Working on culture change in the NHS: one trust's journey


The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, have launched a cultural change programme - Tony Spotswood, Chief Executive and Nicola Hartley, Director of OD and Leadership talk about the journey so far.

Tony Spotswood, Chief Executive at The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust

Why did you set out on this culture change journey?

Our work is focused on building staff engagement and realising opportunities for staff at all levels to improve their own and their colleagues’ experience in order to strengthen the care we provide to our patients. The need for a coherent evidence based approach is clear - already there are many examples of this leading to better care and outcomes.

Why is culture change important at this point in time for your trust?

Culture is central at all times to the effectiveness of an organisation, as the challenges facing trusts become more stretching so it is the culture that will make the difference in enhancing the care we provide to our patients. It is the means and route map to a sustainable future, and we have to create this through our behaviours.

Why did you take the decision to create the post of Director of OD and Leadership to lead this work?

This work is critical and as such needs to be led and informed by those who know how to do it. It is best not left to chance and requires skilled and experienced leadership to help create the desired changes in approach and behaviours.  

This work is not optional or an add-on; it is integral to a healthy, successful organisation. It is a marker of the quality of its leadership.

Nicola Hartley, Director of OD and Leadership at The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust

Why was the cultural change programme launched?

I was recruited a year ago to lead a cultural change programme to support the trust in its ambition and commitment to Quality Improvement (QI). The trust had already standardised its approach to QI and recognising the role leadership has in creating culture, believed the next step was to develop an aligned leadership strategy. This had huge support from the board.

Who is in the change team?

Our change team is one of the things we are most proud of. We developed a set of criteria in order to recruit to it. To apply, individuals had to:

  • have the sponsorship and support of their line manager
  • meet the criteria
  • commit to attend 6 workshops 
  • undertake cultural audit work between the workshops 

 All of this was in addition to their “day jobs”.

Applicants were shortlisted and assessed by a panel that consisted of execs, non-execs, heads of nursing and quality and directors of operations. The board was also fully engaged in the process. We deliberately recruited a diverse section of people in terms of grades, roles, skills and experience. We tried to select a team that was representative of the workforce. 

We originally planned to recruit 12 change champions but from a strong field we actually recruited 15 people from a pool of 30, one of the team is a patient/volunteer representative. Being in the change team is a development opportunity. 

At the first workshop, the team developed their team objectives and progress against these was reviewed at each workshop. The development programme included looking at personality types and understanding differences, which was then used to think about how the team members could work effectively together to achieve their aims and objectives. Another session focused on presenting with impact and we engaged an actor to help facilitate that.

What has the impact been?

The impact has been huge. At the end of Phase 1, they gave a presentation of their findings to the board and received a standing ovation. The board wanted to know how things really were, and the change champions felt they were doing something really valuable. We took the views of over 900 staff into account and, in itself, the cultural audit has proved to be a very positive engagement activity. 

The final report to the board was huge, a lot of information and some important messages. It had a short executive summary to help make it digestible. The board dedicated a four hour development session to receiving the feedback which was presented by the change champions. The findings were themed into key messages and although some of these were hard for the board to hear there were no real surprises.  

Developing an action plan

The change champions then worked with the board to determine priorities and develop next steps. They gave further presentations and then sought feedback from the clinical directors and the council of governors. This work was then translated into an action plan which was agreed at the board meeting in July. The action plan set out our quick wins’ ‘just do it’ actions and things we need to take to the next phase: Phase 2: Design.

Next steps

Roadshows from our diagnostic phase – the ‘cultural audit’ - are now underway with a series of open meetings and attendance at existing team meetings being held. In these sessions, the findings of the cultural audit are being shared, staff are being invited to feed back on the findings and recommendations and shape the new culture. These sessions are being delivered by the change champions who are working in pairs and supported by a member of the executive team at each session. 

We are now developing the design phase and looking to recruit more change champions alongside the current team.

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