Cultural transformation as part of the People Promise

Key benefits and outcomes

• An increase in staff recommending the organisation as a place to work to 49.35 per cent, the highest in five years.
• A year-on-year increase in scores for the we work flexibly People Promise since 2021, with the percentage of staff feeling satisfied/very satisfied with the opportunities for flexible working increasing by 7.08 per cent on the previous year.
• A 0.55 increase in scores for the sub-theme of appraisals since 2021, with scores for question 23d (It left me feeling that my work is valued by my organisation) increasing by 6 per cent on 2022, and the score for question 24d (I feel supported to develop my potential) increasing by 6.7 per cent.
• SaTH was ranked among the top ten trusts for improvements in four of the People Promise elements including staff engagement.

What the organisation faced

The results from the 2021 NHS Staff Survey showed that staff didn’t feel that the care of patients/service users was the organisation’s top priority, or that their role made a difference to patients/service users. 

In addition, staff reported higher than average levels of bullying and harassment from colleagues, were feeling burnt out, and felt unsupported in terms of appraisals and work-life balance. 

Scores for morale and staff engagement were the worst for the sector. The main areas of concern were: compassionate culture, appraisals, support for work-life balance and flexible working, line management, health and wellbeing, and, particularly, advocacy.

What the organisation did

To enable the trust to measure and monitor the growth and development in key areas, it designed and implemented a trust culture dashboard. Using the results from the NHS Staff Survey it included six themes to ensure focus and monitoring: compassion, vision and values, teamwork, goals and performance, learning and innovation, and health and wellbeing.

The trust focused on the three key areas where it could make the most improvement:

• Creating a sense of belonging and how it feels to work at SaTH? This looked at civility, respect and inclusion.
• Organisational mindset to approaching flexible working.
• Talent management – reviewing the appraisal process and talent conversations.

Health and wellbeing was seen as a golden thread across all of the above. The trust committed to strengthening its health and wellbeing offer to staff. This included: bereavement support, menopause support, and advice and guidance for managers and staff. The health and wellbeing package was also extended to include financial wellbeing with a hardship fund created to support staff through the cost of living crisis.

The trust designed and developed a civility, respect and inclusion programme, in collaboration with Dr Chris Turner from Civility Saves Lives. The initial session was rolled out in a board development session in August 2022., and then across the trust to support the cultural transformation programme and the Getting to Good programme for the Care Quality Commission's (CQC) Well Led agenda. This is still in progress, with target areas and department areas now. The aim of the programme was to create a social movement among staff, raising awareness of and giving them the tools and confidence to challenge disrespectful and uncivil behaviours. Alongside this, the Freedom to Speak up team supported colleagues in raising concerns.

In addition, the trust developed 30 voices, listening to the lived experiences of staff experiencing racism at SaTH. The findings from the project have been used to inform wider retention initiatives around inclusion and belonging.

In recognition of staff feeling burnt out, and in particular the increase in staff experiencing stress, a psychological hub was launched to support teams with space to reflect, critical incident debriefing, increasing psychological awareness as well as providing support to individuals.

The approach to appraisals was reviewed with a working party created. New documentation was trialled and approved, providing greater focus on talent and career pathways, recognising that everyone was considered as talent. Career conversations using the Scope for Growth model were introduced and a talent portal was launched, offering career planning resources including self-assessments and on-line learning. Health and wellbeing conversations were also included within the talent framework, further strengthening the health and wellbeing offer.

In response to the results on flexible working, a conversation took place with the organisation utilising the Making a Difference Together platform. Using the top five themes from this conversation, changes were made to the flexible working policy and hiring managers were encouraged to consider flexible working options in their job adverts. Staff stories and a video were used to showcase flexible working in a range of roles across the trust. 

The flagship programmes were taken to the trust’s people and OD committee which was regularly updated on progress. In addition, a culture steering group was formed to monitor progress against the six domains within the culture dashboard, as well as identifying the top 10 departments to support. As part of a wider project, a retention group tracked progress of the flagship programmes.

While not part of the flagship programmes, a new management development programme was created to support line managers. Striving Towards Excellent Programme (STEP) was launched as part of a wider leadership development framework, with the aim of developing managers’ competencies in the practical aspects of managing a team such as absence, health and wellbeing, roster management and flexible working. STEP also features a session within its programme on the staff survey to highlight the importance of participation and engagement within teams. 

Results and benefits

SaTH has seen an increase in scores for all the People Promise elements as evidenced by the 2023 NHS Staff Survey scores. The improvement is the culmination of the last three years’ work and that of its progress in the flagship programmes, the trust’s people strategy and the People Promise priority actions. 

• The overall score for engagement is at its highest since the pandemic at 6.59, with the score for the sub-theme of motivation mirroring that of the average for the sector. The score for the sub-theme of involvement is also at its highest since the pandemic at 6.70.
• The percentage of staff experiencing bullying, harassment or abuse from staff in the last 12 months has also decreased since 2021, with ethnic groups showing a reduction from 32.73 per cent in 2021 to 28.46 per cent.
• All six themes of the culture dashboard have seen growth and improvements.

The trust has seen an improvement in the most recent CQC Inspection from Inadequate overall to Requires Improvement overall, reflecting the work of it’s Getting to Good programme which encompassed many of the key activities above.

Retention across the organisation as a whole has seen a reduction from 15 per cent in April 2022 to 10.8 per cent in April 2024.  The 2023 NHS Staff Survey score for the sub-theme of thinking about leaving shows an increase from 5.92 in 2019 to 6.01, the highest in five years, and while the trust still has some way to go, it demonstrates the positive impact that the interventions described have had.

SaTH was ranked among the top ten trusts for improvements in four of the People Promise elements including staff engagement. 

Overcoming obstacles

The trust has faced significant challenges with demand in urgent and emergency care, which has impacted on teams across the organisation.

The social movement around the civility, respect and inclusion programme has been slower to gather momentum than had been hoped for. Feedback from some staff suggested the programme should be mandatory as it was felt that the messages weren’t reaching those that were perceived to need it, underlining the need for individual accountability at all levels. The trust continues to promote this programme, encouraging everyone to reflect on their own behaviours.

There is still some way to go with flexible working, with managers in some areas reluctant to embrace flexible working or to explore alternative options when considering work-life balance.

Top tips

It takes time for the results of interventions such as those described above to show the benefits, so perseverance is key.

• Communication is critical - good two-way communication is vital for ongoing staff engagement alongside engagement activity with opportunity for staff to give feedback, listening sessions with senior leaders, and regular cascaded team briefings.
• Leadership from board to ward - support from the board and senior leaders is essential along with support for line mangers to foster engagement within teams.
• Led locally - staff engagement solutions need to be owned locally and adapted to areas circumstances. We used a range of techniques that have successfully shown an increase in those areas who really took ownership.

Contact information

For more information, please contact Sharon Parkes, staff survey lead at the trust via sharon.parkes@nhs.net or Dawn Thompson, assistant director of people, leadership and OD via d.thompson19@nhs.net.