Chief Executive’s Message – Friday 9 August
August 9, 2019
The last few days have seen major announcements about restored NHS capital funding, as well as hints of progress on pensions! We expect that they will once again allow us to press ahead with projects we have in hand, with schemes like the major investment in Neonatal services at City now well advanced, and enabling works underway for the GP practice at Sandwell. These announcements are separate to the Midland Met contract which is in the latter throes of government approval, having been agreed by NHS Improvement.
One of the many architects of our work on long term finance, on new estates, and on patient quality, was Tony Waite. Tony sadly passed away earlier this week in his beloved Yorkshire. I know that he remained fiercely proud of this organisation, clinically and in terms of our ambitious vision. Tony will be missed in all the organisations he served over a career with more than thirty years as a director, including his five years with us. Thank you to everyone who has offered support and condolences to those most affected by this unexpected news, and we will continue to try and deliver that 2020 Vision – reporting back next year to local residents as we promised we would. Trust was such an important part of how Tony worked, and who he was, and I know he would want to try and build even more confidence from local people in the honesty with which we deliver change and improve care.
More doctors in training joined us this week, with some staying on from FY1 rotations. I hope very much that you are being made to feel welcome. In coming weeks we hope to put in IT, through Unity, which makes working here smoother and easier, and in particular means that prescribing will become electronically enabled. One of the key steps to Unity Go Live is to tackle the backlog of unacknowledged results, for imaging, which sit in our system. Chetan Varma, for medicine, and Tina Robinson, for surgery, presented their plans to do over the next six weeks to last week’s Board meeting. We have over 800 red flag results still in our system, and have made it clear since April that we need to go over to Unity with our recent backlog largely cleared and with each specialty and team having a very clear process, not less than weekly, to clear all acknowledgements.
I have mentioned a couple of times here, and the latest Heartbeat also features, our new Tap & Go IT login. This product gives you rapid access to Unity, and from 2020 single sign on to a variety of Trust IT systems. By this time next week we will have material out letting you know how to access the new facilities, which requires for some users a small chip addition to your staff access card. In many areas the team will come to your patch to get this installed before Unity Go Live. Our Access Fairs will also be a way to get yourself ready, and details of those are pretty much everywhere!
Last week we started a new feedback loop from our frontline shift leaders in nursing on staff shortages and clinical risk. We still have vacancies and sickness and those cause shifts where our staffing numbers fall below those agreed by the Board. Even as we tackle sickness rates, and press ahead with over 700 job offers, we need to remain focused on the ways we mitigate risk when we are short-staffed. At the same time, we are re-signing off our approach to Focused Care trust-wide so that the 10-20 patients at any given time we may need enhanced help do get that. Paula Gardner and I will report back to the Board at the end of August on the new data, which is not intended to be onerous. There is lots to learn between teams from how individuals take mitigating steps in leading a shift, and we need to learn for when that arises, even as we make great progress reducing its likelihood. We also want to hear clearly the voice of those having to manage overnight or out of hours about what really happens and how it feels.
Managing risk in any large organisation, especially healthcare perhaps, comes with complexity. As individuals we rate risk differently. Some inclined to over-estimate, some to under-rate. That is why we have systems to try and tackle risk assessments and get a few pairs of eyes looking at issues, risks, and solutions together. Of course at the same time we engage in managerial behaviours which can on occasion either ask people to call out risks, or imply that doing so is somehow ‘unhelpful’. We can only manage and mitigate what we know and we can only manage from truth, so my own view is that it is helpful to speak up. The Managers’ Code of Conduct, the final text of which is attached, goes live Monday with some support material on Connect and in our bulletin. The Code has benefitted from your feedback, and is a simple list of ten norms that we want to make our own. That will only happen if we use the Code, and use it to give feedback when behaviours are really helpful, and likewise when someone’s approach may cause inadvertent or explicit harm.
One feature of the Code of Conduct, which I personally think is important, is the need to improve consistently how we articulate why we are doing something or asking for something. On occasion I hear versions of ‘we’re doing it because we were told to’, ‘because Toby says so’, or ‘the commissioner wants it’. All of us tend to work best when we know why we are being asked for extra or different work and we want to become smarter as a Trust is asking for, and explaining, why something is going to change. Taking that step tends to mean we understand what is needed better, and may adapt the request to improve it further. Try it with Unity, as you launch into your team simulations: Are you sure you know why that approach to handover or board rounds is the one?
#hellomynameisToby
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