Organisational context
Salisbury NHS Foundation Trust provides a range of clinical care, including general acute and emergency services, to over 200,000 people in Wiltshire, Dorset and Hampshire. Specialist burns, plastic surgery, cleft lip and palate, genetics and rehabilitation extend to a much wider population of more than 3 million people. The Duke of Cornwall Spinal Treatment Centre covers most of southern England with a population of 11 million people.
The trust provides child and adolescent mental health services. It also maintains close links with other NHS organisations and some community services are based at Salisbury District Hospital. Trust staff provide outpatient clinics in community hospitals in Dorset and Hampshire. Specialist staff hold outreach clinics in hospitals within the region. In total there are 3,773 members of staff; this includes full- and part-time staff.
High-quality care and three stars in national performance ratings for 2003–04 made Salisbury District Hospital one of the top NHS hospitals in the country, enabling what was then Salisbury Health Care NHS Trust to apply for NHS Foundation Trust status. To continue with its application, the trust had to maintain its high standards and retain three stars in 2004–05, which it did. Consistently high standards and excellent financial management led to the authorisation of the hospital as an NHS Foundation Trust under the Health and Social Care (Community) Act 2003 on 1 June 2006 and a new name: Salisbury NHS Foundation Trust.
NHS foundation trusts are legally independent organisations known as public benefit corporations, with a duty to provide NHS services to NHS patients. NHS foundation trusts are still firmly part of the NHS, but with greater freedom to develop in the way that local people and staff feel is appropriate for them.
What has NHS foundation trust status changed?
- The trust is now directly accountable to local people through the Council of Governors.
- There are more opportunities for local people to get involved in the hospital and help the trust continue to improve services for patients.
- There is now greater financial freedom that can be used to develop facilities and services in the organisation to benefit patients.
What stayed the same?
- Care and treatment continues to be free at the point of delivery.
- The trust continues to provide services to the high standards set by the Department of Health.
- The trust continues to work in co-operation with other health and social care organisations for the benefit of local people.
- Organisational challenges come from defining new ways of working and learning as a new NHS foundation trust within the NHS.
An overview of coaching within the trust
Coaching is part of the Trust Lifelong Learning Strategy (2003) and work is ongoing to develop a comprehensive infrastructure to support individuals and teams to make best use of the coaching approach. A coaching culture is seen as fundamental to achieving strategic and individual objectives, as this will enable talent management and enhance individual and team performance. There are two main strands of coaching actively taking place within the organisation: formal coaching embedded in programmes, and informal coaching in projects/teams. Coaching is a fairly new approach for the organisation and therefore the structure for this is immature. There is a requirement to evaluate how best coaching can be used and the return on investment for the organisation.
The role and potential of coaching within Salisbury NHS Foundation Trust
Coaching is seen by advocates within the organisation as being a comprehensive tool to empower the workforce at all levels. It is recognised as having potential to support the development of the trust’s capabilities, for example, by improving morale, productivity, managerial effectiveness and good leadership skills. An additional organisational benefit is that the coaching approach has been cascaded through teams, as team members who have experienced coaching use coaching themselves to support their colleagues. Modelling of the coaching approach takes place informally within line management relationships and enables staff to manage and make sense of change in their specialist areas, providing greater involvement in new ways of working and learning. A coaching approach has greatly supported management of change, engaging hearts and minds and aiding organisational development.
There is a strong sense among those involved in coaching in the organisation that coaching should be used to enhance skills individually or within teams and not be used as a remedial tool. Line managers undertake coaching informally with their teams and formal one-to-one coaching development takes place with external coaches. Learning and development professionals within the organisation hold that formal one-to-one coaching works best when it is offered outside the line manager–reportee relationship, with objectives set so that individual/organisational/coaching benefit could be measured.
Coaching at Salisbury is considered part of overall organisational development. In many work areas a coaching approach has developed in an organic way due to individuals having a particular interest in using coaching.
Coaching embedded in programmes
Managerial/leadership programmes
The majority of coaching that takes place in the organisation happens within bespoke management/leadership programmes. These have been designed in partnership with external companies to challenge the individual manager/leader and enhance their critical thinking skills. The coaching is undertaken by external coaches, who work with the individuals on personal/professional development objectives. These are generally defined as ‘business conversations’. An evaluation process is in place for the end of the programme and individuals also feed back to their line manager and the trust’s Education, Workforce and Development Group, who commissions training. Coachees were more inclined to apply for promotion, as they felt valued and more confident after the coaching.
