The story of a journey through organisational and cultural change “Are We There Yet?” The story of a journey through organisational and cultural change

Aims To share our experience of significant service change. To talk through the processes we went through in order to arrive at the current point in the journey. To discuss the challenges of delivering quality services within a structure driven from above and subject to change. To identify key components for the success of the journey.

Once upon a time….. One Trust (total Trusts in Health Board area - three) Two SLT services; three LA areas Mix of hospital & community Each Service working entirely independently; each led by an SLT Manager New Management requires only one Manager

The New Structure 1 SLT Manager; 5 SLT Lead Clinicians Each Lead Clinician with responsibility for a clinical team; the teams ranged in size from 1 staff member, to 21 staff members Different grades for SLT Lead Clinicians 2 Leads managed clinical groupings whilst three were responsible for geographic areas Link for some Lead Clinicians, but not all, with area of clinical expertise

Other Complexities Recruitment/Retention Structures/Processes Relationships with partner agencies Monitoring/review of service including waiting lists Clinical Governance Culture

The Bottom Large number of complaints Partners in Education raising concerns Financial situation Reputation Whistle

The Change Removal of SLT Manager post Creation of balanced clinical teams, based around patient categorisations & geography/area A matrix that ensures that each geographic area has at least two Lead Clinicians involved Initially, a Project Manager from outwith the Department for support

The Real Change Lead Clinicians have to get to know each other & work as a team. Lead Clinicians have to gain credibility with staff. There are still influences allowing the negative culture to perpetuate (previous manager still employed; change feels temporary & subject to review; Lead Clinicians come with reputations; negative culture is the comfort zone)

The Move Successful recruitment & retention Successful projects implemented across area eg job descriptions; data collection Implementation of consistent policies & procedures across the area (eg sickness reporting/absence management) Team Building Day

The Context No place to hide - wider organisational change - wider SLT leadership restructuring Removing comfort zone Giving the wider picture Building reputation of Leads & of the Department Allowing stories to be heard but then moving on

Key Messages Staff hold the memory of the organisation. You need to know where you’ve come from in order to move forward….. But history should not be the major influence. Consider the three strands of Staff, Financial & Clinical Governance and apply principles of integrity, transparency, consistency & equity.

Key Messages Continued Team working supports efficient & effective service development by allowing staff to play to their strengths. Everyone has pieces of the jigsaw for the whole service. It’s important to support staff to see the whole picture. Working together across organisational boundaries reduces duplication and promotes equity & consistency. Link all change to improvements in service for patients.

Key Supports Make use of other departments eg IT, Finance, H.R. Use other departments/influences to give staff the wider picture Find a sponsor/champion from outwith the department Use your Incident Reporting system

Are we there yet? Now 4 Lead Clinicians, 4 clinical teams ‘Merger’ of two Health Boards AHP Review (since last Summer) - outcome not yet known but creation of Community Health Partnerships means Management wants boxes & boundaries Redesign coming!

Key Considerations for All What is the benefit (or detriment) to the patient journey? Are there risks/benefits for Staff, Financial, and Clinical Governance? Who are my champions within the department? In the wider organisation, who can provide support for any proposals? How can I demonstrate compliance? Where are the ‘Yes but…’ areas? Are there any ‘no’ areas?