Rewarding innovation in the workplace

You may have seen that Wolverhampton, my home since I was in short trousers in 1967, was recently cited by the Lonely Planet Guide as being the 5th worst city in the world. In simple terms the people who wrote that report can never have been to the city, or perhaps they just rode through on a train to elsewhere. Wolverhampton is a vibrant city with some of the friendliest and most helpful people I have ever had the privilege to meet. Having joined Wolverhampton Health Authority in 1979 and been a user and supporter of the health services within ever since I find it desperately frustrating when there is little or no acknowledgement of the innovation and resourcefulness of the people employed in our hospitals and clinics.
    
So now to redress the balance (a little): As a membership organisation the Healthcare Facilities Consortium has always endeavoured to find and propagate the very best of good practice and in the last few months our local PCT Facilities Team has won three such awards and our local acute hospital premature infant team earned a national reputation for excellence.
    
The Royal Wolverhampton Hospitals NHS Trust runs the premature infant team at its New Cross Hospital base and the Express and Star, the local evening paper, recently ran a half double page spread under the headline “Mother of all baby units”. This report highlighted how the unit is receiving premature babies from as far afield as Scotland and the Isle of Man because of its very high reputation. The report highlighted: “From consultants to domestic staff, all play their part in helping New Cross Hospital’s neonatal unit maintain its reputation as one of the finest in the country.” It is very pleasing to see that the Domestic Services team are mentioned in the article on an equal basis with the consultants, nursing staff and EME technicians that maintain the unit’s seven high dependency and 12 low dependency cots. The cleanliness of the unit is critical to maintaining a healthy environment for the infants and this has to be carried out with the constant flow of concerned visitors and staff. No wonder the domestic services team drew special mention. With this success behind it the unit is now bidding to expand.
    
Through my membership of the HefmA West Midlands Branch I was aware that the Wolverhampton City Primary Care Trust Facilities Team had won the Branch Good Practice Award in 2009 and subsequently also came second in the HefmA National Facilities Team of the Year Award. Later in the year the team also came second in the Building Better Healthcare Award for Best Facilities Management Service. No mean achievement for a Primary Care Trust team! So what is special about the team and the services they provide and how can the rest of us involved in healthcare facilities learn something from them?

Leading together
As a start point I viewed with interest the presentation made to the local HefmA Branch meeting in November last. Each HefmA West Midlands Branch award winner is expected to make such a presentation to the branch members with the clear intention of sharing best practice and so the presentations take around half the year to complete being made to the bi-monthly meetings. The first thing that struck me was that the presentation was made by a team of two senior managers who effectively share the role of leading the team. Joanne Appleby and Lindsay Ibbs-George are the general managers for Facilities within the Wolverhampton City PCT.
    
In looking at ‘Facilities in the Community’ their presentation reviewed how the PCT has devised a new approach to their facilities team in the community setting. The Trust has established a flatter management structure, defined roles and responsibilities and actively encourages the team members to take responsibility and innovate. Looking at the flatter than I am used to management structure it was obvious that this is not what we would normally call a ‘Facilities Department’. To start with there is no estates function – this is handled by the Estates Team, which is not linked in any (formal) way to the Facilities Team. As well as Housekeeping, Catering, Transport and Waste there is an Arts Coordinator and Warehousing also included in the team’s responsibilities as well as Contract and Performance Monitoring. One other significant difference from what we are more used to seeing in the management structures of E&FM departments or directorates within the health service is that the Team reports directly to the finance director and not the more usual facilities or operations director. So what differences does this approach make?
    
Although the presentation was good and very informative I wanted to know more and so I arranged a visit to their offices. This was a little bit of a trip down memory lane for me as I was part of the commissioning team for West Park Hospital in the 1980s and helped establish the new Unit Works Department that looked after the (then) new hospitals at West Park and Penn as well as maintaining the Health Centres, clinics, ambulance stations, staff accommodation, the old Eye Infirmary (now sadly closed along with the patients’ chapel that we built out of the old theatres and equipped with stained glass windows from a local redundant Church (now my financial advisor’s office!) and the Rehabilitation Centre at Patshull Hall – now a local golf club and hotel). The approach to the hospital entrance was very pleasing to see, well laid out with a ramp instead of the steps that were part of the new build. The reception was bright and airy and noticeably clean and well maintained and I was properly greeted on the reception desk and directed to the offices. Walking down the corridor I noticed the crisp design of the facilities team uniforms, a facilities notice board and a pull up promoting the Dr Hans Clean campaign being run jointly between the PCT and the acute trust.
    
