Interim report - NHS Professionals

Interim report - October 2014
www.rcn.org.uk/culturechange
National Advisory Group for Cultural Alignment
Foreword
Culture within health care organisations has been highlighted as a key factor in some
of the most high profile and concerning issues in patient care of recent years. Sir
Robert Francis in his letter to the Secretary of State presenting the Mid Staffordshire
Public Enquiry report stated that they found a culture focused on doing the system’s
business – not that of the patients.
Within the clinical voice, the need for a positive, patient focused culture has also
been identified for some time and work to help organisations understand their culture
was originally commissioned by a group of key nurse and health care leaders (Dame
Elizabeth Fradd, Baroness Emerton, Flo Panel Coates, Tricia Hart, Professor Anne
Marie Rafferty and Sir Stephen Moss) with the academic development of the ‘cultural
barometer’ tool which is now in its final stages of development.
What we as a Royal College have found in discussion with our members, is that the
culture of their organisation remains a key factor in their ability to make the best
decisions with patients and to know that their organisation is aligned and will stand
by that decision even when it may conflict with the measures by which organisational
success is externally viewed.
We know that many organisations recognise they would like to develop their culture
but it feels that there has been little or no central support or guidance to support
organisations to make that move.
Formation of the National Advisory Group for Cultural Alignment (NAGCA) by the
Royal College of Nursing came from recognition that as a Royal College we can and
should work together with other key organisations and individuals to provide that
focus of support and shared learning. The group now works with three health care
organisations, Kent and Medway NHS and Social Care Partnership Trust, Sherwood
Forest NHS Foundation Trust and The Christie NHS Foundation Trust, each of
whom describe in this report the vision for their future.
We see in this report how these three quite different organisations have put
themselves forward to begin a cultural shift with the aim that this will help them to
consistently provide their best in both patient care and the experience for all those
connected with their work.
I welcome and congratulate the sites working with NAGCA and look forward to the
continued development of the work of this group. There is huge potential for this
work to impact on patient care and development of a model of culture change which
others can benefit from. I anticipate much will be learned and shared along the way
and I look forward to the final report at the end of this phase of NAGCAs work in
summer of 2015.
Dr Peter Carter, Chief Executive & General Secretary of the RCN
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Content
1. The National Advisory Group for Cultural Alignment
1. a Function of the group
1. b Our purpose
1. c Our membership
2. Background
2. a Terms of reference
3. How the group work together with sites
4. Live sites
• Kent and Medway NHS and Social Care Partnership Trust
• Sherwood Forest NHS Trust
• The Christie NHS Trust
5. Member biographies
6. Identified learning from the process to date
7. References
8. Appendices
Appendix 1 – Terms of reference
Appendix 2 – Expression of interest document/Frequently asked questions
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1. The National Advisory Group for Cultural Alignment
Before we retrace the background to how the group developed, a key
question which is frequently asked is what do we do? In order to answer
this and create a common understanding of the group we begin with
description of what we seek to achieve.
1. a The function of the group
The main function of the advisory group is to provide expert skills, advice and a
safe area for discussion to the organisations in relation to undergoing culture
change in the health care sector.
1. b Our purpose
The purpose of the group is to provide the organisations with access to support,
knowledge and expertise at a national level to ensure that:
• the process of cultural alignment at each site is optimised
• sites are supported in achieving their existing organisational development
plan
• sites are able to share their learning
• resources and skills are pooled thereby preventing duplication of effort at a
national level
• sites have a more positive experience as they can gain support from others
• information gathered from the site experience informs a replicable model of
cultural alignment as a basis for wider use.
1. c Membership of the group
Our core membership was developed around the anticipated need of sites and
therefore includes members with experience around each of the four elements of
the process of culture change to cover assessment of culture, interventions
required to support changes, individuals with coaching experience, national
knowledge and experience of the process of change.
The advisory group representation includes:
• Royal College of Nursing
• NHS Leadership Academy
• NHS Employers
• NHS Professionals
• The Pacific Institute
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Work began in August 2013 with feasibility meeting with external partners to
establish the value and support for a national group.
In September 2013 we identified key national partners to form an advisory group.
Members of this group share their knowledge and skills in order to maximise
learning and prevent duplication of effort across the health care sector. They offer
individual support to organisations and participate in focus days where sites and
group members share knowledge and experiences of the technical and pragmatic
issues associated with cultural change.
2.a Terms of reference
In order to clarify our ways of working together as a group and with our sites
detailed terms of reference have been developed and agreed as a group
(appendix 1).
