We can’t allow ourselves to normalise poor performance, says James Devine, Chief Executive of Medway NHS Foundation Trust, speaking at the recent Healthcare Partnership Network event.
The ease with which NHS Trusts can be focussed only on targets, tables, and tightening purse strings has been at the forefront of my mind for the past few years I have spent at Medway. That said, hardship within an organisation can bring about incredible changes. Here at Medway, we have seen ourselves overwhelmed by judgement of performance, and then go from strength to strength under a new financial and cultural regime. Special measures became, in a way, a driver towards success. This is something that many NHS Trusts are experiencing.
In 2013, we were placed in Special Measures, staying that way until March 2017 in one of the lengthiest stays of NHS Trusts in the country. It meant a complete change in the organisation. We are currently in year two of our three-year improvement plan, implementing a number of measures to propel Medway towards success. Coming out of Special Measures in March 2017 was massive. We were autonomously able to set out what was realistic to achieve, rather than being told what to do. It brought back a sense of control that is lost when you go under that intense period of external and internal scrutiny.
Pressing the ‘reset’ button
So how do you reset the bar of expectation in an organisation that has had these kinds of issues? How do you reset the culture bar? How do you reset the behaviour bar? Last year, we launched our cultural program called ‘You are the difference’, supported by some external partners who have done a lot of good work within the commercial sector, turning around retail brands. This marked the start of our cultural transformation, which will be the focus of my speech at next week’s Healthcare Partnership Network.
Turning around the culture is largely about behaviour. It’s about people feeling like they can, and should, go the extra mile for our patients. Of the 1700 staff members who have gone through that program, the results are great. We have notices all around our buildings showing that staff have signed a commitment to improve, so patients and visitors will know that we are serious about making tangible steps towards excellence. I have seen a fair few visitors stopping to look at these notices, and I believe it is crucial to be transparent about what you’re doing. It’s important that we connect to the population, especially considering struggles such as poverty and unemployment. Trusts with a similar demographic must adapt continuously and show people evidential proof of change.
Defeating organisational debt
Of course, with all the work we undergo to make sure we improve, there is always the overhead cloud of finances. What we do is try to see this challenge as a driver, not a limiter, to what we have set out to achieve. The fact we have smashed through our savings target this year, to me, really sets the tone of the next two years to come. This debt is something that leadership teams of days gone by have grappled with and not delivered on, and I have belief that yes, we can clear our organisational debt with our current vision.
This debt has not held us back. The senior leadership has regular dialogue with staff; feedback is of utmost importance to me, alongside clear communication and a common goal in mind. In the beginning, we saw people blaming our financial situation for the things they could not do. We have stopped normalising that sense of malaise, the sense that we can’t do anything to improve. One of the things I would like to improve, and something that more Trusts should be focusing on, is their engagement with staff. Staff in many organisations can be forgiven for their sense of apathy towards a constantly changing senior leadership team. We must show staff that we are present, that we mean business and that we are here to support and value them. That takes time, because people need to believe you. And the only way to make them believe you is to show them and be consistent.
Poor patient experience shouldn’t be normalised. Preoccupation with money shouldn’t be normalised. We aren’t about ignoring the data sets and targets completely, but what Trusts must realise is that behind the endless lists of numbers, are the patients. Trusts that experience difficulty need to design a plan, and stick to it. Hold your nerve when under scrutiny, and have confidence in your vision as a Trust.