Culture Review report and response

Our response to the Culture Review report

We welcome the Culture Review, its recommendations and commit to fully implementing them; they provide further, extensive independent insight into how our valued colleagues think and feel about working at University Hospitals Birmingham (UHB).

The review also highlights how, over a considerable period of time - in different ways and for different reasons - some unacceptable behaviours and poor working practices have developed across the different sites making up the Trust, which have caused many of our staff to feel isolated, discriminated against, unsafe and undervalued.

We want to apologise for this and to commit to creating the best possible place to work, which supports all staff and enables them to flourish.

The Culture Review also highlighted that despite significant challenges in staff experience our staff remain committed and proud to provide care to the population they serve.

The review, which was commissioned by UHB and undertaken by thevaluecircle, heard from over 4,000 colleagues across all of our hospital sites and from a range of staff groups, between March and June 2023.

Staff voices were sought through a range of methods including confidential surveys, anonymous digital routes, listening groups, site walkabouts and confidential interviews. We want to thank all who were involved and spoke about how it feels to work at the Trust.

We also want to thank thevaluecircle, the Culture Reference Group and its chair, Roger Kline, for their input and guidance throughout the review.

Our colleagues have clearly stated that they want:

• to feel valued for what they do
• to feel psychologically and sexually safe
• zero tolerance of bullying, harassment, racism and all forms of discrimination
• to be treated fairly, consistently and be confident to speak up and be heard

We want this too and will continue to listen, respond and take action, as we have been doing over the last nine months, to deliver a seismic shift in organisational structure and culture.

We are pleased that the review acknowledges that we are already making steps to respond to the challenges outlined in the recommendations, and that we are committed to creating the best possible place to work and be treated; but we have much more to do.

While the review makes very difficult reading, it resonates with what we have heard directly from staff. We have begun putting into place changes in structure, and in leadership, which provide a good foundation for the further actions we need to take to improve morale and address staff concerns.

The review clearly underlines the scale of the challenge we have ahead of us, which will take time to deliver; taking time for the impact of those changes to be felt by those that need to feel them most, but there are also some immediate and shorter-term actions, we will take to enable change to happen.

The review sets out four fundamental shifts as recommendations, which are all are fully accepted by the Trust Board. An associated action plan and progress tracker will be produced, discussed and monitored in detail at the People and Culture Committee and reported on at public board meetings going forward.

Our summary response to the ten key findings in the review

During the course of the review, we have seen a change in substantive leadership, with the appointment of a new Chair, Dame Yve Buckland, and Chief Executive, Jonathan Brotherton. We have appointed six new non-executive directors and restructured the executive team, in readiness for the implementation of a new operating model, which will ensure leadership is strengthened at all levels, particularly at individual hospital level.

The appointment to these new roles has followed open and extensive recruitment processes, involving a wide range of external and internal stakeholders (including staff, Governors, and senior local/national NHS colleagues).

Our new operational model - the first phase of which goes live next week on Monday 02 October 2023 - will create local leadership at hospital level, whilst maintaining the benefits of working at-scale. It will deliver increased engagement with colleagues across our services and a determined focus on building a values-led culture, which rightly prioritises the welfare and wellbeing of all.

The new operating model, which has been co-designed with colleagues across the organisation, sees us move from a centralised management approach to a site-based approach that gives our individual hospital sites more autonomy to make decisions that will benefit the services they offer and the communities they serve and engender an improved sense of belonging and identification with their local hospital and site.

We have started the co-design, development and delivery of a new Trust-wide strategy with an extensive engagement programme with staff, patients and stakeholders around our vision, strategic priorities and the behaviours our staff expect to see, would like to see and don’t want to see, to be an outstanding place to work and be treated. This will take place over the autumn. We will also be further promoting and embedding our values-based leadership programme and values-driven behaviour expectations; we believe that it is essential that all our leaders live and breathe our values of kind, connected and bold.

We are committed to developing a psychologically safe, positive, and inclusive work environment where people want to come to work, in a place that they are proud to work in, to do their very best for our patients. We have a wide range of wellbeing services on offer, including staff-led networks, but clearly, we need to do more. Our wellbeing services need to be better targeted and to be regularly evaluated to support their effectiveness in meeting the needs of our colleagues.

We will not tolerate and will take action to prevent discrimination, misogyny, sexism and sexual harassment; to raise awareness of this, we are developing a sexual safety and end sexism campaign that we aim to launch in October. Our anti-racism statement and strategy will be launched widely during Black History Month in October, led by our fairness leads, staff network colleagues and our Chief Executive and Chair.

We will review and improve the channels for speaking up and speaking out for all staff so that they can have confidence they will be heard and encouraged to share their concerns.

In order to help improve and develop our culture further, our Chief Executive will create and lead a new Culture and Inclusion Board, which will be responsible for developing an inclusion strategy that will be co-designed with colleagues from across the organisation. This is something we are extremely committed to; it will be the primary means of ensuring we create the kind of culture that everyone at UHB can be proud of.

The changes that we have already delivered, or have started, take us part of the way there, but there is much more to do. The impact of change must include ensuring people feel valued, included, encouraged and respected, so that teams thrive – and where we get it wrong, listen to the feedback and learn. It will also include improving health outcomes, through pioneering research and innovation along, with high-quality education and training for our workforce.

We are absolutely committed to learning, improving and evolving – all fundamental things that are at the core of the NHS’s values and UHB’s success – to benefit our patients and incredible colleagues.

We now need the time and space to continue this work and create some momentum and progress on delivering the necessary actions for our colleagues and just as importantly, our patients.