These are the terms of reference for an independently led review of organisational culture at University Hospitals Birmingham NHS Foundation Trust (the Trust/UHB). The Review will look to establish how it feels to work at UHB, by engaging with, hearing the thoughts of, and understanding the feelings of Trust staff, and will take place between April 2023 and June 2023. The Review will be overseen by a Reference Group and a report detailing the findings will be available in July 2023, which the Trust will then use to inform and embed consistent improvements to its organisational culture moving forward.
This Independent Review is commissioned by University Hospitals Birmingham NHS Foundation Trust.
|Dame Yve Buckland, Trust Chair
|David Cockayne, thevaluecircle CEO
|Independent Culture Review Reference Group Chair
|Overarching oversight of all Trust reviews
|Professor Mike Bewick
Providing safe spaces to listen, understand, reflect and review – hearing all voices.
The valuecircle approach
Background to the Review
The Trust has proactively commissioned an independent review of its culture, further to agreement with NHS England on 30 November 2022, as it recognises the strength of internal and external concern that has arisen pre- and following a series of events since December 2022, including adverse media coverage. The Trust is keen to understand and learn about, in detail, what areas of good and poor culture exist across the organisation. This will then enable any concerns to be identified and fully addressed, the sharing and dissemination of positive practice, the opportunity to collectively and individually move forward, as well as the continued fostering of positive working relationships.
The Culture Review
For the purpose of this Review, it is proposed that culture is defined as:
How it feels to work at UHB and how we get things done around here: an opportunity for colleagues to share their views, both negative and positive, of the values and behaviours they experience at work and their ideas on what must be addressed and how things can be improved.
The proposed definition best summarises concerns/sentiments from media allegations, feedback from staff key themes from myriad staff voices – quantitative, qualitative and anecdotal.
The Trust’s values are to be "kind, connected and bold": in the kindness that people show each other every day, the connections we build with everyone around us, and the ability to be bold in how we think, speak and act. We want these values to be at the heart of everything the Trust does, and to understand whether we live and experience these values in our workplace.
The Review will focus on listening to and engaging with staff and then taking positive action to improve how it feels to work and thrive at UHB. The Review will also identify any systemic issues, practices or processes, organisational development and other gaps that need urgently addressing and a framework to address them.
The Review will make recommendations on how to make positive changes to move forward, while acknowledging the failings/learnings from the past. It will need to provide for all colleagues to make their views heard, as well as addressing the known and documented concerns from key staff groups, such as doctors in training and the consultant body.
The Review will need to consider processes and practices in the Trust, but importantly also understand and reflect the human element and impact – what our staff at all levels of the organisation are thinking, feeling, saying, seeing and doing, and how that is shaping the culture experienced.
There are two other organisational reviews taking place: one is a Patient Safety Review, arising from the media coverage and allegations, commissioned by the Birmingham and Solihull Integrated Care Board, and the second is a Well-Led Review by NHS England. Emerging cultural themes from the Patient Safety Review will be followed up and further investigated through this culture review, incorporated within the scope set out below.
There is a further piece of work being undertaken, commissioned by the new Chief Executive, with external support, to design and implement a new operating model with strong site-based and clinical leadership. Staff are being meaningfully engaged in its development to ensure connection and buy-in to the future arrangements. Close integration by the Independent Reviewer will be needed with the culture and engagement strands that will arise out of the operating model review and design.
The Trust has also been actively undertaking positive cultural improvement actions, including work through a Fairness Taskforce, and has an existing baseline of UHB culture and engagement actions and impacts from the last 12 months as well as a forward look through 2023.
thevaluecircle will deliver a review that uses its "mechanics&dynamics" approach to assess and help the Trust understand the drivers shaping its culture and address any gaps or areas for wider development. This will be underpinned by the Independent Reviewer’s understanding of the Trust’s cultural legacy, current challenges and long-term objectives.
The Independent Culture Review will cover the following:
- Understanding UHB as a place of work with regard to our Trust values, and in ensuring the treatment of staff with fairness, dignity and respect and maintaining an open, supportive and compassionate culture
- A neutral assessment of how concerns are raised, reported on, listened to and acted on, considering the effectiveness of the FTSU mechanisms and how trusted this is
- Exploring any culture of bullying and harassment as defined by the organisation’s policies and exploring any culture of incivility within the workplace
- A consideration of the behaviours and decisions of leaders at all levels and the impact they have on people and culture in the organisation
- Exploring the Trust’s culture of learning and continuous improvement, including how RCAs and Serious Incidents are approached
- Considering the impact of individual or group behaviour on people and culture
- Considering the impact of team-based customs and traditions on people and culture
- Identifying whether counter-culture behaviours are more prevalent in particular staff groups, professions, sites, areas or staff by protected characteristics (including those identified through the Patient Safety Review)
- Discovering what disrespect and incivility look like in the organisation through what staff are experiencing and through behaviours
- Exploring communication processes, and assessing how mechanisms of feedback work
- Highlighting examples of effective practice in the Trust to illustrate the approaches that work and which can be fostered
- Drawing on findings and expertise to recommend the approach to improving the culture of the organisation
The Review does not seek to replicate large-scale workforce engagement already undertaken.
The Review will not reopen past bullying and harassment complaints or employee relations’ processes, nor will it reach conclusions or make recommendations in respect of any individual concern raised. Where evidence is revealed of individual(s) currently exhibiting or experiencing inappropriate behaviours these matters will be raised by the Independent Reviewer with the Culture Review Reference Group Chair, or designated representative.
Existing avenues for the raising of complaints or concerns available to staff will not be affected by the Review. Contributors to the Review process will be provided with information about existing processes for raising concerns, complaints or grievances and the appropriate Trust policies available and the appropriate contact points.