2.b How we work with sites
As a group we identified the initial capacity to support four sites through a
process of change. We sought sites which rated themselves in a midpoint of
culture and advertised the opportunity to submit an expression of interest to join
the work (appendix 2).
3.a What we do and how we work with sites
As an advisory group our principles are to help sites to access the knowledge
and skills they require to achieve their culture shift and support them through the
process.
We work to a four stage process as outlined in the diagram overleaf, Figure 1.
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Figure 1 – Transitioning Culture
The stages in more detail
1. Assessment of present culture across the organisation
The organisation would be expected to undertake a formal assessment of its
present culture using recognised, evidence based tools which are repeatable
(pre and post interventions) and give a measureable outcome. Each pilot
organisation will identify a tool that meets its own needs in terms of its
programme and be able to explain the rationale for the choice of tool
(recognising there may be a cost associated with this). There is no prescription
of tool to be used. The assessment should be undertaken from a representative
amount and distribution (grade and geography) of the staff and should ideally
take place prior to any interventions.
It is important that these assessments also include the standard measures
undertaken by the organisation such as staff survey, patient and family test, etc
to fit into the organisational reporting structures, both internally and externally.
Analysis of this data should give the organisation a picture of its current culture
and any pockets or trends of difference. The organisation would then identify
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(with access to support from the group) the appropriate interventions required to
take its organisation towards alignment of the optimum culture.
2. Build cultural consensus
Working with a site from stage one, the group will support them in identifying and
gaining consensus on a vision of the desired organisational culture towards
which the organisation will work.
3. Interventions
In order to make the journey between present and optimum culture for the
organisation, it is highly likely that additional intervention will be required and the
site is expected to take up the identified interventions required (these may be
supplied by any appropriate provider which the organisation sees as meeting its
need). These interventions may take a variety of forms, such as team
development, leadership training, insight into culture and behaviours and their
impact on other etc. It is possible that interventions will be required at all levels
of the organisation, from support staff to clinical staff and board members.
Interventions and their impact on culture take time.
4. Evaluation
Following the programme of interventions and associated behaviour change,
re-assessment of organisational culture is required. The site is expect to
undertake this evaluation at least one year from the beginning of interventions
and may be at much longer intervals in order to ensure that cultural change has
been sustained.
The evaluation should use the same tools as were used for the initial
assessment and, as far as possible, the same number and distribution of staff.
Again, the site should include its standard measures, such as staff survey and
patient and family test to gauge the impact of its cultural change on patient care
and staff satisfaction.
Our links with sites – the team
Coaches
In order to build a relationship with each site to understand their needs and offer
support we link each site with a named coach from the group. The role of the
coach is to build a relationship with the site in order to help them work through
their programme of change through targeted and supportive questioning, active
listening and appropriate linking to other enablers, such as people, skills and
resources. The coach also links with the project manager and the site to enable
the work of the site to be mapped against the four stages of transition and also to
prepare for face to face group meetings and reporting.
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Technical knowledge of culture change methodologies
Transitioning cultures is not new. Work in this area has been ongoing for many
years in many different sectors. In order to utilise this experience and knowledge
the RCN employs consultancy from The Pacific Institute (TPI) who has many
years experience in this field. Lynne Oliver represents TPI within the group and
shares her experience of culture change with each of our sites. Also within the
group is Dr Julia Phillippou, lecturer at Kings College London, and part of the
research team developing the cultural barometer tool who have built up a large
body of knowledge around assessments of culture.
Project management – mapping activities across the four stages of activity
A key part of our purpose as a group is to enable sharing of the learning gained
through this process of transition. In order to help this sharing become a reality
we have a project manager working across the sites to support the momentum of
the groups work and to map activities across the four stages of the process.
Focus days
As a group we will run a series of focus days which aim to:
• provide an opportunity for teams from each site to meet together and share
experiences
• to provide targeted sessions of input around the skills and tools for culture
transition
• identify those elements which are positive contributions to a model of culture
change.
The first of these three days was held in June 2014 at RCN HQ in London. The
event was attended by teams from both of our sites live at that time, Kent and
Medway and Sherwood Forest NHS Trusts. The day was positively focused
around understanding what culture is, how it feels in your organisation and next
steps for each organisation.
Future focus days are planned for December 2014 and April 2015.
