National Case Study. Engaging and empowering staff for better patient outcomes. Breaking paradigms, creating ambition, raising the bar

LiA is a powerful force for cultural change says Chief Executive, Alwen Williams We know that to be compassionate to our patients, we need to be compassionate to our staff. Following a period of significant change at Barts Health NHS Trust, I joined as Chief Executive in June 2015 and decided to adopt Listening into Action (LiA) as the main vehicle to engage staff on a widespread basis around changes that matter to patients and to themselves. This links directly to our Safe and Compassionate improvement plan, and is all about making demonstrable improvements to patient care while, at the same time, unblocking the way for staff so they can get on and do their jobs. Barts Health is one of the biggest NHS Trusts in the country with around 16,000 staff, so getting traction around a fundamental shift in ways of working and leading is no small challenge. And yet the results and impact we have seen within even the first 10 months speak for themselves. As a new way of working which centres on engaging with staff, listening to staff, and empowering our frontline clinical teams to work together across all of our sites to bring about improvements in patient care, the difference that LiA is making is clear. Being on this journey is helping to galvanise and connect leaders across all of our sites, especially as we work together on linking the engagement effort to the most important aspects of patient care. At the outset, more than 2000 staff were involved in an initial round of catalysing LiA Big Conversations which I personally led, to talk about what gets in their way and to surface great ideas for action. This is driving change at all levels to unblock the way for our staff. At the same time, we mobilised 40 clinical teams who pioneered adoption of the LiA 7 Steps over an initial 20 weeks to improve patient care in their own areas. This has led to a wealth of stories and outcomes such as a one stop breast clinic, improvements in Cardiology services, cutting waiting times in Trauma and Orthopaedics, and halving the number of unstable patients admitted to our Observation Unit to reduce cardiac arrests. The stories and outcomes from the first 40 teams has quickly fuelled the spread to 80 more, and we will be picking up the pace over the next few months. In terms of staff, our LiA Pulse Check - completed by almost 3000 staff in September and then again in May - shows an unprecedented improvement in how engaged and valued people feel. Our results are up on all 15 questions. And this is just the beginning! I am very confident that we will continue to make significant improvements to the quality of services we deliver to our patients here at Barts Health. But we will only achieve that through the dedication and commitment of all our staff. LiA is a powerful force for cultural change. - all rights reserved

LiA has been a transformative experience at Barts Health Professor Charles Knight, Consultant Cardiologist and Managing Director, St Bartholomew's Hospital LiA has been a transformative experience at St Bartholomew s. We ve seen real results for patients being delivered halving outpatient waiting times, reducing length of stay and surgical infections, and the development of patient welcome packs amongst many other examples. At the same time, staff experience has objectively improved and morale boosted. We re excited about the LiA journey ahead! Denise McEneaney, Head of Midwifery, Whipps Cross Hospital LiA feels more like a movement than a strategy. I almost spontaneously clapped recently listening to some staff explain to colleagues how the planned improvement they were about to start was about making positive changes together, no just moaning allowed and how they needed to include senior and junior staff and service users together. I didn t have to say much except that I would support the team. Tim Peachey, Consultant in Anaesthesia and Deputy Chief Executive For me the most obvious benefit arising from the LiA approach is the change in culture in the organisation where staff now enjoy being involved in improvement activities, celebrate their achievements and spread their message with pride. Our workforce is now much more engaged and determined to succeed. Tom Smith, Intensive Care and Anaesthetics Consultant Staff now recognise that before they felt frustrated, they were worried about patients on their ward, they didn t know how to access help or what extra resources were available to them, and through LiA they re now seeing that their voice is being heard - that we ve changed the way we respond and we ve listened to their concerns. Lee Parker, Consultant Orthopaedic Foot and Ankle Surgeon Patients are happier, there are fewer complaints and we spend less time on the phone explaining to patients what the inefficiencies are and answering complaints. Patients are seen quicker, my surgical conversion rate is higher, there are fewer patients out in the community waiting for appointments, and the clinic staff are happier as well. Zaliwe Chabala, Service Manager for Trauma and Orthopaedics Clinic turnaround time has improved, our patients are much happier, and our clinicians are much happier as well. - all rights reserved

