Organisational Development Strategy
REFERENCE NUMBER: IN-384
Organisational Development Strategy
AREA:
Corporate
NAME OF
RESPONSIBLE
COMMITTEE /
INDIVIDUAL
Nicola Plumb
NAME OF
ORIGINATOR /
AUTHOR
DATE ISSUED
Nicola Plumb
REVIEW DATE
October 2014
DUE FOR REVIEW:
August 2015
16th October 2014
Date Ratified
RATIFIED BY
Trust Board
13th August
2014
TARGET AUDIENCE / All staff
DISSEMINATED TO
VERSION CONTROL
ADDED to INTRANET
IN-384
Version 1
Mark Dobbs
Version 1
Date Added:
23/10/14
October 2014
1
Organisational Development Strategy
Organisational Development
Strategy 2014-2017
IN-384
Version 1
October 2014
2
Organisational Development Strategy
Organisational Development Strategy 2014-2017
1.0
Purpose of this document
2.0
Overarching ambitions
3.0
Defining the culture we want to nurture:




Humanity, kindness and trust
Openness, transparency and candour
Accountability and responsibility
Questioning, learning and innovation
4.0
Collective leadership: a framework for cultural improvement
5.0
Other key work streams
6.0
Evaluation
7.0
References
Appendix A: Related staff insights
IN-384
Version 1
October 2014
3
Organisational Development Strategy
“…kindness promotes well-being, reduces stress and increases satisfaction for the
patient, the worker and the organisation”
“The process of creating a culture that will nourish compassionate healthcare begins
with daring to turn the focus from chasing poor practice and controlling people to
supporting and enabling staff to do what they would in most cases want to do well…
“A compassionate healthcare culture depends on having the courage to trust the
goodwill and skills of the majority, and the imagination to understand what they need
to help them do their jobs well.”
(Intelligent Kindness, reforming the culture of healthcare)
“Engagement is fostered when there are relatively flat hierarchies, widespread use of
rituals and rites to celebrate contributions and success, and where there is
consistent celebration of accomplishment and innovation.” (West and Dawson, 2012).
IN-384
Version 1
October 2014
4
Organisational Development Strategy
1.0
PURPOSE OF THIS DOCUMENT
This organisational development strategy sets out our ambitions to improve as an
organisation, focusing particularly on culture, leadership and staff experience. We
will adopt the framework of collective leadership to empower and support staff, to
improve their experience of Dorset HealthCare and to enable them to deliver their
very best with our patients and service users.
This is a strategic-level document and as such, provides a framework for action,
going on to signpost ambitions, principles and work streams. It sets out immediate
steps for progress but more detailed action plans will be developed to ensure
delivery.
Organisational context
The Blueprint published in May 20141 sets out the recent journey and significant
improvements that have been made to both Trust governance and to strengthen the
skills and capability of leadership at Board level.
The improvements in governance have inevitably focused teams and people on
ensuring we have the robust quality assurance systems and processes that are
fundamental to becoming an exemplary organisation. This strategy helps us to now
work on the environment in which those systems and processes are operating and to
ensure our attention is always, individually and collectively, on the quality of care and
outcomes we are achieving with our patients and service users.
This strategy will guide us in forming the relationships and behaviours required to
have healthy relationships with and understanding of, accountability, responsibility,
authority and power. It will help all of us to be clear that quality improvement is
owned by everyone and is our responsibility, individually, as teams and collectively
as a Trust.
Related activity
The organisation has significantly strengthened its governance processes and will
continue to improve the way it is managed and conducts its business. The newly
appointed Director of Strategy and Business Development will take the organisation
forward in these areas and we will ensure that the work produced by this document
supports the organisational strategic direction.
Our procedural organisational development also continues with ongoing support
from PM Governance, to move our quality governance and assurance from
functional to exemplary, as outlined in The Blueprint. Again, we will ensure the
appropriate connections are made to this activity.
