Looking for a rewarding role? Go to a challenged hospital.

Caroline Shaw CBE, Chief Executive of The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust shares her insights on why turning round a hospital known as one of the very worst in the country has been the hardest but most rewarding role of her career to date. And why she is adamant we should put our brightest and best CEOs in challenged hospitals.

It’s a cliché, I know. I went into the NHS to make a difference. My Dad had MS and I had seen first-hand the impact good and not so good care had on our family – and how important research was after taking part in a beta interferon research trial eased his symptoms.

I started out in the mid-80s as a student nurse and quickly moved into midwifery. It felt a natural fit, I’m a feminist at heart really – and I enjoyed the job and making a difference. It wasn’t long before I moved into general management and realised that being part of a leadership and management team meant that not only could I directly influence patient care, the work I did impacted on so many more people; I loved it. I took more academic qualifications and had a really varied career and for the last 22 years I have worked in teaching hospitals at Board level. I have been lucky to have had some incredible jobs and fortunate to work with many extraordinary leaders who have believed in me and inspired me.

I was approached about the QEH CEO role in the winter of 2018, faced with the opportunity to lead a Trust that had just been put back into special measures with very significant quality of care and financial issues. At the time it was known as one of the worst Trusts in the country, ‘a basket case’, and one lots of leaders wouldn’t touch with a barge pole.

The challenge was an exciting one - and I felt for the local community and staff. It reminded me of where I was brought up in the Lake District. Geographically isolated, rural Trusts have a hard deal and yet regardless of where a hospital is located, we owe it to our patients and local communities we serve to provide the very best care. It’s about fairness and for me, that’s a big deal.

I knew it was going to be hard work and harder still as we decided not to move as a family. My children were at important stages of school and to be honest, the reality is if you don’t turn things around you are going to get the sack.

But the job played to my strengths. You can wrap your arms around the hospital, get to know the people and I like that, it fits well with my personality. And I was keen to work with a very experienced Chairman and build a new Board so we could, together, focus on improving services. And that’s exactly what we’ve done.

The hospital at that time was renowned for being dreadful – the sound of dropped bedpans had most definitely reached Whitehall and Matt Hancock. Twelve CEOs in ten years, and the reality of a ‘revolving door’ at the top as so many staff reminded me of regularly – you ask: “what made me different?” When I strip it back, it’s been about authentic leadership, gaining trust and giving people the power, permission and belief to do things and lead change. There were three things that were really important to me:

• The first recognises that no hospital works in isolation and so I met with key stakeholders and undertook some stakeholder analysis to think about what we needed to do as a hospital and a community to improve our relationships, which were non-existent when I started. I knew that we wouldn’t fix the issues overnight and so have managed key stakeholders with honest conversations, delivering on commitments made and not promising jam tomorrow when you know there isn’t going to be any
• The next was to start fixing the basics of quality of patient care and experience. The Trust’s CQC report from 2018 was the worst CQC report I had ever read; it would make you cry – and the 30 or 40 complaints we received a month sadly supported those findings
• The third was starting to address one of the worst staff survey results in the country. They were truly miserable; staff didn’t feel supported, cared for or valued and people weren’t kind. We needed to focus on being kind to each other, supporting wellness and making things fairer in terms of recruitment, retention and opportunities.

We also needed to be brave enough to develop a simple strategy for the future. I knew we would be going places if staff at any level of the organisation could say what the vision of the Trust was and how they contribute personally in their role to improving Quality (Q), Engagement (E), and Healthy Lives (H). QEH is loved by the community and is proud of its royal connection to Sandringham so everyone could affiliate with the ‘QEH’ strategy and use it as their compass, regardless of their role in the organisation.

I was really clear about standards of care and walked and talked that as a leader. When I was first at the Trust, I would be working in my office in the evening and could hear the buzzer on a ward go off and no one would answer it. I worked out what ward it was and would run up myself and say ‘buzzer, can we answer it’ and run down again. At the time people couldn’t see it - poor performance and poor attitudes had been normalised. The ‘inadequate’ sign we all walk past on the wall every day and leave on the way home, had become a feature. It was the hardest job and the worst and most unkind Trust I had ever worked in – people had given up.

I brought in an Executive Team who really understood what was important about patient care and experience and patient safety and improving staff experience - and we held the mirror up. We have done a lot of work on culture and kindness and being really honest and saying when things aren’t good practice.

We focused on getting the basics right, like customer service and kindness, and took a lot of learning from the private sector. It was like hitting the jackpot the other week when our Lead Governor said someone had said to her when she walked in the hospital, ‘good morning, you look lost, can I help you?’

As a Chief Executive you sometimes forget some of the little things mean and lead to big things. I recently tweeted about one of our nurses being fabulous. Her mum works at the Trust too, and she told me how thrilled and proud she was to see it.

Another thing I have been clear about is governance - where do we make decisions, how do we monitor what we are doing and how do we give assurance to the Board and what does that look like. I completely restructured the governance framework, simplified it and made it really clear. I pushed decision making down to the Senior Leadership Team and was clear about how we would hold people to account and support and develop people.

Working with a Trust that has been in and out of special measures for the last ten years I knew it wasn’t going to be hunky dory overnight. Three years in, with the publication of our latest CQC report this month, it is time to reflect on how far we have come – and I couldn’t be more proud of Team QEH:

• Out of special measures and ‘Good’ for well-led, caring and efficient
• All three services inspected rated ‘Good’ overall
• 206 ‘must’ and ‘should dos’ to 4 and 9 and all conditions lifted
• 30-40 to 3-4 complaints a month
• A better place to work - 12th most improved national staff survey in the country (from bottom in almost every domain in the survey to close to or average for all – a step change)
• One of lowest nurse vacancy rates in the NHS c. 15% to 5%
• Culture transformation (and a relentless focus on kindness, wellness and fairness) having a tangible impact
• Nationally recognised for our Duty of Candour Covid exercise
• A huge focus on staff engagement and wellbeing, the spin off being better patient care and better clinical outcomes
• National reputation for work to support staff going through the menopause
• Strong staff networks are in place ensuring our staff have a voice
• Only Trust in the region to have a full-time equality, diversity and inclusion lead
• Achieved financial plan for two successive years and achieved savings plan two years running
• Excellent research record – ranked 27 of 507 Trusts nationally for Covid related research
• Significant external recognition and endorsement – national, regional and local
• Passionate support for our new hospital bid from all stakeholders and one of the best external stakeholder perception survey results our auditors have seen
• Over £30m capital investment to modernise and digitise our hospital in 2021/22 – more than any other Trust in the region and more than ever for QEH – demonstrating the level of confidence in QEH and our delivery is growing.

And the list could go on and on.

Reflecting on these three years, I think it is good to get experience working in a special measures Trust for experience and not to overlook them. If you genuinely come into the health service to make a difference to patients, I promise you that by turning round a difficult hospital you’ll get real pleasure and personal satisfaction from it. It should be something every aspiring leader and CEO aims for. Challenged Trusts deserve our brightest and our best.

I feel personally proud and proud of my staff to have come this far in just three years – and I know that our patients and their families are getting a much better deal. And ultimately that’s what I came into the NHS to do.

A shortened version of this article was published in the Health Service Journal on 23 February 2022.