Leading one of the most successful NHS Foundation Trusts in the country, we are very grateful to Dame Jackie Daniel for finding the time to share her insights and experiences from her time at Newcastle upon Tyne Hospitals NHS FT and previous organisations. With a strong emphasis on the importance of partnership and the potential this brings to the sector, she highlights the strength of communications and the encouragement of innovation to build a culture where partner-working is embraced.
You have been in your role for just over a year. What attracted you to this role as CEO of Newcastle upon Tyne Hospitals NHS Foundation Trust?
I was looking for a role that was fresh and would challenge me – that was a key priority. When I started looking at this role in Newcastle, I immediately started to recognise both the challenge and the excitement that it would bring.
This is a really high performing regional centre with a great reputation across both the North East and the wider UK. It had been meeting the constitutional standards and targets while being a going concern financially. It was in a very good place (none of which was my doing), but it made the prospect of working here and the process of the organisation’s further evolution very exciting. The Trust is closely aligned with the City’s civic partners such as the University of Newcastle and Newcastle City Council, both with strong leadership and great ambition. This rich mix of partners thinking together about health and innovation presented an excellent opportunity to make a difference.
I don’t think there is a place in the UK that is in a better position to deliver on the forthcoming NHS Long Term Plan than the organisations here in Newcastle. I believe we will be able to start to offer something special for the next generation in terms of health and care and that was a huge driver for me in taking on this role.
You have previously been involved in implementing large cultural change programmes within the organisations which you have led. Has innovation been a priority in delivering sustainable cultural change?
I do think that we need to be clear that innovation can mean many things to different people. In terms of cultural change, innovation is about the way in which you move relationships on and work with people. At Newcastle Hospitals we have 15,000 employees and thinking about how as Chief Executive I really connect with people across hierarchies and sites requires innovative thinking. I am a social media fan and I often use different media to communicate with staff in an imaginative and creative way. We have also established programmes of work that bring people together with areas of common interest. In Newcastle I am leading one called Flourish which I also worked with in my last organisation. It is a totally flexible programme and extends across all employees. It focuses on listening to staff to establish how we can create an environment that enables them to bring their best to work and allows them to really flourish. This really has innovation and staff involvement at the heart.
It is important to get staff into a ‘discovery’ rather than ‘defence’ mindset. This comes from them feeling supported and valued and can make a transformational difference to patient safety and feedback, as well as staff sickness and absence.
Can you share an example of an innovative approach that has made a difference to the approach or culture of an organisation where you have worked? Did you implement this in your previous organisation and how has it evolved since then?
What I would really emphasise is that any innovation or change does need to be tailored to the organisation, the environment, the people and what you are trying to achieve in terms of strategic objectives. In Newcastle, we have a lot of people interested in innovation, research and new product development for example.
A key example to highlight in more detail is the Flourish programme, which was implemented in my last organisation but has been evolved for Newcastle. Through this programme we hold ‘big conversations’ where we issue open invitations and regularly get around 200 people there at a time, ranging from consultants to scientists, porters, nurses, catering staff and receptionists. They set the agenda for the programme. We are working on a range of things, including keeping minds and bodies fit and healthy. This may seem rather obvious, but when they are not properly supported there is a risk of burn out and stress. We look at what we can we do within the working environment, including our food and catering outlets and what opportunities for memberships of physical exercise classes and social organisations there are.
Another key area is behaviours as we want to try and set particular standards. A cross-profession working group of has begun work to develop a behavioural charter and establishing how we share this with staff.
Flourish is pretty freeform and can seem a bit daunting, but we have a group of people who are working on how you can bring that together and it moves and flows. We want it to be as agile as possible, only working on projects and initiatives that offer a benefit to staff.
How innovative is your approach to partnership working?
Innovation works best when you bring partners together. At Newcastle there has historically not been a great track record of working in partnership or collaboration with other organisations. I believe that we can really achieve our best when we use the diverse skills of a partnership arrangement, which is why I am working hard on links with the Newcastle City Council, University of Newcastle, as well as across the commercial and voluntary sectors. We are keen to build these relationships to create physical spaces across the city where people can come together and consider ways to transform and innovate in health, wealth and wellbeing.