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Focus day with colleagues from Kent and Medway and Sherwood Forest
Trusts, June 2014
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2. Live sites
In order to give a picture of our three sites we asked each site to submit an
expression of interest to the group. These expressions of interest provide a
picture of both the organisation and its vision for the future.
Kent and Medway NHS and Social Care Partnership Trust
www.kmpt.nhs.uk
Background
Kent and Medway Partnership NHS Trust (KMPT) is a large mental health trust
providing a range of mental health services, including community, acute, crisis,
forensic and older people’s services. The trust employs over 3,000 staff and has
social care staff seconded from Kent County Council to provide integrated
teams.
Three years ago the trust was halted in its journey to foundation trust status due
to serious incidents and reputational issues. There were also significant changes
in leadership which impacted on morale and culture.
The trust is now performing well and has improved in significant areas.
Partnerships are good and quality has improved consistently. However staff
surveys three years ago showed the trust in the bottom 20 percent in many
areas and improvements are not as fast or significant as we wish.
Culture and trust approach
Improving the trust culture is key for internal reasons (drive to continue to
improve, ensure compassionate and quality focused care, achieve more
motivated and valued staff who believe the trust enables their best and is the
best place to work) and in response to the Frances review to support more
patient focused services and ongoing learning.
Considerable attention has focused on understanding the trust culture and
identifying a focused approach to developing a positive culture that will support
valued staff and high quality care to patients.
Informal intelligence gathering included:
• meetings across the trust with staff sharing observations and hearing views.
• specific workshops with doctors and managers to assess what
culture/relationships were operating and improvement opportunities.
• establishing a clinical cabinet that focused its time on identifying current and
optimal culture.
• engaging OD consultants to support initial assessment from surveys,
meetings with staff and workshops.
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As a result the culture was initially and informally identified as;
• “them and us” frontline teams feeling distant from leaders and disempowered
from decision making
• overly bureaucratic with decisions and actions taking too long to put in place
• lacking clinical voice – managers making decisions without clinical input.
Actions underway
As a result of these early findings a number of actions were implemented. They
include:
• strengthening the clinical cabinet and growing its profile in leading culture.
(Clinicians lead all work streams across trust)
• staff forum looking at how staff are supported and engaged
• OD programme initiated and now being refreshed
• local leadership groups put in place to support autonomy at local level
• formal cultural assessment planned and resourced to support next stage of
OD and leadership strategy.
Trust commitment
The CEO and board are supportive of joining the programme. The clinical
cabinet is also committed to the approach and we have identified some resource
to enable formal assessment of culture (scheduled for summer 2014) and some
external support with OD and leadership. We are also evaluating internal
leadership and capability.
Sherwood Forest NHS Trust
www.sfh-tr.nhs.uk
At Sherwood Forest Hospitals NHS Foundation Trust we have much to be proud
of. We are tremendously proud of the dedication of our staff and of the high
quality care they individually and collectively provide each and every day to our
patients and their families. Being in special measures as one of the ‘Keogh
trusts’ our staff have experienced high profile changes in a very short period of
time. Our trust is at a seminal point in our development as we move from special
measures and financial turnaround to the creation of a sustainable long term
high performing trust. To achieve this transition we have developed a number of
strategies, of which one, our organisational development strategy focuses on the
work we will do to ensure our staff are passionate about working for our
organisation, proud of the difference we make for people and inspired to
continuously improve all we do. Listening to over 400 people’s views about what
truly excellent staff and patient experience means and what we need to do to
enable this, we set our Quality for all values which set the platform of a culture
where staff feel valued and empowered to do an excellent job and proud to work
for our trust.
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We are at the beginning of our organisational cultural change process and
believe the advantages of being a pilot will offer support, by signposting us to
theoretical and practical inputs which will help shift / develop our culture to the
ambition we have set. Our starting position is one of mid line. Over 1,500 (out of
3,600) staff has attended a launch event of our Quality for all values – each
session led by our CEO. Our whole trust board have contributed to using the
outputs from our listening events to develop our strategic bridge – a high level
summary of the ambition and activities that will guide our work to improve staff
and patient experience. Our CEO has already signed up to actively support this
opportunity to be a site, with a commitment to support resources.
Being a special measures trust has been both a challenging but learning
experience. Being a site, raising our profile and accessing the support of key
individuals whilst being part of a national shared report are all part of the
direction we have set ourselves.
