The secret to successful change? Hit the ground listening

Barking, Havering and Redbridge University Hospitals NHS Trust is an acute hospital in east London. We were the most improved trust in the country in the last 12 months for A&E performance and for radiology waiting times. We’re also out of special measures, as of May.

The reason I came here three years ago is that, some years ago, I was regional director for the Care Quality Commission for London in 2013 when the Trust was first put into special measures. My attitude was that as I had put a place in special measures, I should also try and help them out.

Moving from the regulator to the provider side, it is interesting to see what we can do in practice to help organisations improve. Professor Naomi Fulop highlights the importance of relationships. And she is right. So much of change is about building and developing strong relationships.

Understand people’s experiences

When I came here, I was the fourth chief executive in seven years. People met me with polite smiles but I couldn’t blame anyone for thinking “here we go again.” There had  been so many change initiatives that people were not really interested in engaging.

People would come to meetings and listen. Then they would walk out and do exactly what they’ve been doing for the last ten years.

Be patient at the start. We often hear about the ‘first 100 days’ and the desire to hit the ground running. But I don’t think that’s right – you need to hit the ground listening.

That’s my advice to leaders going into organisations that need to change.

Listen and be patient

Don’t always listen to the first people that make a beeline for your door. Some people who are really invested in the Trust didn’t come forward for six to twelve months. Why? Because they understandably thought I was another blow-through executive who would not stay the course.

So, listen to people and be patient. Often, the presenting problem in the NHS isn’t the real problem in an organisation. You’ve got to try to get into that deeper culture of an organisation before you really understand where you can influence and where you can start to push change.

You have what looks like a relatively simple problem – how do we discharge more people earlier in the day? But these are difficult, complicated problems that are all about people and how they work together. It takes time.

When people see your commitment, they start to really believe in what you’re doing.

Show your commitment

High leadership turnover affects trust and confidence. I did an interview with Health Service Journal when I’d not been here very long, where I said if I hadn’t sorted out A&E performance within the next year, I’d have to consider resigning.

Quite a few of the clinicians said this was the point when they realised I was serious about the place. I’d invested myself and my reputation in the organisation’s success.

When people see your commitment, they start to really believe in what you’re doing.

Build the right team

Build a team that addresses your own weaknesses: my deputy chief executive is one of the best operational minds in the business, I’ve got a superb chief medical officer, a hugely quality-focused chief nurse. Get the people around you to make your change programme work.

Stronger leadership tends to give hope to people whose heads have dropped.

We’ve had people who have worked here for a while step forward for leadership roles because they now believe they can make a change. We’ve had people who trained here come back because they want to work with our newer leaders. This stuff takes time.

You may decide you need to change structures to deliver change, but I tend to wait a while before I start doing this unless you have major problems. Structural change takes up a lot of time and energy. You need to be clear about why you’re changing structures. things and what you hope to achieve.

The structures you implement need to be there to make clear who is accountable for delivering better patient care, and to make it easier for clinicians to do their jobs well.

When I worked at the CQC, some ministers thought you could regulate quality into healthcare. You cannot. You can try to regulate failure out of healthcare, but it’s clinical staff that drive quality into healthcare. Regulations are a backstop.

The way you lead your organisation and how you organise your services to deliver is more important.

Be genuine

Don’t get depressed when things don’t work. I’ve had some pretty grim times in my professional career where I’ve gone home at night and thought, I’m making a mess of this, I should leave.

You have to recognise how your mind and body responds to failure, and where you get your sources of strength. Talk to people and find out how they think you’re doing, because you will have bad phases during change journeys.

You need to be able to take people on a journey of hope that starts where they currently are.

A lot of it comes back to your ability to lead people in a way that helps them feel valued and cared about, and where they feel hopeful about where you’re going. That’s not easy in the NHS just now.

Some of our staff come in to packed corridors and unhappy patients every morning. People can’t get the care they need, and the staff feel the weight of that.

If I were talking to the Secretary of State, I’d say we’ve some tired people in our hospitals. We’ve got folk who’ve finished a half marathon, and they’ve been told, “Surprise! It’s a marathon! You’re halfway, there’s the next half, right ahead of you!”

How do you recognise that fatigue? How do you encourage people to go on that journey? And how do you do that when we need to make some hard decisions about where to spend our money in the next few years.

Because what the NHS needs to do next is to have the courage to recognise that the acute sector will have to hold its position while we fix community, primary care, social care and mental health care.

That means people like me need to be able to deliver hope to staff who probably won’t see much new investment for a couple of years. The system outside needs time and attention to improve, and healthy acute hospitals will rise from healthier systems around us.

Leave things better than they were

We can’t naively say it’s all going to be better. There’s something interesting about the Secretary of State saying it’s broken, because that sends a certain interesting set of messages.

If you’re working in an A&E caring for patients in corridors or dealing with people who are waiting nine months for an appointment, things do feel a bit broken. You have to start from where we are, one foot in front of the other, and start to make changes.

Our staff know how great the NHS can be when it’s working well. You don’t have to think back too far to remember that. We’re not asking people to do something impossible – we’re asking people to take a few steps at a time and head back towards what works.

Change can be great fun and most of work is change. It can be hugely energising, it can be exhausting, frustrating, but it can be wonderful in the long run when you see the right things start to happen.

It’s about people, really – it’s about getting good folk in, focusing on what needs doing and improving things. We want to leave organisations better than we found them. That should be what change is about in the NHS – are things better than they were when you started?

Matthew Trainer is Chief Executive at Barking, Havering and Redbridge University Hospitals NHS Trust.