SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST EXECUTIVE SUMMARY: REPORT TO THE TRUST BOARD. Wednesday 18 April 2012

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1 SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST H EXECUTIVE SUMMARY: REPORT TO THE TRUST BOARD Wednesday 18 April 2012 Subject: Sheffield Teaching Hospitals NHS Foundation Trust Organisational Development and Workforce Strategy Supporting Directors: Mark Gwilliam, Director of Human Resources and Organisational Development Andrew Riley, Corporate Development Director Authors: Mark Gwilliam, Director of Human Resources and Organisational Development Andrew Riley, Corporate Development Director Status (see footnote): A* PURPOSE OF THE REPORT: The purpose of this report is to present the OD and Workforce Strategy for approval by the Board of Directors. KEY POINTS: The benefits of delivering the OD strategy will be in supporting the delivery of the overarching corporate strategy by ensuring that the workforce is capable with the skills and experience required to maintain STH at the forefront of medical science, creating excellent patient experiences and maintaining strong industrial relations. The OD strategy has a development plan underpinning each of these objectives setting out a five year delivery trajectory. IMPLICATIONS: Money: Sets out a strategic approach and a key aim of spending public money wisely. Access: Quality: Ensures providing patient centred services is a central aim of the organisation. Provides the basis to deliver the best clinical outcomes and sets a vision for the organisation to aspire to be the best provider of integrated health care in the UK. RECOMMENDATION(S): The board is recommended to approve the Organisational Development and Workforce Strategy APPROVAL PROCESS: Meeting Presented Approved Date Trust 11 April April 2012 Executive Group Board of Directors 18 April 2012 Status: A = Approval A* = Approval & Requiring Board Approval D = Debate N = Note 1

2 Organisational Development Strategy for Consultation Sheffield Teaching Hospitals NHS Foundation Trust 2

3 Introduction Sheffield Teaching Hospitals NHS Foundation Trust s vision is: To be recognised as the best provider of health care, clinical research and education in the UK and a strong contributor to the aspiration of Sheffield to be a vibrant and healthy city region. The principal aims of the Trust are: Deliver the best clinical outcomes Provide patient centred services Employ caring and cared for staff Spend public money wisely Deliver excellent research, education and innovation Delivery of these objectives will require effective communication and engagement with staff. In particular, the Trust s commitment to have caring and cared for staff by developing a dynamic culture of staff engagement supported by an effective two way communication model at directorate/department level, and horizontally across the Trust. One of the principal aims in the Trust s Communications Strategy for , is also incorporated into this Organisational Development Strategy as follows: To ensure all Sheffield Teaching Hospitals NHS Foundation Trust staff are fully engaged in the organisation s commitment to deliver high quality safe care, by keeping them informed about what is changing, why change is needed and most importantly involving them in the decisions that affect them. 1. Organisational Development Organisational development (OD) is described in many ways but form used in this strategy is planning interventions to bring about significant improvements in organisational effectiveness and health. Essentially there are seven elements to an OD strategy; 1. Strategy; The coherent set of actions that sets out the organisations direction over the next 3 5 years 2. Shared Values; The idea of what is right and desirable in corporate and individual behaviour 3. Skills; Capabilities and knowledge possessed by the organisation 4. Structure; The way the organisation is divided up and integrated into Business Units the Chart. 5. Staff; The people who deliver services, their motivations and behaviours 6. Systems; The processes and procedures through which things get done from day to day. 3

