Tackling the little things to make people happier in their jobs

Sometimes it’s the little things, like it taking four phone calls to get someone to come and change a light bulb, which make it so much harder to do your job. That’s why the relationship between departments specialising in corporate support services like human resources, IT, estates and finance are crucial to the smooth running of health services. These support functions are also vital to many innovation and improvement projects, but are sometimes overlooked or undervalued.

Our Shared Purpose improvement programme focused on the collaboration between clinical and corporate teams, working together to improve quality of care. Nine projects responded to this brief in different ways. The Liberating sisters to lead project looked at ways to simplify business processes that were taking up ward sisters’ time.

Liberating sisters to lead

Liberating sisters to lead was run by University College London Hospitals NHS Foundation Trust (UCLH), in partnership with the Clinical Operational Research Unit at University College London.

Ward sisters at UCLH are a key part of the team. The project sought to highlight their crucial role in clinical care, and the amount of time they often need to spend dealing with administrative tasks and corporate issues. Ward sisters influence the safety and quality of care and the experience of patients, as well as providing clinical leadership on their wards. Dealing with complex corporate processes – when a new recruit starts work or when something on the ward needs to be repaired – can take them away from that vital role.

The Liberating sisters to lead project aimed to give sisters as much time as possible to spend with patients and lead their teams.

Understanding the issue

To understand the problem, the project team set up a temporary concierge service. It acted as a service desk for the ward sisters, taking ownership of problems, liaising with corporate services to resolve them and keeping detailed records of issues for retrospective analysis.

Over the 18 months in which the concierge service was running, it supported sisters on more than 800 issues. The next step was to categorise the issues, identify and coordinate improvements for each of these areas.

Making change

The project team found that one of the most time-consuming activities was filling in a form, used to delegate financial authority for expenditure. It was a complicated form, requiring signatures from three levels of management. It was a barrier which could result in delays of three months before the form was filled in. The project team worked with procurement colleagues to develop an email template to replace the form, and the time taken to complete it was reduced to just one day.

The project also found that administration for new recruits was taking around 20 hours of ward sister’s time for each new starter and there was a delay of up to six months to ensure that all new starters had an ID badge, an IT account, a uniform and access to electronic systems. The project team worked with each of these corporate areas to map the relevant processes and streamline them.

One of the key learning points for the project team was the changes needed often required a cross-department approach.

Wider impact

Some of the most time-consuming and complex issues were successfully tackled. The process for a new person starting work was also significantly redesigned, and the impact of this has been felt across UCLH. The team estimates that each recruiting manager saved 19 hours per new starter. The process for recruiting nurses was also redesigned, with a dedicated team taking on shortlisting and much of the related administration. Over 2,000 new staff joined UCLH in 2015/16 and the changes the project enabled have helped make sure the recruitment process is now one of the quickest in London’s NHS.

An initial aspirational target was for sisters to be able to spend 75% of their time on clinical leadership. However, it was clear from early on in the project that even if the time sisters spent on corporate functions was reduced to zero, it would still be unlikely that the 75% target was achievable. Sisters reported spending a considerable amount of time on ‘other’ activity, a category which included conducting their own clinical work and covering for staff shortages. Indeed, although time spent on corporate functions was reduced, evaluation of the project has been unable to determine whether sisters were able to spend a much larger proportion of their time on clinical leadership. The changes gave ward sisters more opportunity to spend time in the clinical area working alongside their teams which might otherwise have been prevented by completing administrative tasks.

Helen Young, project lead says, “The project helped us highlight the complexity of the ward sister’s role and also how a good working relationship between corporate and clinical areas can improve processes for all staff.”

Changes made to processes as part of the project are now embedded in practice, and the work continues in other ways too. Information from this project has been used to develop the UCLH future programme, a transformation strategy for the trust which features corporate support services as a central part.  The project team is now embedded within the new Staff Experience team at UCLH, which is continuing to work on issues identified during the project.