This is the full report and recommendations of the independent audit of organisational culture at The Christie together with information on the next steps which was shared with staff on 19 December 2023.
The audit was commissioned as part of our response to the ‘should do’ recommendations of the CQC reports published in 2023 and based on inspections in late 2022. It was designed to give us more detailed information on the culture in our organisation and to help us to make improvements. It builds strongly on the initial engagement and feedback events undertaken after the CQC Report was published. These included people from right across the organisation including consultants and the outcomes were an important contribution to the audit work.
The following ‘Frequently Asked Questions’ give much more information on the audit, its findings and next steps. All departmental and service leads have been asked to read the report carefully and discuss with their teams. The advisory group (see below) will be reviewing the recommendations and overseeing a process of discussion and consultation leading to a clear programme of future work by February 2024. Your continuing help and involvement in developing this plan will be crucial to ensure that it addresses the key issues.
A really big thank you to all those people who have been involved so far. Your contributions will help set a realistic plan for how we can better support all our staff and improve the environment within which we all work. The report confirms the dedication of our staff to providing the best care we can but reminds us that we must also look after and support our staff, treating each other with respect and kindness but never being afraid to speak up when something can be improved.
Thank you again.
- Chris Harrison, on behalf of the cultural audit advisory group
If you would like to make any comment on the report or ask any questions, please email the cultural review mailbox which is accessed by members of the cultural audit advisory group.
Frequently asked questions
Who undertook the audit?
The work was undertaken independently by the Globis Mediation Group, which has an established national reputation and expertise in organisational diagnosis and development.
How was the audit undertaken?
The audit involved scrutiny of relevant documents, 107 individual staff interviews, 16 staff focus groups, a questionnaire survey of all staff, and site visits. Overall, contributions were made by 1,171 staff members. In addition, the audit team received a summary of all the feedback received as part of the initial engagement exercise when the CQC report was published. This included information from staff from across the organisation including open sessions for clinical staff.
We are extremely grateful to all those who have taken part both in the initial engagement sessions and in the audit. Your contributions will help us plan and implement improvements.
Who commissioned the audit?
Whilst independently undertaken, the audit was commissioned by the executive team and supported by an advisory group convened by Prof Chris Harrison and including the three clinical staff governors and the staff side chair (partnership officer). The full membership of the advisory group was:
- Prof Chris Harrison – Deputy CEO
- Gemma Jones – Staff governor
- Rachael Bailey – Staff governor
- Kantappa Gajanan – Medical staff committee chair/Staff governor (In view of Mr Gajanan’s leave, Prof Omer Aziz kindly advised on the draft report)
- Gillian Hobson – Staff governor; Staff side partnership officer
- Rebecca Coles – Head of engagement and organisational development
- Louise Westcott – Company secretary
This group has agreed to continue to meet to advise and support the next steps as we respond to the recommendations.
What does the audit show?
The audit report describes how staff at The Christie are extremely passionate about the specialist nature of the work carried out. There is a huge desire to provide exceptional patient care, to support and enhance the reputation of the Trust, and to encourage improvements to working practices. There are some teams and some working relationships within the Trust where there is a strong sense of team collaboration and support.
However, across the Trust, there is frustration about workload, communication, variable leadership styles, certain working practices, behaviour toward colleagues, inconsistent teamwork and resources. This is affecting the way some people feel about their roles, as well as their overall wellbeing and levels of stress.
Bullying and discriminatory behaviour is totally unacceptable at The Christie. However, whilst the audit has not identified evidence of a culture of systematic discrimination or bullying, it confirms that there is a great deal to do to achieve our aspirations on these issues and we can take some immediate actions to improve. It is essential that as leaders and staff we ensure that our own behaviours match up to the expectations set out in the Trust’s values.
The report also concludes that positive elements described by most staff, such as a welcoming environment, ‘family’ feel, and excellent reputation may have in themselves led to a culture that has at times had difficulty in dealing with conflict, promoting transparency, acknowledging mistakes, and embracing change. In addition, for some, the success of The Christie has led to expansions in the service that have not been met sufficiently by changes to infrastructure, systems, processes and resources.
The audit’s findings triangulate with feedback following the staff engagement sessions following the CQC reports, with the observations and experience of the executive team and with the feedback from staff side representatives. They provide a solid evidence base for making significant changes to the way we do things.
What does the audit recommend?
The report makes 16 recommendations each accompanied by an explanation and specific actions. When taken together, they give us an opportunity to reset and rethink our approach to leadership and service improvement and to ensure that senior leaders throughout The Christie have the skills and support required to lead our organisation with compassion in difficult times and with all the pressures we face.
The 16 recommendations are:
- Establish a mechanism for staff to gain a greater understanding of job descriptions, different roles, departmental structures and decision-making processes and ensure that communication channels are clear.
- Provide safe spaces and access to emotional support for all staff.
- Support managers throughout the Trust to perform their role to the highest standard.
- Review procedures that relate to PDRs and access to training and development opportunities.
- Review the Freedom to Speak Up process and the options and support available to staff who raise concerns and those dealing with the process.
- Implement activities to encourage all colleagues to reflect upon their behaviour and improve the level of kindness, civility and respect in the workplace.
- Equip all staff with the skills to better manage difficult conversations and deal with challenging behaviour.
- Exit interviews to be carried out for all leavers and the data analysed.
- Produce transparent and consistent recruitment and selection criteria for every role and development opportunity to reduce perceptions of ‘cronyism’ or favouritism.
- Continue and enhance activities that promote equal treatment of staff regardless of race, religion or any other characteristic.
- All leaders should communicate and behave in a way that makes it clear bullying/racist behaviour in the workplace in unacceptable. A transparent and robust grievance process should be well documented and easily accessible.
- Create more opportunities for staff to shadow, mentor, learn from and meet with those from other teams and in other roles, to improve understanding, share best practice and encourage learning.
- Senior managers to acknowledge the importance of listening and learning to make improvements and display behaviour that reassures staff of their commitment to improvement.
- Review and prioritise ‘quick fixes’ in terms of equipment, repairs and space to work/conduct meetings/meet as a team etc.
- Issue clear policies on remote working.
- Comprehensive policy development across the whole organisation, rather than decisions being made at managers discretion. Policies should be tailored to the specific needs of The Christie and regularly updated as needed.
What happens now?
Rather than rushing to produce an action plan, the advisory group will be working through the recommendations to assess them and will be commissioning a further programme of engagement events in the New Year to give staff opportunities to talk about the findings to senior leaders, consider the recommendations and to discuss and help design a comprehensive programme which has the confidence of all staff.
This engagement and consultation programme will be through existing formal mechanisms such as divisional and departmental meetings, professional forums such as the Chief Nurse Forum, Staff Forum, the Grand Rounds and Medical Staff Committee. There will also be a programme of additional engagement events including online meetings, drop-in meetings and in person meetings. The detailed programme is being developed by our Communications and Organisational Development Teams and details will be made available as soon as possible.