4 7. Style; The way leaders collectively behave This document covers numbers 2, 3, 5 and 7 from the list above. 2. Shared Values 2.1 Consultation Following consultation with patients, key stakeholders and over 4,000 staff during the period between September 2011 and March 2012, including a subsequent working group of 52 staff from across the Trust, Sheffield Teaching Hospitals NHS Foundation Trust (STH) values and behaviours were established. These will be publicised as part of the refresh corporate strategy in April 2012 and have been included in the new appraisal being launched at the same time. They re state the idea of what is right and desirable in corporate and individual behaviour, recognising and rewarding preferred behaviour whilst taking decisive action to minimise unacceptable behaviour. The values and behaviours that will guide STH over the next five years will sit under the strapline of Proud to make a difference and the acronym PROUD will represent the values. They are: P patient first R respectful O ownership U unity D deliver This will define our culture i.e. the way things are done around here. The working party are continuing their project by suggesting ways in which we can embed these values throughout the organisation. In tandem with their work we will use the values/behaviours to assess individuals through appraisal and as part of our recruitment process and induction programme. We will ensure that our external and internal communications take every opportunity to promote our values and will create a culture where we hold each other to account to consistently behave in a way that reflects our values. 2.2 Appraisals Introduction of performance and behavioural appraisal In April 2012 we will launch an appraisal that includes a review of behaviours and performance measures. It is a Trust wide appraisal that has a consistent approach to content of discussion, paperwork used and recording of completion. Roll out process 4

5 The introduction of this new appraisal will induce a significant cultural shift for both the appraiser and the appraisee. For that reason we are rolling out the new appraisal in a staged process, starting with senior leaders first and then adopting a cascade effect through the hierarchies As we roll out through the organisation we plan to invest in significant training for both the appraiser and appraisee, to ensure confidence and capability in conducting quality appraisals. The engagement process will be supported with close monitoring and leaders being held to account to deliver by their line manager. We are ensuring that each cohort is fully confident in the new process before we move on to the next group. Our goal is to have a generic appraisal system that is robust, sustained and meaningful. We anticipate that it will take up to 2 years for us to complete the roll out. Assessment process The performance objectives are agreed between line manager and their direct report. This process begins with CEO and continues through the hierarchies, ensuring that objectives set at each level feed into the priorities of the organisation, as set in the annual plan. The behaviours that each individual is assessed against are the STH PROUD behaviours established in April The STH behavioural expectations are consistent through the organisation regardless of grade, with the leadership behavioural expectations from National Leadership Framework layered on top for those that hold leadership positions. The behavioural and performance sections of the appraisal require an assessment against expectations and the final part captures the individuals potential and aspirations. The former will allow us to plot our workforce capability and the latter allows us to generate a Trust wide talent and succession database, which will support a succession planning process. The PROUD behaviours outlined in the appraisal will subsequently be used as part of our recruitment process, induction training and assessment for promotion. The next 5 years The roll out of the appraisal during the next 2 years will help to embed the STH PROUD values and behaviours. It will act as a conduit to connect every employee to the Trust vision and objectives through their appraisal discussion. The clarity around the expectations of each employee, and the subsequent assessment of their performance at their appraisal, will aid our performance management effectiveness and give us focus to invest in our top talent. This will feed our ambition to ensure we have our teams operating at the best they can be and that we attract the cream of external applicants, as the Trust carves out a reputation for being an employer who develops its people. As the workforce become clearer about what is expected, and put actions in place to close any gaps in performance, we will drive the productivity gains we are looking for over the next 5 years. 5

6 The accompanying leadership development opportunities eg courageous conversations workshops, will build our leaders confidence and ability in delivering through others. We will also encourage leaders to conduct a 360 review to enhance their self awareness, which will give further richness to the appraisal discussion We will use the scoring to identify trends in our workforce eg directorates with high predominance of performance issues and those that are regularly feeding our succession plans and reflect those trends back to the leaders of those directorates. Each year we will build our completion rates of appraisals across the Trust with the ambition of achieving 95% by 2017 By 2017 all employees will have a quality annual appraisal with their line manager that is motivational, honest and stretching. They will feel valued as their contribution is recognised and will be more engaged in working for the Trust. The higher level of engagement could result in less absenteeism, lower staff turnover, lower mortality rates and higher productivity. 3. Skills 3.1 Education and training High quality patient care and a positive patient experience is synonymous with investment in the education and training of all our staff to ensure they have the knowledge and skills to undertake their roles effectively. It also depends on high quality practice placements for all our students and good relationships with our education partners. Within STH we have a good track record in delivering education and training. Our partnership with Sheffield college allows us to deliver everything from apprenticeships to NVQs to employability to ensure that our Bands 1 4 not only receive essential training to do their jobs but a connection with learning and development services early on to help them develop further. This is underpinned by a central induction programme for all staff when they start work in STH to ensure new starters have the essential information and mandatory training they require before they take up post. Our partnerships with Sheffield Hallam and Sheffield university ensures our students are well supported and staff can meet their CPD requirements. The Learning and Development department also has an extensive portfolio of further learning opportunities for all staff. However the world is changing which brings new opportunities and challenges. Regulators want to see comprehensive evidence of mandatory training which requires us to review both our systems of training delivery and the systems we use to report on this information. A significant amount of mandatory training is now delivered by e learning which staff need to be able to access at a time and place convenient to them. This will require us to review what we are currently able to provide and look to make improvements by forging alliances with our academic partners. 6