This document does not explicitly include a section on training and development,
although there are clear connections and its action plans will reach in to these
existing areas of work. Similarly, there is already a programme of work underway for
1
The Blueprint (May 2014) available at www.dorsethealthcare.nhs.uk
IN-384
Version 1
October 2014
5
Organisational Development Strategy
board development, which we will ensure is connected to the activities proposed in
this document.
Finally, the need to establish and develop 13 strong, integrated locality teams is
considered throughout this document and its actions will complement and inform a
pre-existing programme of activity for the induction and development of this new
cohort of leaders. We will ensure that all of the appropriate connections are made as
we move forward.
2.0
OVERARCHING AMBITIONS
Our strategy for cultural and experiential improvement is to go back to basics on
values, behaviours and humanity. We will focus on relationships, promote kindness
and recognise and empower staff to innovate and improve services for those we
serve. We will nurture a culture that will be an enabler and support us to achieve our
business objectives.

To promote connectivity and trusting relationships amongst our people
and with patients, to welcome ‘authentic patient partnerships’2 and
enable collective leadership: Our focus must be on relationships within
teams but also, relationships between teams and with patients, breaking down
silos and giving our staff and our patients a continuity of relationship and
experience.

To nurture a single, strong organisational culture that puts quality of
care above all else, hallmarked by openness, transparency and candour.
We will nurture an affirmative environment where the culture is an enabler for
improvement and accountability, not restrictive and controlling. We will
promote a single culture, seeking to overcome functional silo working that can
lead to competing sub-cultures.

To give our staff the best possible experience at Dorset HealthCare, so
they will be at their very best for our patients and service users: we must
inspire and empower, recognise and celebrate, not audit and measure. We
must give people a belief in their own value and freedom to act, promoting
innovating. We must give staff a voice and listen and act on what they tell us.
We will do more to ensure staff have the tools and information to be excellent
for our patients.

To make quality everyone’s responsibility: We will foster real ownership of
quality throughout the Trust and make sure we do not rely on regulation to
identify what quality looks like for our patients and service users. We will
promote individual accountability for professional practice and standards of
behaviour. Berwick writes that every member of staff should “be a quality
inspector, never knowingly passing on a defect, error or risk to a colleague or
patient”3.
Berwick, D. (2013) ‘A Promise to Learn, A Commitment to Act: improving the safety
of patients in England’ Department of Health p18
2
3
Ibid
IN-384
Version 1
October 2014
6
Organisational Development Strategy
These ambitions signal our intentions, outlining a vision for the sort of organisation
we will work to become. The actions that arise to deliver on these ambitions will be
monitored and evaluated over time via a range of metrics and insights.
3.0 DEFINING THE CULTURE WE WANT TO NURTURE
Berwick: “In the end, culture will trump rules, standards and control strategies every
single time”4
Humanity, kindness and trust
Culture is a combination of tangible and intangible elements; systems and processes
alongside behaviours, attitudes and beliefs. Ultimately, our organisation is a
collection of people and relationships, which we must nurture and care for5.
Ballat and Campling write: “To fail to attend to the promotion of kinship,
connectedness and kindness between staff and with patients is to fail to address a
key dimension of what makes people do well for others”6.
By kindness, we mean the ability to connect with the humanity of another person.
Nurturing an environment where we are kind to one another and in tune with each
other’s humanity increases trust in all relationships, which in turn increases
cooperation and communication and ultimately improves outcomes. We will promote
a culture that recognises the people behind functional and professional roles and the
person beyond the list of problems.
Openness, transparency and candour
Robert Francis’s report on the unacceptable events at Mid Staffordshire7 concludes
time and again that NHS organisations must be honest, open and truthful, to prevent
such tragedies from ever happening again.
We will underpin all that we do with a commitment to nurturing a culture of openness,
transparency and candour, as defined by Robert Francis:
Openness: enabling concerns to be raised and disclosed freely without fear,
and for questions to be answered.
Transparency: allowing true information about performance and outcomes to
be shared with staff, patients and the public.
