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

2. 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.

3. 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

4. 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

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

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

8. 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

9. 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)

10. 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

11. 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

12. 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.

13. 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.

14. 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

15. 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!

16. 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?