Faye Swanson Director of Compliance and Assurance South Essex Partnership University NHS Foundation Trust Yale & SEPT International Healthcare Management Programme 2010/11 What makes organisations successful can also make them struggle Beyond a performance driven culture?

South Essex Partnership Trust Positive reputation Track record of achieving targets Evidence of service transformation Excellent staff satisfaction One of the “Top 19 high performing NHS organisations” (Manchester Business School June 2011)

Essex Community Mental Health Services only achieve patient satisfaction levels that are “about the same” as other providers. The problem… The objective… To identify and take action that will lead to further improvement in patient satisfaction levels.

“About the same” patient satisfaction Staff satisfaction Standards Systems/ processes Management and leadership Resources Service performance Staff culture Root Cause Analysis

Staff satisfaction and culture Strong relationship between staff satisfaction / culture and patient experience/ outcomes National staff survey results: 09/10: 8 awards for “best employer” 10/11: top 20% performance in 28 out of 38 survey areas and staff engagement score of 3.90 (out of 5) Results representative of front line perception?

Alignment 75% Clear understanding of vision 74% believe organisation is focussed on the right things 72% satisfied with amount of info Quality focus 72% agree that quality is top priority 61% confirmed that there are good info flows 77% agreed that quality efforts are measured and communicated 63% rated morale as good or very good 67% were satisfied or very satisfied overall. “keep doing what we do” “SEPT is doing it’s best” “everything being done” Root Cause Analysis Focus on staff satisfaction and culture

“The key elements of successful quality improvement efforts present several paradoxes. Top performing organisations know how to manage paradoxes inherent in organisational life” Bradley et al circa 2006 Paradox Paradoxical view in quality improvement “An apparent contradiction or state in which two conflicting elements (poles) appear to be operating at the same time” Stacey 2003

“If you always do what you've always done you'll always get what you've always got” Mark Twain Potential Strategy CostCapacityCapability Impact on experience StandardsYES ? Service performance YES ? ResourcesYES ? Systems and processes YES ? Management / leadership YES ? Staff satisfactionYES ? Staff cultureYES ?

Potential Strategy CostCapacityCapability Impact on experience StandardsYES ? Service performance YES ? ResourcesYES ? Systems and processes YES ? Management / leadership YES ? Staff satisfactionYES ? Staff cultureYES ? “Patient satisfaction is fools gold” If Disney Ran Your Hospital 9½ Things You Would Do Differently Fred Lee 2004

Competence Courtesy Compassion Inspired Staff motivation Staff performance Patient evaluation Selected Strategy: Perfecting Customer Service Strategy Required Hired Fired1-2 Dissatisfied 3 Neutral 4 Satisfied 5 Very satisfied Fred Lee 2001

07/1108/1109/1110/1101/1204/12 Evaluation Communication Prep for national survey Review recruitment, induction and training Measuring what’s important Buy in Project group Focus groups Strategy agreed Recognition programme Implementation Plan

Strategy in place Increase in number of stories about staff making a difference Measuring what is important to patients: improvement over time against baseline National patient survey results Evaluation Metrics

Lessons