South London Healthcare NHS Trust
Organisational Development Strategy
2009-2012
April 2010

South London Healthcare NHS Trust

Organisational Development Plan 2009 – 12

Contents

Introduction

Trust Objectives

Priorities for action

Engagement...... 5

Organisational Development Priorities

Programme One – Designing structures, roles and plans to deliver the strategy

Programme Two - Creating a leadership style that supports an engaged workforce

Programme Three - Developing an organisational culture that enables individuals and teams to deliver high performance

Programme Four - Working Differently to deliver A Picture of Health…………………………… .13

Success measures

Delivery and Accountability

Appendix One

Review of progress 2009/10

Appendix Two- Delivery Plan 2010/11...... 20

Introduction

On 1st April 2009 a brand new health organisation came into existence in South London. South London Healthcare NHS Trust is the product of the merger of three smaller hospital trusts - Queen Mary's Sidcup NHS Trust (QMS), Queen Elizabeth Hospital NHS Trust (QEH) and Bromley Hospitals NHS Trust (BHT) - to create a single healthcare organisation on several sites.

“The way we develop our new organization is a vital investment, it is the essence of delivering success and not an extra. We can create a recruitment and retention premium by looking after staff and developing them. If their life is better, then the quality of experience for the patient improves. We want to encourage change and see it continue to bubble up throughout the organization and so it would be foolish to consider that we don’t do what we have agreed within this document” Chris Streather, Chief Executive

This Organisational Development strategy provides a framework to continue to bring this vision to life. Its aim is to align a range of activities to raise the performance of the organisation in order to deliver our stated ambition. In writing the plan, we have recognised a number of competing priorities and so it is important to ensure that we move forward with urgency, but in a planned way.

The Trust has seven objectives:

Objectives

Our patients.
We will put patients at the centre of everything that we do. We will ensure that all patients experience care that is safe, maintains their dignity, treats them with respect and leads to agreed outcomes.

Financial viability.
We will develop and commence implementation of a strategy to achieve and sustain financial viability in readiness for a future foundation trust application, ensuring that our services are provided within available financial resources and that we get paid for the services we provide.

Leadership and workforce.
We will provide positive leadership and effective management and engagement of staff at all levels and in all disciplines in the transition to the new organisation to ensure a safe and supportive working environment. We will develop a workforce that is increasingly sensitive to the needs of patients, exploits every opportunity to improve its productivity without sacrificing quality of care, and is proactive and flexible in its approach to service change.

High Quality Clinical Care.
We will deliver high quality clinical care through the application of best clinical practice and by ensuring that the principles of clinical governance underpin our organisation's culture, our systems and the working practices of our clinical teams and clinical services.

Healthcare acquired infections.
We will continue to drive forward improvements in reducing health care acquired infections, to ensure that patients receive safe care that conforms to nationally agreed best practice and which leads to reductions in the incidents of Clostridium Difficile infections and MRSA.

National and Local Priorities.
We will demonstrate that the Trust is providing high quality cost effective services through achieving the national priorities highlighted in the Operating Framework and through the achievement of a high level of performance in the measures included within the Annual Health Check (or Care Quality Commission equivalent), including the Auditor's Local Evaluation Assessments.

Services and facilities fit for the future.
We will work closely with partners in primary and social care to develop new and improved services to benefit our local population, with particular emphasis on the quality of care within improved patient pathways. We will ensure that our buildings, equipment and infrastructure are fit for purpose and capable of accommodating service change.

Priorities for action

The Trust has ambitions to become a foundation Trust in 2013. The organisational development strategy and plans will support the short, medium and long term to deliver these ambitions. To do this, the Trust aims to:

  • Reconfigure clinical services across the three sites
  • Recruit and retain the best leaders for the new organisation
  • Introduce robust governance arrangements
  • Meet targets and be in surplus in two years
  • Develop a ‘healthy’ organisational culture that enables all individuals to deliver these aims

The organisational development plan has four key and interrelated programmes of delivery to support these aims:

  • Designing structures, roles and plans to deliver the strategy
  • Creating a leadership style that supports an engaged workforce
  • Developing an organizational culture that enables individuals and teams to deliver high performance
  • Working differently to deliver A Picture of Health

ENGAGEMENT

The organisational development plan was developed in the summer of 2009 through a series of engagement sessions with the senior team and wider staff groups, including clinical leaders.

