Podcast | Culture of Care

Episode Transcript

Better Never Stops | Culture of Care

Brenda McLeod: Thank you for joining us for Better Never Stops, our podcast for healthcare leaders and everyone committed to transforming healthcare. On each episode, we speak with leaders from our clients and partners around the world, as well as leaders here in Seattle who are working to sustain a culture of continuous improvement at Virginia Mason Franciscan Health.

Together, we explore the philosophy of Go See, Ask Why, and Show Respect, and how those principles come to life in healthcare organizations every day. I'm Brenda McLeod, Associate Executive Director at Virginia Mason Institute, and I'll be your host for today's episode. Today, we're discussing how healthcare organizations can improve staff experience, wellbeing, belonging, and inclusion through equity-focused improvement work.

Joining me today is Kuldeep Singh. Kuldeep is a quality improvement lead at Birmingham and Solihull Mental Health NHS Foundation Trust, and has been overseeing their involvement in NHS England's multi-strand Culture of Care program over the last two years. Also joining me are Helen Cyrus, consultant at IMROC, and Alice Forsythe, executive partner at Virginia Mason Institute.

Helen and Alice coached in the staff care and development aspect of the Culture of Care program. Thank you all for being here today.

Alice, let's begin with you. Can you give us an overview of the Culture of Care Program and the scale of this work across England?

Alice Forsythe: This was an extensive partnership. It was commissioned by NHS England and Virginia Mason Institute and multiple other partner organizations worked on the staff care and development strand of the Culture of Care program, including IMROC, which Helen is part of.

This was a two-year national program, and it involved 173 mental health wards across England from 58 different provider organizations. And we focused on wards that serve people with mental health diagnoses, learning disabilities, and autistic people. The goal of the program was to create safer, more therapeutic, equitable, as you mentioned, Brenda, environments for patients and more fulfilling workplaces for staff, and staff don't often get these opportunities.

So that's why this was such a gem of a program–to help staff feel seen and valued, to give them a voice in raising issues, and then a voice in sharing their ideas for how to improve those issues on their ward, and help them have a greater sense of wellbeing and belonging and improve their experience overall, which as research shows, will also improve the experience and the care for patients.

Today since we have Kuldeep joining us, this is a look as well as what Birmingham and Solihull are doing. They were one of the organizations that had the most wards involved in our program over the 18 months that we worked with wards.

Brenda McLeod: Can you tell us more about the staff care and development strand and what that work looked like in practice?

Alice Forsythe: Sure. So this was unique in that it was entirely co-designed and co-delivered with people with lived experience of mental health services in England. And so for the first six months of the two-year program, we co-designed with our colleagues from IMROC and In Health Associates, and their perspectives really helped us develop an authentic and grounded approach that was multi-pronged to support staff.

So we created reflective spaces for staff through team coaching. We also offered individual coaching, which is not usually offered to frontline staff. It's more often offered for leaders. So this was a great opportunity for frontline staff to have that one-on-one coaching opportunity. We also did workshops to set up their experience in the program, and we visited all the wards that participated to enable staff to meet us and to get to know them and start building those relationships that are so important in coaching, and to have them share their thoughts about what's going really well in terms of their culture of care and what they'd like to see improved.

And then we dove into the coaching. Each ward had three to six people involved in team coaching, and they each had at least five hours of team coaching, if not more. And each ward had eight hours of individual coaching, which was a wonderful opportunity for those folks who took part in that.

And we also, as part of the program, had reflective practice training that was supported by a different partner organization. So it was a wonderful, well-rounded approach. And then folks like Kuldeep supported from a QI perspective within each organization. And the real focus areas were improving high-quality relational care, improving those positive informal interactions on the wards, so teams really felt that their team working was improved by the end of the program.

And then we had a clear focus on psychological safety and helping teams feel more psychologically safe so that they could raise issues as they occurred. It was a wonderful program, and I'm really excited to talk about it with you today.

Brenda McLeod: It sounds like a wonderful program. Kuldeep, can you share more about your role and how you became involved in this work?

Kuldeep Singh: Yes, of course. Thank you, Brenda. First of all, thank you for having me on this podcast, and it's lovely to be back with Helen and Alice, after a while now. So my role has really been to help connect the national Culture of Care ambition with the reality of day-to-day ward life here at my trust, Birmingham and Solihull Mental Health Trust.

