60 Nhs highland pledge – development and implementation of a physician compact to deliver the highland quality approach (hqa)

NHS Highland, the largest geographical Health Board in Scotland, has responsibility for Adult Health, Social Care and Paediatric services. In 2014 the Board described quality ambitions to underpin the vision, mission and strategy of the organisation. This project describes how clinicians were engaged to ensure delivery of the HQA. Staff surveys during 2013–2015 highlighted that medical staff reported being highly engaged in their work but only 52% reported sufficient opportunity to put forward new ideas for improvement. Only 35% of staff were confident their ideas would be listened to and 22% felt consulted about changes. In addition only 60% of our doctors would recommend NHSH as a place to work. These data did not align with the vision of the organisation. A small discovery team, supported by clinical directors, created an urgency for change using plenaries and sharing feedback from workshops. As themes arose the compact developed as a 2 dimensional construct. We started small, using “safe” meetings to test the compact. Once confidence was gained, we delivered “using the compact sessions” with all key clinical groups. The organisation now uses the compact to ensure collectively that staff are aligned to the Board’s vision. Our next step is to go back to all groups and determine how the compact is being used and to measure its impact Our current compact is patient focused. Our clinicians had lots of ideas on improvement and demonstrated great examples of successful change. However, we also learned that our clinicians didn’t feel valued or listened to. Staff were over burdened with work; managers and clinicians were not working together to common goals, resulting in sadness and frustration. As an organisation, we valued action over reflection. Using the compact we have shone a light on this and opened opportunities for new conversations. We have increased communication and are planning interventions to help managerial colleagues to achieve a better work-life balance.