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Why Northamptonshire Healthcare NHS FT tore up the traditional management structure

23 Jan 2020 By Eleanor Whitehouse

Learning from failures at other trusts, the community and mental health care provider implemented the concept of 'distributed leadership' to give staff autonomy and improve engagement

Anyone who’s ever had a job is used to the long-established leadership hierarchy. But what if you did away with the formal ranking and gave everyone in your organisation the tools and confidence to solve problems without needing to defer upwards? That’s what community and mental health care provider Northamptonshire Healthcare NHS Foundation Trust (NHFT) chose to do – and so far, the somewhat unorthodox decision is paying dividends.

In 2016, with the dark cloud of a ‘requires improvement’ rating by the Care Quality Commission (CQC) the previous year hanging over it, survey results put the trust’s staff engagement at just 3.85 out of 5. Little more than half said they would recommend it as a place to work, and 15 per cent of positions stood vacant. “The organisation wasn’t in the best place,” admits Chris Oakes, director of HR and OD (pictured). “We had some challenges around cost improvement and high use of agency staff.”

Learning from other trusts in far worse predicaments was the first step on NHFT’s road to recovery. Oakes describes how the 2013 Francis report into failures at Mid Staffordshire NHS Foundation Trust found a ‘command and control’ structure, in which staff felt disempowered and unable to make decisions in the absence of their superiors. “No matter how many standards you have, you need people who, when managers aren’t around and things aren’t right, will do something about it,” Oakes says. That idea and the desire to break away from traditional management structures led to the discovery of the ‘distributed leadership’ model – in which every member of the trust’s 4,200 staff feels like a leader and is able to make decisions without deferring to a manager.

But rather than simply putting its people on a one-off training course to teach them to be leaders, Oakes and his team across HR, OD and communications worked to embed this concept across the trust’s culture. “We weren’t telling staff they had to go off and do an MBA – it was more about agreeing how we expected them to behave instead of just having certain skills,” says Oakes. “We want them to see a problem and do something about it, not walk away because it’s too stressful.” 

And getting staff to sign up to a way of acting at work meant defining a set of agreed leadership behaviours. Crowdsourced from more than 200 employees at one of the trust’s regular Leadership Matters conferences, the set of four defined behaviours – ‘being authentic’, ‘embracing change’, ‘taking responsibility’ and ‘working together’ – are embedded across NHFT’s entire ethos. “It’s the bedrock of everything we do,” says Oakes. “It’s not just a policy that’s created and then sits on a shelf gathering dust.” And to help staff live the behaviours, the trust’s new approach is bolstered by a range of training courses, including negotiating for influence and personal brand, to further empower employees. The response to the changes has, Oakes says, been extremely positive, with the best feedback being when those who undertake the courses go on to get promotions.

But it hasn’t always been plain sailing. “It’s taken a lot of trial and error,” says Oakes. “Continuous learning has been a big part of it.” For example, targeting the courses at certain groups of staff has helped those taking part get the most out of them, and they are now offered as part of a portfolio of training. The trust also places emphasis on improving diversity, and works with employees to overcome their individual barriers to career progression – part of which is a reverse mentoring programme with BAME members of frontline staff. “It was incredibly enlightening,” says Oakes, who was mentored by a nurse. “She faced so many challenges in coming to the UK and carving out her career – it changed how I see my job.”

To ensure the leadership behaviours continue to be used, they now form the basis of appraisals and onboarding, as well as key staff communications, including a weekly email newsletter and a podcast that aims to maintain engagement among particularly hard-to-reach employees. “Lots of our staff are based in the community and prison healthcare environments, so can’t always access our intranet or emails,” says Oakes. “But they can listen to a podcast while driving to work, and we take on board what they want to hear about.”

NHFT’s distributed leadership work also sits alongside its wider commitment to improving engagement, dubbed the Let’s Talk Plan, which aims to engage staff across different directorates by sharing and acting on specific results from the staff survey, as well as ensuring a joined-up approach to themes such as wellbeing and diversity across the entire trust. “We’re doing everything through an OD lens now and looking for more long-term solutions,” says Oakes. “It’s more holistic – not just grabbing the policy off the shelf.”

And the new strategy of empowering and communicating with staff is clearly working – the trust’s engagement score jumped to 4.01 in 2018, and vacancies in December of that year sat at just 8.7 per cent. The engagement and leadership work also earned NHFT a string of accolades in 2019, including the CIPD People Management Award for best employee experience initiative; best wellbeing and staff engagement initiative at the Nursing Times Workforce Awards; and the Health Service Journal’s staff engagement award. 

What’s more, the trust is fresh from its second consecutive ‘outstanding’ CQC rating, and is now being used as an example of best practice to support other trusts. As Oakes highlights, all the work his team is doing boils down to improving care for patients. “We need to invest in our culture to make it work,” he says. “And the right culture will give the right care.”

Take a leaf out of NHFT's book and enter the CIPD People Management Awards – and you could just leave with a prize. The 2020 awards are now open – visit for more information and to download an entry kit

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