I came to this work as a Culture of Care Program Lead, but very quickly it became much more than a program management role. It was more about building relationships, helping teams feel confident to take part, and also make sure that the work had enough senior sponsorship and practical support that was needed around it for it to be succeeding.

So in my early stages of being involved, a lot of my focus was on securing organizational sponsorship, particularly at exec level because ward teams need to know that this is not just another short-term initiative landing on them, which sometimes unfortunately happens. They needed to feel that senior leaders are genuinely behind it, are willing to remove barriers and challenges for them.

And also, keeping senior leadership involved from the beginning really paid dividends for us. It created a sense that this work mattered to the organization, not just to the wards who were taking part. And when teams could see that our exec chief nurse, and senior managers were interested, they were asking questions and listening to the learning, it gave the program that credibility and helped people feel that their ideas would be taken seriously.

Reflecting back, I think the mindset change was really important here. Once the teams moved from thinking that we have to deliver a project to have permission to improve things that mattered to us, so you could see the creativity actually opened up, and it just enhanced everything.

People began to suggest things that were grounded in everyday ward life. Small things like maybe a calm space, a better conversation, a new way of listening, protected learning time, or small changes that helped staff feel more human during a very difficult shift So we worked across a range of wards in our trust, including some very different clinical environments, and this was important because culture of care is not one size fits all model.

The national program gave us a strong framework and a coaching offer, but locally we had to translate that into something that felt really meaningful for each particular ward, whether that was something around maybe staff wellbeing, therapeutic environments, co-production, leadership confidence, or simply creating a space for honest conversations.

Brenda McLeod: What were some of the biggest challenges in the early stages of this work?

Kuldeep Singh: Oh. I would love to say everything went perfectly fine from day one, but the honest answer is that it really didn't, and actually that was one of the most valuable parts of our story. In a large organization, as you would know, we sometimes assume that news travels quickly, but it doesn't always reach the right people in the right way.

Some teams were really enthusiastic straight away, but in other places the program felt like another new thing that they had to do. And also this arrived at the time when staff were already stretched, like in terms of capacity, in terms of time. So the biggest challenge was probably creating that time and head space for our clinical teams in the wards.

So ward teams were managing a lot of operational pressures. There were staffing challenges, acuity, emotional weight of inpatient mental health care was there. And you have to recognize that is what they may be thinking. Even if it's a very, very positive improvement work, you have to recognize that, they probably think that, "Oh, is this another one of the things that we have to do? Another new thing that has come up that we have to kind of do now in addition to all the work that we're already doing?"

I remember one of the staff colleagues, kind of very beautifully summed this up for me. They said, "We want to do this, but we need someone to understand what our day actually looks like and feels like."

So this was a real barrier, but it was also an important reminder that improvement has to start with empathy for us. I think like there were some moments where early enthusiasm dips. We saw that some of the teams, they were really high in energy when we started off because it was something new and they said, "Oh yeah, we are all up for it."

But then the day-to-day pressures took over. Rookery Gardens, that's one of our areas, had a stop-start journey before things actually picked up and they started, like, running with it. Citron Ward, that was another one of our areas. They had strong initial interest but engagement then became quite difficult when the ward was experiencing some really complex operational things.

Some cultural issues cropped up as well. I think what mattered was we did not treat this as a failure, just learning. So the compassionate coaching approach from Alice and Helen helped us stay very curious about what was happening rather than being judgmental. So instead of saying like, "Why you haven't done this?"

or, "What's, what's the progress now?" We started asking, "what's getting in your way, and how can we support you?" So that simple change in mindset created more psychological safety, and psychological safety became a driver for creativity. Don't get me wrong, there were, like, difficult issues that surfaced through the coaching conversations too, and I'm sure Alice and Helen will probably tell you a little bit more about it as well.

But they were very excellent in the way they handled those moments. They were quite compassionate, they were patient, they were persistent, but they were also very clear when something needed to be escalated. They picked up sensitive issues. And I'll recall, some of the issues were quite sensitive from some of the ward conversations they had, and they flagged up to me and the senior management as well.

And they also gave us really thoughtful advice on how best to approach them without making the teams feeling exposed or any kind of a blame landing on them. So the balance of kindness and honesty was one of the reasons, I think, why this work stayed very constructive going forward.

