Leadership: Integrating Organisational Development into My Practice as a Leader in the NHS - A Focus on Patient and Staff Experience
2016/26 - Tracey Wrench
Integrating Organisational Development into My Practice as a Leader in the NHS - A Focus on Patient and Staff Experience
I am an Executive Director of Nursing and Quality at Coventry and Warwickshire Partnership Trust. The organisation is a community focussed specialist mental health, learning disability and physical healthcare provider. I commenced my scholarship with a leadership diagnostic with Sue Machel in February 2015. This provided an excellent foundation on which to plan my scholarship focus and energy and after considering the potential options, I chose to undertake the world renowned Organisational Development (OD) Certificate Programme at the National Training Library (NTL) Institute for Applied Behavioural Science. With 25 days attendance in six module weeks over a period of twelve months, with additional intense preparation time and post module reading and reflection, commitment to completing the programme was my key area of focus for my scholarship.
Learning and Development
The NTL OD Certificate Programme integrates a sequence of experiential work modules designed to provide participants with a thorough knowledge of the underlying principles and theories of organisation development (OD) and to build their capabilities across a full range of OD interventions through the grasp of the ‘use of self’ principle. This is a programme aimed at people who have extensive practice working within human systems such as the health service for a number of years and want to develop their knowledge and skill base while searching to pull together their values, passion, motivation, skills and knowledge and who they are, and into this an integrated approach to the way they work.
All six modules were very experiential in nature, committed to the implementation of theory into practice at many levels. Some of the modules had real life organisational cases, the representatives from outside organisations coming into the NTL space and receiving ‘real time’ interventions. Others focussed on the real life practice examples of the participants and on all modules involved focus on self as practitioner.
I would describe the impact of this programme as personally transformational. The most fundamental impacts the programme has had on me are;
- The concept and practice of ‘use of self as instrument’ and presence; continually attending to how you are responding to the environment and interactions, and the use of purposeful intent to have impact.
- The development or refinement of your ‘go to’ theories or mental models in terms of using the OD cycle to creating the positive environments. I want to create stronger emphasis on appreciative inquiry and the co-creation of positive future states.
- Attending to and working with diversity and difference; exploiting its potential.
- Working with systems thinking and how you can impact on different levels of system, often several levels at the same time. Embracing and accepting that learning organisations work with ambiguity and constantly emergent change, not linear processes, and to influence and go where the energy lies.
- Accepting that you cannot do ‘cultural change programmes’, culture evolves over time in response to multi-layers of interventions and is influenced by the open systems in which an organisation operates. Your leadership behaviours have a profound impact on this.
My OD programme experience and learning has also had impact on my Patient Care Improvement Project.
Patient Care Improvement Project
For my project, the aim was to develop real time feedback mechanisms to capture Patient Reported Experience Measures (PREMs) and a set of Staff Reported Experience Measures (SREMs) at team level to promote compassionate practice for patients and staff engagement and wellbeing, and have helpful conversations to improve.
The objectives were:
- To develop a set of Patient Reported Experience Measures (PREMs) and a set of Staff Reported Experience Measures (SREMs) based on some local previous work and a literature review in this area.
- To develop two APPs to capture the PREMs and SREMs at team level to facilitate quarterly capture reporting of quantitative feedback and qualitative in at team level.
- To undertake an initial pilot of these APPs in adult services within the Trust, and use the learning from this to identify further improvements and approach across the Trust.
Through the engagement and leadership across the senior leadership team in the Trust, the initial pilot was undertaken in March 2016, with an evaluation exercise commenced in late March and early April to expediently capture feedback to support the next stage of piloting beyond the scholarship project. The key messages, themes, and areas for learning were;
- Further work to ensure IT connection issues are resolved for some teams.
- Ensuring the coding to individual teams is put in place correctly to enable accurate feedback to the right team.
- Put explanation of the tool, why we are collecting the feedback and how it will be used to support improvement at the beginning of the tool itself, not just on a separate explanation sheet.