In the event a person discloses information which raises a concern regarding the safety or well-being of a member of staff or patient safety, the Reviewer will disclose this information to the Commissioner, Chair of the Reference Group or designated representative.
Appropriate avenues for a range of psychological well-being support are already available and will be re-publicised across a variety of communications channels by the Trust, for anyone who requires support through this process. These services are available through our internal Occupational Health, Well-being and Inclusion services.
Over the period April to June 2023, the Independent Reviewer will gather evidence of the experience our staff have in their working environment and the wider culture of the organisation. It is proposed that this would be done through a range of channels, which can give ample space to the wide range of voices we need to hear so that all feel valued and listened to.
The approach will capture all voices through the assessment of both the mechanics (systems and processes) and dynamics (relationships, values and behaviours) of the Trust’s organisational culture with a future-focused lens for development.
- Initial data analysis, including but not restricted to:
- staff survey results
- medical engagement scale reports
- employee relations data
- exit interview summaries
- Friends and Family Test results
- staff engagement data
- leadership engagement data
- Getting a grip on the emerging themes
- Developing a core set of culture key lines of enquiry
- Comparison of policies and procedures against national standards
- Analysis of the relevant systems and processes
Anonymised online feedback
- Trust-wide closed-format survey for individual perception and experience
- Targeted team pulse surveys where required to assess sub-culture team dynamics
- Dedicated inbox run by thevaluecircle, to confidentially submit free format comments
- Interviews with leadership and external stakeholders
- Use cultural key lines of enquiry to understand top-down tone, messaging and how it is received
- Comparison of external perception with internal environment
Listening groups and observations
- c. 10 walkabouts across all sites
- c. 50 listening groups with a cross section of staff
- c. 5 – 10 observations of existing forums e.g. team meetings
- Immersive weight in to team and ward culture
Final report and feedback
- Triangulation of all findings
- Report writing and review process
- Board feedback session
- Staff feedback, in person and via webinar
The Independent Reviewer will, as part of its methodology, draw on any culture outputs from the parallel Patient Safety Review and the Well-Led review, as well as connected to the cultural indicators arising from the current review of the operating model, and with reference to culture work already undertaken in the Trust.
The Trust has 24,000 staff and the Independent Reviewer has established a proportionality of methodology.
Culture Review Reference Group
Part of assurance in a process such as this, is encouraging people to come forward (anonymously or openly). It is therefore important not only that the Independent Reviewer is external and independent of the Trust, but also that there is additional scrutiny and oversight of its work.
A Culture Review Reference Group (“CRRG”) has been established to oversee the review process and output against the terms of reference. It will ensure there is clear, transparent and effective governance around the culture review and independence in which staff, patients, communities and wider stakeholders can trust.
The Reference Group will provide a forum for emerging issues, concerns or enquiries to be discussed with the Independent Reviewer.
An Independent Chair has been appointed to the Reference Group – Roger Kline.
The Reference Group membership will be:
- Roger Kline, Independent Chair of Reference Group
- Dame Yve Buckland, Chair of UHB Board and Review Commissioner
- Lee Williams, UHB Council of Governors representative
- Professor Julian Bion, Freedom to Speak Up Guardian
- Veronica Morgan and Jonathan Whitney, elected Executive Chair and Vice Chair of staff-side JNCC
- Mr Ansar Mahmood and Dr Achuthan Sajayan (Sajay), elected co-chairs of staff-side LNC
- Natasha Salmon, Matron
- Barry Panton, Staff Partnership Lead
- Bev Baker, Fairness Lead
- Randeep Kular, Director of Strategic Projects
- Ali Fisher, Head of Leadership Engagement
- Professor Andy Whallett, Health Education England
Professor Mike Bewick and Giles Peel, who undertook the Patient Safety Review, will be attending the Reference Group meetings. Dr Ravi Kumar, father of Dr Vaishnavi Kumar, Cathi Shovlin, Chief People Officer, and Mehrunnisa Lalani, Non-Executive Director and Chair of the newly-established People Committee of the Board, will also be attending and supporting meetings.
The Reference Group may also co-opt other individuals or representatives of stakeholders from time to time, where special expertise or experience is required to assist the Reference Group in its role.
The Reference Group will have its own terms of reference, but it is proposed that it shall meet at least fortnightly through the course of the review period once established, and more frequently if required by the Independent Chair.
A function of the Reference Group will be to receive any information from the Review Team that may require an immediate response.
The Reference Group will also assist the Review Team in understanding context where needed, but not to determine matters of interpretation of evidence.
The Reference Group may well be best placed to remain established following the reporting of the Review to help shape, monitor and evaluate implementation of recommendations to achieve the required outcome.
Reporting and timescales
The Review will take place during the period April to June 2023, with a final report available in July 2023.
The Reviewer will prepare a detailed written report to the Commissioning Officer (the Trust’s Chair) and the Culture Review Reference Group which should include the following:
- Executive Summary
- Terms of Reference
- Recommendations that ensure restorative and preventative measures can be taken forward, tailored to support the Trust’s journey to improvement
As part of these Terms of Reference, the Independent Reviewer may be required to present a summary of findings and proposed actions to the Culture Review Reference Group.
Any additional concerns which may be raised or identified during the course of the Review, which are outside the remit of the Terms of Reference, will be referred by the Independent Reviewer to the Commissioner/Chair of Trust Board.
All data and information that is accessed and gathered during the Review will be handled and processed in accordance with the Trust’s Data Protection, Confidentiality and Disclosure Policy.
Last reviewed: 26 April 2023