For the first time we have found a key to unlock widespread staff-led change Matt Guinane, Consultant Gastroenterologist One of the things about adopting it as a culture and a methodology for delivering change is that it keeps us all focused on the simplicity of what is required to deliver change. The challenge for us all is to have this embedded as the fundamental way we go about doing things and how we change things in this hospital and in Barts Health as a whole. Michael Pantlin, Director of Human Resources, Barts Health For the first time we have found a key to unlock widespread staff-led change across our large and diverse organisation. The energy, pace and engagement has led to a growing sense of ownership for improvements at all levels towards issues which really matter to staff and patients. Sebastian Dawson-Bowling, Consultant Orthopaedic Surgeon One of the things that Listening into Action allowed us to do is to formalise a structure of better communication channels between the teams across the different sites and to break down those artificial barriers that we have traditionally had between the different teams. People understand that really there is one mission in terms of the type of patient care we re looking to provide." Lucy Morrissey, General Manager As a manager, I know it s really important to listen to staff s views. In the hospital setting we have a range of different professionals, all of whom bring a different perspective on the patient pathway. We ve been able to use LiA as a framework to really understand staff s views and how we can improve the patient pathway. Darren Barnes, Senior Cardiology Nurse, St Bartholomew s Hospital Listening into Action really does what it says on the tin. It has allowed us as leaders to listen to frontline staff of all disciplines about what needs unblocking in the organisation and gives staff permission and courage to make changes and improvements. By sustaining and spreading this new way of working, the future at St Bartholomew s Hospital is looking increasingly better for our staff and our patients. Helen Byrne, Director of Operations, Whipps Cross Hospital There has been excellent clinical involvement so I think loads of positives from our LiA opportunity. We have embraced the concept and the tools and it s working really well. - all rights reserved

Delivering demonstrably better outcomes for our patients, staff and our Trust (here are just a few examples from many) Better for patients Better for staff Better for organisation Outpatient waiting times halved in Cardiomyopathy 100+ days with no pressure ulcers based on staff and patients Tree of Ideas Cardiology Day Care Team show the biggest national improvement ever in their LiA Team Pulse Check 100% feeling valued! 98% of medical records now available at Outpatient clinics Barts Cancer Centre becomes first London Hospital to win Macmillan Environmental Award More than 2000 of our staff help to shape change at our LiA Big Conversations 160 days harm free care on surgical wards with I want great care scores up from 60% to over 90% Increased early morning discharges and 50% reduction in length of stay for complex patients in specialist medicine LiA Conversations in wards, clinics, theatres, teams engage teams around making changes together Intensive care nursing team Top 3 in Nursing Times Award for Best Student Placement Request to Recruit approval down to 3 days and 40% jobs now filled from our own workforce through Grow Your Own STOP PRESS! Trust-wide LiA Pulse Check huge shift in improving staff experience #NHSBartsHealth across all 15 questions Every Cardiology and Surgical patient seen every day by a consultant, reducing length of stay by 1.5 days 40% reduction in Surgical Site Infection rates with a follow-up Wound Clinic run by Band 4 Healthcare Worker Vacancy rate down from over 50% last year to 16% this year New Doctors Mess for rest and relaxation makes everyone feel more valued Feeling a shift working the LiA way is starting to bring our values to life Visible leadership - senior leaders in front of staff in a way they have never been before, leading 28 LiA Big Conversations so far 7 day Pharmacy service in Oncology means patients get home faster, reducing length of stay by 1 day Halving number of unstable patients admitted to Observation Unit means fewer cardiac arrests New Junior Doctors Forum for training and quality improvement work Estates leading lots of small changes that make a big difference - heating adjustment, toilet painted, new carpet 120 LiA Clinical Teams follow LiA 7 Magical Steps to improve patient care within 20 weeks LiA locked in with Safe and Compassionate Improvement Plan Cystic fibrosis patients often teenagers given ID cards so they can come and go freely from the ward One stop Breast Service up and running with significant involvement from patients to get it right New Grand Rounds consultant-led junior doctor scenario-based teaching sessions 5 minute plan the day huddles for student and mentors in Theatres and Sycamore Ward Patient clothing cupboard sponsored by M&S means emergency pathway patients have clothes to go home in Managing Director breaks contract to remove fees from local cash machine in one of poorest boroughs in London 50% reduction in Theatre cancellations for nonclinical reasons 60 wasted time slots saved per week as Trauma and Orthopaedic specialty slots allocated to the right patient Rotation set up between Theatres, Neurosciences and Paediatrics to enable retention of staff inspired by staff Making our Transport services better for patients and staff through a revised contract Expansion of the Patient Forum enables widespread engagement in the codesign of our services More than 40 LiA Clinical Teams impact patient care and inspire others within 20 weeks - all rights reserved

