A new programme which gives NHS staff the power to transform their workplace has been going from strength to strength, say John Adler and Hannah Forbes

Following the success of early pilot work with more than 50 trusts, a new approach has been developed in the NHS over the past two years to systematically engage and empower staff.

The aim of Listening into Action (LiA) is to empower staff to drive the changes they want to see for the benefit of their patients - with ownership firmly in their hands, and the backing of the trust’s leadership and management teams, whose job it is to help unblock the way.

With a groundswell of new energy from staff and top-level sponsorship, the possibilities are endless. At Optimise we call this the four Cs:

  • Making connections Building relationships, bringing people together across boundaries and reaching out across agencies and organisations. An informed understanding must be developed, connecting staff with the vision of the organisation and the organisation with employees’ needs, and creating the space to act on what is heard.
  • Fostering collaboration Bringing together those who need to share their perspectives with colleagues to understand how they can contribute.
  • Common purpose having a well framed, simple mission that brings people together around something they care about.
  • Collective ownership stepping away from the tendency to give the “wish list” back to managers and executives to realise, and instead building commitment from the people who can deliver the changes.

Critically, the LiA approach ensures that NHS staff own delivery of the changes they want to see and are “given permission” to get on with it. This gives a sense of pride and empowerment, and becomes the inspiration to spread the approach further.

Sandwell and West Birmingham Hospitals Trust was the first to launch Listening into Action across its whole organisation, starting in March 2008. The backdrop to this was several years of getting back into financial shape, and a sense of staff having been “done to”.

At Sandwell, over an intensive three-phase approach which lasted nine months:

  • The organisation gained a clear view of what really matters to its staff and engaged them directly in addressing the items that were agreed to be priorities.
  • Seven departments and teams were supported in pioneering the LiA approach to engage all the right people around their specific “mission”.
  • Inspired by the first seven, and encouraged by a high profile campaign and support from the LiA expert engaged by the trust, more than 50 service areas were working the LiA way. This included stroke care, pharmacy services, midwifery, physiotherapy.

By this time, this new way of working had started to become embedded. This was the tipping point that the trust had been seeking and the sign it could manage without external help.

After just over a year working with LiA, results at Sandwell and West Birmingham show:

  • There are more than 2,500 people directly involved, with more than 50 teams, departments and pathways using LiA.
  • A shift in staff survey results, with an increase in positive responses to the statements: “Senior managers encourage staff to suggest new ideas for improving services” and “Senior managers here try to involve staff in important decisions”.
  • A rise in inpatient survey results, with Sandwell moving from the bottom 20 per cent in 13 areas in 2007 to only one area in 2008.
  • Stories from teams about the improved care they are delivering and the increased morale they feel in doing so.
  • Reports from clinicians, managers and the executive team of more collaborative working, as well as a positive shift in the style of leadership and culture of the organisation.
  • There is evidence that LiA is officially cutting mortality rates and staff sickness levels.

Critical success factors

  • Unwavering commitment from the chief executive and a carefully appointed sponsor group of key influencers in the organisation.
  • The LiA process itself, which creates a groundswell fuelled by the will of staff to deliver better outcomes for patients, and develops top level sponsorship for changing working practice.
  • Expert leadership and facilitation lent into the organisation to launch and embed the LiA way of working into the community.

Case study

The chief executive of University Hospital of North Staffordshire Trust will host a series of big staff conversations this autumn to listen to what really matters to staff.

The output from sessions will be shared back to the organisation within a week of the final session, along with priority actions which will be delivered without delay.

Teams, departments and pathways will be invited to nominate themselves to become pioneering LiA teams and offered support and coaching to deliver the changes they wish to see.