Organisational Development Priorities

The senior team identified in 2009 three root causes of the challenges that needed to be addressed to realise the benefits of and maximise the opportunities presented by the merger:

  1. Strategy – the changing face of healthcare in London means that the DGH model does not work within the M25, a new organisational model is needed to deliver excellence
  2. Leadership – there was a lack of consistent leadership in the legacy organisations, resulting in a lack of ambition and direction; leaders are too busy to lead
  3. Culture – a combination of resistance to change or a passive approach; the need to become a high-performing organisation

At its inception, the Organisational Development (OD) strategy and plan focusedon three key programme areas that support the development of the organisation to overcome these three challenges and to maximize the opportunities identified by staff during the engagement sessions. It now also focuses on a fourth programme, specifically added to the strategy in 2010:

, 4. Working differently to deliver A Picture of Health

The aim is that the programmes work together to drive higher organisational performance that responds to the external requirements of the organisation – patient expectations, quality requirements, commissioner expectations, etc.

The four programmes are outlined on the following pages, with a review of deliveryin 2009/10 attached at Appendix One and a plan for delivery in 2010/11 at Appendix Two.

Programme One – Designing structures, roles and plans to deliver the strategy

The first programme drives the implementation of the corporate and divisional structures– this programme is about implementing the right structure and roles; ensuring that those structures work effectively; and developing skills to deliver safe, effective services with an improved patient experience, whilst also meeting financial and workforce targets.

  1. Implementation of Corporate and Divisional Structures

Phase One – corporate directorates restructured by September 2009

Phase Two - focuses on the three new Divisions and how the new clinical management structure will enable the delivery of cross site service integration, by December 2009

Phase Three – focuses on the lower level managerial staffing within the Divisions and Clinical Directorates, by June 2010

  1. The Trust will develop an approach to job design and banding that begins to reflect similarities in posts across different sites. Such an approach will enable the organisation to develop opportunities for career and personal development by enabling staff to smoothly shift between roles and sites to widen experience and develop new skills.
  1. Skills analysis –in order to deliver improved patient care, in a seamless way, the Trust’s workforce will need a set of core competencies common across all roles and grades. The competencies will reflect the ability to put the patient at the centre, an ability to challenge practice and constantly improve,a capability of adding value to multi-disciplinary teams to describe a few requirements. The development, communication and identification of skills to deliver services now and in the future is required; as is an analysis of current workforce against those skills, aligned with KSF – by July 2010. This work will also support Programme Four with its emphasis on changing roles and working practices.
  1. The Trust will be developing an organisation wide workforce strategy by October 2010, and a workforce plan (numbers, bands, skills, locations) by March 2010. Each division will have an identified workforce plan that reflects the Trust Workforce Plan by April 2010.

Programme Two - Creating a leadership style that supports an engaged workforce

This part of the organisational development strategy supports the work of the Service Improvement Strategy – building capability and leadership for improvement, and aims to provide clear links across the programmes and support for design, delivery and evaluation.

  1. Develop a framework for leadership development – December 2009

At the time of developing this strategy, there was a range of leadership development activity underway or being planned. A framework is required to ensure that future investments are being made in the right place, with the right providers, and that return on that investment in being measured. Opportunities for learning, developing leadership, and making improvements need to be systematized to obtain the biggest gain, without stifling the enthusiasm of emergent leaders. These actions aim to provide clarity and direction for a leadership approach.

  1. Review all current programmes delivery to inform future investment decisions – e.g. fit, impact, return on investment, need and overlap
  2. Develop a framework for leadership identifying what is needed by the organisation to deliver improvements
  3. Exploring current leadership frameworks in use and agreeing a model of SLH leadership behaviour for future recruitment and development of leaders
  4. Agree a set of alliances with key providers, identifying benefits and proposed activities
  1. Deliver a range of prioritised leadership activities – immediate design and procurement to commence November 2009
  2. Board development programme to Foundation Trust (FT) - design of ongoing programme of support to align organisational development to the needs of FT status and to develop an appropriate board structure and approach to enable conformance and performance
  3. Senior team support – development of the Executive team as a team and at individual level including coaching to enable rapid delivery of key priorities
  4. Developing clinical leadershipwith National Institute of Innovation
  5. Working with lead clinicians at group and individual level to deliver their roles as leaders
  6. Learning sets to commence in Autumn 2009
  7. Developing Next Generation Directors – using the NHSLondon model to deliver a number of development centres
  8. Implement the SLHT Leadership Forum – an opportunity for management cascade, increased executive visibility, external learning and teaching, sharing of best practice and local lessons learnt and feedback – commence in July 2009
  9. Develop and implement a comprehensive and flexible leadership and management development framework to enable all staff to assess themselves against standards and to continuously develop their skills and knowledge
  10. Develop an organisational coaching strategy:
  11. Understand the need for coaching through change and invest if appropriate, targeted at particular teams
  12. Review current practices at four levels – executive, senior manager, band 7 and band 6 – understand impact and review future investment in internal capacity and external buy in.
  13. Invest in team development to support the new divisional structures

Programme Three - Developing an organisational culture that enables individuals and teams to deliver high performance