That shift was I think, quite important because it kept the teams in the work. It acknowledged the reality of ward life without blaming them for anything, for stalling things or going slow, but still holding on to that ambition of culture of care.

I must say some of our best sessions generally started with the feeling of, "Is anyone joining?" Because there was hardly anyone in the call, but ended up with saying, like, "Actually, this has been really helpful. This has been really useful." I remember one colleague said, "I thought we were just going to be asked to do things or told to do things, but it felt like we were actually being listened to."

So those moments, I mean, they just remind me that engagement often builds very slowly, sometimes just from one interested person who feels encouraged enough to bring others with them.

Brenda McLeod: Thank you. Helen, I'd love to bring you into the conversation. Can you tell us a bit about your background and your role within the program?

Helen Cyrus: Yes. Thank you, Brenda. That was great to hear your feedback, Kuldeep. So my background was that I was born in Belfast, and I spent my early years in the Caribbean before moving to the UK at the age of 19 to pursue nursing. And after I qualified as a nurse, I transitioned into education, became a lecturer for nursing studies and health and social care and access to nursing.

I then moved into public health and I took on a role of development worker for inequalities in health, targeting Black and White minority groups, as outlined by the Department of Health. And then after a career break, I became a life coach working with women and supporting mental health by running courses at community drop-in centers.

And this later then expanded to delivering coaching skills courses within Nottinghamshire Healthcare Trust. And then four years ago, I began working with IMROC, and then that was when I became a consultant on the Culture of Care project. So I was sort of blending my work experience, including my own lived experience of a chronic health condition for 38 years, and my various professional backgrounds to really feeling that this combination helped to prepare me to contribute to this important work.

Brenda McLeod: Thank you for sharing that, Helen. Can you tell us more about the lived experience aspect on the ground?

Helen Cyrus: Yeah, I think it was important to have team members with lived experience. And this was an important strength to the project because we included the voice of the service users, as well as IMROC represented the lived experience side of things.

So having colleagues with lived experience of neurodiversity brought a valuable perspective to ward visits and team coaching, as well as individual coaching. And the diversity of lived experiences and intersectionalities across the team enriched our understanding of the challenges that were faced by both staff and patients.

And these perspectives strengthened our ability to advocate for equitable person-centered care, and also to be able to recognize issues that might otherwise have been overlooked. My own lived experience as a nurse, I felt, was fundamental to my approach in this work and my experiences of experiencing racism forty-three years ago and then doing the ward visits and listening to what staff were talking about was very powerful, and it enabled all of us to be able to listen to staff with empathy and understanding, particularly when they were describing some very big challenges that people faced.

And staff spoke from experiencing racism and abuse from colleagues and barriers to promotion, as well as unequal access to development opportunities and being able to attend courses. And this also transpired to having abuse from patients towards staff, as well as witnessing the abuse between patients.

So these were very difficult for us as a team going in. So for the five organizations that were working on the ground, we also recognized in our own reflective practice that we needed to be able to talk about these issues and to be able to look at how we could develop anti-racist practice, and so we had training.

So this was quite interesting for us as a team as well as what we were able to support people with on the ground. So we set up a policy for ourselves as working staff members, as facilitators in this program, and looked at something which I think has been very important and is again a tool that could be used going forward, for anyone in an organization looking at allyship and how to support one another when you are in an environment where you are witness to or with someone who is actually feeling uncomfortable about dialogue, who is feeling quite threatened themselves because of the discussion.

And so how do you support that member of staff? How do you stand up for them? How do you speak out? And I think we all learnt how to call things in and call things out. So how to create psychological safety, which was really important, and to equip staff with the confidence and skills, and this came out in the team coaching as well as the individual coaching, through powerful questioning and reflective conversations and helping staff to examine language and behaviors and workplace culture, particularly in relation to equality, diversity and inclusion and intersectionality.

The coaching helped individuals address these difficult issues, and not to just leave elephants in the room. It was about providing a pathway for escalating concerns where safety or wellbeing was at risk. And in addition, having team members with lived experience was definitely an important strength to this project.

People were able to really embed their own life experience into the project to bring added value. And in addition, lived experience of mental health provided that valuable insight into ward environments, which helped to identify both effective practices and areas that required improvement. So these experiences helped to offer that unique perspective that definitely enhanced our observations and our recommendations, and it also shaped the way that we did our reflective practice, and it helped us to have those opportunities for open and honest conversations where, you know, once a week or once a month we would get together as an individual team or on a monthly basis we'd get together as a bigger team.

