East Lancashire Hospitals NHS Trust: improving through partnerships - Kevin McGee

Kevin McGee, Chief Executive of the East Lancashire Hospitals NHS Trust, wrote an article in the GGI Festival review (2018 edition).

It was a great achievement for East Lancashire Hospitals NHS Trust (ELHT) to be rated ‘good’ in our most recent CQC inspection, demonstrating the hard work and dedication of all our staff since being placed in special measures as a result of Sir Bruce Keogh’s review four years ago. However, as I have consistently said, the journey is not over and I am confident that all staff at ELHT are fully committed to continuing our improvement journey to achieve an ‘outstanding’ rating from the CQC. It is my firm belief than an organisation should never stand still, it must always be striving for the next improvement.

The opportunity to work with, and support other organisations is a core part of our approach to quality improvement - providing opportunities for us to celebrate our successes, hone our methodologies, and develop our staff – a view shared by The Foundation Trust Network whose ‘Review of Buddying Arrangements, with a Focus on Trusts in Special Measures and their Buddying Organisations’ highlighted the benefits of mutual learning and support. And indeed, there have been a number of examples of effective ‘buddying’ in the NHS including our own experience with Salford Royal NHS Foundation Trust, and University Hospital Birmingham NHS Foundation Trust’s partnership with George Eliot Hospital NHS Trust.

Therefore, when NHS Improvement asked me, in 2017, whether ELHT would consider a ‘buddying’ arrangement with North Lincolnshire and Goole NHS Foundation Trust (NLAG) it was something my Board and I felt we could not say no to.

Now, almost a year into our buddying programme, we are able to reflect on some of the key challenges and learning from our experience. Although a lot of this smacks of common sense, it is too often overlooked or unapplied within the NHS.

Culture and behaviours

On first glance, ELHT is well placed to support NLAG – we were both Keogh Trust’s, and we both operate across three sites, serving a similar size population, with a similar size income. However, this assessment devalues the importance of cultural alignment and personal relationships. We know that stressed organisations are often experiencing significant churn and can adopt a defensive, or ‘bunker’ mentality, hindering collaboration and it is therefore important for the leadership of each organisation to develop relationships with their counterparts and build a shared understanding and ownership of the challenges. This is something we were particularly mindful of when developing our support offer

Capacity and resource

It is easy to underestimate the time and resource commitment required to make a success of a buddying arrangement, and those organisations that fail to appreciate this risk not only losing the benefits from the collaboration but also significant reputational damage. This issue of capacity assessment and mapping should be an open, transparent and continuous process that is explored at the on-boarding and planning stages and in joint governance arrangements.

Evaluation and learning

Perhaps the greatest value, from our experience, has been derived from the shared learning and development opportunities that the buddying arrangement has provided for our, and NLAG’s, staff. We have been particularly mindful of the opportunity for staff to:

• Reflect on divergent ways of working and learn from good practice
• Socialise and network beyond our individual organisations
• Take on leadership roles and responsibilities and gain valuable and significant experience of delivering large quality improvement programmes
• Generate and promote learning for the wider health and social care system

Communication and visibility

Organisations receiving buddying support are often doing so at the behest of a regulator and, as such, the morale of the staff at the organisation may be low, with suspicions about the value in “yet another programme imposed on us”. It is important therefore that staff understand the buddying relationship as beneficial rather than burdensome, and not as something that is “being done to them.” Ensuring clear and transparent communication and engagement with staff can help address cynicism and maintain workforce morale throughout the duration of the arrangement, provided it is based on authentic engagement and connects to the way staff feel and see their organisation.

Regulation

As buddying arrangements are typically an improvement exercise to support a challenged NHS organisation, it should come as no surprise that regulators can have a significant impact in the effectiveness of any partnership. In our experience, there are three areas in which regulators can add value to buddying programmes:

• Selecting the most appropriate buddying organisations, in tandem with those involved
• Working with buddying organisations to set relevant and realistic performance indicators and be guided by the buddying organisations as to what will work best. In monitoring performance, regulators should be mindful that rapid development cannot always be achieved
• Providing support, and where necessary, resources to ensure the success of the arrangement

The direction of travel for health and social care is clearly one of increased partnership and collaboration. In such an environment Boards will need to be cognisant of the potential benefits and challenges to be derived from bringing together a range of organisations with often strikingly different cultures and backgrounds. In this context, buddying arrangements should be pursued by a wide range of organisations pursuing improvement, not just equivalent organisations and not just those that have been directed to. The learning from our experience, and that of a range of other organisations involved in buddying arrangements, is captured in a report we have recently published, in collaboration with the Good Governance Institute.