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					                                                                            BOD 241/2009

           BOARD OF DIRECTORS – 16 DECEMBER 2009

       ORGANISATIONAL DEVELOPMENT PROGRAMME:
           PROGRESS SUMMARY AND REFRESH




                                     EXECUTIVE SUMMARY

Organisational Development is an important strategic initiative for the Trust. The
Board of Directors approved the programme in January 2009. This report outlines
progress achieved in the first 10 months and sets out the work programme for the
next year.




                          THE BOARD/COMMITTEE IS ASKED TO

- Note the content of the report and discuss the future work programme and
  suggested approaches.




Regulatory framework

This report supports all of the Strategic Objectives.

This report provides evidence in respect of Healthcare Commission standard C8b,




RESPONSIBLE DIRECTOR: David Brettle, Director of Human Resources
Striving for Excellence
A Three Year Organisational Development Programme
January 2009 – December 2011
Progress Report at December 2009

1. Introduction

1.1 CNWL’s three year organisational development was approved by the Board of
    Directors in January 2009. This report highlights the key achievements made
    during the first 11 months, it sets out those areas where progress has been
    more limited and explores the reasons for this. Finally the report highlights new
    streams of work that have been initiated and those that need to be incorporated
    into the programme during the next year to 18 months.

2. Context

2.1 The external climate has shifted quite radically during the past year: an increase
    in the public sector debt levels which is likely to impact across both health and
    social care; a more assertive approach to commissioning care services; and
    greater regulatory demands on the organisation to demonstrate the quantity and
    quality of care provided. All of which culminate in a demand for higher quality of
    care (which needs to be demonstrated/measured) at a time when investment
    levels reduce.

2.2 Taking account of the above the central elements of the organisational
    development programme remain as being:
        to ensure a fair but rigorous approach to performance management,
         investing in the potential of our existing workforce wherever possible;
        to maintain our reputation for excellence and continue to attract high
         quality staff;
        to support the development of the organisational infrastructure – systems,
         processes, ways of working, and change management – to improve their
         effectiveness; and
        to develop the connectivity between clinical and corporate services to
         optimise performance across the whole.

2.3 The OD programme highlighted its connectivity to other programmes of work:
    the collection of projects designed to put in place a technological architecture
    and use business intelligence tools to aid performance management and the
    development and implementation of a quality framework. All three strands
    continue to be seen as fundamental to the future success of the organisation:
    understanding current and improving future effectiveness of delivery and the
    quality of care through using information intelligence; and supporting our
    workforce to develop their caring, management and leadership and
    organisational change capacities to deliver excellence to the populations we
    serve.




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3. Progress report

3.1 Progress made against original timescales each stream is indicated using a
    RAG status.



     Stream 1
     Infrastructure


Objective:       To have in place procedures, policies as well as a technological
                 infrastructure to facilitate an environment where workforce
                 development happens in a planned way, is aligned to service and
                 trust objectives and tracked to determine its effectiveness.

Work completed:

1)    The procurement and implementation of the learning management system
      happened within the agreed timescale. The subsequent roll out of the system
      to all staff has been brought forward and will take place during December
      2009. Its successful implementation contributed to our Level 2 award by the
      NHS Litigation Authority.

2)     Some progress has been made with integrating our workforce and business
       planning processes. A workforce plan was signed off by the HR Group in
       March 2009 and a framework produced for HR Managers to deliver within the
       service directorates. However this needs further work to truly integrate our
       processes. It is proposed that this happens through a new performance
       management project (see below).

3)     A new centralised system for recording the status of appraisals has been put
       in place and is reported quarterly. Not unexpectedly, the quality of the initial
       data is low however this is actively being addressed and we anticipate being
       in a position to formally report through the clinical governance route by March
       2010. The importance of supervision and appraisal is being reinforced with
       staff through a number of routes: a communiqué from the Chief Executive,
       with Service Directors at the HR Group, with staff through a new in-house
       supervision and appraisal training course.

4)     A revised secondment policy has been issued and the organisational change
       policy is under review.


Work still to be done:

Performance Management

      A performance management and reward system is in place that reflects and
       rewards achievement at organisation, team and individual level.



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      The knowledge and skills framework, incorporating leadership competencies,
       is seen as a useful tool to aid workforce, service and personal development
       planning and review.

      Individual reviews such as annual appraisals, which may incorporate a 360°
       element, are centrally supported and quality assured.

Work will be undertaken over the next financial year to develop the performance
management culture and underpinning systems to ensure that we are appropriately
identifying and incentivising individual performance; financially rewarding individuals
when it is positive and managing it appropriately when it is not. Linking in the core
behaviours to the appraisal process will happen. We are learning from the approach
taken by John Lewis Partnership and this will inform our approach. As part of this
process, it is recognised that we will need to align organisational, directorate, team
and individual objectives.

The original timescale for delivery was October 2010, this remains achievable.

