Elements of CF Objective 1: To critically evaluate the relationship between staff attitudes and behaviours and organisational change to support SMS/SDM Objective 2: To assess the degree to which PCFT staff’s beliefs and attitudes align with the organisation’s strategic objective to support patients to be increasingly confident and competent to manage their own health through supporting SMS/SDM. Objective 3: To provide recommendations on ways to reduce any identified barriers to implementing the Trust’s strategic objective. Strategic Goals Self-completed questionnaire Items 4,16,17 Semi-structured interview Self-completed questionnaire Items 4,16, 17 Semi-structured interview Self-completed questionnaire Items 16, 23 Organisational Culture SD: staff questionnaire: care of patients is my organisations top priority Semi-structured interview Self-completed questionnaire Items 6, 7, 8, 9, 11, 16, 18, 19, 20, 21, 22 SD: the opportunities I have to use my skills. Semi-structured interview Self-completed questionnaire items 17, 20, 21, 22 Semi-structured interview Self-completed questionnaire Items 14,16, 23 Sub-cultures SD: feedback from patients is used to make informed decisions within my directorate/department Semi-structured interview SD: I am able to make improvements happen in my area of work SD: I am able to deliver the care I aspire to SD: the action plans devised as part of the training packages delivered Semi-structured interview
Self-completed questionnaire Items 4, 5, 6, 7, 8, 9, 12, 13, 15, 18 SD: analysis from 2014 re delivering aspects that evidence SMS approach SD: Bury baseline and outcome importance/confidence scales SD: the team I work in has a set of shared objectives Semi-structured interview Self-completed questionnaire Items 4, 5, 6, 7, 8, 9, 14, 15, Self-completed questionnaire Items 10 Leadership SD Senior managers here try to involve staff in important decisions SD: Communication between senior management and staff is effective SD: all of item 8 which describes beliefs about the senior managers in the organisation (I know who they are/communication between them and us is effective/they try to involve staff in important decisions/they act on staff feedback SD: all of question 7 in staff questionnaire, 7 items which describe beliefs about immediate line management competencies Semi-structured interview Self-completed questionnaire Items 14, 15, 17, 18, 20 SD: survey of why people didn’t achieve their actions: any themes around line management barriers? Semi-structured interview Self-completed questionnaire Items 14, 15, 16, 23
The SCQ then asked staff their views about what the organisation could do differently to better support SMS/SDM. Four key themes emerged which are presented in Table 7, in order of frequency of suggestion. Theme Description Specific areas for development Theme 1 Trust to champion SMS/SDM more actively an internal campaign to staff to ensure wide knowledge of this as a priority area support for more active positive risk taking ensuring incidents/complaints support positive risk taking and patient empowerment an external campaign to support system-wide change, engaging with citizen and health and social care partners Theme 2 Access to training Ensure sufficient training is available to staff to support the development of of the agenda, as well as specific skills acquisition Theme 3 Influence a shift to outcomes-based commissioning Work with commissioners to identify patient-focused outcomes as measurement for contract delivery, with associated key performance indicators supporting person-centred care Support the shift away from performance management where this doesn’t reflect patient outcomes Theme 4 Support staff to develop new ways of working Ensure caseloads are manageable and allow for personal and service development activity to deliver SMS/SDM Identify early adopters of SMS/SDM and support them to spread good practice to other teams Table 7: Staff suggestions of ways the Trust can support SMS/SDM A number of comments were offered during the interviews which support the above themes, and give further insights to how these actions might happen in reality, for example; “we need someone to model it, perhaps a trouble-shooter based
about their opinions and perceptions of priority of SMS/SDM. Clarifying whether there is any disconnect, and undertaking a diagnostic to inform corrective actions would be worthwhile. The lexicon of SMS/SDM can be confusing; within the Trust there are several approaches to supporting patients to have a holistic experience of care that supports their confidence and capability to take control of their own health and wellbeing, for example whole person care, co-produced care, self-care, shared decision making, and person-centred care to name but a few. Identifying the differences and similarities and agreeing a common language to describe the strategy is likely to lead to a greater impact of any communications and attempts to increase engagement in the agenda. A common language might also strengthen cultural ties to this way of working as part of a value set. In addition, whilst this research has asked about clinicians’ beliefs and attitudes to SMS/SDM, the specifics of what this means have not been tested. Using the CS-PAM (Hibbert et al 2010) would provide a more targeted diagnostic of individual and collective areas for development. With respect to sub-cultures, it is worthwhile exploring why engaging with nursing communities is more challenging than AHPs. Nursing staff form the largest professional group across the organisation and are recognised as having particular challenges, with morale, recruitment and retention being national problems. Understanding the basis for these issues would provide the