7 Community staff have formally enjoyed a different model of training delivery and we need to ensure that the model we put in place now they are part of STH not only meets their needs but opens up opportunities through our learning and development strategic alliances that were not previously available. Leadership is at the heart of high quality patient care. STH has made a significant investment in leadership in 201/11 and it is anticipated that most staff in leadership and/or managerial positions will undertake some form of leadership development in the next 3 years. The Trust needs to capitalise on these staff particularly in light of the challenges we are facing. Nationally the model for commissioning education is changing. The creation of Health Education England and provider led Local Education and Training boards (LETBs) will make Trusts more accountable for the education and training of their workforce. As a major Trust in Yorkshire and the Humber it is important that we are at the forefront of these reforms and in turn review how we govern education and training internally as well. 4. Staff (the workforce) 4.1 Staff Engagement Research has shown that when employees are engaged they feel positive about the organisation and this can lead to improvements in the quality of working lives and enhanced performance. However, employee engagement goes beyond job satisfaction and is not simply motivation. Employee engagement is everyone s responsibility and positive contributions can be made throughout the organisation to enhance it. Set against the context outlined earlier in this document staff engagement is critical if we are to deliver our vision and aims. In particular the significant transformation agenda facing the Trust will require levels of staff engagement not previously experienced. A great deal has been learnt from the Trust s Lets Talk engagement initiative which was launched in September 2009 along with the research conducted in 2011 with clinical consultants about what they require to become more engaged in the issues and aspirations of the Trust. The consultation process to develop the Trust s corporate strategy also provided valuable discussion and feedback with the highest ever level of staff involvement. 7

8 As a consequence of this insight staff communication and engagement is a key priority for the Trust and three work streams are in place to deliver improvements in the following areas: The staff journey Staff engagement Staff health and well being There are action plans in place for each work stream and progress will be measured using a set of defined metrics which include key indicators in the NHS national staff survey and a follow up annual internal communications audits. A group of senior managers and representatives of staff are also engaging in a piece of work to redefine partnership working in the Trust. The outcomes of this work will feed into the development of the Organisational Development Strategy and will be a key component of the ongoing communications and engagement strategy implementation. Effective internal two way communications is pivotal to supporting a dynamic culture of staff engagement. As such a full review of communication channels, tactics and flow will be carried out to inform future developments. Some of the basics of good internal communication have already been put in place, with the introduction of Team Brief, the insistence that all staff have a regular appraisal (PDR), that there are regular team meetings and one to ones, and the introduction and development of small group engagement events such as conversations with the Chief Executive and Lets Talk sessions. 4.2 Employee Resourcing The Employee Resourcing team is corporately responsible for the services of non medical recruitment, workforce information and the management of the Electronic Staff Record (ESR). The aims of the employee resourcing team within the context of the NHS restricted financial climate are: To facilitate the deployment of the workforce in an efficient, cost effective and safe manner and in doing so support managers in achieving workforce savings. To provide an efficient and cost effective recruitment service, ensuring recruitment time are kept to a minimum without compromising the standard of employment checks To promote the Trust as an employer of choice. To develop ESR as repository for all workforce information and increase accessibility of the system to managers 8