- Review the language used in the tool, and more importantly, continue to support the understanding of the statements in the tool so their use is embedded.
- Some teams acknowledged the benefits of having the tool, giving fresh perspectives on the delivery of compassionate care at team level from both staff and patients. The planned further piloting and use to complete the cycles of improvement are needed, including increasing skills and experience in using the feedback as a team.
- A way of reporting the measures at team level as part of their outcomes has yet to be finalised, this will be developed as further piloting and reporting takes place.
As a result of the learning from my project, not just the current evaluation of the initial pilot, but also the journey I have undertaken integrating my knowledge and experience in leading a clinical strategy, service improvement methodologies and OD practice, there have been several outcomes that I have positively influenced, including two key ones:
- Building on the work of the project, the Trust has a Quality Improvement Goal for 2016/17 on “Team Effectiveness: Team Building and improving patient and staff experience”. We will use our PREMs and SREMs in ‘real time’ at team level as part of its commitment to staff engagement and wellbeing, and helping teams to receive feedback and have helpful conversations.
- PREMs and SREMs at team level will be used as part of the approach in undertaking a diagnostic phase across our organisation as part of ‘Great Place’ Organisational Development Strategy work, and will be built into measuring the success of our strategy.
I have also really benefited from becoming part of an OD learning community that is committed to creating, sharing and disseminate knowledge and practice. As a result of this development, I have taken a lead role responsibility in the development of the Trust’s ‘Great Place’ Organisational Development Strategy and a group formed to take forward the strategy. I have also engaged in the work of NHS Employers and the NHS Leadership Academy in the ‘Do OD: Organisational Development’ initiative, very recently become a member of their National Steering Group, so I can be influential in its dissemination in the NHS.
Scholars visit to Northern Ireland - Integrated Care
Our Scholars study visit to Northern Ireland (NI) took place in early December 2015. Our fellow scholar, Caroline Lee, was able to facilitate a very informative and stimulating visit with the following elements;
- Tour of Stormont and an overview of the political environment and political processes for health in NI.
- An overview of primary care, community care, acute care and mental health services in Belfast (and the wider model within NI) – with senior guest speakers from relevant specialities and disciplines.
- The health challenges facing the population of NI.
- An overview of the strengths of a more integrated way of working to life and the familiar challenges of capacity and demand.
- A visit to a health centre in Belfast centred in a bigger community health and wellbeing facility.
Of particular interest to me were the work being undertaken in the 5 Step Mental Health Strategy, a project called ‘A 1000 Voices’ to gain patient stories and promote engagement in service redesign. We also got to learn about the Frail Elderly Pathway in which Gerontologists worked across acute care and with a specialist intense care at home to prevent admission to provide seamless care and positive risk management in the community, and the development of a community nursing safe staffing model.
I have really valued and experienced the real benefits of being part of a community of practice with my fellow scholars. We have shared theory and practice examples and provided both practical and emotional support to one another. The connections and learning within this community will endure well beyond our scholarship year, and I feel very thankful for this.
Throughout the scholarship and its multiple facets, I have paid attention to and focussed on the integration of all the skills and experience I have had. I believe I am a more resilient person who practices the ‘use of self’ and purposeful intent to have increased impact in both my professional and personal lives.
I would like to thank the Florence Nightingale Foundation and in particular Professor Elizabeth Robb, for their commitment and support to leadership scholarships and for support for myself as an individual scholar. I would like to thank Health Education West Midlands for sponsoring my scholarship. I would like to that Rachel Newson, Former Chief Executive Officer, and Simon Gilby, current Chief Executive Officer of Coventry and Warwickshire Partnership Trust, who generously supported my scholarship including the study leave required. I would like to thank Chris Butler, former Chief Executive of Leeds and York Partnership Foundation Trust, who was my mentor during the scholarship. I would like to thank Sue Machell for her coaching support throughout my scholarship. Finally, I wish to acknowledge my appreciation of my husband Simon and son Oliver for their untiring patience and love whilst I undertook my study, frequently staying away from home.