The Barts Heart Centre (BHC), formed in May 2015, has an ambition; to be World Class. This requires a World Class Workforce. BHC is hosted by the Barts Health NHS Trust (BH). Its formation has been fraught with highly publicsed difficulties, leading to a poor CQC inspection.

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The scenario was described “moving to a nicer house but having to move your children from an Outstanding OFTSED rated school, to a school that was not only in Special Measures, but also had a reputation for bullying – the size of the challenge could not be under estimated. 1200 WTE transferred from 3 different hospitals into a brand new building. It was extremely important to avoid a sense of “them, us and us”. Here is a summary of some of the OD work undertaken:

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• Early appointments were made to the Clinical Director and Senior Leadership Team (SLT). Appointment processes paid careful consideration to Values and Behaviours of leaders

• There was an overt commitment to integrate teams from the outset. Each ward and department were allocated an equal number of staff from each of the 3 hospitals, plus a vacancy factor. This was crucial to break down previously strong sub-cultures, but created risks because single working practices needed to in place, understood and implemented from day 1.

• Standardised objectives were developed for 80% of roles using a quadrant model focusing on Quality, Behaviours and Values, Operational Delivery and Finances. The appraisal cycle was tweaked so that leaders could get to know team members and review performance more sensibly at a later date.

• Charles Knight, Professor in Cardology and ultimately responsible for the success of the merger led a series of Leadership Conversations convened informally over nibbles and drinks. Charles met with small groups of leaders responsible for services and honest discussion took place about what had worked, what was left to do and what the BHC senior leadership team needed to do, to unblock the way and make things easier for departmental leaders. There was an element of celebration and appreciation, recognising how very difficult the role of the leader is during the change process. There was also a clear message to those in leadership positions, that looking after the team, through the change and on and ongoing basis, was as important as any other objective.

• Several large scale staff engagement sessions took place, designed to introduce colleagues to each other, identify key issues, dispel myths and to encourage teams to design new procedures and ways of working, taking the best from the best.

• Away days – celebrating the history and what had been achieved so far, and focusing on what was left to do. William Bridges Transition Curve was used and teams reported that it was very helpful to know that their feelings were “normal”. These took place in the first 100 days.

• Operationally focused “team conversations” with multi-professional teams took place. Teams directed the content of discussions, agreeing changes to working practices, designed to improve patient experience and safety.

 

McKinsey (2009) found that 25% of respondents described culture as the key reason for merger failure. 44% cited poor leadership of the integration effort as being a significant reason for merger failure. The SLT knew that they needed to spend major time and attention spent on developing and communicating the vision. They needed the right level of leadership capability and visibility, so that engagement and morale levels would not dip post merger. Traditionally, BH has higher than average turnover levels when compared to other London Trusts and there was already a high vacancy factor which needed to be carefully managed.

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The project covered a 12 month period from pre-merger, right through to the transition into Business as Usual (BAU). The project outline followed a logical framework with clear outputs during each phase (pre-day 1, day 1, first 100 days, 306 months, BAU). Clinical Directors were drawn from all 3 sites and provided useful intelligence, focusing finite resources into the right place. Each OD intervention was grounded in practical application so that “non-believers” could link the benefits with tangible patient outcomes. Wherever possible, patient stories were used to illustrate the benfit to patients. Patient representatives were invited to join several interventions.