Candour: ensuring that patients harmed by a healthcare service are informed
of the fact and that an appropriate remedy is offered, whether or not a
complaint has been made or a question asked about it.
Op cit.
See Barrington-Bush, Liam (2013) Anarchists in the Boardroom
6 Ballatt, J. and Campling, P. ‘Intelligent Kindness, reforming the culture of
healthcare’ (2011) Royal College of Psychiatrists p.3
7
Francis, R. (2013) ‘final report of the Mid Staffordshire NHS Foundation Trust Public
Inquiry’
4
5
IN-384
Version 1
October 2014
7
Organisational Development Strategy
Collective leadership, accountability and responsibility
“To rebuild accountability requires a sense of responsibility. When we are trusted, we
feel more responsible for what we do and in order to build trust, we need to share a
sense of empathy for one another. When we can empathise with each other, we lay
the foundations for trust.”8
The focus of this strategy is to develop our quality and governance culture so that
the systems and processes are founded in an environment that promotes and
enables individual and team responsibility and autonomy.
We cannot rely solely on assurance control systems and processes to drive quality
improvement, because we risk stifling innovation and individual creativity, as well as
unwittingly encouraging negative relationships and mistrust.
We will nurture an environment that promotes positive influence and innovation,
which ensures clear and vital board accountability, whilst promoting collective
leadership and sharing authority and responsibility for quality with everyone, through
earned autonomy and trust.
Questioning, learning and innovation
We want our staff to have the confidence to constantly question and learn, innovate
and adapt services based on their knowledge and expertise and their connection to
what our patients want and need. We will create the spaces and initiatives to allow
this to happen, to be recognised and be valued.
4.0
COLLECTIVE LEADERSHIP: THE GUIDING FRAMEWORK
“Leadership culture must be understood as the product of collective actions of formal
and informal leaders acting together for organisational success… Collective
leadership means the distribution and allocation of leadership power to wherever
capability, expertise and motivation sit.”9
We will adopt the Kings Fund and Centre for Creative Leadership framework for
collective leadership, published in May 2014, as our leading development activity.
This framework has cultural improvement at its core and will support transformational
change so that leadership responsibility is shared by every member of the
organisation.
We are incredibly fortunate to already have a relationship with the Kings Fund, who
have identified Dorset HealthCare as one of a small number of sites with whom to
work in partnership as an early adopter.
We are delighted that in October this year we will welcome Michael West, Kings
Fund Senior Fellow and Professor of Work and Organisational Psychology and, Katy
8
Barrington-Bush, L. Op. Cit. p219
Eckert, R., West, M., Altman, D., Steward, K., Pasmore, B. (2014) ‘Delivering a
Collective Leadership Strategy for Healthcare’ Kings Fund
9
IN-384
Version 1
October 2014
8
Organisational Development Strategy
Steward PhD, Kings Fund Assistant Director of Leadership Development, to Dorset
HealthCare, to begin the conversation and process with the Board.
The indicative dimensions of our collective leadership strategy will include: focusing
on the qualities and competencies of leaders; the skills and behaviours in our
leaders; collective capabilities such as producing faster integration of care; and
creation of a leadership culture that is cross-functional, with cross-organisational
collaboration at its core.
Example areas for action will include: induction and socialisation processes;
individual, team and organisational assessments; individual development plans; new
learning experiences; work assignments; coaching/mentoring/feedback; and talent
development.
5.0
OTHER KEY WORKSTREAMS
Vision and purpose, who we are and what we stand for: at the heart of nurturing
that strong, single organisational culture is building a shared sense of common
purpose and working with staff to be clear about who we are as a team and what we
stand for. We will undertake a programme of work to involve everyone in defining
that vision and purpose and support them to connect their role and responsibilities to
that overarching purpose. This will build on the outputs of an early and positive
board workshop in July 2014, facilitated by an external brand expert.