The Christie NHS Foundation Trust
www.christie.nhs.uk
The Christie is a tertiary service specialising in cancer treatment, research and
education. We are the first UK centre to be accredited as a comprehensive
cancer centre. We are the largest cancer centre in Europe treating more than
44,000 patients a year. We serve an immediate population of 3.2 million in the
Greater Manchester and Cheshire area and also deliver a number of regional
and national services from our main Christie site. Our patients are at the heart of
everything that we do.
The Christie has a track record of high performance meeting all national and
local targets. The trust is supported by the Christie charity and as a result has
delivered significant service developments and academic investment to support
our future ambitions and provide a level of care and experience for patients
above and beyond that funded by the NHS.
In September 2012 we launched our 2020 vision, based around four themes it
describes our ambition to be of the top five integrated cancer centres in the
world. The themes are:
•
•
•
•
leading cancer care
the Christie experience
local and specialist cancer care
best outcomes.
Our staff survey results indicate good levels of staff engagement when
compared with other trusts. Our advocacy scores are amongst the highest
nationally with 90 percent of respondents recommending the Christie for
treatment and 75 percent as a place to work. This is supported by a local
monthly staff friends and family test which we implemented in April 2013.
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(98 percent of staff would recommend us for care and 90 percent as a place to
work).
We recognise that our 2020 vision provides us with both challenges and
opportunities to further improve patient care, experience and outcomes. In 2012
we developed an organisational development plan which we call the Christie
commitment. This describes how our patients can expect to be cared for and
what our staff should expect from the trust and each other. The principles and
behaviours and staff pledges within the Christie commitment are integral to our
success.
One of our key priorities over the last 18 months has been the implementation of
our management and leadership development programme. Recent feedback
from delegates has highlighted a view that the culture of the Christie should be
re-aligned to include greater empowerment for leaders at all levels and
professions in the trust.
We are at a key stage of our development. Recent changes at senior levels
within the trust (both clinical and non-clinical posts) offer us an opportunity to
clarify the expectations of our new and existing leaders to support a culture of
empowerment and accountability within a supportive environment. We consider
the chance to take part in a pilot with The National Advisory Group for Cultural
Alignment will provide additional support and further opportunity to progress our
vision.
3. National Advisory Group Member biographies
Membership of the group is varied, both in professions and organisations
represented. Each member of the group is driven in their desire to support
cultural transition.
The core members of our group are outlined below in more detail but we would
also like to acknowledge the input of two members of the group, Dr Dave Ashton
from the NHS Leadership Academy and Judith Parks, Chair of Clinical Leaders
in Hospices.
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Member biographies
Chair - Dr Naomi Chapman
Executive Nurse Network Lead
Royal College of Nursing
Naomi joined the RCN from the National Institute of Health Research (NIHR) in
2011. She has established, and now leads, the RCN Executive Nurse Network
which provides support and a conduit for the voice of executive nurses across
the UK and across all sectors of employment.
Naomi is an experienced researcher, nurse and allied health professional. In her
most recent NHS roles Naomi has worked as a clinical commissioner leading a
service wide redesign of health and social care intermediate tier services and
also as an allied health professional commissioning and quality adviser. From a
research perspective, Naomi has a PhD from the University of Leeds and has
worked nationally for NIHR. Her research interests are patient reported outcome
measures, quality of life and service evaluation. She has published in both
nursing and medical press (as Naomi Reay).
Naomi is currently an Honorary Research Fellow with the University of Leeds
(School of Medicine) and has held several roles in NHS research and
development.
Naomi’s interest in organisational culture has developed through experience and
understanding of the impacts of a spectrum of work place cultures. She feels
strongly that a positive culture leads to a positive experience for both staff and
patients alike and she seeks to support health care organisations through the
process of change.
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Deputy Chair - Karen Barraclough
Senior Nurse/ Head of Governance
NHS Professionals
Karen is a registered nurse with over 20 years’ experience in the NHS in Leeds
along with roles in research and audit in the private sector.
Karen joined NHS Professionals in 2002 initially providing account management
support to ward managers before moving into a clinical governance and risk
management position in 2007 and is now senior nurse/head of governance in the
organisation. As well as the different aspects of clinical governance and risk
management in temporary staffing, Karen is also responsible for providing
clinical leadership, support and advice across the organisation.
NHS Professionals is the leading provider of flexible managed workforce
services to the NHS helping client trusts to save money and improve governance
by centralising and standardising their approach to temporary workforce
management.