In Newcastle we have the National Institute for Ageing with lots of expertise across different sectors and this gives us a leading edge in the UK. It is a true partnership between three big civic groups in the city and is attracting new business, which in turn is driving up economic growth and regeneration. We are continuously thinking about how we can shine a light on opportunities for different sectors to engage and how many more people can we bring into full-time employment in health and care. It is attracting a lot of commercial interest to the city, and this is helping to develop businesses locally.
This is absolute vital innovation, as wealth brings better health overall. It is so inextricably linked, and you can just see the vibrancy of the city and the potential for growth. Our hospitals are at the heart of that innovation, and the regeneration of spaces in the city provides an excellent opportunity for our staff to get into discovery mode and contribute to its development moving forward.
Looking more broadly, how much opportunity do you believe innovation has to thrive in the UK health and care sectors?
There really are endless opportunities. However, as health leaders we need to think about how we are prioritising the innovations and how we translate some of the stratospheric opportunities across the hospital environment for all to understand. I am continuously moving between very local innovations and panning out to international opportunities, and this can be difficult to communicate effectively.
For example, I was in Boston recently with a group of colleagues from health, care and university settings looking at how we might link up with the Age Lab that has been set up at Massachusetts Institute of Technology (MIT). Trying to connect what is being done there with what we are doing here in Newcastle can seem quite remote, so it is vital that we get the narrative right. We need to be connecting with staff, telling the story and explaining why our focus on aging and the link with this project has the potential to be revolutionary. Not just for Newcastle, but for health outcomes and next generation of health and care across the region and beyond. The work we are doing today has the potential to leave a legacy for generations to come – helping people to age better and live a full life into old age.
Another key area of innovation for us is in the field of robotics and digital surgery. We are one of very few hospital Trusts that is training staff in digital and robotic surgery. It is an absolute game changer for patients and their experience of care and treatment.
I really don’t believe that innovation has boundaries; it is just a case of how fast we can get there.
Are there barriers or enablers that you would particularly highlight in this context?
In order to optimise any of these innovation opportunities, an organisation needs to be in a really good state of readiness. Newcastle is already such a high performing organisation in every sense that it has the ability to be an edge leader. We have the capability here to think about innovation, but we have also the people who can work to deliver it. That key mix is not universal, but there are others including the big teaching hospitals and NHS Foundation Trusts across the country who are also able to really take advantage of innovation.
The fact that we are about to embark on a new NHS Long Term Plan in health opens up opportunities too. It feels like a permissive context in which to be working with many of the arms’ length bodies such as NHS Improvement and NHS England supporting the service. They too seem to be looking for people who can help drive this forward and are supporting us as we look to the future together.
How is technology helping to drive innovation in the health and care sector?
We believe here in Newcastle we are among the most digitally-enabled Foundation Trusts in the UK at the moment. We have been highlighted as a global digital exemplar and are working in partnership with NHS Digital and NHS Improvement to push the digital boundaries as much as possible.
We have well-connected care records, right from general practice and across the network of hospitals in the North East. For example, at the push of a button a consultant can access GP notes or vice versa with images available from theatre for a GP. All our notes, measurements and prescriptions are kept digitally with no paper. Our staff use digitalised rotas which allow them to log in and out, meaning no completion of timesheets is required.
We have also introduced a new system for requesting a porter’s services, which is bit like ordering an Uber. It works through a handheld device and a clear tracking system makes the whole thing much smoother and more effective, which is paramount from a logistics perspective when running a billion-pound organisation.
The crux of this is that the technology has to work. We have learned such a lot along the way and adapted as we have gone. We are continually working with the teams to establish the best technology to help them and to ensure our patients receive the best, most efficient care.
Has the greater use of technology required more investment in staff training?
It has taken significant levels of training, but to get everyone on board we have had to go that extra mile. Everything is online, all our statutory, mandatory training is done digitally. We do recognise that we are running busy hospitals, but we needed to be creating bandwidth and even offered the opportunity for an extra day’s leave to get the training completed. There are younger staff who need less training but there are cohorts who require quite a lot of support.
The Trust’s status as a leader in this area of digital in health and care engenders massive pride for staff: they are part of something that is really developing. I am very interested to see how these advancements will affect where people go and work in the future and how we recruit here in Newcastle. If you can work in a place that makes doing what our staff do each day much easier – digital solutions have the opportunity to provide a very interesting evolution for the NHS, challenging the more traditional bureaucracy and hierarchy, I believe that is exciting. As a leader you have got to be prepared to let people make decisions and take risks, and this is an important part of how we are aiming to evolve culturally.