And it helped us to be able to continue to build our own knowledge and skills through the targeted development, including training in anti-racist practice and gender awareness. And this ongoing learning definitely strengthened our ability to support the ward teams and to foster that more inclusive, compassionate and equitable culture in the culture of care, which was invaluable.

Brenda McLeod: Thank you, Helen. So one of the most interesting aspects of this work was the coaching approach and the on-the-ground engagement with teams. I'd love to hear from all three of you about what that experience was like.

Alice Forsythe: As Kuldeep mentioned earlier, this was very much an approach for coaching where we met the teams and the individuals where they were.

It was not a one-size-fits-all approach so that people felt empowered to raise issues and to really drive the development of change ideas on their wards and drive the projects that they would be working on, and this helped embed that muscle of QI work on the wards. And this idea of doing it that way is, and was to support sustainable culture change rather than short-term fixes, and ensuring that these teams would be able to do this not only in this program, but again in the future as they continually improve the experience for their staff and their patients.

Brenda McLeod: Helen, how about from your perspective?

Helen Cyrus: This has definitely been one of the best programs that I've ever worked on in my professional career. And I think it was absolutely unique to be able to have the individual coaching side of it. As a professional coach myself, I was really excited about this element of the individual coaching because I felt that it really helped people to open up, once there was that recognition that we were not from the CQC, we were not here to be, you know, carrying back information, I think people relaxed into it, and they signed up for it.

And they got a lot from it because it helped them with their own personal development. It helped them if they had their own mental health problems and they wanted someone to talk to outside of the organization. This was one of the things that we picked up. I, I think, maybe Alice would agree to this, that...it just gave that anonymity. It helped because we had somebody from the outside coming in. You know, us as coaches, we weren't part of their establishment, and it gave them an opportunity to think about their own career prospects, you know, if they wanted to develop, what ways they could go, who could help them, and this is where we're able to signpost them either back to their QI lead, like Kuldeep, or the matrons, or the ward managers and where they could get that information.

And there were a lot of staff who recognized the need for further training. They were in specialist units. And so I remember one person saying, you know, that they worked a lot with clients who had drug and alcohol problems. And so she wanted to update herself on alcohol abuse and how it impacted her client group.

So this was something that she was going to go away and try and get onto a course. So I think it just gave people that one-to-one, even though there were two of us coaching, it just gave them that opportunity to be able to speak unhindered and for us to help guide them to where they wanted to get to.

Brenda McLeod: Thank you. Kuldeep, how about you?

Kuldeep Singh: I would echo what Alice and Helen had just said. It was quite a unique aspect of the program, and I would say it's one of the most powerful aspects of the program because from our perspective, it changed the tone of the work that we were doing.

And it wasn't just about someone external coming in with all the answers. It was much more about like slowing down things, listening carefully, helping teams notice the strength and possibility that were already there. So I think it actually changed the way we were looking at our work as well.

And what I really valued was the patience and the consistency which Alice and Helen, as national coaches, brought because they just kept showing up. Even when attendance was patchy or when teams were unsure what the program meant for them, that consistency mattered.

And it definitely made a difference. And it sent that message to the staff that it was not a tick box exercise and that their experience was worth investing in. So that actually mattered a lot. These two were very good at staying with the discomfort of that work and discomfort of the silence sometimes were there in those sessions, not rushing to easy answers and gently helping teams move from frustration into actual possibility.

So that shift was very, very important as such, yeah. Also, I think we had to adapt the approaches across very different settings. Like Helen was saying that all the wards, clinical settings were different, and there were different cohorts of patients they were looking at, and the environment was different as well.

And some services had very particular communication needs. Some had very specialist clinical models that they were using, and some were carrying long-standing cultural and environmental challenges within their own environment and the teams that they were working in. So the coaching helped teams move away from thinking culture of care is another extra thing that they have to do or is another project they have to do, towards seeing that the staff care and patient care are deeply connected.

We know that without good staff care and staff experience, you can't have a good patient experience. So once that mindset began to shift, innovation came quite naturally to them and became sort of a second nature towards the end of the program.

Yeah, so because people-- we had this issue of permissions before. So now people started moving away from stopping things just to wait for permissions... And they started asking, "Okay, what small thing could we do? And what thing can we do today, or what thing we can do this week?" So that's the kind of a big shift in the thinking and the work shifted that way as well.