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Angela McNab, Chief Executive
Kent and Medway NHS and Social
Care Partnership Trust
Angela started her career as a speech and language therapist and from there
she moved into a general management career in the NHS. She fulfilled a variety
of senior and board level roles in trusts spanning strategic planning, operational
delivery and quality. Her career has included national strategy and public health
policy within the Department of Health, as well as PCT chief executive posts in
North East London, Luton and Bedfordshire. She led the Human Fertilisation and
Embryology Authority (a national regulator for IVF and embryo research) for six
years.
Angela has strong experience in setting up new organisations, driving major
change and turnaround and developing organisations in culture and
engagement. Her qualifications include BA Psychology, Msc Health service
management and a Diploma in executive coaching. She actively coaches and
mentors both within and outside the NHS.
“The cultural alignment programme is of key interest to me since I firmly believe
that a positive culture is essential if we are to give our very best services to
people. We cannot value and show kindness to others, receive feedback without
being threatened and learn how to reach our full potential unless we operate in a
safe and valuing culture. In a context of increasing expectation and pressure and
a critical public arena this is more difficult but even more important.”
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Lynne Oliver
Head of Products Processes and Quality
The Pacific Institute
As The Pacific Institute’s organisational culture and leadership specialist, Lynne
combines a wealth of technical expertise with a genuine understanding of and
appreciation for the role of constructive culture in developing successful
organisations.
Highly regarded for her work with key stakeholders in effecting individual and
organisational change, Lynne demonstrates excellent communication and
facilitation skills, allowing her to share her specialist subject knowledge easily
and impact fully. Her expertise in executive coaching and mentoring is sought by
senior leaders both in the UK and internationally.
Lynne is regarded by The Pacific Institute UK as their most effective consultant
in the area of organisational transformation. Her knowledge base is outstanding
and she receives extraordinarily positive feedback from every client organisation.
She has a national reputation for her work across the public and private sectors.
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Angela Hopkins
Executive Director of Nursing and Midwifery
Betsi Cadwaladr University
Health Board, Wales
Angela Hopkins is the executive director of nursing and midwifery at Betsi
Cadwaladr University Health Board, the largest health organisation in Wales.
Angela joined the health board in June 2013 from Cwm Taf Health Board in
South Wales, where she was executive director of nursing for four years. Prior
to that Angela was executive director of nursing and midwifery at the North West
Wales NHS Trust, a post she was appointed to in 2004.
Angela has enjoyed a career in nursing, midwifery and neonatal intensive care,
working in both clinical, management and executive positions.
Her executive portfolio includes responsibility for safeguarding children and
vulnerable adults, quality and safety of clinical services provided by the health
board, infection prevention and control and professional responsibility for over
5,000 nurses, midwives and specialist community health practitioners.
Angela has a keen interest in the impact cultural norms have on the patient
experience and outcomes, and the negative and positive impacts for staff
working within different cultural settings. She has been involved in leading
cultural change programmes throughout her career.
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Paul Taylor, Assistant Director
Organisational Development
NHS Employers
Paul Taylor created and leads Do OD, the national organisational development
resource for the NHS that helps OD professionals to connect, share and learn.
Paul joined NHS Employers in April 2013 following successful OD, HR and
Workforce roles in NHS Midlands and East, NHS East of England and the Essex
Workforce Development Confederation. Paul joined the NHS in 2003 having
worked in organisations across local authorities, the voluntary and private
sectors.
Dr. Julia Philippou, Lecturer
Florence Nightingale
Faculty of Nursing & Midwifery
King's College London
Julia is a registered adult nurse with a background in critical care. She holds a
BSc (Hons) in Nursing Studies, an MSc in Nursing Research and a PhD in
Nursing from King’s College London, where she currently works as a lecturer at
the Florence Nightingale Faculty of Nursing and Midwifery. Julia is the
programme lead for the BSc in Nursing Studies and has an array of leadership
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and teaching responsibilities across undergraduate and postgraduate provision.
Julia’s teaching focuses on evidenced based practice and health care research.
Julia’s research focuses on uncovering the responsibilities of employers and
employees in career management and the development of nurses in the NHS.
She is currently involved in research around the substantive area of the health
care workforce, and nurses in particular. Her interests lie in research that
contributes to fostering a culture of quality care through workforce development
and engagement. Julia has a wide range of methodological expertise in survey
methodology, questionnaire development, interviews and systematic reviews.
Tom Sandford
Executive Director
Royal College of Nursing
Tom is employed by the Royal College of Nursing as the executive director of
their services across England. Before joining the RCN, Tom was general
manager of mental health services across the London boroughs of Camden and
Islington. Tom trained as a general nurse and a mental health nurse at the
London Hospital in Whitechapel between 1975-1979.
