A hospital division has achieved unified working by agreeing a charter for staged change, write Jon Baber and Mary Sexton

The NHS Institute for Innovation and Improvement and its predecessor the Modernisation Agency have been testing ideas for "social movement thinking" for the past five years. This advocates that healthcare improvement strategies need to extend beyond the top-down, programme by programme approach to embrace a concept of citizen-led change.

Over the past two years the institute has focused on developing a set of tools derived from social movement principles to mobilise and engage staff in change. The strategy is called The Power of One, the Power of Many.

Milton Keynes General Hospital was one test site where social movement approaches have been developed to great effect. Acting nursing director Mary Sexton was nominated as strategy co-ordinator. She soon realised that the challenge of creating this notion of social alignment among her nursing and midwifery staff was a serious one and came to me in my capacity as director of Neos Learning to partner her in this process.

We devised a strategy that focused on engaging nursing and midwifery staff within the women's and children's division at Milton Keynes.

Up to this point, the division had acted in a disjointed way along specialty demarcations, with the parts almost working in opposition to each other. This had a negative effect on motivation. The position was summarised by one nurse, who said at the start of the project: "We never talk to each other, let alone work with anyone's interests in mind apart from our own wards."

The aim of the social movement initiative was to replace this silo mentality with a more cohesive, unified approach. The project was staged over six months and combined formal workshops held away from the hospital with informal team sessions held at the workplace. The idea was to provide support where appropriate to guide and train the team, but this also relied on team members applying this knowledge back in the workplace and using the skills learned.

The process began in June 2007. I facilitated a short workshop in which the division management heads discussed the overall purpose, values and key behaviours necessary for them to work in a unified way. These were merged into a team charter that was to be the central document on which the rest of the initiative was based.

Before any official action was taken, the charter was "tested" across the division and all staff were asked for reactions and observations. In principle it was given unanimous support.

Positive feedback

The next stage, in August 2007, was for the division's management team to devise a collective strategy. This involved reviewing the parts of the team charter and linking them to the existing division development plan. The existing plan was mainly task focused, so the act of including the elements of the team charter began to provide a balance between tasks and people.

In the final stage of the initiative, several representatives ran short workshops to discuss how to implement the demands of the charter, which clinical staff from the team were trained to deliver. From these, team action plans were completed, with ward teams committed to making them happen.

The workshops were run in September 2007 and feedback was positive. One nursing sister stated: "We see so many different management ideas come and go that I thought the nurses would react negatively. I could not have been more wrong. They really liked the principle and have worked hard to make it happen in their ward team.

"I can already see the results of it in how they deal with each other, but also [in] how they interact with other people: nursing staff, patients and visitors."

Teams within the division's various wards are now working with their action plans and the focus is on implementing these. Regular reviews and discussions at team level focus on the continual application and evolution of the charter within the team and across the division.

"I cannot believe the difference this process has made to my division in a short time," says Ms Sexton. "The staff are noticeably more engaged and motivated and are all actively helping each other to achieve even better results.

"By focusing our energy on the creation of a simple charter that gave a sense of identity and belonging to the division, we have made the theory of social movement a reality at Milton Keynes."

The next stage of this process is to cement the learning made so far and to keep the process going into 2008 and beyond. Already, the division is planning a follow-up day to compare ideas of best practice from the first phase and to discuss what they might need to do next. There is no need for external help in this phase as the teams are operating successfully on their own.

Enormous benefit

A formal analysis of the output of this project will be made in June 2008 but results so far indicate enormous benefit, with the project being used as a benchmark at Milton Keynes for future development. The key anecdotal improvements cited so far include:

  • staff in the division working within a common behavioural framework and functioning more as a cohesive unit;

  • all members of the division being aware of their responsibilities to each other, which has led to a greater sense of cross-division interaction;

  • improved morale, motivation and energy within the division, which is having a positive impact on productivity.

The process is already being recreated at other hospitals in the area as a way of harnessing the energy, talents and motivation of individuals within the NHS and creating a positive environment in which to work.

Team charter key points

Our purpose:

  • Committed to quality care for all

As a team we will:

  • Show respect to all

  • Communicate in a timely and effective way

  • Achieve a positive work environment

  • Facilitate team and individual development

  • Have equal ownership

  • Work together to provide quality care for all Our behaviours

  • We will continually seek improvement

  • We will be honest at all times

  • We will be flexible in our approach

  • We will embrace diversity

  • We will be focused on achieving our goals

For information on social movement, visit www.institute.nhs.uk