Sharing a coffee and a chat with Lindsay and Joanne was very illuminating as they poured enthusiasm for what they have achieved. The finance director has actively encouraged the team to put in for awards and their success has been a springboard for other elements of his management area to follow their lead and it looks as if there is now a healthy competition growing amongst the departments which is resulting in spin off benefits for the local community. As an example the IT department have launched a website on children’s nutrition in conjunction with the school nurses and I gather that this is being put forward for an award. The Directorate hold Team Away Days and each department is required to make a presentation on what they are doing: Informatics have been working in support of The Good Shepherd Centre, a hostel for the homeless I the city centre, Procurement are working with local schools providing football training – well we do have a Premiership Team again! These activities are undertaken by the staff in their own time and the finance director’s view is that Corporate Services should be out and understanding the Trust functions better – and this drives the additional benefits into the community.

Winning the awards
Looking more specifically back at the Facilities Team and having judged awards in the past I wondered why you would put yourselves through the awards process? For the Facilities Team at Wolverhampton City PCT the trigger was a number of LIFT projects some 18 months previous and they found themselves competing against the local authority teams and wanted to show that they were better and worthy of being granted the services provision. Having produced the evidence there was very little extra effort required to make the information already at their finger tips into an awards submission. In particular, as some of the team had suggested Theme Days amongst the staff to brighten the atmosphere for patients, showing the staff all dressed up for a 1940s day gave a very real and visual image of the drive within the team. They have subsequently held Asian and Ascot days.
    
Having received these three recognitions there have been some very real benefits for the team. Firstly the team received £500 as part of one of the awards and use d this as a primer for some BICS training for the housekeepers. With the number of staff involved additional funding was required and the approach to the FD after winning the first award was like pushing at an open door. Funding in the region of £20k has provided training for 120 now qualified to Cleaning Operative Proficiency Certificate level and the supervisors are going on to the next level. When the team come up with new suggestions they do not have to prove to the same degree as the quality of the service has been proven in a comparative with their peers from around the country. It was also interesting to hear that the awards are displayed in the CEO’s office – he values “his team” having won them.
    
Some of the suggestions that have come through the team include a BAG to the FUTURE; they will be collecting bags of old clothing that generates around £400 per ton. One member of the team decided to walk to work and raised over £75 towards the British Heart Foundation. One of the housekeepers suggested providing bottled water instead of the traditional jugs to the elderly patients (frail patients find the jugs difficult to handle, something I know only too well having seen both my late parents struggle with them). This provided a cost effective solution as there is a significant saving in cleaning and refreshing the jugs through the day. Added benefits are that it is far easier to monitor how much water the patients are consuming, the patients them selves can manage the sports tops easily and there is less spillage. They have now implemented their own recycling scheme for the volume of plastic bottles they use.
    
From the PEAT evaluations they have built action plans and develop bids for funding for innovative ideas to improve the patient experience. One example of this is that they now provide newspapers for the patients on the wards and also run an afternoon cakes trolley for patients and visitors – the aim being to make the ward a more homely environment for their patients. The housekeeping teams cover a wide range of areas including food, environment, cleaning, laundry and bed making (this later item being introduced this month). At the Mental Health Unit younger patients are encouraged to make their own beds with the housekeeping team providing the linen as they do the routine tasks. The aim is to provide a less institutionalised environment for the patients.

Facilities Coordinators
In the community there are facilities coordinators covering the 25 Health Centres and they act as a focal point for all hard and soft FM issues handling deliveries, flooring work, contractors’ attendance etc and all attendance by the internal Estates Maintenance teams. This is part of the proven ward based service being rolled out into the community properties. It has proven far easier with these staff in place to prove both the services and also invoicing for things like waste. Lindsay and Joanne told me that the awards have helped them prove that they can do these things; this has then been followed up by proven cost efficiencies one example of which is their Continence Service. As part of a tender exercise locally they decided to consider an internal service using a warehouse receiving bulk deliveries and internal distribution rather than home deliveries by the distributors. This has proven successful and cost effective and may lead into other allied arrangements.
    
Following the Deep Clean programme, which was executed primarily using contractors, the team undertook a review to consider how they were going to maintain the standards. Use of contractors proved difficult partly because of the high demand for their services but also because of the problems of arranging access for the contractors to so many outlying properties. They built a proposal for an in-house service and this has shown cost savings over the contractor programme and also enhanced service flexibility. The service is run using a housekeeper with two full time equivalent staff and with full liaison with the Estates Team to provide for the removal of fixtures and fittings. The first period of the new service was followed by a thorough audit and proof positive of the benefits of this service provision.
    
As noted earlier the team includes an arts Coordinator but I think I will leave this for a later article as there is significant interest in this kind of work to warrant a further look. The Facilities Team has its own branding, in house magazine and will shortly be moving into its own Facilities HQ including its own training centre. All in all a very forward looking and effective team from the Trust’s high end management structure and approach through the two general managers and their infectious enthusiasm to the staff at the sharp end who appreciate the freedom to think and innovate and value the opportunities they are given to provide their own input into the planning and decision making processes. The fact that so many get involved on a voluntary basis with fund raising and patient support activities is testament to the loyalty and commitment that the management methodologies are inspiring.