Agenda Item 4b
Southport and Ormskirk Hospital NHS Trust
REPORT TO THE TRUST BOARD : 14the January 2009
Title of Report
Update on Professionalism
Executive Summary
This report provides an update to the report presented to the
Board in January 2008. The Report clarifies the action
taken and those actions ongoing.
Actions Requested
The Board is asked to comment on progress to date.
Links to Principal Objective
Numbers in Assurance Framework
1,2,3,4,5
Equality and Diversity Assessment
No equality & diversity implications
Risks Attached to the Project/
Proposal
Loss of reputation, volume and income
Public and/or Patient Involvement
N/A
Resource Implications
None at present.
Communication
Name
Jonathan Parry
Job Title
Chief Executive
Month and Year
January 2009
Paper to the Board : January 2009
Update on “A Renewed Culture of Professionalism”
We previously agreed that we would publish a Charter of Professionalism, incorporating all of
the issues that staff had told us were important to them, together with those issues that the
Board deemed appropriate for inclusion. This has not been produced yet because we have
concentrated on delivering some of the specific solutions we discussed at the June Board.
Nonetheless, a draft document will be available at the March Board.
In the meantime, this document should be read in conjunction with the June paper and the
original paper dated January 2008, which are attached for ease of reference. The following
issues were highlighted in the June paper and are updated here:•
Uniform Policy – we have issued mandatory scrub tops for junior doctors and recognising
the need to travel off site, have also made available scrub tops for consultants for those
who wish to wear them.
This assists compliance with the “bare below the elbow”
requirement and also allows patients and relatives to easily identify the doctor – an issue
for some of the junior doctors.
•
Mandatory – we have not completed our work on the definition of “mandatory” and
therefore have not published this. We intend to include it in the draft document which will
be presented to the Board in March 2009.
•
Smoking – new signage and bins have been installed in all the peripheral areas identified
as “hot spots”. However, staff still stand outside the boundary of the hospital and smoke,
presenting a poor image to patients and members of the public.
•
Clutter – further work has taken place to reduce ward clutter. This is an ongoing issue
and we have now established two Hospital Environmental Action Teams, one for each
site, to take forward this work.
•
Sickness – this issue and our response has been revised in a new policy.
•
Information, IT and Financial Support – I have discussed the issues of prioritisation and
customer feedback with the Director of Estates and Facilities. I hope that a new system
will assist staff in understanding when their request will be dealt with.
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•
Hand Washing – patients and visitors are being urged to encourage staff to wash their
hands before treating patients.
•
Training and Development – we are working hard to increase KSF compliance and as
part of aspirant FT status we will review Training and Development policies.
•
Competency – part of the responsibility of the new Divisional General Managers will be to
review the competency of the managers currently in post.
•
Punctuality – the start of finish times of theatres are currently monitored but we need to
do more analysis on outpatient clinic start and finish times.
•
Medical Operational Management – ensuring that this is seen to be fairly and properly
arranged is a major objective for the Divisional General Managers and the Associate
Medical Directors jointly.
•
Policies and Procedures – all have been reviewed as part of the NHSLA review and they
will be constantly updated in accordance with the review timetable and the lead manager
for each policy.
•
Ormskirk Site – Janette Brookes will have lead responsibility on the site for all staff.
•
Empowerment and PRIDE – Details of the Trust’s Pride Awards are covered under
Agenda item 4(f).
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Paper to the Board: June 2008
A Renewed Culture of Professionalism
Following the draft paper produced with the same title as above, the Executive Team have
taken the themes outlined in that paper and turned them into tangible actions to ensure that
staff are very clear in terms of what this Trust expects from them across the range of issues
previously discussed. Our intention is to produce a booklet entitled “A Renewed Culture of
Professionalism” that will be given to all staff to define the Trust’s expectations. Furthermore,
we intend to publish a Charter of Professionalism, adapted from the booklet, which will inform
our staff and patients of the standards we expect all our staff to uphold. Both of these
documents will be presented in draft form to the Trust Board for approval before they are
formally launched later in the year.
Whilst the booklet and the Charter will cover all aspects of dignity, respect, pride, timeliness
and fairness, the specific points from the previous paper are further defined as follows:■
Uniform Policy - The new Doctor’s Scrub Suits will be incorporated into the policy and we
will review all existing uniform policies to ensure they are up to date and consistent in
requiring our staff to present themselves to the public suitably attired.
■
Mandatory – Myself and the Director of Human Resources will attempt to define those
actions and responsibilities which the Trust considers mandatory and the penalties for not
following those mandatory rules.
■
Smoking – We will place bins at the boundary of the sites together with no smoking
signage and we will ban staff smoking on the front boundary of the site.
■
Clutter – We have already gone some way to reduce ward clutter, but the senior
management walkabouts will further help reduce recidivism.
