Image: Invest in Skills.How investing in learning and development helped Blackpool, Fylde and Wyre Hospitals NHS Foundation Trust create a more confident and productive workforce and turn round a £24 million annual deficit within 18 months.

About the Trust

Blackpool Fylde and Wyre Hospitals have around 4,500 staff, catering for a local population of 330,000 – which includes a significant retirement community. However, given Blackpool’s popularity as a tourist destination, the NHS in Blackpool also has to deal with the diverse healthcare needs of more than 12 million annual visitors. Not surprisingly, its accident and emergency unit is the busiest in the country.

The organisational challenge

As well as facing significant financial difficulties, when Julian Hartley took over as Chief Executive of the Trust, he inherited a workforce that was low in morale and anxious about the future.

Julian knew that in order to tackle the Trust’s financial deficit, he needed an organisation that was pulling together and a workforce that was motivated and willing to respond to the changes he would need to implement. He also recognised that transforming people’s behaviours, attitudes and management styles would require an open and honest dialogue and an ongoing investment in learning and development.

“ People come into the health service because they want to care for people; they want to put something back; they want to contribute. But often, in a traditional hospital model, things start to go wrong because people don’t feel they are able to do that. Other stuff gets in the way.”

Nick Grimshaw, Director of Human Resources and Organisational Development, Blackpool, Fylde and Wyre Hospitals NHS Foundation Trust

“ By involving staff in identifying exactly what was going wrong, getting their input on where we ultimately wanted to be, and imagining how that would feel once we got there, we were able to create a blueprint of what somebody working at Blackpool would be like – in terms of skills and behaviours. We then repeated the exercise for managers. The end result was widespread staff agreement on explicit statements of expected behaviours for Blackpool employees and their managers.

“The management team then worked backwards to identify and implement the changes required. We asked ourselves: How do we do things now? How can we do them better? What skills do we need to develop? What changes do we need to make to help us work in a better way and what are the implications? How will this impact on our people, on job plans and on the way things are structured?”

Aidan Kehoe, Chief Executive and former Deputy Chief Executive, Blackpool, Fylde and Wyre Hospitals NHS Foundation Trust

Changing the culture

Enlisting the support of his management team, Julian’s first step was to consult extensively with the Trust’s workforce. This involved open discussions with around 4,000 staff to find out about the problems and frustrations they were experiencing and establish what behaviours and culture changes were required. Staff groups distilled the issues – creating meaningful visions and values – with the focus firmly on quality of care for patients.

The Blackpool person will be:

… considerate
… conscientious
… reliable
… honest
… open to change
… friendly
… positive
… team orientated
… customer focused
… patient focused
and … have initiative.

The Blackpool manager will be:

… visible and approachable
… accountable
… decisive
… facilitative
… fair
… professionally competent
… pro-active
… motivational.

Re-skilling the managers

To bring about the changes required across the workforce, Julian and his team had to ensure that managers behaved differently and adopted a more enlightened style of management.

Based on the qualities and behaviours already identified for the ‘Blackpool Manager’ during the staff consultation, a management questionnaire was devised and completed for every manager, every six months. Each manager’s direct reports were asked to rank their manager’s performance. Is he/she approachable? Does he/she motivate and inspire you? Does he/she delegate effectively? Does he/she give you the training you need? Does he/she appraise you regularly?

It was made clear to everyone from the start that the exercise wasn’t some sort of hard-nosed performance management tool – it was about improving people’s performances as managers.

“ What’s really interesting is that this is the sort of thing that, traditionally, the health service has put no emphasis on whatsoever. We’ve concentrated on the length of waiting lists and access targets, more recently we’ve focused on decreasing infection rates, but a focus on the style and effectiveness of management was missing. Once you start giving it some attention – telling people that it is important, providing the necessary training and development, and giving appropriate recognition of a job well done – surprise, surprise, things really start to improve. People buy into it rather than being scared and confidence grows across the board.”

Nick Grimshaw, Director of Human Resources and Organisational Development Blackpool, Fylde and Wyre Hospitals NHS Foundation Trust

Working together to tackle the financial deficit

The management team realised that significant reconfiguration was required to reduce the financial deficit. Rather than make staff redundant, the decision was made to find alternative options, such as changing the way that services worked – at the same time focusing on improving patient care.

