change team to ensure we have a mix of people who have the necessary skillset to help with what Phase 2 will require. 

Were the resources easy to use?

It probably wasn’t as easy to use for us as it will be for other trusts moving forwards, but that’s because we have been involved in the design process. 

Board interviews are straight forward to do and the survey takes some time to establish but once that’s done it’s easy and generates lots of useful information.

The leadership workforce analysis has been trickier – particularly in identifying key roles. It’s broad and may generate a huge amount of data.

It’s been a fantastic experience both for the trust and me personally. I’ve had the opportunity to work with a lot of really interesting people and it’s great to be able to do something positive and meaningful for our staff and patients. 

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