% Positive Response A transformational shift in staff morale and motivation is already evidenced in our LiA Pulse Check 2015-2016 70% LiA Pulse Check Results Barts Health (weighted average)* 60% 50% 40% 30% 20% 10% 0% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Sept 2015 49% 37% 36% 21% 32% 50% 41% 42% 58% 27% 52% 50% 27% 28% 33% May 2016 58% 48% 45% 29% 41% 59% 49% 52% 63% 37% 61% 56% 37% 34% 41% LiA Pulse Check Questions Notes: Responses: 2934 in 2015, 2883 in 2016 Sept 2015 May 2016 All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner. LiA Pulse Check and results for use by NHS Trusts and organisations under license only

A transformational shift in staff morale and motivation is already evidenced in our LiA Pulse Check 2015-2016 - percentage point shifts + 9% 1. I feel happy and supported working in my team/department/service + 9% 6. I believe we are providing high quality services to our patients/service users +9% 11. I feel that the quality and safety of patient care is our organisation's top priority +11% 2. Our organisational culture encourages me to contribute to changes that affect my team/department/service +8% 7. I feel valued for the contribution I make and the work I do + 6% 12. I feel able to prioritise patient care over other work +9% 3. Managers and leaders seek my views about how we can improve our services +10% 8. I would recommend our Trust to my family and friends +10% 13. Our organisational structures and processes support and enable me to do my job well +8% 4. Day-to-day issues and frustrations that get in our way are quickly identified and resolved +5% 9. I understand how my role contributes to the wider organisational vision +6% 14. Our work environment, facilities and systems enable me to do my job well +9% 5. I feel that our organisation communicates clearly with staff about its priorities and goals +10% 10. Communication between senior management and staff is effective +6% 15. This organisation supports me to develop and grow in my role Responses: 2934 in 2015, 2883 in 2016 All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner. LiA Pulse Check and results for use by NHS Trusts and organisations under license only

% Positive Response A transformational shift in staff morale and motivation is already evidenced in our LiA Pulse Check 2015-2016 - St Bartholomew s Hospital results 70% LiA Pulse Check Results 2015-16 St Bartholomew's Hospital 60% 50% 40% 30% 20% 10% 0% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Sept 2015 49% 40% 39% 22% 34% 56% 41% 45% 58% 34% 56% 54% 31% 33% 35% May 2016 55% 48% 45% 26% 41% 63% 46% 54% 59% 37% 60% 51% 35% 36% 38% LiA Pulse Check questions Responses: 853 in 2015, 594 in 2016 Sept 2015 May 2016 All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner. LiA Pulse Check and results for use by NHS Trusts and organisations under license only

% Positive Response A transformational shift in staff morale and motivation is already evidenced in our LiA Pulse Check 2015-2016 - Newham University Hospital results 80% 70% LiA Pulse Check Results 2015-16 Newham University Hospital 60% 50% 40% 30% 20% 10% 0% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Sept 2015 54% 40% 36% 30% 35% 56% 45% 47% 60% 31% 57% 61% 36% 36% 41% May 2016 62% 54% 44% 36% 47% 67% 54% 54% 68% 47% 66% 70% 48% 45% 48% LiA Pulse Check questions Responses: 422 in 2015, 577 in 2016 Sept 2015 May 2016 All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner. LiA Pulse Check and results for use by NHS Trusts and organisations under license only