So I'm just thinking of one of our wards, Magnolia Ward, just a really good example of some practical things that they did. They did this something called a Let's Be. It was a co-produced agreement that helped staff and service users talk about how they wanted the ward to feel, not just like how they wanted to be fixed, how they wanted to fix things, yeah?

So they also looked at sensory spaces, some protected, kind of a learning time, which sounded quite simple. But it speaks to the deeper message. We are allowed to create conditions where people can pause, learn, recover, and care well, and that was quite important and very lasting message that the co-production kind of gave.

So one of the comments that's coming to me that was said that time is it feels different when we are designing this with people, not for people. So this is exactly the sort of mindset change that unlocks creativity and that we were really looking forward to. One of the other areas that I mentioned earlier as well, the Rookery Gardens, their journey was not smooth at first.

The coaching seems to unlock their leadership confidence. It helped the team connect with what they wanted to connect to the program. So that why was answered for them, and then that created that energy, the buzz for them, and they started, like, kind of flying from then onwards.

One of the kind of, what colleagues was describing that we had ideas, but the coaching helped us believe that we can actually do something with them, and that was quite powerful. At another ward, the Jasmine Ward, there was a lovely sense of possibility because the team brought good engagement and ideas from a unique service perspective because they had quite unique services there.

And that included, like, how to think creatively about technology and AI. So that's something that's, not the future, it's now, it's the present, isn't it? Technology and AI. So they were thinking in those terms, like how do we incorporate that into what we do? So all these examples just made the work very real and quite, like, present, in the present context because they were not, like, polished success stories from the start.

They were just human stories of people finding their way to do things as such, yeah. So thinking again, kind of a biggest mindset changes or the shifts, from my perspective when I was looking at things and the program itself as well, was staff champions everywhere.

Because sometimes we thought, "Oh, well, people don't have the capacity, don't have the time, so probably there won't be anyone coming up or putting themself up the parapet and say, 'Okay, I want to do this. I want to do something different.'" But there were staff champions who wanted to create something new and wanted to change things everywhere, and that was quite surprising for me.

And it came from all different staff groups. Sometimes they were ward managers, sometimes it was activity workers, some junior staff. Service users was really, really great. Experts by experience or colleagues who have been just waiting for that permission or the space to contribute.

So it was just wonderful to see that, yeah. And once that space was created, people had ideas. They had pride in their ideas as well, and the stories they wanted to tell, that all came to the fore. And then of course, the innovation starts from there. That's something which really mattered to me, and I think some of the things that they were doing for loads of like years and years they've been doing that, but they never changed even if those things were not working.

So people said like, "Oh, can we actually change the handovers? How the handover actually feels, and, ‘how do we do it?’ kind of thing." So that was something they do every day, but they never thought about like changing it. And one of the service users said, I think, "Could this place not feel that clinical? Can you make it less clinical?" And these are small questions, but they led to very meaningful changes, so that was the kind of a starting point for us as such.

Brenda McLeod: Yeah. Thank you all. That was very interesting and lovely to hear your experiences. Alice, there were many notable outcomes from this program.

Can you share some highlights as well as key recommendations that emerged from the work?

Alice Forsythe: Three takeaways from the final survey that we ran with the folks who participated in the program showed that their confidence levels in developing and implementing QI work on their ward went up almost 30 percentage points.

And their confidence in being able to do that work internally without outside help went up double digits as well, which was really exciting to see. The psychological safety on the ward went up according to the folks who responded to our surveys. These results were what we were hoping for and speak to the work that the wards did to really lean in to some challenging conversations and to trying new approaches that they've not really done before.

A lot of the folks on the teams that participated in coaching were clinical, and they maybe hadn't done much QI work. So this was an opportunity for them to also experience some of Virginia Mason Institute's equity-focused QI tools. So what we brought were a couple of tools and techniques that we taught at the initial workshops, and then we carried those through in the coaching meetings.

When we talk about QI, quality improvement, we often think of, well, what's the waste in the process? So Virginia Mason Institute has an inequity waste tool where we look at, well, what are those inequities that are contributing, and how can we reduce or eliminate those? And that resource proved to be eye-opening and really helpful and meaningful for teams who were able to have conversations that previously they just had a hard time bringing up those issues.

