Trust reduces workforce turnover and vacancy rate with a programme to encourage staff involvement in decisions, promote their wellbeing and by developing a diverse network of Freedom to Speak Up Champions

Synopsis:

NHFT’s vision is to be a leading provider of outstanding, compassionate care. To achieve this, our staff need to feel valued as highly engaged staff deliver better care, and create better outcomes for patients.

Our NSS 2017 results highlighted strengths in the way the Trust used patient feedback. Our staff engagement plan was built on the principles of communication and co-production, with the aim of improving results for “advocacy” questions as research shows strong correlation between improvements in these and improvements in patient care (e.g. Sizmur and Raleigh, 2018)

The “Let’s Talk” plan brought together various staff engagement initiatives into a cohesive, visual plan; with Trust-wide, cultural workstreams as well as specific objectives for each directorate to address local areas for improvement. Numerous initiatives run under the Let’s Talk plan, Trust-wide actions include:

• A diverse network of Freedom To Speak Up (FTSU) Champions to promote the principles of speaking up about issues relating to patient care, to an individual who is local and accessible.
• Wellbeing Strategy– switching the focus from managing sickness/absence to improving wellbeing, resulting in better continuity of care for patients
• Launching our Respect and Compassion charter, which was signed and displayed by teams across the Trust

Ambition:

All work at NHFT is underpinned by our organisational mission, Making a Difference For You, With You. In terms of staff engagement, this means that co-production, distributed leadership and an open, transparent culture are essential. In early 2017, National Staff Survey (NSS) results demonstrated a reduction in recommendation as a place to work, and staff engagement score. It was clear that to achieve the Trust’s aim of being a leading provider of outstanding, compassionate care our staff needed to feel engaged and valued, which would result in improved patient care and outcomes.

The ‘Let’s Talk’ plan was formulated during 2017 and formally launched in 2018. The plan works on both a ‘Top Down’ and ‘Bottom Up’ approach; with seven Trust-wide, cultural initiatives focused on improving experiences for all staff, as well as locality objectives that were focused on improving experiences at a local level.

The Trust-wide workstreams were intended to embed a staff-positive culture by improving representation and inclusion, encouraging speaking-up, and improving staff wellbeing, amongst others. The locality objectives were co-produced, owned and delivered by staff in each locality area to ensure meaningful action and change was being delivered based on staff feedback in the locality.

Outcome:

Although only in place for one year, our Let’s Talk plan, has seen significant positive outcomes that affirm we are achieving our aim of improving staff engagement:

• Staff engagement score risen to 4.01 in 2018 (7.5/10 in the new reporting measure). Overall, NHFT’s staff engagement score is 7th nationally in 2018.
• Recommendation as a place to work increased year-on-year, giving NHFT the highest score for Trusts of our type in 2018 and has increased 15% since 2016
• Recommendation as a place to receive treatment increased year-on-year, giving NHFT the highest score for Trusts of our type in 2018.
• There were also positive improvements aligned to particular workstreams, including:
• Increased wellbeing measure - NHFT is second nationally of all NHS Trusts for health and wellbeing focus
• Number of staff who have confidence reporting unsafe clinical practice risen significantly to 68.9% in 2018

We have also had excellent qualitative comments from the Staff Survey which demonstrate positive staff engagement and improved patient care, including, “I think NHFT is a great place to work that values staff and wants to ensure they are fully engaged and empowered. It continues to strive to improve as an organisation and deliver the highest quality of care.”

Spread:

Including local objectives in the ‘Let’s Talk’ plan, and ensuring each locality is held to account in achieving their own objectives, has been key to this project. Firstly, it allowed the different directorates to set objectives that are relevant for and make a difference for their staff. Secondly, dispersing the responsibility for staff engagement actions across directorates and involving different managerial levels has ensured the initiatives are embedded more effectively. This has been embedded in the Trust’s governance processes and ensures accountability of progress and outputs to the Trust executive board.

Pulling together various staff engagement initiatives together on a visual plan has helped to highlight the work being done more clearly to staff across the Trust than if the workstreams had remained disparate. The Friends and Family Test questions are being used throughout the year to provide up-to-date feedback to localities across the Trust.

We actively seek opportunities to spread our learning and expertise, and recently hosted an NHS Improvement day for Trusts in the Midlands and East. Staff engagement was featured as a spotlight session. Likewise, our Staff Engagement Lead and Internal Communications Lead presented the Let’s Talk plan at a Picker event for NHS Trusts recently.

Value:

Improvements in staff engagement undoubtedly lead to improvements in patient care. For example, the ‘Helping you to Speak Up’ workstream has included promotion of our commitment to Freedom to Speak Up including a network of Trust-wide champions. As a result, reports have increased over 10 consecutive quarters, demonstrating engagement with FTSU, the embedding of a no-blame staff-positive culture, and, ultimately, improved patient care due to changes made as a result of FTSU reports. In 2018, NHFT was the 4th highest-rated trust for Safety Culture on the National Staff Survey.

Wellbeing is a significant part of Let’s Talk at both a Trust-wide and local level. The Trust has fundamentally changed its approach to focus on health and wellbeing of staff, away from traditional sickness and absence. Actions include wellbeing meetings for staff upon return to work, strengthening our Occupational Health offering, offering resilience and ‘courageous conversations’ training to staff at all levels, and holding an annual Wellbeing Festival.

A number of positive outcomes indicate this approach is effective, including a Trust-wide reduction in vacancy rate, staff turnover and agency usage, all of which have positive financial implications for the Trust and result in improved consistency of care for our service users.

Involvement:

Staff involvement is key to NHFT’s engagement strategy. The “Equality for all” workstream invests in staff networks (BME, Disability, LGBTQ+, Working carers) to ensure the voices of staff with protected characteristics are heard. For example, NSS results showed that BME staff felt they were limited in their careers compared to white colleagues. Through the support of Staff networks, bespoke career development workshops for BME staff were delivered, resulting in a 7% improvement in feeling that career progression is fair in the NSS 2018.

‘Let’s Talk’ includes locality objectives to maximise opportunities for staff to share ideas and make improvements. We have seen year-on-year improvements in these questions and achieved the highest scores for Trusts of our type in 2018. We have successfully embedded an open and transparent culture, where staff receive feedback on changes in response to reported errors, achieving a 13% improvement in three years.

The ‘Let’s Talk’ plan was created by involving staff. This approach engaged contribution from a diverse array of staff across the Trust, including members of the executive and senior management, as well as grassroots staff from all directorates. NHFT’s Governors also inputted into the plan’s development, contributing feedback from their Patient and Staff Subgroup.