Gemma Stacey visits East and North Hertfordshire NHS Trust
My visit East and North Hertfordshire NHS Trust was an opportunity to explore the collective impact of leadership development opportunities provided by the Florence Nightingale Foundation (FNF). There are 12 FNF nursing and midwifery scholars working across the organisation at a range of levels and from diverse personal and professional backgrounds. I am convinced of the difference the programme makes to the individual. I have the privilege of hearing daily stories of personal transformation and reconnection with the love of the professions. I am often left wondering however, what are the consequences of this for the organisation and the communities who are supported by the services? My visit gave me the opportunity to dig deep and understand this from the perspective of the FNF scholars, their colleagues, and students.
I approached the visit with the recent government commissioned review of leadership across health and social care at the forefront of my mind. The Messenger Review highlights the importance of organisational culture and emphasises the importance of collective and inclusive approaches to leadership throughout the NHS and wider system. The review recognises the role the medical profession plays in influencing culture and behaviours and describes its unique responsibility for leading change which will enable all staff to flourish. Whilst this statement reflects an awareness of the need for leadership development to be considered as of equal importance to clinical expertise and experience, it fails to acknowledge the considerable influence nurses and midwives have on organisational culture as the largest professional groups practicing within health and social care. I see evidence of this influence constantly and my visit to East and North Hertfordshire NHS Trust gave further evidence to support this.
“This is what I bring, and it is valued.” Czar Cacanindin
I was greeted by Rachael Corser, Chief Nurse and FNF alum. Rachael has been in post since 2018 and has therefore led the workforce throughout the pandemic. As we walked through the hospital it was clear Rachael is a visible leader, with meaningful connection with so many individuals wearing a range of uniforms indicating their varied contribution and seniority. As she greeted each by their name and a smile there was a sense of a purposeful yet natural motivation to connect. This has been an important aspect of Racheal’s strategy for the nursing, midwifery and allied health professions which includes concerted attention in making it easy for staff to access senior leaders and nurturing a culture where all staff feel valued and supported to progress.
I entered a room of many familiar faces. Bev Summerhayes, a current FNF Scholar, had arranged for me to speak with several FNF scholars, other senior leaders, students, and internationally educated nurses. The environment was joyful as it represented an opportunity to pause, reflect and acknowledge the personal and professional strides individuals had taken and the contribution they were making. There was an environment of mutual celebration and admiration for each other. We set to a deep conversation about what had enabled these achievements and the ambition they had for further influence by being role models or national exemplars of best practice.
The consistent theme of the conversation was confidence. I heard from Czar Cacanindin and Shaverick Granpil that, as internationally educated nurses, they had lacked the confidence to speak to leaders because of English not being their first language. The FNF programme had enabled Czar to “settle into my own skin” and have belief that “this is what I bring, and it is valued.” There was increased celebration of the importance of being their authentic self – “culture is part of us and that is perfectly fine.”
Dionne Thompson and Dede Thorpe are both midwives in the organisation and from ethnic minority backgrounds. They shared a passion to improve the experience and outcomes for women of colour who are having babies in the community East and North Hertfordshire NHS Trust serves. Both Dionne and Dede had implemented initiatives which were improving the cultural intelligence of their colleagues. They recognised that this would not be a quick fix and long-term effort would be needed. The survey Dionne had designed to capture the experience of women of colour was now asking the right questions and showing better experience, but outcomes had not yet improved. Dionne was unpicking this and demonstrating her commitment to continuing to enable the voice of women of colour to inform and shape maternity services. She attributed her confidence to champion this cause to her FNF Quality Improvement project which had given her permission to drive forward change. She was now building on this momentum and receiving recognition from the region inviting her to share her learning and cascade best practice. Dionne was advocating “race has to be part of the clinical picture” which would require a culture change for the midwifery profession.
“We are actively making improvements” Lorraine Williams
Audrey Scott is a current scholar and has just embarked on her scholarship year. It was clear she had been supported and encouraged by the senior leadership team to apply for the opportunity as she was transitioning from a highly specialised clinical role into the leadership of a team of specialist nurses. Audrey reflected on her decision to step back from leadership when she had children and focus on developing her specialist knowledge and skills. However, she now recognised that she could and should do both as she has the opportunity to “manage upwards” and influence decisions at a strategic level which will make a difference for the people she cares for. The group reflected that the ethos of development for the sole purpose of growing specialist knowledge had been shifted in the organisation and that personal growth was now seen as of equal value.
Lorraine Williams, also alum, described her FNF experience as life changing and was committed to sharing her learning with her team and wider colleagues. She reflected “we have impact, people can see who we are and that we are actively making improvements” and the group agreed this was having a ripple effect on the wider culture of the organisation. For example, Czar had implemented the Quality Improvement project named “Joy in Work” which focused on understanding what really matters to people. The outcomes had informed actions and practical changes had been made to promote psychological safety, comradery, reward, and recognition. Challenges with holding difficult conversations and giving constructive feedback had been identified as the area which was most influential on team wellbeing. In response he had provided training and a structure to foster facilitative conversations which were underpinned by learning as opposed to criticising.
Rachael recognised that they had not yet reached every frontline clinician and the aftermath of the command-and-control leadership approach that had been required during the pandemic was still permeating. Fear of reprimand and unhelpful power differentials which sustain the negative impact of hierarchy were not absent. However, every person contributing to our conversation (including internationally educated nurses and students) believed that this is an organisation that is in a strong position to transition working as part of the Integrated Care System. The mantra “civility saves lives” was articulated and role modelled by Rachael, and it was this ethos that underpinned the generosity and mutual celebration of each other. The group described working beyond the metaphorical and actual walls of the institution as welcomed prospect. Dionne believes “it will enable meaningful collaboration with communities to promote health for all.” They were confident, that their FNF leadership development and ongoing support would enable them to have a voice and be at the table. It had prepared them to be ready for the future.
 DHSC (2022) Health and social care review: leadership for a collaborative and inclusive future. Independent report from General Sir Gordon Messenger and Dame Linda Pollard. (Accesses 21/06/22 Health and social care review: leadership for a collaborative and inclusive future – GOV.UK (www.gov.uk)