Shaping the culture - learning from culture surveys We are 3 years on from when we first offered culture surveys to organisations as part of the 1000 Lives Campaign. Comparing ourselves with Jonkopping, 3 years may not be long into the journey and we clearly have a long way to go, but now is a good time to take stock, reflect on what we are learning and think about our next steps on a journey. 8th November 2011 Shaping the culture - learning from culture surveys Presenters: Tim Heywood & Debbie Morgan Learning from culture surveys

Why survey culture? In an attempt to reveal things about our organisational culture ‘landscape’ and possible changes over time. As a way of stimulating discussion and practical actions – a tool for improvement. “What you do with your survey results is as important as the results themselves”. The nature of culture is that we rarely see it directly – we see its impact on behaviour, but the beliefs and assumptions that lie at the root of culture are generally hidden from view, to ourselves, let alone to eachother. So we were interested in bringing them to the surface to see what that revealed. Not benchmarking, not comparing between organisations – we undertook specifically that we would not do that – in that sense, we were certainly measuring to support improvement, not measuring for judgement. We were also interested in what changes might be detectable over time, so we committed, from the outset, to doing a second survey at the end of the Campaign. Second, more important reason… Undertaking a survey is a cultural act in itself - participating in a survey and not being seen to share or act on findings is worse than not doing the survey at all. Learning from culture surveys

1000 Lives Plus culture surveys 2008 GP survey offered to all Practices in Wales. Employee survey offered to LHB’s and Trusts. 2010 Second survey round offered to all GP Practices 2011 Second survey round offered to all Health Boards and Trusts. (This survey included additional statements at the request of the Welsh Partnership Forum). Used 2 survey tools. National level reports of both GP surveys and the 2011 employee surveys received by all participating LHB’s and Trusts. LHBs and Trusts also have drill down tools Practices also received their own survey reports. Learning from culture surveys

GP Practice survey 27 statements linked to 5 domains: Leadership and teamwork Reporting and learning Communications Resources Relationships with LHB’s Learning from culture surveys

GP Practice survey response rates In 2008, 2,344 staff participated in 306 Practices (63% of all Practices in Wales). In 2010, 1,916 staff participated in 241 Practices (49% of all Practices in Wales). Numbers of admin and ‘other clinical’ staff held up well. Number of GP’s decreased but still had 550 GP’s participating in the second round. Learning from culture surveys

2010 GP Practice survey responses by domain 2008 and 2010 profiles very similar, varying by no more than 1 or 2 % at national level. Reports went direct to Practices from the system, and LHB’s also only have aggregrated responses, albeit have more granularity than at national levle Learning from culture surveys

GP Practice surveys compared: “relationships with the LHB” These changes may not look large, but they are all pointing in the same direction. The reasons may be linked to temporary impact of organisational change, but during the Campaign we did identify this as a domain that would be important to look back at. There is an OD challenge here for integrated HB’s and W&OD Directors discussing how we begin the engagement required between practice level work and the wider health board. There are a number of ongoing 1000L+ linked work that may have something to offer here The development of primary care GTT CHF, atrial fibrillation and anti-coagulation. % agreement (strongly or tend to agree) Learning from culture surveys

Employee surveys Learning from culture surveys 6 domains: Learning and Innovation Communication and reporting Senior staff engagement Team working Staff support and performance appraisal Individual perception of safety culture. Response rates In 2008, 4,616 staff in 9 Trusts and 21 LHB’s. In 2010, 10,320 staff in all Health Boards and Trusts. 2011 response profile More than twice as many staff participated in second round. 3,700 non-clinical (36%) 720 doctors and dentists (548 consultants) 5,800 other clinical staff. Surveys tools were not identical, but 16 of the statements did not change. We need to be careful not to over-interpret results, but approach with a spirit of curiosity. Learning from culture surveys

Some statements had a less positive response… Survey statement % agree Change from 2008 survey This organisation’s leaders listen to me and care about my concerns 35% - 4% Senior staff often meet with front line staff to talk about safety issues -11% Senior staff often meet with front line staff to talk about service improvement 39% - 11% Senior staff are approachable 60% - 15% All of the statements that moved in a negative direction related to senior staff engagement. Is this a short term consequence of organisational change, or is this a feature of the ‘organisational depth’ we are now dealing with. Useful starting point for discussions.. Are Board level WalkRounds as effective as they could be? What learning can we apply to senior staff engagement at other levels? Learning from culture surveys

Some positive changes.. Learning from culture surveys Survey statement % agree Change from 2008 survey Most staff are not embarrassed to admit if they do not know or do not understand 70% + 22% I am encouraged to take responsibility for addressing problems myself, rather than leaving them to others 82% + 18% I would feel safe being treated as a patient here 61% + 16% I am encouraged by my colleagues to report any safety concerns I may have 76% + 10% If you ask colleagues for help, they are happy to give it 87% + 9% I receive appropriate feedback about my performance 42% Patient safety errors are handled appropriately here 64% + 3% I am encouraged to work as part of a team Not all bad news. The highlighted statement is one that was first used in the SPI safety culture survey. Learning from culture surveys

Learning from culture surveys The positive change is across all categories of agreement. We looked at skill-mix – comparing with clinical staff only and non-clincal staff only. We took ABMU out (as they didn’t partipate in 2008) and we looked at C&V only ( as they were major pariticipants in 2008). However, you cut it, the change looks similar. A good starting point for discussion – “ This is what 10,320 staff said – does this surprise you?” Learning from culture surveys

What next? Drawing together learning about survey administration. “Making the most of your culture surveys” webEx. Testing and sharing ways of using findings in different forums. Another national survey in 2012/13? Learning from culture surveys