Values and behaviours: individual actions and behaviours significantly affect and
influence the workplace culture, so we will work to articulate and share a common
set of behaviours and reassert the values of the NHS Constitution. A ‘values
programme’ will bring the values to life at every opportunity and support us to talk
constantly about our values.
Breaking down hierarchies and bureaucracy, unleashing innovation: we will
continue to work on getting the right balance between accountability and autonomy,
so that we don’t overwhelm staff with demands for more and more information and
stifle their freedoms to be flexible and responsive to our patients and service users.
Staff engagement, involvement and recognition: by engagement we mean: “A
positive attitude held by the employee towards the organisation and its values. An
engaged employee is aware of business context, and works with colleagues to
improve performance within the job for the benefit of the organisation.”10
A 2012 Kings Fund report authored by Michael West and Jeremy Dawson 11 found
that:
 Staff with high levels of engagement were less likely to report suffering workrelated stress
 Patient satisfaction is significantly higher and levels of patient mortality are
lower in trusts with higher levels of employee engagement
Definition of engagement from the Institute of Employment Studies and adopted by
NHS Employers see www.nhsemployers.org
10
West, M. and Dawson, J. F. (2012) ‘Employee engagement and NHS
performance’, Kings Fund publication
11
IN-384
Version 1
October 2014
9
Organisational Development Strategy

Engagement is a statistically significant predictor in explaining absenteeism
Engagement is not a process or activity led by a staff engagement lead separate
from day to day business-as-usual. Staff engagement is every line manager’s
responsibility and includes having:






Well-structured teams
Well-structured appraisals
Supportive line management that encourages innovation
Learning opportunities
Good job design with clear tasks and the information to do the job well
Repeat opportunities to be involved in decision-making
We will seek to better understand staff experience of the Trust, to identify those
areas where we need to improve and to develop the ways that we support line
managers.
We will transform the way that we recognise the work of our staff. We will recognise
not only their achievements, long service or retirement but, also the often unspoken
reality that healthcare work is emotionally demanding and we need to take care of
ourselves, too.
In collaboration with our communications activity, we will campaign to remind people
of the small but significant gestures that recognise one another: using names, being
open and approachable, having mature conversations, saying thank you and saying
goodbye at the end of the day.
6.0 EVALUATION
Evaluation, insight and feedback are critical to understanding the impact of our
actions and directing next steps. This document signposts some significant pieces
of work and further action plans; we are committed to ensuring that each is
appropriately evaluated for effectiveness and monitored through the appropriate
channels.
7.0 REFERENCES
Ballatt, J. and Campling, P. ‘Intelligent Kindness, reforming the culture of healthcare’
(2011) Royal College of Psychiatrists
Barrington-Bush, Liam (2013) Anarchists in the Boardroom
Berwick, D. (2013) ‘A Promise to Learn, A Commitment to Act: improving the safety
of patients in England’ Department of Health
Eckert, R., West, M., Altman, D., Steward, K., Pasmore, B. (2014) ‘Delivering a
Collective Leadership Strategy for Healthcare’ Kings Fund
Francis, R. (2013) ‘final report of the Mid Staffordshire NHS Foundation Trust Public
Inquiry’
West, M. and Dawson, J. F. (2012) ‘Employee engagement and NHS performance’,
Kings Fund publication
The Blueprint (2014) Dorset HealthCare NHS Foundation Trust
IN-384
Version 1
October 2014
10
Organisational Development Strategy
Appendix A: Action plan 2014/15
Vision and purpose: who we are and what we stand for
With external expertise, deliver programme of staff involvement
to develop our vision and purpose and inform our strategic
objectives
Refresh the Dorset HealthCare visual identity to reflect our
vision and purpose and amplify our values and priorities
Our values and behaviours
October to
December 2014
April 2015
Bring the NHS Constitution values to life by engaging with staff
October to
to articulate the behaviours we expect of ourselves and others
December 2014
Establish a behaviours framework with tools and resources to
January 2015
enable everyone to use that framework in day to day activities
Develop a planned programme of activity to embed our values
January 2015
and bring them to life, including: induction, appraisal, training
and development, recruitment, values mentoring, a values
champions network, role-modelling, celebrating values in action,
story-telling and values-related awards and recognition
Breaking down hierarchies and bureaucracy, unleashing innovation
Sign up to the ‘busting bureaucracy’ initiative with the Health
August 2014
and Social Care Information Centre
Build on the iMatters platform and work of the innovation team
January 2015
to continue to raise awareness of and strengthen ideas
generation. Produce a plan that includes establishment of an
ideas pipeline in specific areas such as sustainable quality
improvement and cost improvement initiatives, as well as
identifying dedicated spaces for creative thinking.