You work in very large multi-discipline organisations. How do you overcome the complexities of communication and drive partnership working?
A few years ago, in a previous role, I developed a framework around communications and this has stood me in good stead. There are three key areas in the framework. The first one I focus on is leadership and I spend a lot of time in this area. I spend time meeting with small and large groups of leaders at different points of the year in both formal and informal settings. I firmly believe in connecting with leaders, talking and listening about what good leadership looks like, hearing some of the issues, and discussing with staff the importance of their responsibilities in sharing information and communicating.
The second area that I look at is what I refer to as ‘System 1’ or the ‘Science’ – the board to ward Governance and performance management structures making sure that the processes are in place, weekly team briefs happen and that clear lines of communication exist. Sound governance structures and processes and clear lines of accountability are key.
The third area that I call ‘System 2’ or the ‘Art’ is much more about encouraging coalitions and networks amongst groups of staff with communities of interest or activity. This area is much lighter touch and we establish different forums for getting together. We have many less formal “networking” groups which offer a great deal.
Finally, the use of multiple channels for communications is vital. I am supported by a great comms team and I really believe investment in that is vital. I use social media at the heart of my communications and write a blog every fortnight, come what may. Consistency is essential, and the information has to flow through your leaders, your formal structures and through the whole tapestry of staff appropriately and sufficiently to make it inclusive. You really can’t do that through one channel.
Do you think that coaching and mentoring programmes are necessary and sustainable within the health and care sector?
In my opinion, this should be part of the day-to-day DNA of any health organisation. I actively encourage coaching and have always believed in it. We have implemented the equivalent of a coaching academy internally and have worked hard to encourage and enable a coaching culture. This is particularly important amongst leaders, encouraging them to talk to staff, undertake performance management and conduct appraisals with a coaching conversation style. We prefer to equip our staff and leaders by training them in this style internally, rather than buying in lots of coaching hours onto already very busy schedules. Coaching really is core to making the organisation and the management of its people sustainable.
You are a champion of sustainable healthcare. What does this look like to you?
It all starts with your people; they are the most valuable asset. It is important that they are bringing absolutely the best version of themselves to work and that they feel valued for doing so. This drives quality and improvement right across the organisation.
A health organisation must be technologically and digitally enabled. The people and the technology are core areas of investment that cannot be ignored.
Most organisations talk about implementing a sustainability plan, but typically that is a cost improvement plan and that is not what I am talking about here. Over the next three years in Newcastle we are moving forwards with our sustainability plan – it is about enhancing productivity, the elimination of waste and maximising efficiency in a range of ways. Sustainability isn’t just about one or two things, it is considering it in a number of connected areas. We will be working in an integrated way with partners across our network regionally and nationally. We are also building global partners as that is what will really help us to make our Trust sustainable – inward investments and innovation, learning from the best.
I have to finish by emphasising the point that better health is inextricably linked to economic wealth. It is vital therefore for the sustainability of health organisations, both here and internationally, that they maintain a clear level of commercial astuteness and proactively look to work with business partners now and in the future.
Dame Jackie Daniel, Biography
Dame Jackie joined Newcastle upon Tyne Hospitals NHS Foundation Trust as Chief Executive Officer in March 2018.
Dame Jackie began her NHS professional career as a nurse before moving into NHS management. She has been a Chief Executive Officer for the last 16 years and has led Acute, Mental Health and a Specialist Trust. She is former Chief Executive Officer of University Hospitals of Morecambe Bay NHS Foundation Trust which she joined in 2012 and led out of special measures.
Dame Jackie was recognised in the 2017 Queen’s New Year’s Honours for her services to health care. She has a degree in Nursing Studies, a Masters degree in Quality Assurance in Health and Social Care and is a qualified business and personal coach.
Jackie is an Executive in Residence with Lancaster University Management School and an avid commentator on NHS related issues such as integrated care systems and creating a sustainable NHS for future generations. She is passionate about the role leadership plays and is a strong advocate of the creation of diverse leadership and the promotion of women in leadership roles. She is a firm believer in liberating potential through engaging and supporting people.