Innovation and Efficiency in the NHS - The Estates and Facilities example
Abstract
Spirals were asked to look at the Estates and Facilities department of a Mental Health Trust to identify how to make a step change in performance, re-engage with customers and deliver better patient care. Our bold recommendations were accepted by the board who then commissioned Spirals to work with the team to redesign the service.
This case study looks at what was achieved through this process and how the process used empowered the staff themselves to make and own the changes.
Outcomes achieved
- Efficiency savings identified of £770,000
- Introduction of new 'housekeeping service' held as best practice across the NHS
- Improved customer service
- Greater alignment to the boards strategic priorities
In November 2008 the Board of Directors of Norfolk and Waveney Mental Health NHS Foundation Trust received a report on the outcome of the Estates and Facilities (E&F) Review. The recommendations represented a fundamental change to the way the services are delivered and managed, and laid foundations for future improvements.
The report recommended significant cost savings in some areas and reinvestment in service improvements in others. The recommendations included increased outsourcing of some services and a more streamlined management structure.
Those involved commented that they were 'impressed with what had been achieved - what had been presented to them was highly impressive in quality, quantity and timescale'; 'the transformation has been incredible”; that they were delivering on customer engagement and “it is noticeable and feels different'.
It was not the nature of the recommendations that was remarkable but the fact that they came from the management teams of the services themselves. Paul Cracknell, Director of Business Support, summarised the experience of the Board and key stakeholders– 'It was noted that EandF had been open to questioning themselves and as a result were proposing significant change. One senior manager from outside the department remarked that twelve months ago had he been toldwe could be where we are today they wouldn't have believed it. This programme of change has been one of exceeding expectations – of stakeholders as well as the managers themselves.'
So how was this transformation brought about and what lessons can be learnt by others?
Leadership
In the first place it was the style of leadership that created the right environment for change. Paul Cracknell, the Director responsible for E&F, had a strong desire to improve the services but an open mind as to how this would be achieved. He was committed to working with his team and he selected consultants, Spirals, with a strong track record of collaborative working with client staff. This was critical to build trust because of previous projects where managers felt that change had “been done to them”. During the project Paul provided clear and consistent leadership and engaged directly with the team through weekly meetings and workshops.
Customer orientation
The initial challenge was to create a shared understanding of the need for change. Spirals facilitated several workshops involving the E&F management team, their customers and their staff. These workshops enabled the management team to see that there were different perceptions about the quality of the services being delivered and that there was a need to align services more to the needs of customers and patients, and improve the consistency of service delivery. During the review there were further customer/patient surveys and focus groups so that E&F could listen and understand their needs and priorities.
Playing to strengths
A key feature of the programme was building teamwork based on awareness of the strengths of individual team members. Each member of the management team completed an on-line Gallup StrengthsFinder assessment. This was followed up with a personal coaching session and team discussions so that individuals could be affirmed in their roles and the contributions they could make to the team. This built the confidence of individuals and greater awareness of others in the team.
Innovation
In process workshops the teams were encouraged to look outside for best practice benchmarks. They researched and visited other E&F organisations and potential service providers. This work was used to generate fresh but practical ideas on how the services could be improved. These ideas included delivery of services to patients and use of technology to enhance effectiveness.
Structure and tools
A key enabler to success was equipping managers with the right structure and tools to do the job themselves. The plan was defined in phases to keep the focus on specific deliverables and milestones. However, the style of execution was highly interactive and fluid with team workshops and review meetings on alternate weeks in the early stages to maintain a “drumbeat” on momentum and progress. A Programme Board met every month to provide direction and give feedback on emerging proposals. This was also an opportunity to manage the expectations of a wide range of stakeholders.
- In the workshops the managers were briefed on a wide range of tools to equip them through each stage, covering e.g. planning guidelines, customer orientation, activity analysis, service level prioritisation and service delivery models, change management tools etc.
- The review meetings provided opportunities for external challenge and more individual coaching at each stage
Conclusions
The programme was successful because the managers of E&F did it themselves. There were times when they needed direction, encouragement, support, challenge and tough decisions, but the quality of the proposals was due to their hard work, perseverance and application of personal skills and experience. The mangers of E&F own the proposals for change so they are committed to successful implementation and realising the opportunities for personal growth.