Revisit the membership of the Clinical Executive and map out
October 2014
the possible formal and informal spaces that unite staff around
common issues and take them outside of hierarchical, functional
and role-based silos. Consider creating a leadership forum.
Staff engagement, involvement and recognition
Collate in to a single resource, all of the sources of insight and
feedback that give us a rounded picture of current staff
experiences of the Trust. This should include at least: the vision
test, Friends and Family Test, qualitative feedback and the NHS
Staff Survey.
Launch rolling employee and team recognition scheme that
regularly acknowledges and celebrates achievement and
innovation, including an annual awards events
Develop a pipeline for submitting applications to regional and
national awards and recognition schemes, and the honours
system
Aligned to development of integrated, locality working we will
create more protected formal and informal opportunities for
dialogue, debate and discussion
IN-384
Version 1
October to
December 2014
Announce
September 2014
October 2014
October to
December 2014
October 2014
11
Organisational Development Strategy
Deliver a programme of activity to involve staff and surface their
ideas around key initiatives, including development of our
quality priorities and cost improvement savings
Develop a programme of activity to increase the Board’s
connectivity to the rest of the organisation, to include: visits to
services, regular open forum discussions, personal invitations to
Board meetings
IN-384
Version 1
October 2014
onwards
October 2014
onwards
October 2014
12
Organisational Development Strategy
Appendix B: related staff insights
A selection of feedback left by staff at engagement workshops held in December
2013 and January 2014; it has informed this strategy.
“Some policies are unclear, overly bureaucratic, hamper service delivery”
“All staff need to be able to say ‘I am responsible this was a decision I made’”
“Greater clarity around roles and responsibilities would improve services for patients”
“Directorates aren’t joined”
“Strengthening the connection between staff seeing patients and the Board”
“Very challenging to instigate / discuss change – cultural change required and
openness”
“No time, energy or encouragement to make any innovations”
“Allow opportunities for shadowing other professionals from the other disciplines that
we work with”
“Work to reduce the fear factor”
“Staff morale is low. How can we improve and offer promote positivity to the
patients?”
“Blame culture. Being told all the time that we need to do more. Information
overload.”
“Remote management with a top down approach”
“You get more love by licking than scratching! Respect, courtesy, manners, we need
more love in this Trust”
“Lose the silo working, there’s far too much paperwork needed to get even simple
things done”
“Let’s have a management walkabout so we can have regular contact”
“Invest in your staff they need to feel valued”
“Need to get the basics right. As in patient nurse I can’t even get towels that are big
enough for patients. We need more autonomy especially if we are working a
recovery-focussed way”
“Forums needed for networking and exchanging ideas”
“To help communication and development of one Trust I think the Directors CEO and
Chair should actually walk the floor.”
IN-384
Version 1
October 2014
13
Organisational Development Strategy
“Those at the TOP are not visible to those at grass roots. We need to know who
they are.”
“Disconnect between Board, senior management and frontline staff. Feedback is not
listened to and we have no influence over services. Innovation/ideas not
developed.”
“There is a lack of trust and micromanagement”
“Directors, senior managers to regularly visit and work in clinical areas alongside
teams and ask patients/carers their views”
IN-384
Version 1
October 2014
14