And this gave them an easy way to sort of say, "Well, that's, that's an access barrier," or, "This is an example of underrepresentation. Can we pause and talk about that?" And that skill of having an equity pause was something that we, we taught at the workshops and then we continued that, through the coaching work.

And teams were happy. This ability that they were starting to have and were building on, was really impactful. So some of those equity components were wonderful to see. A couple of other meaningful results and aspects of this program were the involvement of people with lived experience in delivering the work, and also in encouraging the teams as they did their quality improvement projects to engage patients and carers or family members in helping them develop their improvement ideas and projects.

And that was a game changer for some of the wards as well, where they were more actively engaging patients, maybe through a community meeting or interviews or surveys in taking part and creating-- Because it's an environment where all the people on the ward need to participate. And so involving people with lived experience, the patients, their family members, was an important aspect of the QI work.

And also potentially doing that through rounding. So simply asking people how they're feeling that day, who they could thank. If the leader is out doing rounding with their patients more for an experience, type of rounding rather than clinical rounding, you know, who can I thank today?

That was a key finding, was making sure that there are ways to recognize staff, embedded in how the ward operates, and making sure there are ways for staff to get to know each other and for them to get to know patients. Some of the most effective and long-lasting projects that we've heard about were ones where staff were able to learn a little bit about each other through a, a visual board, through handprints.

One ward in Bradford created a board that had handprints from every person on the ward, staff and patients, and then on each handprint was their likes and dislikes and key facts about them they wanted to share. It was just a way for people to get to know each other and to share a little bit and start building, kind of break the ice with one another, and it involved patients as well, and patients loved it.

And then another key type of project that many wards undertook was around wellbeing. And an example from Oxford was where they did two things. They did a daily check-in where each staff member shares their wellbeing on red, amber, green, and blue If they're sad or things aren't going well for some reason, they don't have to say why, but then the work that the charge nurse assigns them is tailored to what they are experiencing that day.

So it's very person-centered. And then the second thing they did was, on a monthly or about every five-to-six-week basis at their supervisions, they share their well-being on a scale essentially of one to a hundred. If I'm a sixty-five this month, my leader will ask me, "Well, what will get you to a seventy?"

And so then they track that to understand people's well-being and support them to improve. So those are some, some key areas that we saw that were really helpful and certainly are translatable to other ward environments.

Brenda McLeod: Kuldeep, how are you thinking about sustaining and spreading this work moving forward?

Kuldeep Singh: Yeah, Brenda, that's quite-- that was very important aspect for us, when we first joined the program as a pilot site, because for me, it was important that this becomes like a business as usual and the way we do things. So sustainability and spread for me, I wanted to ensure that the culture of care does not sit as a separate program somewhere in the trust the sidelines of the organization somewhere.

So the national program really laid strong foundations for us. The NHS culture of care standards, the coaching approach which Helen and Alice introduced us to the focus on trauma-informed, autism-informed, and anti-racist practice, and the clear message that lived experience and co-production have to be central rather than optional for everything that we do.

So we are now building on that foundation by making culture of care a trust-wide program in phases and by connecting it directly to our new trust strategy. So we started with the learning from the national pilot, and then we moved into a wider local collaborative across all our directorates.

So now it includes our acute care wards, children and young people directorate community teams, which is a huge part of our organization, dementia, frailty and specialities, which are very specialist services, secure and offender health services and steps to recovery. So it expands across the whole organization now.

Which just thinking about it, because our organization is huge, it's got like fifty-plus different locations across our patch as such. So by scale it is quite huge and daunting as such. But we are quite encouraged by the strong foundations we have for the national program. So the intention is to take the core principles and support each area to apply them in a way that fits their context.

So that phased approach really matters because the spread is not about just copying and pasting what worked in one ward into another ward as such. It's about building that readiness, first of all, listening to the local pebbles in the shoe, supporting teams with QI skills and expertise, and the local kind of skill in terms of doing improvement work and creating that peer learning so that wards can learn from each other as well.

So we use regular culture of care meetings, learn and share events. Because it's QI approach, so we have some measures, dashboards, there's a whole governance route around it. And there's ownership, accountability of this program is quite local. So the local leadership structures keep the work visible and connected in a way that works for them as such.

We are also thinking carefully about how to embed this into everyday operational culture as well. That means like linking culture of care with board accredi-accreditation scheme that we are launching, clinical governance that we have, staff experience, patient and carer feedback. There's something called fifteen steps that we do.

