How we’re helping to release the capabilities of frontline staff | Rachel Houghton

Rachel Houghton

Nottingham University Hospitals’ award-winning shared governance model has fundamentally changed how the trust operates, empowering staff to innovate and improve care and services for patients and staff. Rachel Houghton, the trust’s shared governance facilitator, explains how.

There are a number of national strategies on how to improve leadership and culture and create new standards within an organisation. But they are focused primarily on more senior roles, and not the coalface. Although both aspects complement each other, for culture change to be embedded, these values and skills need to be grown in areas directly involved in patient contact, or it will not be sustainable.

Nottingham University Hospitals (NUH) began a journey of culture change in 2012 in response to low staff engagement and morale, poor retention and a looming national nursing crisis. Over the past six years, NUH staff have surprised us time and time again with their ideas, passion and dedication to their patients, the trust and to the NHS as a whole.

Our journey began with the creation of shared governance, a model of leadership which encourages personal and professional development while focusing on improving patient safety, patient experience and staff experience. It follows four key values: accountability, equity, ownership and partnership.

Through the model, we created a council of staff members that come together out of clinical areas to focus on projects that are meaningful to them. They highlight issues and problems and then create and input into solutions.

Staff councils are supported by shared governance clinical educators with their initial set up and training on vital tools and skills, with ongoing project support when required. Ultimately, they govern themselves, with a chairperson and secretary collating meeting minutes and monthly leadership reports. This process:

  • empowers staff to take ownership of their environment and the care delivered
  • provides broader development opportunities
  • creates an understanding of their wider organisation and their impact
  • enables collaborative working with other departments, breaking down barriers
  • increases their confidence to challenge poor practice.

The pride and professionalism shown by council members is limitless and the trust is reaping the benefits of the hive of innovation and activity.

“I didn’t know what empowerment meant until now” Council Member, April 2018

Nottingham University Hospitals shared governance councils

The buck stops here
NUH believes in effective leadership at all levels, with an understanding that frontline staff are the specialists and know what they can provide and how to provide it to achieve excellent care for our patients and support for our staff.

Staff have these goals engrained in their hearts: to provide excellent care for patients and a positive staff experience. And evidence proves what we knew all along: that compassionate leadership and focusing on staff needs will directly impact on the care being delivered.

An empowered and skilled frontline workforce builds the foundations of Nottingham’s future, creating leaders at all levels, supports a multi-disciplinary approach and creates equal responsibility across the trust on what we deliver and how we work – the buck does not stop at the board.

It is challenging the status quo of what we have done in the past and is a slow-moving iceberg towards culture change. This is not a quick fix and requires dedication from the trust board and senior stakeholders at a time when money is scarce and staff difficult to recruit.

It is a bold move but shows what NUH is achieving and the values that we hold. Chief nurse, professor Sunderland, chairs the monthly leadership council where councils meet to unblock barriers, celebrate successes and provides direct support from their chief nurse.

Projects include:

  • Adapting Bilirubin monitoring in accordance with NICE guidelines
  • Outside garden area for patients and relatives
  • CPR Teachathon: Teaching lifesaving skills to the public for free
  • Sensory suitcase for patients with confusion or dementia
  • Nurse-in-charge identifier stickers
  • In-house laundry service provided to patients #EndPJParalysis
  • Reducing phlebotomy clinic waiting times
  • Nurse-led telephone triage for pre-assessment
  • End-of-life boxes containing comfort based products and to create a more homely environment
  • Patient drop-off area and ambulance drop-off area for ambulatory clinic
  • Skills lab teaching on ten different interventions

After six years in the making, we have reached a point where shared governance is how we do things: council numbers are increasing, there is a focus on solutions instead of problems and how to deal with them; and there is a cultural shift towards innovation and action.

It sounds like a Pandora’s box of potential extra work and risk, but what NUH has done is create the capacity for staff who already have the capability and upskilling and talent managing frontline staff (Bands 2-7). It goes to show that if you have the courage to trust your staff, they will deliver for you.

To see what this looks and feels like in practice, the Institute of Nursing and Midwifery Care Excellence holds showcase days on shared governance and Magnet: please email to register your interest or follow our progress on Twitter @SharedGovNUH.

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