Subsequently Tom has held a variety of clinical nursing posts in the fields of
family therapy, acute psychiatry and liaison psychiatry. He was head of
professional development in Bloomsbury Health Authority and was a member of
the ministerial task force co-ordinating the development of the NHS mental
health national service framework. He has served on several public untoward
incident inquiries and has taught multi-professional mental health service
integration programmes at Universities in Frankfurt and Irsee in Germany, and
case management programmes in the Nursing Faculty at the University of
Barcelona in Spain.
He writes on mental health issues and his recent book with Peter Phillips and
Olive McKeown Dual diagnosis – practice in context was published in January
2010 by Wiley Blackwell. His book, Working in mental health: policy and practice
was published in April 2012 by Routledge.
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6. Identified learning from the process to date
Development to this point has been both exciting and challenging and we are
pleased to be working with three sites that are making key changes to attitudes
and behaviours in order to work toward the culture they want to achieve.
Whilst each organisation is at a different stage of its unique journey we have
identified several key elements which have prevented other organisations
continuing their journey as sites. Two organisations were accepted as sites but
made a decision that the time was not right for them to go ahead. This decision
was focused around either substantial organisational change at board level or
involvement in another national programme of change at the same time.
Therefore we have identified that organisational stability and resource focus
have already arisen as possible elements which are key enablers for
organisations to begin this process.
These factors are seen in the positive when we consider the sites who are
working with us. Each site has clear commitment at board level and the timing of
this work sits well with the aims of the organisation and their commitment of
resources and positive behaviours to drive this transition.
The next stage – 2014-15
The group and sites continue in this current phase of working until summer 2015
at which point we will be presenting a final report of this phase.
The key components of this work going forward will be:
• developing our relationships with and between sites
• mapping the progress of each site as they progress through the four stages of
transition.
• providing support and guidance through input of the site coaches and their
links
• providing team support for the sites through the focus days planned for
December 2014 and April 2015
• responding to the understanding gained through this iterative process
• identification of those positive elements of a model of culture transition.
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References
• Keogh, Bruce (2013), Review into the Quality of Care and Treatment Provided
by 14 Hospital Trusts in England: Overview Report. NHS
www.nhs.uk/NHSEngland/bruce-keogh-review/Documents/outcomes/keoghreview-final-report.pdf
• Final Report (2103) The Mid Staffordshire NHS Foundation Trust Public
Enquiry chaired by Robert Francis QC
www.midstaffspublicinquiry.com/report
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Appendix 1
Terms of reference
The groups terms of reference were developed over a period of several months
and required exploration of our core values, purpose and organisational
relationships. These terms of reference are signed up to by all our group
members including our sites.
Agreed terms of reference 2014
Function
The main function is to provide expert skills, advice and a safe area for
discussion to the pilot organisations in the health care sector.
Purpose
The purpose of the group is to ensure that the pilot sites have access to support,
knowledge and expertise at a national level to ensure that:
• the process of cultural alignment at each site is optimised
• sites are supported in achieving their existing organisational development
plan
• sites are able to share their learning
• to pool resources and skills thereby preventing duplication of efforts at a
national level
• sites have a more positive experience as they can gain support from
others
• information gathered from the site experience informs a replicable model of
cultural alignment as a basis for wider use.
Values common to the group
•
•
•
•
•
•
Putting the needs of the organisation above those of the group.
Commitment to attending meetings and delivering on actions in a timely way.
Commitment to open and transparent communication.
Respecting confidentiality of meetings and meeting documents.
Mutual respect of colleagues.
Co-operative working.
Deliverables
• A safe environment for discussion for the organisation with the group by full
attendance and commitment to the group common values.
• Sharing of expert skills and experience from all those involved.
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• Share experiences and learning with others.
• Development of a replicable model as a basis of cultural alignment change in
other health care organisations.
• To provide a culture of support for organisations which have a health care.
background in order to prompt an improvement in care.
Secretariat
Secretariat will be provided by the RCN. The group secretary will arrange and
minute calls and meetings, bring together and circulate meeting papers, circulate
a contact list of members and support the communications strategy as
appropriate. Minutes will be stored securely electronically by the RCN
secretariat.
Quorum
• Quorum for face to face meetings will be 50 percent including at least one
site.
• Quorum for teleconferences will be 50 percent including at least one site.
