A simple story of trust - Lynne Hunt

Developing a positive engagement culture at one of the country’s largest NHS mental health and community trusts.

Lynne Hunt, Chair, Southern Health NHS Foundation Trust

I took on the role of chair at Southern Health after it had been through a number of years of challenge, scrutiny and changing leadership.

My first task was to find a group of new non-executive directors to join the board; I was ably supported by a strong group of governors who were wholly committed to bringing about positive change. My second task was to appoint a new chief executive, and with him a strong, inspirational and dedicated executive team. Together, we realised that a focus on culture was essential if we were to bring lasting improvements to staff engagement and, through that engagement, to patient care.

In this blog I’m going to outline our journey and the outcomes we’ve achieved so far. The most positive part of this exercise has been hearing the views of other board directors. So although this piece carries my name it is very much produced as a result of teamwork, which has been central to our journey at Southern Health.

Our journey

The journey towards an improved culture at Southern Health has been both a story of and a focus on trust. After a number of challenging discussions, the trust board was clear that we needed to nurture a deeper sense of trust between staff, our service users and their families, commissioners and wider stakeholders. It was with this in mind that the first strategy developed was the people and organisational development strategy, which focused on the board’s role in developing and reinforcing the trust’s aim of continuous improvement, as well as promoting a just culture.

Looking back, the core elements of our journey are best told through the lens of Ken Blanchard’s ABCD Model of Trust. For the last four years, we have been unwavering in our commitment to enhancing the organisation’s Ability, Believability, Connectivity and Dependability.

Our new Abilities

Our ambition was, and still is, to become a patient-, family- and public-led organisation. We introduced and strengthened our User and Patient Involvement Team by employing people with lived experiences. Through this, we have gained unique perspectives with which to improve care.

We put on board seminars and senior leaders’ conferences to learn together, discuss problems collectively and tackle our most challenging issues. All directors invested in executive coaching to learn, reflect and grow, building self-confidence and resilience. Elevate, the trust’s suite of leadership programmes, was designed in-house by our staff, for our staff, and reflects our belief in nurturing leadership at every level.

We developed quality improvement capability and capacity to empower decision-making closer to care delivery. Our QI methodology has increased user, carer, and stakeholder involvement in change across the organisation.

We have developed a cultural insights dashboard and pulse check to monitor the performance of individual teams and to signpost our developmental resources to the places with the greatest need. These evidence-based tools give us meaningful, quantitative insights into staff engagement against a range of evidence-based metrics, which enables targeted interventions and empowers our teams to develop programmes of improvement.

Believability as the norm

We have owned our history, journeyed with it respectfully, and accepted accountability. We will not forget what has happened before. We are committed to never-ending improvement. This has become a core part of our narrative.

We are creating a just and free culture. To us this means being non-judgemental when mistakes occur and committing ourselves to learning from them. We are developing compassionate casework for workforce-related matters. This can be challenging, but we know it will improve patient care, staff engagement and genuine learning.

Being honest and transparent is key, especially when times are tough. We record and publish our open board meetings and papers as well as the programme of board-to-board meetings with our partner agencies. We make public statements and apologise openly when we get things wrong. We admit to our weaknesses – acknowledging, for example, the inclusion and equality disparities within our trust. We held a four-hour public board meeting to learn from staff and partners and explore with them what was needed to improve services. We were able to inspire debate and make positive change.

Embedding connectivity

We listen, listen, and listen again to our patients, families and stakeholders. We invite them to help us co-create a new Southern Health future. We don’t always get this right, but we are moving forward.

We developed a trust communications strategy, which ensures that we share key messages and the board’s vision for the organisation: to drive up communication and engagement skills, ensure our communications reflect our values, and take a more proactive, inclusive approach to communication.

We further developed our approach to internal communication, creating and aligning new channels, including Facebook for staff and a dedicated app to help keep staff informed and aware, especially during the pandemic.

We understood the importance of showing appreciation and role modelling in developing our culture. We developed a comprehensive reward and recognition system, which aligned to our values and helped us achieve our aspirations.

We developed compassionate leadership frameworks, embedding them as core leadership competencies; these were included across our internal leadership programmes. Board-led visits inspired connection, trust and a two-way dialogue from board to patient-facing services.

Improved dependability

We reorganised our services around the local areas they serve rather than clinical specialties. This brought about better operational clarity and enabled stronger relationships with local partners. To further strengthen this and ensure robust professional leadership and delivery, we appointed additional senior clinical leaders in each new division.

Better performance management through executive performance groups ensure we deliver what we promise. We also invested in and continue to grow our business intelligence platform to enable staff at all levels to gain insights from the data we collect and use this to improve our care, efficiency and effectiveness.

We have become more open and responsive to concerns via our Freedom to Speak Up Services, Listening Ear (bespoke coaching for wellbeing) and ongoing CEO engagement programmes with frontline staff.

Improved outcomes from greater trust

Our focus on a culture of trust has resulted in improvement in many measurable outcomes. Here are some of the indicators that give us confidence in our approach:

• In January 2020 our overall CQC rating improved from ‘Requires Improvement’ to ‘Good’ – for the first time in our history.

• We have seen year-on-year improvements in the NHS Friends and Family test results, with more people than ever recommending Southern Health as a place to receive care or a place to build a career.

• Improvements in retention of our staff have seen our workforce increase by over 500 people in the last couple of years, despite the challenges of the pandemic and well known recruitment difficulties across the NHS.

• We now have a more representative trust board and more diversity in our workforce, following a conscious effort to demonstrate our commitment to this agenda and visibly celebrating diversity.

• We’ve seen consistent increases in incident reporting, with reducing the severity of incidents. This suggests a positive reporting culture and a shift away from fear of blame. Complementing this has been an improved Freedom To Speak Up ranking.

• There have been year-on-year improvements in our stakeholders’ attitudes towards the organisation, as measured in annual audits.

In conclusion

We are far from complacent, and we know that there are many areas that we still need to strengthen and develop, but as we continue to travel along this improvement road, one thing’s for sure: we will remain steadfastly and relentlessly focused on our culture and the vital importance of maintaining trust and a just and safe culture for all.