There's an approach that we use. Lived experience leadership. Now that's a big move from just having a representation in the meetings to actually lived experience leading the work as such. And of course, QI capability is something that we want to develop more and more because that we know how much it makes a difference in this kind of a work as such.

Like I was saying earlier this also like links strongly to our new five-year c-trust strategy. And in that we have these four C's pillars that are strong pillars of that strategy, which is care, communities, culture and creativity. Now culture of care is the golden thread that goes across all four of these.

So it's about improving the care of people's experience, strengthening the communities around our services, shaping the culture staff work within, and also giving people the permission to be creative about the solutions they want to bring to the board as such. And thinking more about it, I often describe this as the end of the beginning.

So the national program was just end of the beginning, as such, and it's the start of something much bigger. The national program definitely gave us the momentum, the confidence, and a shared language, which was quite important. So now our job is to keep that spirit alive locally, to stay compassionate when progress is uneven.

We know it won't be plain sailing all through. And to keep asking staff, service users, and carers what would make this a better place to receive care and to also a better place to kind of work in. So if it only lives as a project meeting or a project as such, it will fade. That we know for sure.

So if it becomes part of how the teams talk, how the teams reflect, make decisions, and celebrate progress, then I think it's much more. It has much more better chance of lasting much, much more as such. So I keep coming to this phrase back that culture of care is not about improving services, it's about reshaping how we feel in our work. So when we start from care, quality, safety, compassion naturally flows from there. And when staff feel trusted to think differently or creatively, creativity follows from there, innovation follows from there, and that we have seen by this program, like what we have seen some brilliant examples of those which we just mentioned, like Alice mentioned some Helen was mentioning, and I mentioned as well.

So that's what I would say is, the work is just beginning now for us, and that's what we want to continue.

Brenda McLeod: That's exciting. One of the powerful takeaways from this program is that approaches designed to improve staff experience can be applied broadly across healthcare settings. Alice, can you expand on that? What makes this work transferable to other environments and organizations?

Alice Forsythe: The improvement methods that we used and the coaching approach that we used, which is very focused on the frontline ideas and empowering the frontline voice, can be adapted and used across different care settings. And we've used them successfully at Virginia Mason Institute, not only with mental health, also with acute care teams and ambulatory or clinic teams.

And it could be used with a community team in the UK as well, people who are working with mental health patients in the community and families in the community. But the staff need QI work for their experience too is one of the key takeaways from this program. And the key huge benefit of staff care and development was this focus on how important it is to ensure that staff have that sense of psychological safety and belonging and relationships among their team as well as with their patients.

And that's universally important across different service types. And the equity-focused improvement techniques that we used can be used across service types as well, and we've shown that with the work that we do at VMI. So it's exciting. It's an exciting set of tools, and as Kuldeep said, it has shown meaningful improvement and has increased joy.

I think that was one of the key things Cilantro Suite–one of the wards at Birmingham and Solihul–said that that's really what they wanted to do.hat was their goal: increase joy on our ward so that patients can feel those moments of joy, and staff can feel those moments of joy.

And so it's great work. Really proud of it.

Brenda McLeod: You should be. So I think the biggest things I'm taking away from this conversation is that VMI co-led the staff care and development strand of the two-year Culture of Care program commissioned by NHS England. The program reached 173 inpatient mental health wards from 58 provider organizations across England.

VMI provided nine coaches who worked alongside IMROC's seven coaches during the program to facilitate team and individual coaching with ward staff. So I know you guys did some survey responses. So based on the comparison of those pre and post-program staff survey responses, staff feeling confident that they can design and deliver improvement projects increased from 63% to 92%.

So a really nice jump there. And it involved team members feeling confident that they possess the skills to improve ward culture internally increased from 75% to 96%. So I think, to that joy aspect and really improving the ward culture it is lovely to see that increase. And then staff feeling confident that they can meaningfully involve people with lived experience improved from 69% to 93%.

So some really impressive takeaways in that survey results. So thank you all for joining us and for sharing your experiences and insights from this important work. And thank you to our listeners for joining us for this episode of Better Never Stops. We hope today's conversation offered ideas and inspiration for how improvement, equity, and compassionate leadership can help create better experiences for both staff and patients.

So until next time, remember, Better Never Stops.