% Positive Response A transformational shift in staff morale and motivation is already evidenced in our LiA Pulse Check 2015-2016 - Royal London and Mile End Hospitals results 70% LiA Pulse Check Results 2015-16 Royal London and Mile End Hospitals 60% 50% 40% 30% 20% 10% 0% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Sept 2015 49% 34% 35% 16% 29% 48% 39% 40% 55% 22% 45% 46% 21% 23% 29% May 2016 52% 42% 42% 25% 31% 55% 48% 49% 59% 28% 57% 52% 27% 25% 31% LiA Pulse Check questions Responses: 879 in 2015, 512 in 2016 Sept 2015 May 2016 All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner. LiA Pulse Check and results for use by NHS Trusts and organisations under license only

% Positive Response A transformational shift in staff morale and motivation is already evidenced in our LiA Pulse Check 2015-2016 - Whipps Cross University Hospital results 70% LiA Pulse Check Results 2015-16 Whipps Cross University Hospital 60% 50% 40% 30% 20% 10% 0% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Sept 2015 49% 38% 35% 20% 33% 47% 43% 39% 60% 27% 53% 51% 29% 25% 34% May 2016 60% 46% 45% 31% 41% 56% 50% 51% 63% 38% 62% 55% 37% 33% 41% LiA Pulse Check questions Responses: 604 in 2015, 808 in 2016 Sept 2015 May 2016 All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner. LiA Pulse Check and results for use by NHS Trusts and organisations under license only

% Positive Response A transformational shift in staff morale and motivation is already evidenced in our LiA Pulse Check 2015-2016 - Corporate Teams results 80% 70% LiA Pulse Check Results 2015-16 Corporate Teams 60% 50% 40% 30% 20% 10% 0% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Sept 2015 44% 29% 38% 18% 22% 32% 37% 32% 62% 15% 51% 24% 16% 9% 24% May 2016 59% 48% 50% 26% 42% 52% 47% 50% 69% 34% 60% 47% 34% 30% 44% LiA Pulse Check questions Responses: 176 in 2015, 392 in 2016 Sept 2015 May 2016 All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner. LiA Pulse Check and results for use by NHS Trusts and organisations under license only

% Positive Response A transformational shift in staff morale and motivation is already evidenced in our LiA Pulse Check 2015-2016 example to show the impact on a team vs Trust baseline 120% LiA Pulse Check Results Cardiology Day Care Team, St Bartholomew s Hospital 100% 80% 60% 40% 20% 0% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Trust 2015 54% 40% 36% 30% 35% 56% 45% 47% 60% 31% 57% 61% 36% 36% 41% CDCT Team 2016 94% 78% 83% 78% 78% 100% 100% 94% 94% 100% 94% 94% 78% 83% 83% LiA Pulse Check questions Responses: 20 Followed full 20 week cycle following LiA 7 Steps Trust 2015 CDCT Team 2016 All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner. LiA Pulse Check and results for use by NHS Trusts and organisations under license only