Coaching is perceived within the organisation as a way to develop emotional intelligence/soft skills and complements the content of the managerial/leadership course. Coachees appreciate the support in developing their management style and confidence working with an external coach as this develops a relationship built on trust. The coach is very clear on what is expected within the relationship and the objectives of the programme. Coachees express that this aspect of the course is the most valuable, as it transforms the way they look at their post and the culture that they work in. Real-life examples are worked on within the coaching environment, providing positive coachee-driven action and solutions. Further support and development come from action learning sets.
Customer service programme
A pilot customer service programme has been designed in partnership with external providers in 2007, using a coaching approach to deliver service improvements and enhance individuals’ skills. This is unique as line managers are given informal coaching skills training and then they coach an individual member of their team through a bespoke customer service programme. Additional one-to-one coaching is provided by an external coach, who also provides underpinning knowledge throughout the programme through one-day workshops. The coachees are challenged to look at service improvement in their area while generating ideas that can achieve this. By using a coaching approach, the manager can support the individual in this process and immediately put their coaching skills into practice.
Line managers welcome the structure provided by this programme as it introduces teams to the informal coaching process, building skills immediately. Valuable skills are gained from the formal coach training and the work with the coachee that can be used in projects and the work team. It is seen as a positive development that supports the coachee to achieve a qualification, engage with service improvement and enhance customer service skills.
Coachees appreciate the support for their service improvement ideas and the opportunity to look at the wider picture of customer service related to their work area with their coach. Individuals report feeling more valued and more inclined to apply for working parties to develop customer service issues further. This programme will link to a new customer service strategy, being developed after evaluation.
Informal coaching in projects and teams
A range of informal coaching in projects and teams takes place throughout the organisation. Coachees experience the coaching approach and then use the approach with their colleagues. This cascades the initial training to other members of the team with good results. This is useful to build confidence within the team and motivate individuals.
An example of this was the ‘Unlocking staff potential’ project, which saw junior staff modelling the coaching behaviour of their colleagues and team leaders. This aspect was not specifically planned but has added additional value to the project as it enabled staff to be supported by colleagues and developed coaching skills in junior team members.
The NHS has a new competency framework, which all staff need to work towards at different levels. This framework emphasises coaching as a way to deliver learning in the workplace. The framework is used as a basis for personal development reviews undertaken by line managers with their staff. Many line managers use coaching skills to work with their staff during the review and identify opportunities for coaching (formal or informal). This could be as part of their personal development plan and highlights that coaching is seen as a positive action in the organisation. Line managers contact the learning and development team to access formal coaching for their staff.
‘Unlocking staff potential’ project – a coaching and e-learning approach
The trust has undertaken a major project to develop a managed learning environment, consisting of an e-learning platform, a learning management system and virtual classroom facility. All staff need to access this system, as this will ensure that the trust offers a blended approach to learning, comprehensive training records and assists with mandatory training requirements.
A training needs analysis identified that many staff within the trust’s facilities directorate did not have basic computer skills, as these have traditionally not been required for their jobs in catering, housekeeping and portering. An innovative approach was required to support these learners to gain confidence in using IT, access e-learning programmes and relate their learning to the workplace. A project was set up to develop ‘learning advisers’ to support these requirements.
The learning advisers were drawn from a range of staff who had responsibility for training or were team leaders in their areas. A programme was developed in-house to provide coaching skills, skills for life/dyslexia awareness skills and training in the managed learning environment. A learning advisers project team was formed, which enabled individuals to share best practice and offer support to each other when planning the project. The lifelong learning facilitator led the project, identified training requirements and provided additional coaching to individuals and teams.
Return on investment
Over a five-week period learning advisers introduced their staff to the managed learning environment and 1,400 e-learning programmes were accessed. This project will continue until all staff are actively using the system. Initial evaluation indicates that learning advisers feel that using a coaching approach has enabled them to overcome barriers to learning and increased team members’ confidence and motivation. An unexpected benefit is that staff who have been coached are using a coaching approach to support their less confident team colleagues.
Additional evaluation will take place to enable best practice to be shared across the organisation and to partners in the South Wiltshire Health and Social Care Academy.
The value that coaching has added to the project cannot be underestimated, as this has engaged staff in the process, developed soft skills at all levels and ensured learning can be applied to the workplace.