Calderstones Partnership NHS Foundation Trust and Impact Consulting Psychologists Ltd
“Calderstones” is a specialist Forensic Learning Disability Trust. In 2013 a new Chair was appointed who in September 2013 recruited the current Chief Executive (CE), Mark Hindle, to turnaround the Trust following “a climate of fear where a culture of continuous improvement was needed”. Impact Consulting Psychologists were commissioned to partner Calderstones on an organisation development (OD) initiative to transform the organisation for the benefit of service users and staff.
The impact on the organisation
- The CQC report in 2014 identified many of the issues above and the trust were rated as inadequate overall
- In early 2013 Monitor assessed the organisation as Red for governance
- The Monitor report on Governance in August 2015 highlighted improvements significantly underpinned by the OD programme. They were rated Green-meets or exceeds expectations in early 2016
- The CQC report in 2016 reported Good overall. Comments at inspection
- “You have done a fantastic job in a short space of time”; “The impression formed is radically different” “Dramatic improvement” “The change has impressed all of the people who have been on both inspections”.
- The trust is number 27 out of 270 in the 2016 “NHS Learning from Mistakes league” table of transparency and honesty, with good levels of openness and transparency, only just below outstanding.
Reflecting back Mark Hindle said that “The Board have been on a traumatic journey, they were characterised by a lack of cohesion and understanding of the capacity and capability of the Trust, no clear strategy and a focus on matters that were irrelevant to the quality of care and safety in the organisation. Executive relationships were poor and often self-serving, there was a denial of the seriousness of the situation, a belief that external regulators were wrong, and low trust between colleagues prevented problem solving.” He emphasised that there were many areas of exemplary work and great commitment to service users by colleagues and this was built on in the ensuing development programme.
Why our approach was innovative
As Occupational Psychologists, we focussed on the leadership of the organisation based on vision, values, motivation and direction to achieve improved service quality. This innovative approach was based on the Psychologica™ Model designed by Dr Phil Bardzil at Manchester Business School, an original piece of work based on research into service quality. The area that had lacked focus at Calderstones was the ‘yellow zone’, the people skills, and this formed the basis of creating a culture of leadership and service quality across Calderstones.
We identified the need for an Organisation Development Programme over a 2-3 year period that focussed on systemic change. The Trust culture had been in a state of stasis for over 20 years and a quick fix would not be effective. The Chief Executive encouraged the Board and the Executive team to talk about this period, to refer to the past and the part that they all played in it without blame. Impact Consulting introduced “Conflict to Collaboration”. This entailed moving from fear to continuous improvement through collaborative behaviour throughout the Trust.
Our approach and project management to make it happen
Shelly Rubinstein, MD of Impact Consulting Psychologists led the team that worked with Mark Hindle, Chief Executive (CE) to steer the organisation development, referring to current organisational challenges and opportunities to set the programme and support the organisation with OD work. Coaching of key team members assisted the process. Team members left and new members joined as part of the transformation.
A series of workshops began in December 2013 with the Executive Management team (EMT) “How to use Calderstones’ Vision and Values to Maximise Performance towards the Strategic Objectives” set the agenda for change. The CE set his vision of a collaborative, engaged workforce, brave enough to tell the truth and openly share challenges with CQC. An agreed programme of change ensued. The results were:
A clear understanding of what excellent leadership and management in Calderstones could look like; improved ability in team working and sound understanding of Calderstones vision and values; reflection on the challenging times in an open and frank manner, sharing feelings with colleagues and agreement on how to move on in a positive way; identification of what helps and hinders the team in the way that they work together and an action plan for working in a collaborative manner, engaging with the workforce to ensure leadership is demonstrated at every level in the organisation and developing an inclusive and positive culture at Calderstones.
We ran a development session for the Board in June 2014 where they identified behaviours for a “values driven” Board, clarified the direction of travel and described the perceptions, roles and responsibilities for each Board member. They described the journey for the next 3 years to deliver the strategic objectives.
After a year of developing the change programme internally a follow up event in January 2015 worked on
- Customer Satisfaction and Service Quality
- Information Management and Technology
- Workforce – leadership, culture
- Business Success and the Financial Situation of the Organisation
The Chief Executive championed the approach, he made the improvement in quality and supporting staff non-negotiable on the journey.
How the transformation work carried out between the sessions involved key stakeholders.
- Scrutinising in detail the original CQC reports, creating an action plan of the “must do’s” (statutory breaches) and “should do’s” and picking out the ‘weak signals’ from the narrative and ensuring these were in the action plan.
- Identifying and ring fencing dedicated time for a project group (3 senior clinical staff) with Executive Director lead responsibility. Ensuring adequate administrative co-ordination of data received and appropriate on-going communications with ward managers and other individuals responsible for discharging actions.
- Ensuring clear task leads, time frames for completion and how the action was embedded in practice.
- Creating a performance dashboard of metrics and regularly feeding back to ward managers and other stakeholders’ performance against requirements.
- Ensuring all Trust Board were actively appraised and involved in the on-going assessment process, including being involved in regular site monitoring and feedback.
- Providing regular support/supervision/coaching to ward managers enabling them to problem solve/resolve challenges.
- Maintaining active monthly review meetings with CQC leads providing assurance/updated communications and receiving support on the progress regarding the CQC action plan.
- Providing regular briefings via the CEO to all staff and service users regarding on-going progress and success to date.
- Establishing a ‘stand up Friday’ – a forum whereby senior managers, directors and ward managers/departmental managers were held to account regarding performance on actions on risk of slippage and to provide support and problem resolution (2 way process).
- Monthly updated reporting and assurance to Quality & Risk Committee and Board.
By September 2015 Calderstones had improved outcomes with agreement for merger with Mersey Care NHS Trust. A plan for implementation by 1st July 2016 ensured ongoing sustainable “good” quality services for people with learning disabilities needing therapeutic and rehabilitative support.
Conclusion
Partnership working can release the power of people to achieve high service quality. The heart of the Psychologica™ model is about service quality and we believe that collaboration improves outcomes