Building leadership capacity and capability to change the way we do change LiA Leadership Scorecard results have already shifted from mostly red to mostly blue or green within the first 10 months Barts Health NHS Trust - Leadership Scorecard September 2015 (65 responses) Respondents: Leadership Teamcross all sites 1 = Strongly Disagree; 2 = Disagree; 3 = Neutral; 4 = Agree; 5 = Strongly Agree Barts Health NHS Trust - Leadership Scorecard September 2016 (156 responses) Respondents: Leadership Teamcross all sites 1 = Strongly Disagree; 2 = Disagree; 3 = Neutral; 4 = Agree; 5 = Strongly Agree Navigation 1 2 3 4 5 Total 1 Different change initiatives are integrated in the minds of management 3.0 2 Different change initiatives are integrated in the minds of employees 2.4 3 Management prioritises the use of resources 2.9 4 Change initiatives work together (left hand knows what the right hand is doing) 2.0 5 Costs and benefits of all projects are managed as a whole 2.3 12.6 Navigation 1 2 3 4 5 Total 1 Different change initiatives are integrated in the minds of management 3.5 2 Different change initiatives are integrated in the minds of employees 2.6 3 Management prioritises the use of resources 3.2 4 Change initiatives work together (left hand knows what the right hand is doing) 2.6 5 Costs and benefits of all projects are managed as a whole 2.7 14.6 Leadership 1 2 3 4 5 Total 1 Serve as effective role models for desired behaviour 3.2 2 Are strong sponsors of change 3.4 3 Hold managers and supervisors accountable for contribution to successful change 3.0 4 Provide coaching and counselling related to change leadership 2.5 5 Effectively communicate about change (reasons for, benefits, strategies) 2.8 14.9 Ownership - People affected by change: 1 2 3 4 5 Total 1 Are involved in the process in a meaningful way 2.5 2 Believe their ideas and concerns are being heard and responded to 2.5 3 Understand the need for change 3.0 4 Believe the change is positive for the organisation 3.0 5 Receive effective communication (timely, relevant, honest) 2.7 13.7 Enablement 1 2 3 4 5 Total 1 Organisational processes are redesigned to eliminate non-value added activities 2.2 2 Organisation structures are designed to fit future needs 2.9 3 Competencies for the 'new' organisation are being identified 2.8 4 Training supports new skill and behavioural requirements 2.6 5 Performance management and reward systems are redesigned to fit the new organisation 2.3 12.8 Leadership 1 2 3 4 5 Total 1 Serve as effective role models for desired behaviour 3.6 2 Are strong sponsors of change 3.7 3 Hold managers and supervisors accountable for contribution to successful change 3.5 4 Provide coaching and counselling related to change leadership 2.9 5 Effectively communicate about change (reasons for, benefits, strategies) 3.1 16.8 Ownership - People affected by change: 1 2 3 4 5 Total 1 Are involved in the process in a meaningful way 3.1 2 Believe their ideas and concerns are being heard and responded to 2.9 3 Understand the need for change 3.3 4 Believe the change is positive for the organisation 3.3 5 Receive effective communication (timely, relevant, honest) 3.0 15.6 Enablement 1 2 3 4 5 Total 1 Organisational processes are redesigned to eliminate non-value added activities 2.8 2 Organisation structures are designed to fit future needs 3.0 3 Competencies for the 'new' organisation are being identified 3.0 4 Training supports new skill and behavioural requirements 3.0 5 Performance management and reward systems are redesigned to fit the new organisation 2.7 14.5 All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner

For more information about Listening into Action (LiA) Quotes from LiA Trusts Hannah Forbes Founding Director of Optimise Limited and joint architect of Listening into Action (LiA) hforbes@optimiselimited.co.uk 07734 812644 Gordon Forbes Founding Director of Optimise Limited and joint architect of Listening into Action (LiA) gforbes@optimiselimited.co.uk 07734 812311 A powerful force for cultural change Alwen Williams, CEO at Barts Health NHS Trust Our staff feel energised and empowered by the LiA approach Judith Graham, Queen s Nurse and Advanced Nurse Consultant This is real staff engagement. It feels different. It feels punchy. It feels great. Dr Esther Waterhouse, Consultant in Palliative Medicine The LiA Pass It On events have the best days in my NHS career John Goulston, CEO at Croydon Health Services LiA is clever in its simplicity. Follow the formula, involve everyone, share your successes and enjoy the culture shift. What s not to like? Tom Johnson, Radiologist LiA is helping us to make significant improvements for patients and staff at Europe s oldest hospital Charles Knight, Consultant Cardiologist and Managing Director of St Bartholomew s Hospital LiA really has developed me into the person and the nurse I am today Sarah Watkins, Ward Sister Magic Dust John Adler, first NHS CEO to adopt Listening into Action (LiA) - all rights reserved