9 To facilitate the CQC and NHSLA compliance agenda through the provision workforce data relating to mandatory training, appraisals and employment checks. To develop the provision of timely, accurate and meaningful workforce metrics to the Board and to managers. To support the workforce workstream in Q&E initiatives which create efficiencies in the workforce To support TEG in the development of a corporate workforce plan. To raise the profile of workforce diversity. Recruitment Objectives; To develop and facilitate the recruitment control framework in order to ensure pay costs are contained and reduced where possible and that that recruitment is prioritised based on service need. To develop the recruitment service with particular reference to minimising recruitment times through the continuous review of process and liaison with external agencies e.g. NHS jobs, CRB, United Kingdom Borders Agency To develop the recruitment system to incorporate assessment methodology based on the established Trust values and behaviours To develop the framework for the use of external workers i.e. honorary contract holders and agency workers within the Trust in order ensure safe practice is evidenced and that maximum efficiency is achieved. Workforce Profiling Objectives To facilitate the most effective deployment of the workforce through the provision of advice relating to contracts, job redesign, agency usage and grade mix. To support the workforce programme in the development of Q&E cross cutting initiatives designed to alter process and procedures with a view to improving workforce efficiency. e.g. contact centres, case note tracking E Rostering. To develop and support directorates in the use of workforce planning models which a view to ensuring a safe and cost effective workforce for the future. Workforce Information/ESR Objectives To develop the provision of timely, accurate and meaningful workforce metrics and KPI s to the Board and managers with a view to providing detail and analysis on trends and forecasts relating to pay and workforce performance. To continue to develop ESR as the repository for all workforce information. This will include extending the use of ESR for the recording of appraisals and mandatory training. To continue to develop ESR as a tool for managers through the use of self service thereby increasing the timely flow of workforce data between, directorates, payroll and HR 9

10 Workforce Diversity objectives To raise the awareness of the workforce diversity agenda through the provision of training. To continue to collect protected charactistic data for all staff To develop a framework for routine analysis regarding the composition of the workforce by protected characteristic, highlighting emerging trends or areas which merit detailed analysis. To review the recruitment process to facilitate access to underrepresented groups where required. To develop network leads for minority groups To highlight and review perceived barriers in employment. Redeployment Objectives The review the practice process of redeployment to ensure that those who are displaced from posts are provided with the best opportunities to be placed in suitable alternative positions. This will include a review of communications, skills assessment and provision of support to employees. 4.3 Occupational Health and Wellbeing Service Strategic Goals To be seen as a highly professional, unified and patient and customer orientated service. As an integral part of STH to continue provision of a first class Occupational Health Service locally and to continue to extend our presence within and beyond the confines of the local health community. To develop our national profile. To continue to be active in initiation and support of research. To expand the links with our existing and potential clients in the public and private sectors. To continue provision of first class undergraduate and postgraduate teaching and training. To further enhance our communication with the users of our service. To be future proof and remain open for new developments in Occupational Health & Wellbeing. To remain receptive and enhance our adaptability to the changes in the healthcare system and society. To develop a culture of continuous improvement of quality and performance at all levels of our service. 10

11 4.3.2 Objectives To involve positively all members of our Service in the process of change and empower and support individuals and teams committed to the goals to make the change happen. To ensure effective communication within the Service, Trust and current and potential users of our service and all relevant external parties. To promote a culture of self reliance and continuous improvement and become proficient in appropriate improvement tools. To reconfigure all tiers of our workforce to be professionally competent, productive, cost effective, flexible and compatible with future developments and needs of the service. To redesign our systems and reporting processes with emphasis on quality, innovation, productivity, flexibility and compatibility with the future developments. To achieve SEQOHS accreditation in To see risk management as a part of the project and become proficient with tools for risk analysis and prevention. To remain responsive to the needs of our clients and service users and to continuously audit and modify our services to increase added value to our customers. To define our relationships with other services, professional bodies and organisations within and outside the Sheffield healthcare community and the region, based on mutual interests, shared values and a culture of support and collaboration. To refine our business model and develop appropriate skills and business connections to acquire and maintain a competitive edge in the market. To remain represented in relevant professional bodies and organisations in order to increase our profile and positive influence and facilitate collection and transfer of information, ideas and skills. To strive for well being, job satisfaction, career and personal development and job stability and security for all members of our team, with the special attention to the needs of those at the beginning of their careers and approaching retirement Occupational Health and Wellbeing Strategy A comprehensive Occupational Health and Wellbeing service delivered through an expanded Occupational Health Service. Partnership working with other NHS providers to deliver cross NHS community led by OHS/STH with a partnership board to stakeholders, ie NHS users and contributors. Which will; 11

