Lucy Richardson discusses how she helped an acute hospital NHS trust improve its quality of care.

The challenge

An acute hospital NHS Trust – serving a population of over half a million people through 4,500 members of staff and volunteers – was on a journey out of special measures. There were operational challenges across three hospital sites, a limited budget, and a need to reset its vision for quality as part of its journey. Gate One was asked to help with the latter: set a vision for quality and a strategy to achieve it. The highest priority throughout this exercise was – unequivocally – to improve the provision of quality care for its patients.

There were four main challenges associated with this task:

  1. Sceptical staff who were demoralised by a performance management culture and an ‘inadequate’ rating by the Care Quality Commission.
  2. A risk-averse culture, which prevented staff-led, innovative change.
  3. Separation of ‘board and ward’: the management team was disconnected from frontline staff.
  4. A lack of guidance for senior leadership who needed support in sculpting the vision of quality.

An empathic perspective

I was excited about this project from the start. In my previous life, I worked as an Assistant Psychologist in a neighbouring NHS Trust. This meant I could empathise with the challenges that the clinical staff were facing: the relentless targets and paperwork, demanding patients – all alongside a stream of new approaches and initiatives from policy makers and higher management levels.

As a result, I understood what I was asking for when I approached both the clinicians and office staff for their time to contribute to the developing quality strategy. I could then use my project management background to take their ideas and concerns and wrap a structure around them, turning them into discrete initiatives to improve the quality of care across the Trust.

The Approach

I worked ‘shoulder to shoulder’ with the existing client Quality Team. At the beginning of the engagement, I developed a clear approach through which the strategy would be developed and implemented. Key to this was the stage gates at which the Executive and quality teams would be able to input and review the recommendations before they were finalised – me developing these in isolation would not work in the long-term.

First, I needed to understand what ‘quality’ actually meant to staff at all levels before improvements could be made. At the top level, I engaged the Trust Board and executive decision-makers in their vision for quality through collaborative workshops and one-on-one meetings.

“Thank you very much for your input to our board development session last week… I know everyone enjoyed the session” Deputy Chief Executive, NHS Trust

In parallel, I engaged multiple groups through an extensive cross-organisation engagement exercise. I ran sixteen structured workshops in two weeks; staff from Board to ward were involved in developing the quality strategy, which ensured alignment and strategic options at key decision points. A critical success factor was making sure that both clinical and non-clinical staff, who all work, ultimately, to improve the patient experience, were engaged.

“Lucy has engaged with all key stakeholders making every effort to understand their challenges and her ability to ‘put herself in their shoes’ has been remarkable. She has attended ward rounds, board rounds, and joined as many key meetings with staff and stakeholders from throughout the trust…” Chief Nurse, NHS Trust

Results and benefits

Through this approach, the foundations for a culture change were laid: staff were lifted out of a fixed, ‘learned helplessness’ mindset and began to be persuaded that increasing the quality of care was within their power. Using the output from these sessions, I developed a vision for quality based on a service culture and reciprocal commitment across the organisation, teams and individuals.

The step-change in culture was fundamental to both the development and success of the quality strategy, gradually empowering staff to improve the quality of care they give to patients. The strategy provided the Trust with recommendations for both short-term and long-term improvements that would be beneficial to the staff member’s working experience – therefore naturally leading to better patient experiences.

Final word

It is well known that the health sector is under ever-increasing pressure and scrutiny. As part of my role, I helped the client to successfully develop a tangible quality strategy, summarised in one, user-friendly page, that was accessible and relevant to busy staff.

I recognise that a quality strategy does not fix all healthcare challenges, but it has begun to create direction for a culture of continuous improvement in that Trust, led by staff who feel empowered.


Lucy is a manager in our health team. She is committed to improving service user experience in healthcare, combining a practical knowledge of the NHS with a transformational programme experience in multiple sectors.