Cleveland Clinic London Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Leaders and staff had a shared vision and culture based on listening, learning and trust. Leaders were visible, knowledgeable and supportive, helping staff develop in their roles. Staff felt supported to give feedback and were treated equally, free from bullying or harassment. People with protected characteristics felt supported. Staff understood their roles and responsibilities. There was a culture of continuous improvement with staff given time and resources to try new ideas.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The hospital made sure staff at all levels were aware of its the shared vision, strategy and values. The mission, vision, and values were visibly displayed throughout the hospital for both staff and patients to see. The values were incorporated into the appraisal system where staff were evaluated against these guiding principles.

The provider had introduced an objectives and key results framework, linking departmental objectives to the hospital’s broader mission and values. These objectives cascaded down from senior leadership and the president’s yearly goals. Staff were involved in the development of the strategy through dedicated strategy days, where their input helped shape the hospital’s objectives. The strategy was continuously reviewed through staff and patients’ engagement. The results of staff and patient surveys also helped inform the direction.

There was a culture of safety and learning that ran throughout the organisation. Staff were encouraged to raise issues and concerns however minor. This approach of raising concerns or issues was reflected in daily safety huddles, governance processes and the high levels of incident reporting.

The hospital operated a Patient Partners Programme, which involved 12 former patients who played a key role in providing feedback. These patient partners participated in patient-led assessments of the care environment inspections and contributed to initiatives like menu tastings and reviewing patient information leaflets. They provided feedback on new patient care pathways and were actively involved in designing dementia-friendly rooms.

The hospital engaged with the local community through various outreach activities. Staff participated in community projects, such as serving Christmas dinner in care homes and volunteering at a local food bank during working hours. This time was protected by senior leadership. Fundraising initiatives, like charity bike rides, were organised to raise money for charity strengthening the hospital’s ties to the surrounding community.

Leaders were open, transparent, visible, approachable, and accessible to staff and patients. Leaders conducted weekly visits to wards and departments to discuss staff and patient experience of the service and listen to any suggestions for improvements. Staff told us this promoted a supportive culture. The executive team began their weekly meeting by discussing patient safety or experience stories making sure the patient was their focus.

All managers received leadership development, which included training based on the hospital's core values. The values were integrated into 360° appraisals, where peers and team members provided feedback on how leaders aligned with the values.

The provider had structured daily team huddles at local, departmental and organisational level with each one feeding information between staff and leaders. We attended the organisational daily huddle which had representation of leaders and staff from all departments, and everyone was encouraged to speak and escalate concerns.

The provider had several initiatives to develop staff and create a succession plan of leaders. A key objective for the year was to ensure all staff had access to development opportunities beyond their current roles. For management positions, there was an ongoing succession planning, with a focus on identifying individuals for key roles and providing them with the necessary education and training to advance. Nursing staff were supported to attend educational courses to develop their careers and progress into roles such as clinical nurse specialist or advance practitioners.

Leaders promoted staff empowerment to drive improvement by encouraging staff to raise concerns and speak up. Staff we spoke with told us managers encouraged them to speak up and they knew how to access support to do so.

There were arrangements in place to support a culture of openness and for staff to freely voice concerns. We noted the hospital had four trained Freedom to Speak Up Guardians (FTSUG), representing a range of disciplines including theatre, general management, medical, and administrative roles. This diversity ensured staff could approach someone relatable to their role.

FTSUGs were promoted through posters displayed in areas such as the caregiver’s lounge. The hospital also conducted "Freedom to Speak Up" roadshows to raise awareness about the importance of speaking up and the guardians’ role. Quarterly reports summarising themes of raised concerns were presented to the quality and safety board maintaining confidentiality, while issues needing urgent attention were escalated directly to the registered manager. Staff could also submit concerns confidentially through the incident reporting system, which provided direct access to the registered manager.

The Freedom to Speak Up process was included in the induction programme for new staff, ensuring staff were aware of how to report safety or other concerns from the start of their employment. Guardians took a proactive approach to addressing concerns, working to close cases in a timely manner and resolve issues effectively.

All policies and procedures included an equality impact assessment (EIA). The assessment was embedded within each policy and reviewed and updated as necessary when the policy was reviewed. Staff were required to complete an action plan and escalate any potential discriminatory impact of the policy as part of the assessment. If new guidance or information emerged that could impact on equality, diversity and inclusion, the provider took immediate action to review and update all policies affected immediately. This assisted in addressing any disparities and ensured the needs of staff from protected or marginalised groups were consistently considered.

The provider promoted an inclusive and fair culture through initiatives and processes. Staff surveys were a key tool in monitoring how different groups, particularly those with protected characteristics under the Equality Act, felt about the workplace environment. If any group expressed concerns, action plans were developed to address those issues, and the impact of these actions was monitored through subsequent surveys.

The provider took several measures to prevent and address bullying and harassment. Freedom to speak up guardians were introduced to help encourage staff to raise concerns. A senior manager provided an example of when staff had raised concerns about working relations and a thorough review was carried out supported by the HR team. As part of the review staff were interviewed and team building exercises were undertaken to improve relationships.

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The service collaborated with external stakeholders and agencies to keep patients safe. Safeguarding referrals were made to the local authority and the service worked with them in the best interest of the patient.

The service worked well with other providers when patients were being discharged from their care. Allied health professionals liaised with colleagues in the community to ensure a seamless transition of care.

The hospital was working with a university and NHS provider to offer training for students and provide leadership training for doctors. Senior managers told us they were committed to improving healthcare across the wider community by providing training opportunities.

The provider was a member of PHIN and worked with partners to make sure patients could access independent information about care providers and doctors to inform their choice of care provider.

The hospital had a defined framework to support continuous learning and improvement. Staff at all levels were encouraged to participate in improvement initiatives. There was a two-year safety and quality improvement plan that included clear metrics for patient safety, experience, and clinical effectiveness. Progress achieving the plan was monitored by the quality and safety board at their quarterly meeting.

Ongoing learning and improvement was encouraged through using methods such as plan, do, study, act. Staff told us they were encouraged to develop suggestions which engaged staff in the continuous improvement on the ward.

Trend analysis of incidents informed continuous learning. We reviewed minutes from different meetings including executive committees and ward team meetings, and found learning from incidents was a consistent theme and we could see the reporting lines from staff on the ward, to senior managers and executives.

A dedicated research department, led by a chief of research and supported by research nurses, furthered the hospital's commitment to learning and innovation. The department focused primarily on research initiatives suitable for self-pay patients and contributed to advancements in pain management. A governance committee, chaired by the medical director, reviewed research proposals to ensure adherence to safety standards, enhancing the hospital’s position as a contributor to wider medical research. The hospital had an objective to establish a database of patients to be used for clinical heath and disease related research opportunities and were developing a UK edition of the Journal Cleveland Clinic Journal of Medicine which was already established in their overseas operations.