Learning Zone

All staff are able to access a newly created learning zone area of the intranet to
assist them in identifying professional development opportunities and pathways. The
zone will provide a comprehensive signposting service, putting staff in touch with a
full suite of clinical, non clinical and management learning opportunities (both
internal and external), framed around the knowledge and skills framework and
leadership qualities framework. The original timescale for delivery was January
2011, this remains achievable.

Timescale:




    Stream 2
    Ensuring the basics are in place


Objective:       The Executive Board is assured that basic behaviours expected of
                 staff and associated with the Trust’s core values are understood
                 across the organisation and form an integral part of all staff
                 interactions. Further, mechanisms are in place to recognise and




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                 reward positive practice and these form part of an overall package
                 developed to motivate our staff to deliver a high quality, innovative
                 service.

Work completed:

1)     A set of core behaviours, derived from the Trust’s Core Values, linked to the
       Staff Charter is in the process of being agreed by the Executive Board. The
       will now be communicated to all staff and formal part of our induction and
       recruitment materials. In addition they will be promulgated through the
       Customer Care training package.

2)    A monthly scheme to recognise and reward good practice has been
      introduced and annual culminates with the Trust wide award ceremony.

3)    The customer care training is being rolled out across all inpatient services. To
      date training has happened across Westminster, K&C and Hillingdon. The
      new financial year will see the training being delivered to Harrow, Brent and
      older adult services.

4)    The Board to Ward programme is underway.

5)     As part of the corporate branding exercise a number of focus groups were
       held to better understand what the motivational factors for our staff are in
       working at CNWL.


Work still to be done:

Quality Accounts

Although some limited progress has been made in defining quality indicators for the
quality account, it is embryonic at best. The original plan was to develop a series of
indicators that routinely monitor the ‘health’ of teams and services (both operational
and corporate). We anticipated that trigger points be developed to highlight
exception, before a situation is critical so that a considered, graded intervention
could be initiatied.

In part the delay to the delivery of the business intelligence software has been a
contributory factor, but more generally the focus on ensuring good quality data
across the organisation remains a priority and is key to the future success of the
organisation.

The service improvement team model - intervening in problematic areas to diagnose
and improve – is delivering.

Work will be undertaken over the next year to deliver the original indicator set. The
original timescale for this work to be completed was March 2010. It is unlikely that
this will be achieved and a new date of March 2011 is proposed.




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Timescale:




     Stream 3
     Shaping change and supporting staff to adapt


Objective:       The organisation is able to respond to its internal and external
                 environment and transform the way it delivers services within an
                 ongoing, realistic change programme. A supportive culture exists
                 that promotes a facilitative process of individual adaptation to
                 change.

Work completed:

1)     Some progress has been made in this area, such as the commissioning of
       project management, change management, negotiation and influencing skills
       training, all of which support the organisation’s change management capacity.
       The introduction of the RCN’s clinical leadership programme for our middle
       managers will also considerably contribute to this, over time. However the OD
       programme has not yet delivered a standard, scalable organisational
       framework to implement change.

       Significant organisational change is currently in initial planning stages – the
       introduction of service line management and adopting a clustering approach
       to service configuration. It is hoped that the OD function, through the
       programme, can support this work (see below).

2)    The original programme identified a need for a networked body of individuals
      working (on a sessional basis) across the organisation to provide additional,
      temporary capacity in supporting the OD programme specifically in relation to
      the management of change. To date, one individual has been funded for one
      session a week to facilitate group and team away days, undertaking work in
      Hillingdon and The Gordon Hospital. It is hoped that additional capacity will
      be created in the future and the five individuals undergoing the RCN clinical
      leadership programme will potentially join the network.




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Work still to be done:

Organisational change framework – service line management

The organisation has signalled its strategic intention to introduce a service line
management configuration, initially utilising a clustering model. Moving from the
current to the future state will undoubtedly involve a significant change programme
for the organisation, which the OD programme could support. The detailed approach
is not yet confirmed and further discussion is needed to progress this.

Research Evidence Base

The organisation has contributed to the national research evidence base for
organisational change and published in this area. The original timescale for this was
November 2011. This date is thought to still be achievable


Outline timescale:




     Stream 4
     Leading to the future

Objective:       CNWL is known across the NHS in London to be an organisation
                 that recruits high calibre staff, supervises them well and invests in
                 their development. It has a reputation for producing the leaders of
                 tomorrow. It has in place management and leadership development
                 programmes that recognise the potential in staff and cultivates
                 them to realise their potential and grow into leadership roles.



Work completed:

1)     Some progress has been made in defining the leadership behaviours we
       consider to be important, which feature in our new Staff Charter. These have
       yet to be fully disseminated. The introduction of a manager’s handbook will
       also provide a mechanism by which this information can be promulgated to
       staff (see below).

2)     A one year development package will be in place to support staff in their first
       line management roles.




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     This was introduced on an in-house basis in January 2009. The first cohort
     (20 managers working in Hillingdon and Harrow) has just finished, providing
     very positive feedback. The action learning sets are extremely valuable to the
     individuals and will continue for a further year. Some additional skills
     development sessions are also planned for the first cohort as part of a second
     year.