Organisational culture change is well-researched, with the evidence suggesting that wholesale culture change takes anything from five to twenty years. It is therefore more realistic to focus on the elements or features of our organisational culture that most profitably need to change. At SLH, feedback and observation suggests that we should focus on the following aspects of organisational culture change in the first instance:

FROM TO (CONSISTENTLY)
Working hard / Working efficiently
Site focus / SLH and care pathway focus
Task focus; push style; command and control; some blame / Performance culture; pull and push; empowering management style; feedback is the norm
“The Trust needs to” / Personal responsibility and initiative; clear accountability
Innovation quietly taking place in parts of the Trust / Innovation seen as everyone’s job; success and learning shared, and that sharing inspires further innovation
Professional silos in parts of the Trust; risk of further new silos developing on basis of new structure / Consistent levels of team and multi-professional working, with quality and the patient’s experience at the centre
Some inflexibility / Flexibility re. what we do, where we do it, and with whom we work
Patchy performance; significant element of surprise then huge efforts required to take control when performance slips; some tension and lack of clarity between the divisions and the centre / Excellent and achieving organisation, made up of well-managed business units. Performance regulated by values and strategy (people doing the right things for the right reasons), service line management providing the right levels of freedom and earned autonomy with clear decision rights

Some specific actions were identified in September 2009:

  1. Revise induction – immediate input
  2. Review and update CEO/Executive slot
  3. Update content to reflect new organisation goals and mission and to enable consistent delivery across sites – developing a model of corporate, site and team specific induction
  4. Review the manager’s induction programme including a ‘Managing People’ programme and ensure mandatory for new bands 7 and 8
  5. Staff engagement and values

a. Engage staff, patients, and visitors in the development of SLHT values and behaviours, enabling staff to identify with South London Healthcare and to shape its culture for the future.

  1. Development of staff partnerships
  2. Reinvigorate staff engagement/partnership approaches to support the delivery of OD programmes and to enable a communications conduit across the organisation. For example re-activate Union Learning Representatives, Contact Officers and Mediators – develop their capabilities as agents of change across the organisation
  3. Update Appraisal processes to ensure they are fit for purpose and used
  4. Review appraisal processes to develop an SLH process with key stakeholders including the Senior Management Team
  5. Agree an appraisal cycle that supports delivery of the business plan and is agreed as an imperative to deliver
  6. Design and deliver refreshed appraisal skills programmes across the organisation
  7. Ensure high level of take-up of appraisal and personal development planning across the Trust
  8. Developing a culture of high performance (2010)
  9. Review Productive Ward programme and consider return on investment of further roll out and of other ‘Productive’ programmes
  10. Support Service Improvement Strategy to develop innovation and creativity by assessing the current culture for creativity and developing responses to that survey including the development of a set of KPIs at individual, team and divisional level to improve productivity
  11. Develop alliance with National Institute for Innovation and Improvement to develop a range of interventions to support a culture of high performance for example the use of ‘lean’ thinking and tools
  12. Develop ‘buddy’ arrangements with high performing organisations in the public and commercial sectors
  13. Design and deliver a Talent Managementstrategy (2010)
  14. Develop a talent management strategy with support from NHS London that enables internal talent to be spotted and nurtured and opportunities to be developed that pull staff through the organization
  15. Create a talent management dashboard to measure progress
  16. Work with local NHS partners to develop and use a talent management toolkit to understand the talent pool
  17. Develop a talent management culture – enabling line managers to be open with staff and be prepared to have difficult conversations
  18. Support staff through change and enable them to manage their careers – develop a range of career development toolkits available on line that supports appraisal preparation and is linked to organisational change
  19. Review reward and recognition processes–
  20. Develop a range of recognition activities that create a culture of valuing staff engagement – events, staff awards - including rewards for innovation - and letters of congratulation, success page in newsletter
  21. Devise a local staff survey that enables rapid feedback on the impact of management behaviour on work climate and fit with espoused values
  22. Integrate with the developing leadership competence framework to support an engaging leadership style that places high value on individuals enabling line managers to use tools such as appraisal, coaching, team development in their day to day people management activities that recognises discretionary effort, develops talent and provides regular feedback. Such a leadership style clearly demonstrates the values of the organisation and the importance placed on all staff to deliver the required changes.

Programme Four – Working Differently to support the successful implementation of A Picture of Health

  1. Workforce plans – define the bands and skills required alongside the numbers, taking account of new delivery models in A Picture of Health
  2. Role redesign – actively seek opportunities to review traditional thinking re. roles; what new roles would meet the work demands and could be more easily met through a greater workforce supply
  3. Greater flexibility – staff will need support to work more flexibly in terms of what they do, and where they do it, and with whom they work to best serve patients’ needs
  4. Commission education and development to support appropriate skills development

Success measures

Measuring the effectiveness of organisational development interventions can be subjective but if we measure what counts then the OD programmes require scrutiny.