12 1 Address major causes of sickness absence and occupational ill health in the NHS workforce by: Provision of appropriate preventative and treatment services to individuals. Identification of risk groups and implementation of appropriate preventative programmes. Active case finding and hazard identification with implementation of appropriate measures to address problems. 2 Use appropriate tools to identify health and wellbeing issues in the health/sth community and implement appropriate measures. 3 Provide more general health and wellbeing events and activities to visibly engage the workforce in key public health agenda issues. 4 The workforce of STH is the largest geographical community of working people in the city. The STH Health and Wellbeing Strategy will meet the need of this community by: Implementing national initiatives required of NHS organisations Boorman, NICE. Responding to local priorities and needs identified within organisations and by local health bodies. 5 It will also enable the Trust to meet its corporate social responsibility aims by: Addressing Occupational Health and Wellbeing issues early to maximise retention of workforce. Providing a service to other employers in the city. Empowering its workforce to act as "health ambassadors" to their own family, friends and community. Reducing health inequalities by specifically addressing the needs of employees from deprived communities Health & Wellbeing initiatives Trust wide physiotherapy fast track service Objective: Reduce sickness absence attribute to MSK conditions by expanding the current provision to include the whole Trust Review the business plan for the Sheffield Occupational Health Service in respect of this service Bid for additional resources to fund this initiative Reduce the level and incidence of sickness absence as a result of musculo skeletal and other injuries Mental Health Pathway Objective: Reduce sickness absence attribute to Stress, anxiety and depressive conditions by developing a fast track pathway for staff with these diagnoses. 12

13 Work with stakeholders to identify clear pathways Review all options for optimal service delivery at VFM prices. Pilot, evaluate and embed practice Workplace Wellbeing Service Objective : A review of the Workplace wellbeing service Consider service provision, cost, and uptake levels to ensure a VFM approach to the provision of this service. Explore alternative options, e.g. other service providers. Update and promote the service via communications strategy to improve uptake Salary sacrifice schemes Objective : Increase the range of alternative areas for salary sacrifice schemes Consider the scope available for extending salary sacrifice schemes for purchasing annual leave, university fees cover, lease car schemes. Advertising the scheme widely via comms Stress management Objective : Embed a holistic approach to stress management using best practice in the organisation To develop a trust wide strategic approach to identifying and managing stress in the workplace To build capacity via targeted training interventions in the planning and management of absence management caused by work (and other) related stress To work together with other health community leads and third party organisations, identifying and sharing best practice To ensure that the strategy and practice is widely and effectively communicated to all staff Ongoing objectives Review and evaluate impact and lessons learned of previous initiatives. Ensure that the Trust is seen and recognised as an exemplar of good practice. Build and develop links with other organisations maximising best use of the Olympic legacy funding. Continue to develop opportunities to provide shared services with third party providers. Seek alternative funding streams to develop staff health and wellbeing initiatives such as the introduction of an STH Health & Wellbeing Lottery 13

14 4.4 Employee Relations The employee relations team is a corporate support service. Our purpose is to support the delivery of Trust objectives by providing appropriate tools and advice for managers to manage effectively. The key aims of the employee relations team are: Development and maintenance of partnership working arrangements with the collective trade unions, to underpin a healthy employment relations environment working together in a culture of transparency and shared understanding; Development and effective implementation of HR policies and procedures that are fit for organisational purpose; Provide a professional and credible HR service giving appropriate support and advice to managers on individual employee relations cases with due regard for HR good practice, trust objectives and employment law; Provide a pro active HR service at all levels; Enable managers to manage their own staff effectively and with confidence by providing systems of support, information and training; Play an active part in the wider HR strategy, particularly health and wellbeing, equality and diversity and staff engagement. Maintain a culture of continual service improvement The key objectives are: Provide directorate management teams with an HR business partner who will work closely with directorates to better understand their current and future business objectives and challenges; Provide managers with timely, accurate and analysed HR information on types and themes of casework for proactive and timely management of issues; Develop agreed performance targets for timely completion of casework Maintain systems of regular performance review against KPIs Establish a regular forum with trade union colleagues where issues and themes can be discussed and resolved; Establish a realistic timetable for review of all HR policies and carry out those reviews in partnership and following research and organisational feedback Provide an effective information service to managers on terms and conditions through appropriate and regular communication methods. Review all Employee Relations Team processes and activities to ensure effective use of resources Review systems that lead to pay and time off to ensure the Trust s pay bill is accurate and appropriate Develop and maintain a culture of continual professional development within the HR team 14

