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East London Foundation Trust Our WRES story Sandi Drewett Director of Human Resources and Organisation Development

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East London Foundation Trust

Our WRES story

Sandi Drewett

Director of Human Resources and

Organisation Development

Mental health services Newham, Tower Hamlets, City & Hackney, Luton &

Bedford

Forensic services All above & Waltham Forest, Redbridge, Barking &

Dagenham, Havering

Child & Adolescent services, including tier 4

inpatient service

Regional Mother & Baby unit

Community health services Newham

IAPT Newham, Richmond and Luton

Speech & Language Barnet

Why it’s important

• Diverse teams, inclusively led, produce better

outcomes than homogenous teams (or

diverse teams not inclusively led)

• Particularly relevant to healthcare, where

team performance depends significantly on

sharing of information

Our Journey

6

• It is typical of an NHS Trust to

collate Data but not do anything

strategic with it.

Use data to

drive

Organizational

and

cultural

change

Improving

data

Collection

and

data

quality

Historically

basic

data

collection

Understand

and

triangulate

data

Analyze and

feedback

data

• Collection of qualitative data by

different means. Improved use

of ESR and other systems.

• Data cleansing exercises and

better use of systems.

• Staff Survey, FFT surveys and

focus groups. Monitoring in

terms of consistency between

localities.

• Frequent reports to SDB,

Board, Workforce Committee

etc.

• Triangulate between data

collection methods i.e. Staff

Survey, FFT surveys,

Disciplinarys, Grievances, Exit

interviews and performance

dashboards.

• To improve, recruitment and

selection, reduce the number of

formal process to cascade data

to decision makers. Thinking

Space Training (Unconscious

Bias)

• Lessons learned following ET

cases

• Service users involved in every

part

• Learning is the focus and not

blame.

It’s important to create a culture in

which staff are more valued. The

staff that feel most undervalued and

least rewarded section of the NHS

workforce – its BME staff – not least

since the evidence is that their

treatment is a good predictor of the

quality of patient care.

At a time when there appears to be

a consensus on the 5

benefits of diversity for all those

receiving health services there can

be no better time to change, once

and for all, the “snowy peaks” of the

NHS.

‘Employee engagement

emerges as the best

predictor of NHS trust

outcomes. No combination

of key scores or single

scale is as effective in

predicting trust performance

on a range of outcomes

measures as is the scale

measure of employee

engagement’

Professor Michael West

Staff Engagement We don’t have the

head start that others

do. It’s not a level

playing field. But we’re

just as talented. All we

need is a bit of help to

unleash our potential.

Sadiq Khan, Mayor

London

The quality culture we want to nurture

A listening and learning organisation

Empowering staff to drive improvement

Increasing transparency and

openness

Re-balancing quality control, assurance and improvement

Patients, carers and families at the heart of all

we do

Staff feedback

Our practice

• Clinically led organisation

• Invested focus on learning and development

programmes for every level and group of staff

– Reflective practice the norm for clinicians

• Focus on learning from what’s going well

• Long term approach to workforce planning with

universities

• QI projects – targeting underlying issues in a

sustained way

• Networks and mentoring

r

Our approach to Quality

Improvement (QI)

• Improvement action to focus on

issues most relevant to staff

satisfaction

• Link with existing work

streams/quality improvement

project where appropriate

• Further work to identify causes of

issues/success identified; in-year

surveys to be launched

Our Contributory factors

Culture

A learning organisation with a focus on research, education and development

Values based; open and transparent

Focus on staff engagement and experience

Organisational stability High performing Foundation Trust

CRES programme and bed capacity well managed

Staffing and leadership High quality staff group

Focus on visible leadership at all levels

Quality Strategy Executive walkabout and local listening to improve programmes

QI projects

Improvement vs assurance

ELFT Workforce profile

• BME representation by profession varies

widely:

Registered nursing 70%

Unreg nursing 65%

Admin & Clerical 57%

Medical & Dental 38%

Allied Health Professionals 24%

• Largest area of under-representation is in relation to

Asian staff

BME staff experience Indicator: BME White

Training/development 81 79

Appraisal 86 85

Well structured appraisal 61 47

Support from managers 3.93 3.91

Communication 43 39

Team working 3.95 3.90

9 November 2016 East London NHS Foundation Trust Page 24

BME staff experience Indicator: BME White

Violence and/or aggression from

patients

24 20

Violence and/or aggression from staff 6 1

Harassment, bullying and/or abuse

from patients

34 32

Harassment, bullying and/or abuse

from staff

24 23

Equal opportunities for career

progression

71 88

Discrimination at work 26 15

WRES Indicators

WRES Indicators 2015

Indicator 1: Percentage of BME staff

in Bands 8-9 and VSM

Descriptor Indicator

Number of BME staff in Bands 8-9 and

VSM 148

Total number of staff in Bands 8-9 and

VSM 590

Percentage of BME staff in Bands 8-9

and VSM 25%

Number of BME staff in overall

workforce 2388

Total number of staff in overall

workforce 4842*

Percentage of BME staff in overall

workforce 49%

Descriptor White Staff BME Staff

Number of Shortlisted

Applicants 2049 3304

Number appointed

from shortlisting 285 362

Ratio -

Shortlisting/appointed 0.14 0.11

Indicator 2: Relative likelihood of BME staff being

appointed from shortlisting compared to that of White

staff being recruited from shortlisting across all posts.

Descriptor White Staff BME Staff

Number of staff in

workforce 2298 2388

Number of staff entering

the formal disciplinary

process 27 101

Indicator 3: Relative likelihood of BME staff entering the formal

disciplinary process, compared to that of White staff entering the

formal disciplinary process, as measured by entry into a formal

disciplinary investigation.

Indicator 4: Relative likelihood of BME staff accessing

non-mandatory training and CPD compared to White

staff.

Descriptor White Staff BME Staff

Number of staff in

workforce 2298 2388

Number of staff accessing

non mandatory training

and CPD 682 799

Indicator 9: Boards are expected to be broadly

representative of the population they serve.

Board

Ethnic Breakdown Total

BME

5 (33%)

White

10 (67%)

Grand Total

15 (100%)

Process of cultural change

OUTPUTS

• Staff who drive improvement

and change

• Staff feel comfortable to raise

concerns and challenge poor

practice

• Staff are empowered and

have a voice

• Effective partnership working

with Trade Unions

• Staff see the impact of Senior

involvement

• An ability to discuss issues

• Increased engagement

scores

• Proportionate and consistent

outcomes in terms of ER

cases

• Positive messaging about raising concerns

• Cultural change

• Staff Engagement

• Acknowledgement of organisational issues

• Communicating organisational Issues

• Mechanism for managing issues (QI)

• Value staff

INPUTS

Key messaging from the top of the

organisation

Equality forums lead by Exec

Directors

QI initiatives more widely

Key input from front line staff

through QI initiatives

Openness and willingness to

discuss difficult subjects such as

race and race inequality

Commitment to address these

issues at senior levels in the

organisation

What we are doing

• Governance:

– Equalities strategy agreed by Trust Board

– Implementation group meeting monthly

– Internal audit and CQC review

• Listening and learning:

– Staff networks and forums

– Staff surveys

• Culture:

– Senior leadership of staff networks, conferences etc.

– Leadership culture programme - with Kings Fund/NHSI

– Quality culture -10 Quality Improvement projects focusing on reducing

levels of violence & aggression

What we are doing

• Initiatives:

– Recruitment – branding, values based, service user on panel

– Developing a performance framework

– Increased range of development courses and opportunities

(i.e. bands 5-7 management development)

– Mentoring – reverse and BME

– Team reflective practice

– Unconscious bias training

– QI projects: BME career progression, Disciplinary Process

Achievements

• Most diverse workforce in the NHS

• Most diverse Board; only BME chair in London and

only BME Chair/CEO team in the NHS

• BME staff more positive than white staff in majority of

staff survey indicators

• Progress in reducing levels of violence, aggression,

bullying/harassment and discrimination

• One of a few Trusts to have positive Workforce Race

Equality Standards indicators

• Most improved NHS trust – Stonewall rankings

• Increasingly recognised as a leader in this area

Areas for improvement

• The numbers of BME staff disciplined is

disproportionately higher than White staff

• Women, BME and disabled staff are significantly less

positive about the fairness of career progression in

the Trust

• The percentage of staff in BME groups in Bands 8a

to VSM is disproportionately lower than the number

of white staff

• High levels of reported bullying, harassment and

abuse (25% of staff)

• LGBT - stigma, lack of data

Disciplinaries

• Evaluation of three years of cases carried out

• Main findings:

– Some (but not all) disparity driven by the role - i.e.

band 3 and band 5 inpatient nursing staff most

likely to be subject to disciplinaries

– Most disparity relates to Black staff

– Large proportion of cases (25%) not upheld at

hearing

– Significant proportion of cases initiated by

allegations by patients. Staff often suspended for

long periods

Disciplinaries

• Actions: – Increased use of informal resolution; performance framework

being developed

– Nursing staff have developed better local induction

programmes for staff

– Fair Treatment Panel to review all disciplinary cases to

check that they are appropriate for formal hearing, or

whether alternative methods should be used

– Full-time investigator to investigate all cases where staff

subject to suspension

Career progression

• Low scores prevalent in following occupational groups:

