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When the Culture of Care programme was developed to meet the ambitions set by NHS England a core component of delivery was the offer of quality improvement training and coaching to participating inpatient teams, and the offer of leadership coaching to senior executive sponsors of the work.

The hope was that by offering ‘ward and board’ coaching we would increase the impact and influence of the culture of care standards and underpinning equity principles. The thinking was that this method would help to spread the message of culture of care beyond the walls of the participating wards to other parts of the organisation. Inviting executive colleagues to take part in the programme, felt particularly important because there is a strong evidence base that leaders have hugely influential role in the establishment of a positive organisational culture and can greatly enhance the psychological safety needed for undertaking quality improvement work.  As the late, great Swiss-American psychologist and Professor at MIT, Edgar Schein said “The only thing of real importance that leaders do is to create and manage culture. If you do not manage culture, it manages you, and you may not even be aware of the extent to which this is happening”.

Given the importance of leaders to create a culture of care, we wanted to invite executive colleagues to co-create a safe confidential space for reflection and protected time to think. Typically, executive coaching is delivered 1:1 by a qualified coach. In the Culture of Care programme the coaching was designed to be delivered through a unique pairing of an expert by experience and a senior leader in healthcare with significant experience of coaching. The idea was that each pair would be able to offer executives a unique coaching experience with a strong focus on the value of lived experience and co-production. Having looked carefully, we’re yet to find any other examples from improvement collaboratives of people trying to coach in this dynamic and interesting way but would love to hear from others trying to share power in this way if they are out there.

In practice, we are learning that whilst we use a great many coaching skills and in our work together with the executives, what each coaching pair are offering is not what you would traditionally call ‘ executive coaching’. One of the main ways it differs is that each pair comes to the session, not as ‘neutral’ coaches with no agenda of our own, but with a real wish to see the Culture of Care standards improve. In this way we are more like sports coaches, than executive coaches, as we are totally invested in the results.

Whilst it’s still early days, what we seem to be co-creating with the executives, is a way of reflecting together on the culture of care standards which blends our collective passion for change and commitment to improvement, with a curiosity about how to support the ward teams in meaningful ways, whilst also reflecting on the leadership dilemmas and pressures each executive and their board faces. When they go well, these sessions feel like reflective spaces, where there is time out of highly pressured days to stop and think, to hear and value the voice of lived experience and to think at a personal level about the leadership gestures and actions that will support this work.

Common themes are emerging from these reflective conversations, such as, how to best implement the PCREF standards, how to acknowledge and think about systemic racism, how to empower experts by experience and ward staff to continuously improve the co-production and improvement processes, how to re-think risk, how to be a visible leader when you are spread thin, how to align the Culture of Care work with ongoing work and Trust strategies etc. We are also seeing a great appetite to learn from the other Trusts involved in the Culture of Care network, to do once and share and to connect.

At a recent meeting of the leadership coaches and experts by experience we concluded that we are not coaching in the traditional sense of the term. We are trying to work meaningfully and respectfully in pairs, bringing together our different skill sets and experience to try to facilitate reflective conversations. It’s not always easy, but when it goes well we live in hope that the dialogue we have and the relationships we are building, might help us  take steps towards creating and managing cultures of care.

Written by Anna Burhouse, Culture of Care Leadership Coach

Inpatient Celebratory Event - 8 January 2025

• Civility and Respect
• Clinical systems
• Ward QI project on reducing incidents of violence and aggression
• Triangle of Care: Expert by Experience (EbE) Carers
• Neurodiversity (SPACE framework)
• EbE’s: Experience & Involvement

• Abiola Jokomba, Ward Manager and Professional Nurse Advocate, Opal Ward said: “The event was really refreshing and provided an avenue to engage with colleagues from other areas. I can’t remember attending such an event in a while.  Also, the talk by Sal Smith, explained the whole essence of the culture of care, which was brilliant!
  

• Dominic Holmes, Charge Nurse, Highfield Unit mentioned: "It was really nice to celebrate the hard work that staff do on a daily basis within inpatient units and feel appreciated by senior management. I would welcome them to attend the wards as part of this valuable initiative to hear the experiences the frontline staff. It is so important for staff to feel seen and valued if want to address the significant challenges associated with the retention and recruitment or nurses."
  

• Charmian Whall, Ward Manager quoted: “Fantastic day, was good to meet people from all of the different teams, to have the time to talk and share information.”