15 4.5 Medical Personnel Department (HR Function) In addition to providing a day to day HR function to the medical workforce, the following major initiatives will directly impact on the Medical Personnel team over the next 3 to 5 years Medical Workforce, Training and Education From 2012 over a 5 10 year period secondary care will start to see reductions in specialty training numbers. There will be a push to increase numbers in primary care; the probable overall impact will be no increase in the junior doctor pool. The national strategy is to create training opportunities in specialties which relate to future health care requirements. The immediate challenges these changes create for the Trust are the: Maintenance of out of hours working patterns Maintenance of European Working Time Regulations Impact on service development Impact on Education and Training Expectations of doctors in training Ability to recruit Financial consequences Developments will continue in relation to health care education and training in general to ensure organisations have the appropriate people with the right skills in the right place at the right time and in the right numbers. Medical Education England (MEE) will be transformed into Health Education England (HEE) as a special health authority from summer 2012 and take on a shadow role by October, assuming full operational responsibilities by April The purpose of HEE will be to ensure the delivery of an appropriate workforce to support the delivery of excellent healthcare. The Trust has already implemented Hospital at Night which has seen the central co ordination of multidisciplinary teams to ensure that a wide range of patient interventions are undertaken both efficiently and by the most appropriate person. It is anticipated there will be further development of this concept to enable the future drivers to the medical workforce, training and education agenda. 15

16 4.5.2 Revalidation Medical Revalidation is the process by which all doctors with a license to practise will need to satisfy the General Medical Council (GMC) at regular intervals that they are fit to practise and that they should retain a license. The regulations that will make revalidation a legal requirement came into operation late The main purpose of revalidation is to: Support organisations in their continuous improvement of the quality and safety of healthcare for patients. Help doctors meet their professional commitment to keep up to date and improve their practise through meeting specialty standards and identifying development needs where appropriate. Help organisations identify issues early and put processes in place to support doctors. It will be essential for the Medical Personnel team to work closely with the Responsible Officer (RO) Medical Director for revalidation to be a success. Doctors will be required to maintain a portfolio of supporting information which spans several years and must cover work for every employer and contracting organisation with which the doctor has worked. Employers will need to support doctors in accessing this information. 5 Leadership development strategy 5.1 Identifying and developing emerging talent and potential leaders All current leaders will have a responsibility for talent spotting and developing potential leaders. This will be principally driven through the new appraisal and development programme which every member of staff will participate. Members of staff from all backgrounds will be able to set out through their personal development plan what their ambitions are and with their manager how they will achieve them. The Trust has a broad portfolio of leadership development programmes ranging from introductory courses through to doctorate level. All participants wishing to participate on a leadership programme will participate in a personal development centre that will help them identify their current leadership style and opportunities for development. 5.2 Supporting and developing the current leadership team 5.3 Achieving the right balance between developing leaders from within the organisation and bringing in new talent from outside. The Trusts vision for leadership development is included in the corporate strategy: As we work towards STH s aspiration to be a provider of world class healthcare, we recognise the critical importance of leadership behaviour and its impact on organisational performance 16

17 Through significantly investing in leadership development we aim to create an environment in which all staff are engaged, committed and encouraged to reach their full potential, whilst continuously enhancing and improving the services we deliver. The Trust recognises that development of such a culture will take time, but it can be achieved if it is based on strong organisational values that are "lived" by all "leaders" at all levels in both formal and informal roles. 17