– Administration

– Healthcare assistants

– Age 51+

– Women, disabled and BME staff

• Some correlation with quality of line management (women,

disabled staff)

• Directorate scores suggest that organisational change has an

impact

• Generally good access to formal development opportunities

• Increased range of development courses and opportunities (i.e.

bands 5-7 management development)

• Impact of secondment and acting-up processes

Career progression

• Actions:

– Admin and nursing development programmes

– Secondments now advertised in line with permanent roles

– BME mentoring and reverse mentoring programmes

– Admin conference to focus on career progression

– Celebration of BME leadership stories

– QI project – BME rep on recruitment panels

– Review of career paths for each profession

Bullying, harassment and

abuse • Context:

– 73% of reported BH&A occurred 1-2 times in the last year

– Workforce composition – 70% female, 19% disability, 18%

BME

– Hierarchy/Targets/regulation - The Chief Executives Tale,

864 lines of reporting

– Safety critical environment

– Conflict - 33% of staff in the last year report bullying,

harassment or abuse from patients/public

– Constant organisational change

– Wellbeing – 38% suffered work related stress in the past

year

What contributes to bullying

at work? • Bullying is not primarily a problem of interpersonal differences

• Even though bullying plays out during interactions between

individuals, features of jobs and factors in the work environment

are the primary determinants

• Stressful working conditions (role stressors, low control) are

associated with greater exposure to bullying

• Overall, workplace bullying reflects the functioning of the

organisational system

• Current actions focus on an individual level, but we also need to

work on the organisational risk conditions (supervision,

performance management, organisational change etc.), and the

wider system prevention (role and goal clarity, reduce amount of

change, reduce conflict, increase support etc.)

Headlines 18th October 2016

• Hospitals to be named and shamed on agency spending

• The NHS is to publish the names of hospitals that spend too much on agency staff, as well as the incomes of the

highest-earning temporary staff, writes the Times £. The decision to name and shame has been made as the NHS

still spends £250m a month on locums and stand-in staff, despite a cap on hourly rates being imposed almost a year

ago. Jim Mackey, chief executive of NHS Improvement, said: “The NHS simply doesn’t have the money to keep

forking out for hugely expensive agency staff. With hospitals across England struggling with patient demand, trusts

need all the support they can get and trying to cash in on the NHS just isn’t on.” Anthea Mowat, of the British Medical

Association, said: “The measures are nothing but a sticking plaster – naming and shaming trusts or individuals will

not address the underlying issues causing and overreliance on agency workers.”

• Regulators place more trusts in financial special measures

• HSJ £ reports that regulators have placed three more NHS trusts in financial special measures. East Sussex

Healthcare NHS Trust, Gloucestershire Hospitals NHS Foundation Trust, and Brighton and Sussex University

Hospitals NHS Trust have been placed in the regime by NHS Improvement. Chief executive of the regulator, Jim

Mackey, said the three providers going into financial special measures are “causing significant concern”. He added:

“They’ve agreed savings targets locally but are a long way from meeting them…The financial performance of these

three trusts has simply not been good enough and so we’re sending in some targeted support to identify what the

problem is, and help them fix it.” Mackey said £100m of potential extra savings have been identified at the five trusts

already in financial special measures from when it was introduced in July.

• Mental health trust criticised over killings by patients

• The BBC reports that a review has found a mental health trust underestimated the risk posed by its patients and

sometimes did not act on threats to kill. The review examined 10 deaths linked to Sussex Partnership NHS

Foundation Trust patients between 2007 and 2015. It found killings by two of the patients had been “preventable” and

“predictable”. The independent review was commissioned by the trust and NHS England in 2015, and looked at nine

killings committed by patients of the trust and the case of one patient who was killed while under the care of the

trust.

Evidenced based strategic

framework for success • Core leadership support that articulates

diversity as a high organisational priority

• Multiple strategies at organisational,

workplace, interpersonal and intrapersonal

levels used simultaneously over a long period

• Mandated targets or actions

Closing remarks • Start where you are

• Look at borough population

• Triangulate your data

• Don’t look at discrimination in isolation

• Where are the bright spots in your community?

• Have the conversation – name the issue

• Senior engagement is key

• Not just about a diverse workforce

• Focus on drivers of experience

• Feedback

• Set yourself some clear actions and measure them

Questions

Your turn

• What’s working well in your trust?

• What have you learned and would want

to share?

Thank you