Independent organisational culture review Report for University Hospitals Birmingham NHS Foundation Trust

A shift to openness and transparency
The Trust Board should publicly acknowledge the depth of feeling, challenge, and concerns that staff have raised in this review. The Board should commit to proactively listening and acting on the issues raised and actively encourage openness and transparency so that staff are able to do the right thing.
Recommended timeframe: Immediate

A shift to valuing staff and ensuring equity and inclusion
The Trust Board should:
• recognise and value the openness of staff in this review
• highlight areas of best cultural practice offered by staff
• support the continuation of an at-scale approach to staff engagement that is
open, transparent and based on staff being able to ‘do the right thing’.
Recommended timeframe: Immediate
To support this shift, the Trust Board should consider a comprehensive and
consistent approach to:
• describing a core set of standards of behaviour that promotes a
compassionate environment
• ensuring effective underlying policies and processes
• defining, embedding, and assuring a zero tolerance approach to the
challenging cultural issues identified by staff within this review
• engagement with staff to understand what these shifts toward a safe working
environment should look like
• create a regular cycle of assessment and review with dedicated Board
oversight.
Recommended timeframe: 1-3 months

The Trust should consider whether its operating framework
enables the promotion of a respectful workplace. Due reference
should be given to thoughtfulness of staff time, protection of
personal boundaries, recognition of service, and the promotion
of a respectful and appropriate tone in day-to-day
management. This should be underpinned by a renewed
approach to accountability.
Recommended timeframe: 1-3 months

A shift to ensuring culture directly connects to effective patient care
The Trust Board should shift to an integrated approach to culture and quality,
recognising the relationship between staff experience and patient experience.
This should be adopted across the Trust at all levels. To support this shift, the Trust
Board should:
• ensures that it places equal focus on both creating and ensuring a positive
culture alongside effective patient care and use of resources.
• develops an oversight framework that triangulates and provides assurance on
key cultural indicators as well as quality of care and use of resources.
• ensures all improvement work care is underpinned by a robust cultural
framework.
• ensures all managerial and clinical leaders have an understanding of the link
between a positive working environment for staff and delivering effective care.
Recommended timeframe: 1-3 months

Overarching recommendation
In light of the issues raised by staff:
• ensure and deliver staff safety as a core focus of UHB
culture
• define and communicate the actions expected by all staff
to create a zero tolerance approach to inappropriate
behaviour
• immediately review the underpinning policies and
procedures which support a zero tolerance approach
• create the mechanisms for assurance and regular
review of this approach alongside staff representatives
• ensure sufficient advice and resources are available to
staff and managers, to support effectiveness of raising
and dealing with concerns, including routes to advocacy
and supporting staff in speaking up.
Recommended timeframe: 1-3 months

Staff Safety
To ensure a culture of staff safety, the Trust should:
• review and broaden its training programmes to enable
staff to have the skills to manage challenging behaviours
from both staff, patients and families
• further highlight the antiracist statement which staff are
supported to live by to ensure zero tolerance to
discriminatory behaviour – positive actions should be
recognised throughout the organisation.
Recommended timeframe: 1-3 months

Sexual Safety
To ensure sexual safety in the workplace, the Trust should:
• develop absolute clarity on what sexual safety means at
UHB, utilising best practice guidance and definitions
(e.g. signing the NHS Charter on Sexual Safety)
• ensure this is widely communicated and understood by
all staff
• develop a clear policy for management and advice on
matters relating to sexual safety
• ensure sufficient advice and resources are available to
staff and managers, including routes to advocacy and
highlighting the key role of restorative justice in resolving
issues
• support and encourage staff to speak up, and respond to
all concerns in a timely manner.
Recommended timeframe: 1-3 months

Staff Wellbeing
As part of acknowledging the culture presented in this review,
The Trust should recognise that for many staff, mental and
health and wellbeing has become challenged.
Whilst this is a thread throughout all recommendations, the
Board should specifically seek assurance and a deeper
understanding of what is impacting staff wellbeing, and develop
a strategy that embeds staff wellbeing into everything the Trust
delivers (including provision of appropriate resources).
Recommended timeframe: 3-6 months

Freedom To Speak Up
The Trust should swiftly review the policy around FTSU and its
application and management in practice.
This should include:
• an understanding from staff of the perceived and real
barriers to raising concerns
• an understanding of how effectively the organisation
responds to concerns raised and feeds back to
individuals
• the effectiveness of communications and engagement
methods to publicise FTSU avenues to all staff
• the approaches to sharing with staff where actions have
led to demonstrable change.
Recommended timeframe: 1-3 months