• Kerri Caffekey, Ward Manager Sandford Ward, Fulbrook Centre said “An enjoyable event, is was a pleasure to have the opportunity to have the focus upon inpatient and for staff to share experiences across many services but all having the inpatient care linking us together. I particularly enjoyed the workshops in the afternoon.

Gardener Unit

The team at the Gardener Unit has fully embraced the ethos of the Culture of Care programme. We have been motivated by the involvement of our young people, families, and staff. Discussion about our change ideas have become ingrained in our normal conversations on the ward. We have been challenged to look at different approaches because the programme has reminded us that it is okay if ideas don’t work. Taking positive risks and 'thinking outside of the box' has helped to engage our young people. We have a strong participation group that has empowered our young people to share their ideas because they feel they are being heard.

We have recently restarted family visits to the ward and received positive feedback from parents. One parent said:

"I found it immensely comforting to see where my son spends his time and the facilities available. Visiting the ward gives me a better understanding of what he has been doing which helps me feel closer to him. He was proud to show me his room and this gave me a renewed sense of connection with him."

The changes that we are making as a part of this programme will not only impact the young people's experiences of care on the ward but will also influence lifelong changes for them and their families.

To find out more contact Mindy Reeves.

Syrena House

At the Learning Network 1& 6 event in Bristol, I was blown away by Livewell’s Syrena House team, who spoke about their journey on the culture of care programme so far, and how much it has meant to their staff and patients. The team became emotional on stage, and I suspect this was coming from a place of really caring about their jobs, their work, their patients, and patient feedback about their delivery of care, including feedback from a patient that "this is the best experience of a mental health ward I have had in 20 years of admissions."

Sitting alongside the Syrena team on the stage, I have never 'felt' a vibe and a culture more, and I can't describe that feeling in words other than I was completely moved. The team’s human-ness, dedication and resilience really showed that day, and it reminded me very much that there are amazing people out there who come to work to go above and beyond doing a good job. 

The team's emotion as they spoke was so powerful, and I feel like as a room everyone came together as humans, cried, and reconnected with exactly what this programme of work is all about. I was so moved when an Expert by Experience from another Trust came up onto the stage to say to the Syrena House team that she thinks they are emotional because they care about their patients, and they genuinely want to make people's lives better.

As their coach I am so proud of the team for the bravery and emotion they brought to the stage that day – and for all of the work that they do on their ward. Chatting to them at the event was truly magical.

Culture of Care YouTube video and podcast

North Staffordshire has created a YouTube video and podcast on the culture of care in their wards. They've taken a unique approach, using the co-produced TRIP framework to guide community meetings with patients, carers, and staff. While four wards are part of the Culture of Care coaching, they are expanding the initiative to all eight inpatient wards and using the same surveys to collect meaningful data.

Reflection from QI Coach Rianna Herbert

"I presented an overview and update on the Culture of Care (CofC) programme to Central and North West London NHS' service user and involvement forum on behalf of one of the wards I am coaching.

"It was positive to hear first-hand that the change ideas that the CofC ward have been testing have been shared with other wards in the trust who are not participating in CofC programme, as well as the community mental health teams.

"I'd encourage other CofC wards to keep sharing as it's integral to change and making an impact." 

Greater Manchester Mental Health (GMMH) NHS Trust - John Denmark Unit

NHS Professionals, who were awarded the contract to provide GMMH with temporary nursing staff, did not have a system in place or consider the need for recruiting deaf staff or hearing staff with BSL skills. Many deaf staff who had mental health experience, gained this working in community roles, therefore they did not meet the criteria for employment, as past hospital based experienced was deemed essential. We liaised with NHSP about the niche communication skills that were required within the JDU deaf specialist inpatient service.

We educated them about the inequality and barriers deaf people have with gaining employment and it was agreed we would create a code for people who were deaf or had BSL qualifications. JDU agreed to support with a local induction within the service to mitigate risks, for staff who had no prior hospital inpatient experience. JDU supplied NHSP with BSL advertisements that could be promoted within deaf specialist forums and on their website and have agreed to support with BSL interpreters for interviews, until they have a system in place to advertise and recruit independently.

Unique codes were allocated to all GMMH staff with BSL skills who work for NHSP and any newly recruited deaf/hearing BSL skilled staff. NHSP have agreed to prioritise recruitment for deaf and hearing staff with BSL skills, even when they have time periods of paused recruitment. Three deaf BSL communicating staff are finalising their employment checks and will be soon available to work. This will be regularly reviewed and audited to monitor and review progress.