The productive Ward
Scheme will further help and we will look at re-designing storage at ward and department
level and examine the feasibility of off-site storage.
■
Sickness – Increased monitoring, particularly on short term sickness by area.
Responsibility for managing sickness would benefit from restatement.
The Sickness
Policy will also be re-examined.
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■
Information, IT and Financial Support – We will look at new ways to log demand and
allow internal customers to chase progress on issues they have raised.
■
Hand washing – We will encourage patients to question staff and we will be explicit about
the consequences of not abiding by our policy.
■
Training and Development – It is difficult to meet our aspirations for training in the current
financial climate, but at the very least we will expect all areas to comply with the KSF
target.
■
Competency – We will reinforce the requirement with all managers for continual
assessment and the identification of problems and sustainable solutions.
■
Punctuality – The Finance and Performance Committee has requested outpatient start
and finish times and theatre utilisation start and finish times. This issue of punctuality will
be defined in the Booklet and Charter.
■
Medical Operational Management – The new Associate Medical Director system and
Clinical Directors will help reinforce the key issues. We will also attempt to get the Junior
Doctors more involved in the day to day running of the Trust.
■
Policies, Procedures and the Disciplinary Process – All policies are currently being
reviewed and some updated. The mandatory nature of some needs to be reinforced and
we need an indexing system to allow easier access to policies and procedures.
■
Ormskirk Site – The impending management changes will improve both the visibility of
senior management at the Ormskirk site and will allow a greater grasp of issues relating
to the hospital. I intend to hold seminars with staff on both sites about our Strategy and
to answer questions; in the meantime Mrs Brookes has made herself available to staff at
Ormskirk and the Executive Directors are planning more walkabouts of that site.
■
Empowerment and Pride – We continue to discuss the best way of ensuring that staff are
both empowered to problem solve and are praised for good performance.
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Paper to the Board: January 2008
Renewed Culture of Professionalism
a draft Paper by Jonathan Parry
With thanks to all of the different staff members who were wiling to talk about
professionalism and to identify where we could improve.
Introduction
Some time ago there was a spate of incidents within the Trust which led me to consider what
the word “professional” actually meant. Experience teaches that it is wrong to develop policy
in response to the extraordinary outcomes of a particular week; such incidents tend to
average out over a longer time period. However, these issues struck a chord with me as I
had been considering whether our “Safe, Clean and Friendly” values were not missing a
particular emphasis on clinical practice.
Whilst a safe, clean and friendly hospital is
something to be proud of, it perhaps lacks an underlying foundation of a professional
approach from all of the different groups of staff that comprise a hospital.
I discussed the concept with the Trust Board and received strong support for a statement of
professional values as a means of reinforcing what the Trust expected from its staff. In order
to do this, I had many discussions with different staff groups to discover what “professional”
meant to them and what they would want to change within the hospital in pursuit of that
elusive standard. This document attempts to summarise my views and the views of many
different staff members on the concept of what values, principles and actions would comprise
a renewed culture of professionalism. It is not meant to imply that the Trust, and in particular
the staff who make up the Trust, do not embody the highest professional standards, but it
does seek explicitly to define what the Trust expects and to remind staff that self reflection on
our personal and professional standards is never wasted.
Words Used to Describe Professionalism
In analysing the responses from different staff groups and members, it soon becomes
apparent that certain key words are regularly used by staff to encapsulate what they
understood by the word “Professionalism”. I record below the most often used words, in no
particular order, to stand as an apt summary of what professionalism means to staff at the
Trust.
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Pride
Empowered
Respect
Partnership
Honesty
Consistent
Effective
Advocacy
Timeliness
Teamwork
Fair
Ownership
Dignity
Attitude
First
Communicative
impressions
Initiative
Valuing
Praise
Supervision
Right first
time
I don’t intend to comment on these words or their particular meanings, but I do think that,
taken collectively, they form a powerful enunciation of what the word “professional” embodies
within the Trust and what staff expect of managers, other staff members and patients.
Common Gripes
In talking to different groups of staff it quickly became apparent that there are a handful of
issues which particularly annoy us and undermine our professionalism which were
repeatedly mentioned. These are:■
Uniform – The most often mentioned issue was staff not obeying the uniform policy or
generically looking scruffy and unkempt to an extent that other staff felt compromised
their professionalism.
■
Mandatory – There were a number of areas such as mandatory training, registration
with professional bodies and annual leave entitlement where it was felt some staff did
not understand the definition of mandatory as obligatory or compulsory. There was a
strong view that the Trust should clearly state what was mandatory and failure to
comply should result in disciplinary action.
■
Smoking – The “smoker’s corners” on the footpath to Scarisbrick New Road and at
the front of the hospital were universally condemned as giving a dreadful impression
to patients and the Trust was urged to find a means to stop smokers using these
areas.
