NHS South Commissioning Support Unit opened its doors for business on April 1st 2013, taking in the region of 250 staff with it from predecessor organisations – a complication in itself in terms of legacy working arrangements, feelings of loss, and fall out from large scale change.
The work to build the organisation had begun a year or so before, in November 2011, with an official MD appointment and an OD assigned lead. The organisation at this stage was no more than a concept, and a lot of work was needed to build it, not least what services it would provide, how many customers it would have and what staff would transfer in from the outgoing organisations.
Alongside the technical issues of setting up a new NHS organisation (ledgers, legal status etc.), we established an organisational development strategy, so that from the very beginning staff would have the chance to input to what it was like, what it stood for and how staff and leaders worked together.
This meant being innovative about how we approached staff – they were all still within the change management processes of the closing organisations, destinations were as yet unknown, they could have been headed for any one of several organisations.
The programme commenced in Mid November with intensive workshops for all staff to support development of the service. This programme ran through the first quarter of the year to ensure that the commissioning support organisation was ready to operate in shadow format and then through spring and summer to prepare for an accreditation process from NHS England.
The programme was broken down into several components to address the broad range of needs for setting up the organisation:
Engaging the support of a more experienced partner in KPMG, using their team to support existing knowledge and processes and to provide insight and expertise where there were gaps, and work with them to transfer knowledge and skills to the new organisations workforce and feed ideas and information into the internal development programme.
Culture and Identity
The new organisation indicated a unique cultural shift for staff from predecessor organisation, where the values and ethos of the NHS were strong, under the incoming legislation (Health and Social Care Act 2012) the new organisation represented a very different way of doing things.
The new organisation was to become a professional services organisation, a provider of services to customers requiring a new way of working; becoming customer centric.
It required a mind shift that for many staff felt foreign; there was an ethos and belief of the ‘customer’ being the patient. And whilst that remained true in general within the NHS family, the new organisation needed to focus on the service paying customers. It also had to actively think about competing for new customers and partners in the wider market as it moved forward. Expansion was also needed for future market position and the creation of a strong identity and a credible reputation for customer delivery was key to this.
To deliver that, we needed to exhibit the right behaviours all the way through the organisation. These behaviours have to be robust and linked to our values which in turn, had to be supported by the infrastructure put in place.
A new set of values – IDEAL – was created through staff workshops to be embedded across the organisation. This was done in a variety of methods, with staff as part of individual development and also as part of the infrastructure. IDEAL was translated into associated behaviours that formed the corner stone of the performance management framework.
New human resources policies in line with ‘the new world’, were put in place support staff. The brand associated with the new organisation was further developed through market testing as well as organic growth. Activities were put in place to encourage staff to feel ownership of, and pride in, the brand and associated artefacts, and this will need to be was developed through clear marketing strategies and aligned internal communications.
The infrastructure of the organisation was designed to support the vision for how the organisation wanted to operate and provide services in the future. This involved the input of all of the senior management team, they drove how the structure of the organisation looked, felt and operated. The infrastructure aligned to the way in which customers wanted to receive services. And led to a matrix structure, based around accountability rather than simply line management.
Individual and leadership development
There were a number of areas in which personal development needed to take place, running throughout the layers of the organisation and taking a behavioural approach.
For staff in general, support to make the change culturally to a new way of working, help to understand and translate the values into behaviours and to see what that means in practice, was needed. This came through developments in both policy and practice across the organisation, through changes in structure and through ongoing engagement in team meetings. There were also staff development sessions to bring staff together to talk through and make tangible, the values of the organisation and the move to more behaviour based ways of working, and measuring performance.
For managers there was a move to accountability structures and ways of working vs. just the traditional line management styles. This meant greater emphasis, especially of our senior managers, on role modelling the behaviours, and living the values of the organisation in order to help make the transition to the ‘new world’. Managers were supported to become more self-aware of their impact on others through emotional intelligence examination and there were ‘taught’ to take on a more coaching style of management, through a programme of both internally and externally supported learning.
The leadership group needed to have a better appreciation of the ‘outside world’, a view and understanding of the markets in which the organisation would be operating and an appreciation of how others do business. This meant a move away from traditional ’learning’ approaches and ensuring that coaching formed part of that approach.
The leadership team was responsible for being visible, for role modelling and for being the champions of the vision and values of the organisation.
An OD Strategy needs to be multi-layered, as a result of doing just that (of creating development around the people processes and culture) the new organisation, NHS South CSU, was supported to become ranked in the upper quartile of all CSU’s operating across England, and expanded within the first year of operation (exceeding its growth targets both in territory and cost base).
• Create multi layered organisational development strategies, look at how you will align people processes and culture
• Ensure buy in at all levels
• Gather champions and role models
• Align the OD strategy to your business objectives