MCA Management Awards 2010: Change management in the public sector

Category winner

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Last Updated: 09 Oct 2013

HAY group with Maidstone & Tunbridge Wells NHS Trust

Maidstone and Tunbridge Wells NHS Trust (MTW) was under severe pressure. In October 2007, a damning report from the Healthcare Commission had criticised it for failing to deal adequately with outbreaks of clostridium difficile (C. difficile) infection, which had led to patient deaths. MTW became a high-profile organisation, but for all the wrong reasons.

Although immediate action had been taken to correct the medical causes of the outbreaks, the report had also pointed a finger at the leadership and organisational culture. 'The lack of organisational stability, with numerous structural changes and a high turnover of senior managers, meant that managers could not settle into roles and focus on the key issue,' it stated.

Most of the board and the executive team had quit the trust and been replaced by a new set of non-executives, an interim chair person and a new chief executive, chief operating officer and director of nursing.

To establish new leadership capabilities and a new culture 'from the board to the ward', the new executive team called in Hay Group to help eradicate the 'Millwall fan' culture ('no-one likes us, we don't care'), to attract and retain better staff and clarify all roles and responsibilities so that everyone knew how the organisation should work. And, of course, to ensure patients were put back at the heart of what the trust does.

Hay Group listened to the team at MTW, but proposed a solution that went beyond what the executives were requesting: leadership development that was integrated with the trust's whole strategy and turnaround plans.

Hay's approach would be based on behavioural leadership techniques that were specifically measurable, and focused on the roles and capability of the leadership groups as teams rather than as individuals.

The intensive programme began in autumn 2008 and ran for a year, with a team of six dedicated senior consultants under director Phil Kenmore. Leadership development work used an integrated approach across four levels of the organisation: the board, the executive team, the senior leadership team reporting to the COO, and the operational division senior managers. Each level had common elements woven together around culture, strategic objectives, ways of working and leadership impact - as well as elements that addressed particular issues for each group.

The executive and senior leader levels, for example, spent time measuring and reviewing their collective and individual leadership impact and accountabilities as a team. They were challenged to take responsibility for the changes they thought were required to ensure better patient care. Hay convinced them that passing everything back up the chain was no longer an option.

Middle leaders focused on how they behaved as individuals and what their leadership role meant for them - for example, as a clinician stepping into their first wider leadership (matron or clinical director) role.

The trust believes it has now turned around its management thinking, clarifying roles and responsibilities, ensuring accountability from board to ward, and agreeing a strong, shared vision of how the components of the organisation should work together.

A year on, MTW now has one of the best records for infection control in the south-east. A&E waiting times have been four hours or less in 98.9% of cases for the year to date, exceeding the national goal of 98%. Cancelled operations are down from 2.3% to 0.8% - bang on the national target. The trust's underlying financial deficit has been halved, and it is well on the way to achieving its aim of being in recurring balance for the final quarter of the financial year.

The trust also says it is beginning to see evidence that people now like the organisation and believe that its leaders genuinely care about what they do.

'We spend too much time reinventing wheels,' says MTW chief executive Glenn Douglas. 'We delude ourselves that our organisation is facing unique challenges, but other organisations have had similar problems. Getting people in from Hay Group with that expertise was vital. They had a good balance of people with NHS experience who talked the same language as us, but also experts with experience of other industries.'

TAKE-HOME TIPS

Determined to put managerial and clinical failure behind it, the MTW trust's new management team enlisted the help of Hay Group - which diagnosed the need for an intensive programme of leadership development and a culture change to emphasise teamwork, with a strong sense of accountability from board to ward. The new sense of purpose has brought tangible results: A&E is hitting national targets on waiting times, cancellation of operations is now a rarity, and the trust's finances are looking healthier too.

- Be willing to challenge senior people - even if they're reluctant to embrace change.

- Appreciate what it's like for executive teams who have to operate in the public eye.

- Stay flexible - schemes must be adapted to changing issues and time pressures.

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