■
Sickness – There is a common belief that some staff regularly take time off by
feigning short term sickness, putting the remaining staff under pressure.
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■
Clutter – The preponderance of Supplies cages, equipment, chairs and condemned
equipment on the corridors was given as a major issue in portraying an
unprofessional approach.
In common with the recent attempts to de-clutter the
wards, it was felt that more storage space should be developed to remove items from
the corridors.
■
Information, IT and Finance Support – Staff recognised that these areas are understaffed and unable to provide the necessary and timely support to the rest of the Trust
that they need in order to make proper decisions. They believe, without being critical
of the staff in these areas, that such under-staffing compromises their ability to do
their job properly.
■
Hand washing – All staff said they had seen other staff fail to wash their hands on
entering the ward environment or fail to wash their hands when moving from one
patient to another. There was strong support for the recent improvements in alcohol
gel stations outside each ward and for the new signage. Most staff were in favour of
applying disciplinary sanction to those few who flout the rules.
Other Themes
■
Training and Development - There was a strong emphasis placed upon training
and development, which it is acknowledged, have not been our strongest suits during
financial turnaround. In particular, there was an emphasis upon the training and
development of middle managers, ward staff and all staff who interact with patients
and relatives. It is clear that we need to invest in these areas and the KSF reviews
being complete for 100% of staff would be an essential pre-requisite for further
development and reassurance that all our staff have a development plan.
■
Competency - A number of comments were made about competency; ensuring
people had the right training, but also recognising that some staff may not have the
skills necessary to perform the roles that are currently expected within the NHS. This
places a primacy upon continual assessment and managerially on providing different
career routes for those who are judged incapable of performing fully to the Trust’s
requirements. It was recognised that now the whole organisation has undergone the
Agenda for Change process, there is an absolute requirement for staff to perform at
the level at which they are remunerated.
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■
Punctuality - The start of outpatient clinics, the first patient in the operating theatre,
sending patients home at the designated time by ensuring the drugs are ordered and
ready, all featured strongly in my discussions with staff.
There was a strong
undercurrent that punctuality is an essential part of professionalism and that more
effort should be put into being punctual, measuring punctuality and removing the
barriers to punctuality.
■
Medical Operational Management - There was a view expressed that doctors are
reluctant to manage other doctors, be that at a similar grade or indeed at a junior
doctor level. There is also a view that the different terms and conditions for doctors
combined with the limited time contracts of junior’s exacerbates the feeling that
doctors are not quite part of the Trust, but are in some senses, separate and aloof
from the operational concerns that most of us face. The corollary to this is that many
consultants expressed a view that over the past few years their status has been
eroded and their views are either not sought at a national level or immediately
dismissed as seeking of self interest.
■ Policies, Procedures and the Disciplinary Process - The Trust has traditionally had a
strong foundation in policies and procedures, driven by the King’s Fund HQS
process and latterly by our risk management system and our desire to comply
with Level 3 of CNST.
In preparation for the new Trust Risk Management
Standards we are currently reviewing all policies. There is a view that having
spent so much time and effort developing the policies we need to police them to
ensure that they are kept up to date and that when they are breached an
investigation is carried out and disciplinary action is taken, where appropriate.
■ Ormskirk Site - The feeling persists at Ormskirk that they do not see the senior
management frequently and that therefore Ormskirk is secondary to Southport.
This is far from the truth, but is a myth that cannot be slain. Given the continuing
importance of the Ormskirk site to the Trust and the opportunity to expand the
services on that site, I intend to change the management structure to ensure that
senior management is strongly and visibly represented at Ormskirk.
■ Empowerment - This word was used a number of times in my discussions with
various Groups.
I took it to mean allowing and facilitating staff to resolve
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problems without recourse to bureaucratic procedures or permission in order to
speedily remove the barriers to excellent care and treatment.
■ Praise - Another commonly used phrase – staff want to be praised when they do a
good job and resent not being praised when the feel it is deserved.
■ Open Day/Quality Awards - Several Staff spoke of the camaraderie and
enthusiasm generated by various events the Trust has hosted in the past. The
two events most often mentioned were the Trust Open Day and the Quality
Awards.
Conclusion
There was a vast range of subjects discussed openly and honestly by staff and this
paper cannot do justice to all of the issues mentioned, although I do have a written
record of them all. Professionalism is not easy to define, over and above the codes laid
down by professional bodies, but the issues raised have given as good a summary of
what our staff believes it means as we are likely to find. It is difficult to write this without
sounding like a heavy-handed disciplinarian; that is not to say that some aspects would
not be achieved by a clear application of the disciplinary rules, but the issues raised here
go much further than simply requiring heightened enforcement of the rules and
punishment for transgression.
If this paper captures the important element of a renewed culture of professionalism in
the Trust, then those elements require a detailed plan, agreed through the Board, of the
action required to produce cultural and operational change in the way we think and work.
January 2008
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