Leadership Style
Consider developing an organisation-wide leadership
programme that specifically:
• is co-produced to reflect the culture that staff would like
to see in the organistion
• enables the trust to deliver the shifts outlined in this
review
• provides a non-discretionary programme that enables
both self-reflection, dialogue and development of
existing managerial and clinical leaders
• recognises the need to place equity, diversity and
inclusion at the core of leadership behaviours, and
support staff to understand this
• becomes a core tool for how leaders conduct
themselves at the Trust.
Recommended timeframe: 1-3 months

A shift to ensuring a physically and psychologically safe working
environment
The Trust Board should consider a comprehensive approach to:
• describing a core set of standards of behaviour that promotes a safe working
environment
• ensuring effective underlying policies and processes
• defining, embedding and assuring a zero tolerance approach to the
challenging cultural issues identified by staff within this review
• engagement and co-production with staff to understand what these shifts
toward a safe working environment should look like
• create a regular cycle of assessment and review with dedicated Board
oversight
• Continuous learning, including ensuring best practice from inside UHB and
other NHS organisations and sectors is regularly considered.
Recommended timeframe: Immediate

To hear all voices and demonstrate to staff they are being
listened to in an equitable way, the Trust should:
• demonstrate a curiosity and inquisitive mind, that invites
and encourages staff feedback from all staff. The Board
should take a leadership role in exhibiting these
behaviours
• ensure all leaders demonstrate and evidence how staff
feedback is being promoted, managed and acted upon
in their business area
• to monitor where and why particular groups of staff are
not able to evidence the use of feedback, and take
targeted action where this is the case
• include training, advice and guidance to all managers as
part of the Trust wide leadership development
programme
• adopt NHS best practice in this area.
Recommended timeframe: 3-6 months

The Board should ensure that all staff experience a culture that
provides resource and opportunity in a fair and equitable fair
way. There should be a zero tolerance approach to
discrimination and prejudice of any sort. The Board should:
• actively promote and assure itself of staff feedback on a
regular basis.
• further highlight the Trust antiracist statement which staff
are supported to live by to ensure zero tolerance to
discriminatory behaviour – positive actions should be
recognised throughout the organisation.
• continue to support the positive changes being made in
recruitment to address inequalities
• recognise and continue to support the current
development programmes
• highlight the role and importance of the staff networks in
providing insight, advice, and guidance on the continual
promotion of fair and equitable culture – both into Board
and to all staff groups.
To support the shift towards an inclusive workplace, good
practice can be found in the principles from creating an
inclusive workplace (CIPD4). This clearly sets out an approach
the Trust could adopt. These are:
• Clarify the organisation’s stance and values: Set clear
expectations of what the organisation stands for and
maintain zero-tolerance.
• Co-create a systemic approach for practical action by
working across the organisation: Scrutinise all
operational processes, ways of working and people
management policies.
• Commit to sustained action through visible leadership
and a willingness to change: Sustained action needs a
long-term plan, led with firm commitment from the top.
• Critically appraise people management approach from
end to end.
• Connect people by creating safe spaces, systems and
times to talk, share experiences and learn from each
other: Ensure plans are informed by employee voice,
and bring in experts where necessary.
• Communicate messages consistently and ensure the
conversation is two-way: Leave the workforce and wider
stakeholders in no doubt about key messages. Ensure
they are reflected in people’s behaviour, in the
organisation’s operations, and in the organisation’s
interactions with stakeholders.
Recommended timeframe: 3-6 months

As part of the broader efforts to create an open and transparent
culture, the Board should consider implementing a clear
framework for co-production as the default method for service
and staff development. This should be implemented alongside
the work on ensuring all voices are heard (Recommendation 4.
Getting Voices Heard, page 48).
Recommended timeframe: 3-6 months

The review recommends that the Trust adopt or adapt
principles for co-production. These should include:
1. Recognising people as assets
2. Building on people's capabilities
3. Developing two-way, reciprocal relationships
4. Encouraging the role of networks
5. Building strong feedback loops for staff
6. Embedding advocacy for seldom heard groups
Delivering co-production will require placing communications
and engagement at the heart of the Trust. The Board should
consider whether the current function has sufficient capacity
and capability to deliver the scale of engagement to undertake
the shifts this review outlines.
Recommended timeframe: 3-6 months

Creating a healthy, open and progressive culture requires
strong, visible, and representative leadership at all levels.
The Board should:
• build on the recent Board changes to further consider
the diversity, visibility, and representation of its
membership
• review and evaluate the levels of transparency and
openness in the Trust recruitment process, particularly
to senior positions
• consider the balance of representation across senior
medical roles, with particular reference to gender identity
• ensure that the principles developed (Finding 5,
Fairness, Equity, and Discrimination, page 49) are
embedded in leadership across the Trust
• ensure linkages to the leadership development
programme (Finding 3.6, Physical and Psychological
Safety and Wellbeing, page 48) so that the Trust can
support and develop leaders with the appropriate skills
and behaviours to underpin cultural change
Recommended timeframe: 1-3 months