• If quorum numbers are not met, the meeting will be cancelled, all group
members will be notified and a commitment to the new meeting date will be
expected.
• If members miss more than two consecutive meetings/calls they will be
contacted to give assurance to their future attendance or that of an
appropriate deputy with authority to commit on behalf of their organisation.
• If three consecutive meetings/calls are missed the member will be asked to
leave the group.
Accountability and reporting
• Personal accountability and group accountability as a whole to maintain
standards of confidentiality.
• Timely communication within the group to avoid unnecessary delays.
• Advice and information provided will reflect best practice.
• To raise concerns within the group, with organisations and /or statutory
bodies if necessary.
• To ensure that there are no conflicts of interest and where unsure that any
potential conflicts of interest are declared.
• Sites are expected to report appropriately within their organisation as part of
a governance stance to ensure progress of work.
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Structure
The group will have a chair and a deputy to be elected by the group by a majority
vote of those in attendance, if quorate.
The role of the chair is to:
•
•
•
•
chair the monthly meetings
review and sign off previous meeting minutes at each meeting
support the group to complete actions within agreed timeframes
act as a figurehead for the group as required.
All members of the group will have equal voting rights if majority decisions are
required if they are in attendance or have submitted their vote in advance or by a
proxy.
• The group will be supported by a secretariat and may develop task and finish
groups as required.
• Meeting papers for monthly calls will be circulated by the secretariat via email
one week before the teleconference.
• Meeting papers for three monthly face to face meetings will be circulated by
the secretariat via email two weeks before the meeting together with a call for
items for AOB.
• Minutes for both calls and face to face meetings will be reviewed and agreed
by group members at the following call/meeting.
Resources and finance
Each member of the group has committed to providing their attendance, skills
and support to the group and the sites and the majority of the core members
represent organisations who may also provide skills and expertise to the
process. Potential resource requirements of core group members in addition to
their time, skills and support may include:
• access to specific skills within their organisation
• links/introductions to colleagues or networks who can provide specific skills
and support
• the RCN will seek internal funding to maintain the consultancy input of The
Pacific Institute
• the RCN will fund secretariat support
• potential financial contribution to support sites to deliver this process, if this
goes beyond their original organisational objective or the site is unable to
continue the process due to lack of financial resource for an unanticipated
requirement.
• resource contribution by equal share of cost is required by all core member
organisations toward delivery of the communications strategy (e.g. report
writing and publication, dissemination events, etc) who are mentioned or have
their logo included on those documents
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• each organisation/individual group member will be required to pay their own
travel and expenses related to the work of the group.
Review
Review of the groups terms of reference and delivery will be undertaken at each
three monthly face to face meeting. Governance of activity will be provided by
the core group member acting as governance advisor. If external governance is
required this will be discussed and agreed by the group.
Communications Framework
• Internal to the group
Contacts - shared email addresses for planning and interim communications.
Monthly teleconferences with opportunity for onsite meeting at RCN HQ,
20 Cavendish Square, London.
Three monthly face to face meetings at which all members are expected to
attend. Meetings will be held at RCN Headquarters, 20 Cavendish Square,
London. Meeting agenda papers to contain the RCN logo as hosted by the
secretariat.
• External to the group
Communications strategy for the group to include:
• agreement on preparation and badging of documents (eg, organisational
logo of those organisations providing appropriate representation at least 80
percent of the meetings/monthly calls
• editorial control of documents and media to rest with majority view of the
advisory group who respond to the consultation/present at most recent
meeting
• dissemination/publication plan – media, social media, interim report, final
report, ongoing blog/social media, and conference presentations
• media management plan for interim and final report.
Confidentiality/sensitivity
Within the group structure and communications all discussions and papers will
be confidential unless agreement is sought from the group to share.
• Each core group member will be bound by the confidentiality rules of their
employing organisation.
• Each site may wish to consider including a confidentiality agreement with the
group.
• Group meetings and calls will be minuted for discussion and action points.
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• Group minutes will be stored securely by the RCN.
• Governance of confidentiality/sensitivity will be led by the core group member
acting as governance advisor.
• The group will maintain editorial control over the reports produced.
• Each site will maintain editorial control and responsibility for their
blog/social media content but maintain respect for confidential conversations.
• Any ongoing unsafe practice discussed within the group that is not felt to be
adequately addressed in a timely manner may be shared through professional
routes for those members with accountability as health care professionals.
• Co-opted members must declare conflicts of interest which will be
documented, recorded and considered by the group as appropriate.