This approach inevitably involved large scale staff redeployment. In total, around 500 jobs were changed. Some people moved into entirely different roles, others moved into similar areas but at alternative sites. To inform the process, individuals’ skills and abilities were identified and their interests and home locations were also taken into account. Where appropriate, staff were given the opportunities to re-skill and move into other areas and provided with the training and support they needed to help them adjust successfully.

Results

The benefits gained from the investment made in the workforce at Blackpool were significant and far reaching.

Service outcomes:

  • 20 point reduction in mortality rates in last 18-months
  • 80% reduction in MRSA rates in 1 year.

Financial and operational outcomes:

  • £24million annual deficit successfully addressed and turned around within 18 months
  • 18-week maximum waits implemented 12 months before the stipulated deadline
  • operational targets for Accident and Emergency consistently delivered
  • in 2008, the management team’s inclusive approach to tackling the staff issues resulting from the financial deficit led to the Trust winning a Healthcare People Management Association national award for partnership working. In 2009, the Trust won the same award for its innovative Stress Reduction Project.

Workforce outcomes:

  • increase in staff appraisals from 24% to 88% in two years
  • significant reduction in staff sickness absence
  • ranked as top 20% overall performer by the Healthcare Commission following the 2008 national staff survey (compared to bottom 20% in 2006)
  • ranked as top 20% performer in the same survey due to staff saying they would recommend the Trust as a good place to work
  • a transformed workforce – better motivated, happier and more confident.

“ The changes in behaviour and attitude have been nothing short of astounding. Staff can now be heard saying – that’s not very ‘Blackpool Way’ – on occasions when people default to the old way of doing things. More and more people are getting involved; making improvements without having to ask permission first. That is obviously resulting in some huge issues around change and training – for staff, who are suddenly being allowed to use their own initiative, and for managers, in terms of learning how to let go.”

Nick Grimshaw, Director of Human Resources and Organisational Development Blackpool, Fylde and Wyre Hospitals NHS Foundation Trust

The Blackpool Way

A common-sense approach to effective employee engagement and high performance based on four key steps:

1. Good communication: educating, informing and involving all staff at all levels.
2. Recognition: acknowledging and rewarding staff both formally – through award ceremonies, certification for learning and qualifications completed, and regular appraisals – and informally, through effective day to day line management.
3. Continuous improvement: looking at people’s individual skills and abilities and committing to ongoing investment in learning and development across the organisation.
4. Enlightened management style: changing behaviours, attitudes and culture and improving management skills.

“ You have always got to invest in training and development. We see that as a key part of our business and would resist any attempt to scale that down – because if ever there were a time when we need to invest in training and development, it’s now.”

Julian Hartley, former Chief Executive Blackpool, Fylde and Wyre Hospitals NHS Foundation Trust

As well as addressing organisational needs, the strategy also helped ensure the Trust’s delivery against the NHS Constitution’s four Staff Pledges:

Staff Pledge 1: to provide all staff with clear roles and responsibilities and rewarding jobs for teams and individuals that make a difference – to patients, to their families and carers, and to communities.

Staff Pledge 2: to provide all staff with personal development, access to appropriate training for their jobs, and line management support to succeed.

Staff Pledge 3: to provide support and opportunities for staff to maintain their health, well-being and safety.

Staff Pledge 4: to engage staff in decisions that affect them and the services they provide individually, through representative organisations, and through local partnership working arrangements. All staff will be empowered to put forward ways to deliver better and safer services for patients and their families.

“ I do believe that training and development is critical to our hospitals – and to the health sector as a whole. We have got to invest in our workforce if we are going to meet the challenges that are posed by 21st century healthcare. We need people – in our hospitals, in our primary care system, in our health sector as a whole – who have got the right skills to provide high quality patient care, but have also got the right skills in terms of customer service, interaction, flexibility, willingness to change; and the appetite to take on fresh skills and the challenges that are always there in the health system.”

Julian Hartley, former Chief Executive, Blackpool, Fylde and Wyre Hospitals NHS Foundation Trust

Download Case Study (PDF)