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Can a change in culture change the game?

Less than six months after the Francis report, the Keogh review furthered the continuing rhetoric around issues of quality of care and treatment within the NHS; 14 hospital trusts in England were identified as having higher than average death rates and once again have put our healthcare system in the spotlight.

  • Photograph: Dave Evitts/Newsteam

As expected Keogh highlighted the need for further change within the NHS; that events such as these should be the catalyst for a new way of working, rather than an opportunity to try to apportion blame at the expense of improving patient care.

And while media fervour will continue to focus on the past-tense, the significant part of Keogh's review for those working within the healthcare system is the recommendations. The review identified areas of action that need to be taken in the next two years as well as some common themes and barriers to delivering high quality care, that are:

- a limited understanding of how important and simple it can be to genuinely listen to the views of patients and staff, and engage them in how to improve services

- the ability of hospital boards and leaders to use data to drive quality improvement. This theme is made more difficult by how hard it is to access data held in different places and different ways across hospitals systems

Precisely packaged into two bullet points, it would appear the solutions must be as equally neat.

However, herein lies the real challenge; let's take the first bullet point, the importance of empowering front-line staff is perhaps not a new tune. Yet finding that way of empowering staff and creating a new culture of openness and transparency, with a common set of core values and standards, is a big challenge for any organisation, let alone one with 65 years of baggage. In one way we can completely identify as an organisation, because we have gone through that same journey of transformation here at Unipart. Perhaps that is why we find it so compelling working with NHS organisations; we can see ourselves in a lot of the challenges being faced.

We learnt our lessons from industry, and while not the most obvious link, evidence has shown when successfully adapted to the needs of the NHS the same principles can deliver substantial improvement. Indeed, where we have had the opportunity to work closely with the NHS, this theory has rung true – principles and practices refined from industry experience, coupled with an approach that starts with a deep belief in people have demonstrated the ability to create engagement and culture change at all levels. The outcome in those hospitals adopting this approach has been significant, with a clear and measurable improvement in patient services.

So in all the posturing surrounding employee engagement wherein lies the key? Engaging people is complex, and unique in every situation, but time and time again these three elements seem to always be in the success stories somewhere.

Starting small

Many senior NHS managers still tend to see employee engagement as a luxury they cannot afford, and are reluctant to take the risk of devolving power when the buck will stop with them anyway.

Those worries are understandable, particularly in the current climate. Therefore, it makes sense to start small and increase the scale, scope and depth of staff involvement, so that trust can grow from the results.

An environment for success

Perspective – a wonderful thing. Creating the opportunity for staff to establish an understanding of where they are now and where they need to get to, before discussing how to get there and agreeing on an action plan on how to do it is crucial. They can identify what is within their collective control and what is not, which means their aim is to make the best possible use of the resources they have.

Solving problems

Empowering frontline staff with the freedom to exercise growing responsibility is what staff involvement to improve the NHS is all about. By mobilising and developing knowledge at the frontline it creates value from a resource that is systematically undervalued − and undermined − by traditional command and control approaches to change management.

We all know that the NHS doesn't need another short term fix, it has seen reforms every 18 months since its inception, what it needs is a lasting and sustainable change. Sustaining that culture shift, to one where frontline staff can then take real ownership for improving the quality and safety of patient care is what will really make the difference in the long term prognosis of our healthcare system.

The Unipart Way: performance improvement that sustains

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