     The original OD programme was clear in its intent to ensure a broad
     representation of staff for BME backgrounds on its management development
     programmes. 53% of staff attending the first cohort were from black and other
     minority ethnic groups.

     A second cohort drawn from across the whole organisation will commence in
     March 2010. Following detailed evaluation a small number of changes will be
     made to the programme.

     In addition, in October 2009 a further 12 individuals (in both clinical and non-
     clinical roles) started the new in-house Diploma in Management and
     Leadership, accredited by the Chartered Management Institute. We have a
     waiting list for places on this programme and hope to start a second cohort in
     February 2010.

     The High Potential Manager Programme run in 2008/09 was evaluated with
     mixed reviews. A decision not to run the programme in 2009/10 was made.
     However development opportunities to this group of staff will be further
     considered.

3)   We continue to invest in clinical leadership across the organisation. Dr Gira
     Patel, Darzi Management Fellow is developing a modular leadership
     programme for SpRs that will be introduced in 2010. In addition the OD
     programme has funded five senior clinicians (OT and nurses) to undertake an
     18 month RCN clinical leadership programme, which the individuals will
     provide on an in-house basis thereafter. Three cohorts are planned for 2010
     offering 36 places. The programme is targeted at Band 7 and 8a staff and
     includes clinical observation work to inform individual projects that are
     designed to improve the quality of patient care.

4)   In house expertise in constructing and running assessment centres continues
     to be developed. In addition to the introduction of assessment centre
     approach for Band 5 nurses, the organisation has adopted this approach for
     all new Service Director positions. Work is in progress to extend this to other
     management posts.




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Work still to be done:

A coaching culture

The original OD programme set out a desire to utilise the skills of senior managers in
mentoring and coaching individuals and groups of staff throughout the organisation.
Training for senior staff in coaching may be needed to support this.

We have been working with Ashridge Business School to put in place support for
senior staff in developing their coaching skills. The initial uptake of this has been
poor and the plan is being reviewed in light of this. It is likely that the focus of this will
move more to the service director and lead clinician roles particularly in light of the
proposed service line management change programme, and the desire to put in
place a more effective performance management culture. A broader focus on
leadership development programmes for these individuals, rather than just coaching,
is likely.

Training Needs Assessment – on line self assessment tool

No progress has been made with developing an automated self assessment tool to
help individuals and their line managers identify skills gaps and training needs as
part of the annual professional development planning process. This is largely down
to workload capacity. However, there remains a need for such a tool and this will be
taken forward in the next year and aligned with the learning zone work outlined in
stream 1.

A focus on Leadership

The original programme set out a proposal to establish a series of monthly master
classes providing access to motivational speakers, the results of latest research
evidence in relation to leadership, new service models and ways of working etc. to
provoke discussion and debate within the organisation. This work remains
outstanding.


Ward Managers

Arising from the special measures work at the Gordon is a proposal to undertake
some specific research around the role of Ward Managers within the organisation:
providing clarity on their responsibilities, accountabilities and the competencies
required to be truly successful; all set within the context of the modern matron role
above, and deputy ward manager below. Ultimately we hope to set out a
development pathway that supports staff, from Band 5 across nursing and other
clinical and non clinical professions, to develop their management capabilities. We
anticipate that this project will look more broadly at other sectors – the police force,
for example – to learn about different approaches.




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Managers Handbook

A manager’s handbook will be developed bringing together the performance
management framework, management behaviours and role expectations, together
with advice on trust policy and key performance indicators for managers. John Lewis
Partnership have developed a specific balanced score card for managers and we
will evaluate the applicability of such an approach within CNWL. The manager’s
handbook will inform our induction process for new managers and will be the
benchmark against which all our managers are appraised. This will be introduced in
March 2010.


4.   Financial Spend

4.1 The following table sets out the forecast outturn position for the OD budget in
    2009/10, together with indicative costs for the remainder of the programme.

                                                             £000
 Element                                      2009/10*       2010/11      2011/12
                                              Forecast
                                              Outturn
 Technology phase I
 Technology phase II                              20
 Learning zone                                                  40
 Performance management (inc John                 20            20           20
 Lewis and manager’s Handbook)
 Core behaviours                                  10
 Reward & Recognition scheme                      10
 Motivation research                                            10
 Indicator pack                                                 5
 Framework in place                                             10
 Confederation                                    9             25           25
 Research evidence base                                         30           30
 Leadership Framework                             5
 First Line Management Programme                  30            30           40
 Self Assessment Tool                                          15
 Assessment Centre Development                    10
 Service Director & Lead Clinicians               50            50
 Coaching                                         15            10           10
 Leadership Portfolio                             10            20
 Total                                           189            265          140




5.   Conclusion

5.1 The Board of Directors is asked to note the progress to date and comment on
    the proposals for future work.




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