Table 8: Implementation Plan NB costs are indicative and are subject to verification by the Trust’s accountants Description Actions required Sponsor Owner Timescale Expected completion Resources 1 Promote and embed the strategic priority Develop a communication, engagement and marketing strategy/ implementation plan for SMS/SDM Director of Organisation Development Head of Communications 6 months December 2016 To be identified as part of the Communication, engagement and marketing implementation plan Identify mechanisms for shared ownership of delivery of SMS/SDM, e.g. IPDR and promote widely Director of Organisation Development Head of Organisation Development 3 months September 2016 Existing mechanisms in place, approximate opportunity costs of 0.2wte Band 7 (circa £1.5k)
Review reward and recognition mechanisms for SMS/SDM to include an annual awards event Director of Organisation Development Head of Organisation Development 3 months September 2016 Awards event costs circa £5k p.a. 2 Develop skills and competencies package Review existing learning offer and re-brand and publicise Director of Nursing and Healthcare Professions Clinical and Professional Education Lead 3 months September 2016 0.4 Project Support Officer (circa £3k) Analyse current competencies and predict levels of demand, compare with current capacity and submit business case to address any gaps Director of Nursing and Healthcare Professions Clinical and Professional Education Lead 6 months December 2016 0.4 Project Support Officer (circa £3k) 3 Plan a targeted approach to gain critical Ensure wide awareness of Director of Sustainability Strategic Lead for Long Term Conditions 3 months September 2016 Use existing resources, approximately
mass and promote sustainability Bury’s model and lessons learned opportunity costs of 0.2wte Band 8a (circa £2k) Support implementation of the model into other business/clinical units Director of Sustainability Strategic Lead for Long Term Conditions Phased approach over 1 year June 2017 Project Support Officer (circa £20k) 4 Implement mechanisms to measure SMS/SDM in practice Identify appropriate measures for SMS/SDM in practice Director of Nursing and Healthcare Professions Strategic Lead for Long Term Conditions 3 months September 2016 Use existing resources, business case for any measures that incur cost Embed mechanisms for local data capture and analyse and introduce benchmarking across the Trust Medical Director Head of Performance 9 months January 2016 Use existing resources, approximate opportunity costs of 0.5wte Band 5 (circa £15k) 5 3 months June 2016
Systematic embedding in service improvement methodology Capture baseline measure of service improvement skills across the Trust Director of Organisation Development Head of Organisation Development Use existing resources, approximate opportunity costs of 0.2wte Band 7 (circa £1.5k) Propose a realignment of existing resources to support systematic support and capability is accessible to across all teams in the Trust Director of Sustainability Transformation team 6 months September 2016 Business case to be created with identified costs Ensure mechanisms for lessons learned, spread and sustainability are built into any new model for embedding Director of Sustainability Transformation team 6 months September 2016 Any costs incurred to be recognised and included in above business case
service improvement 6 Develop and deliver systems to enable SMS/SDM Ensure clear mechanisms in place for continued support for systems development Director of Service Sustainability Sustainability team Ongoing Ongoing Individual business cases for products e.g. College, Flo Simple Telehealth 7 Provide organisational support to the delivery of the patient experience strategy Ensure linkage between sustainability leadership teams and patient experience leadership teams Director of Service Sustainability/Director Nursing and Healthcare Professions Deputy Director Governance/strategic Lead for Long Term Conditions 6 months September 2016 Any additional costs subject to submission and approval of business case 8 Identify quality drivers/enablers Ensure examples of emerging good practice feed into discussions for 2017- CQUIN schemes and Quality Account Medical Director Head of Integrated Governance 12 months June 2017 Within existing resources , approximately opportunity costs of 0.1 wte Band 5 (circa £2.5k)