How Dorset Healthcare engaged with staff to solve internal problems
When Dorset Healthcare found it was in danger of losing its licence to operate, it asked its people to help identify the solution
After being found in breach of its licence because of the poor quality of healthcare services in 2014, Dorset Healthcare NHS Trust looked to its employees to solve the crisis.
Over the following four years, the Trust progressively improved following a new scheme of engaging its staff in its workings. Within one year it had moved to a status of ‘requires improvement’; by 2017, it was found to be ‘good’ and finally, in 2019, the trust has been ranked ‘outstanding’.
Nicola Plumb, director of people and culture, who came on board at the height of the crisis, says the Trust’s success is almost entirely down to unifying and engaging its staff. however, its journey is not over.
‘I would describe it as a journey of improvement which is always continuing,’ she says. ‘We are by no means a finished product – we are a work in progress.’
In 2011, three organisations came together to form Dorset Healthcare, which employs nearly 6,000 people providing physical and mental health services at 300 locations across the county.
‘Four years later, people were still talking about the merger,’ says Plumb. ‘There were strong divisions across the group according to geography and people relating only to their location, rather than being part of one organisation. We needed to bring them together. The problem to solve was how do you really get effective communications across such a wide network?’
The first thing the Trust did was establish a leadership forum, bringing together the leaders from different parts of the county to share their views. Next, the Trust needed to find a new ‘mission and vision’ for the organisation – a new message that would unite people.
I would describe it as a journey of improvement which is always continuing
Following discussion sessions with leaders, everyone across the Trust was given the opportunity to explain their contributions. ‘We did this by asking staff to answer a survey with three questions: What do you do? How do you do it? And, Why do you do it? We held a series of workshops across the county, available to all staff, so it was done in a genuinely shared way.’
Once gathered together, these insights were distilled down to a common vision for the Trust, which was Be better every day, says Plumb. The Trust reached this new message after testing different options for a common vision and then returning to the board for a final decision. ‘The culture of the NHS is one of improvement: the idea is of ongoing progress and improvement,’ she adds.
The Trust has tapped into its employees to iron out the wrinkles suffered by every organisation, particularly one which had relatively recently undergone a merger, through what it calls ‘Rapid Improvement Week’, where volunteers from back-office support units shadow clinicians and other front-line workers.
‘We realised too many different processes were hampering actual clinical time,’ says Plumb. ‘We sent volunteers to spend ‘hack days’ with clinical teams to understand which processes were getting in the way and then try to improve them.
‘One problem is that clinicians and support providers usually only talk to each other when there is a problem. This was putting them together when things were good to build a rapport and understand each other’s positions and needs better.’
This has been a particularly effective approach, with, for example, an immediate improvement in intranet WiFi in the areas it was not working properly. ‘On the back of the hack days, people said they felt they had been listened to,’ says Plumb.
The Trust also started ‘air and share’ drop-in sessions hosted by directors around the different locations in which it operates. ‘We also did topic-specific drop-in sessions, for example, we might do one about staff communications,’ says Plumb. ‘Then we invited staff personally to afternoon tea with directors to try to close the gap between senior staff and managers.’
The Trust also aims to celebrate the achievements of its employees. To better recognise their contributions, it has relaunched an awards scheme, which takes place once a month with awards presented at tea parties.
This was putting them together when things were good to build a rapport and understand each other’s positions and needs better
‘It is part of creating touch points for staff to be engaged,’ says Plumb. Simultaneously, the Trust launched a new multi-channel intranet platform for workers which is in line with the new visual identity, or ‘brand’, of the organisation. ‘We use social media to engage staff,’ says Plumb. ‘For example, at our winter stalls two years ago, we got the most engagement on Facebook and Twitter with staff sharing photos of their teams going about their day. It is building a sense of ownership.’
The Trust now wants to tell its stories more frequently on Twitter and plans to ‘flood’ the organisation with GoPro cameras which teams can use to illustrate what they do.
‘The geography was a real divider across the county. It could easily be ‘them and us’ but we are all in it together and we need to think about what could be done better as a whole.’
The Trust now carries out an annual staff survey to measure engagement. This has shown a significant year-on-year improvement for four years in a row. ‘There is a clear parallel in the improvement of staff engagement and the improvement of quality,’ says Plumb.
As a result, Plumb now finds it easier to make a case to the board for investing in staff engagement programmes. The next step will be to focus more on increasing staff empowerment and to expand leadership development.
‘In our work, we have found that people’s experience with line managers is not as good as we would like, so now we are looking at engaging specifically with line managers to improve this,’ says Plumb. ‘This is an important next step for us – to improve the experience of managers. For us, staff engagement is the real milestone.’