Peter Homa explains how Nottingham University Hospitals Trust is achieving more from less with a whole hospitals change programme

As one of the pilot trusts for the productive ward programme, we quickly learnt that we could not achieve the best results without first creating a productive trust.

Our vision is for all our services and departments to be in the top three teaching trusts in England by 2016; delivering high-quality care, safely, consistently and productively.

In 2009, we embarked on trust wide transformational change. Better for You aims to improve what we do through authentic staff involvement and empowerment. It is our unique opportunity to ask the question: “If the services we provide didn’t exist, how would we create them?” From our staff and patients responses, it’s clear we would not create what currently exists. The trust is determined to improve the patient and staff experiences while delivering financial savings.

Having decided to undertake a large-scale change programme, we had to decide where to start. We progressed four parallel activities:

  • Learning from others about different approaches to change.
  • Defining our organisational values and behaviours.
  • Assessing our opportunities and readiness for change.
  • Building on productive ward and other showcase projects.

Large-scale change programmes can achieve significant improvements in patient outcomes and cost. We sought to learn as much as possible from others around the world. This included literature searches, learning from international conferences, discussions with other organisations and, importantly, also learning from within NUH.

We have drawn on our experiences of service redesign personally and organisationally. Alongside trust deputy chief executive Jenny Leggott, executive sponsor of Better for You, and NHS Institute for Innovation and Improvement director of transformation Helen Bevan, I have led a hospital-wide re-engineering programme at Leicester Royal Infirmary. Other NUH colleagues also have experience leading change in and outside the NHS.

We had a good practice guide on the principles of service redesign and undertook many individual projects, achieving pockets of success. However, we needed a framework for change across the entire trust.

Through “in your shoes” sessions, values surveys and “values into action” workshops, run in conjunction with April Consultancy we worked with more than 100 patients and 1,000 staff to define our organisational values. These are now the behavioural compass that guides our work.

Knowing the organisation’s performance baseline and opportunities for improvement are essential. We commissioned external support to help us understand this. These focused on the potential opportunities from benchmarking ourselves against the best trusts, an assessment of our cultural readiness for change, an analysis of our organisational abilities and an estimated return on investment from Better for You.

Commitment was key

The productive ward programme taught us the importance of having showcase areas from which to develop our approach and learn. In parallel with the set-up activities, we started a project, using the principles of Better for You in our emergency department where there were significant operational pressures. Excellent communication was essential. We conducted a stakeholder analysis and ensured we engaged with staff side and primary care trust colleagues and GPs.

The foundations of Better for You are staff and patient engagement and involvement. Demonstrating commitment from was essential from the beginning. Our 13,000 staff were invited to 130 launch events in marquees at our two hospitals held between 7am and 11pm over a two-week period, including weekends, to increase the likely staff attendance. More than 7,500 staff turned up and we received more than 5,000 suggestions for improvement. These have all been reviewed, with many now implemented.

Lessons learned

  • Decide the most appropriate approach to large-scale change for the culture of your trust.
  • Understand your organisation’s values and readiness for change.
  • Identify your knowledge, capacity and capability gap for large-scale change.
  • Involve staff side colleagues early and continually.
  • Invest appropriate resources in support of the programme.
  • Have a clearly defined expected return on investment for the change programme and measure progress against this.
  • Recognise the need to balance benefits between patients, staff and finance.
  • Understand your stakeholders and their requirements.
  • Develop “showcase” project areas to provide experience and encouragement to others.
  • Early and continued staff and patient engagement, involvement and ownership are key.
  • Communicate, communicate, communicate.