Consequences for breach of confidentiality
As the group will be exposed to information from sites which may be of a
sensitive nature any core member of the group who is found to have breached
the confidentiality of the project and/or site will be asked to leave the group. A
decision will be taken by the chair and/or deputy as to whether escalation is
required to the member’s employing organisation, site and/or statutory body as
appropriate.
If any information is obtained from a site by the group which causes concern, a
decision will be taken by the chair and/or deputy as to whether escalation is
required to the chief executive of the site and/or statutory body as appropriate.
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Appendix 2
Expression of interest/frequently asked questions
Invitation to join us as a site in the journey to change your culture
The National Advisory Group for Cultural Alignment (NAGCA) aims to work with
healthcare sites to support them through a process of cultural alignment. The
group includes the Royal College of Nursing, The NHS Leadership Academy,
NHS Employers, NHS Professionals, The Pacific Institute and key individuals
with experience of shifting culture within healthcare organisations.
We are looking for more organisations to work with us and have put
together the following guide for your information. If you would like to find
out more about working with the group as a site please contact Dr Naomi
Chapman at naomi.chapman@rcn.org.uk
Frequently asked questions
Q. What are the advantages of being a site working with the National Advisory
Group for Cultural Alignment?
A. As a group we share a common interest and experience of the impact of
culture within health care organisations. Many of our group also work within
organisations which provide expertise in shifting cultures and developing
leaders. As a site working with the group you would have access both to the
members of the group and their skills, but also to a structured programme of
theoretical and practical input about organisational culture and the process of
cultural change.
What does that input look like?
•
•
•
•
An initial site visit by members of the group to meet with your staff, talk
through the process and offer expertise to inform your organisational
journey.
A place around the table of the group which meets monthly by
teleconference and three monthly face to face, giving opportunity to
discuss, meet, share and inform your OD plan.
Exclusive access for up to five of your team to join the group at full day
events which will include taught sessions around the process of cultural
alignment and leadership and an opportunity to talk with other sites to
share and learn from experiences. These events will be held at the
NHS Leadership Academy in Leeds or at RCN Headquarters in
London.
Input into a shared report (July 2015) which shares our experiences
with others in order to inform other organisations embarking on the
journey of cultural change.
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Q. We are considering expressing an interest as a site, what key things do we
need to consider?
A. Are you a health care organisation directly related to patient care (preferably
an acute or primary care organisation)?
•
•
•
Would you assess your own organisational culture as mid-line that is at
neither extreme of negative or positive culture.
Do you have a clear organisational commitment to achieving a positive
cultural alignment at board and chief executive level.
Has your organisation got the ability to support (with resource,
commitment and finance) the process of cultural alignment within the
organisation?
Q. What will we hope to see in return for this investment?
A. Benefits from a positive culture
•
Evidence indicates that cultural alignment has positive results both for
staff and, by implication, patient care (Watts et al., 2013). Findings
from this research suggest that perceived positive culture is related to
nurses’ morale and perception of personal accomplishment which
reduces the likelihood of burnout. This may also have links to positive
recruitment and retention of nursing staff which is particularly relevant
in our current times of shortage of registered nurses.
Staff wellbeing and the relationship with patient care
The feeling of social support referenced within Watts et al 2013 is also
a positive for staff wellbeing, especially in times of stress and high
demand and there is evidence that when nursing staff experience
symptoms of burnout this may impact on patient care (Vahey et al,
2004 – US study).
•
National profile as an aspiring organisation
•
•
Being a site organisation will raise your national profile and indicate that
you are positive about providing a unified and positive culture for
patient care
Anecdotally, taking the organisation and its staff through this process
can bring with it additional benefits of better team working, unified
identity and levelling out of sub-cultures which may exist eg. from
amalgamation of different organisations, services, etc.
Q. What does my organisation need to consider?
A. The organisation will need to commit leadership priority, time, OD and some
financial resource behind this process.
•
Priority - It is key that at chief executive level this is a key strand of the
organisations priorities which is maintained even in challenging times
and that this is role modelled by all the board.
30
•
Time - This will require a time resource at all levels of the organisation
and involvement and engagement from leaders, managers of all levels,
organisational and professional development teams is clear.
•
Money - There may be some cost to the assessment and interventions
involved. These may be financial costs. The advisory group members
have committed to supporting with their individual and organisational
expertise.
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Royal College of Nursing of the United Kingdom
20 Cavendish Square
London W1G ORN