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

Managers and leaders were caring and compassionate and had the skills and abilities to run the service. Managers were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles. The service had a vision and strategy for what it wanted to achieve and plans to achieve it developed collaboratively with the team. Managers monitored action plans to deliver the strategy. The senior team promoted a positive culture that supported and valued staff. Staff felt respected and supported and were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear. The Imaging service operated effective governance processes. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss, and learn from the performance of the service. There were appropriate systems to manage performance effectively. Risk management systems were well developed and multidisciplinary.

This service scored 82 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff from all scanning specialty said they felt their service was well resourced and the provider was responsive with requests for new equipment. Staff told us they felt the leading-edge equipment in their department contributed to a feeling of pride and empowered them to work towards service excellence.

The provider had an overarching mission and vision that applied to all services. These focused on the quality of healthcare, underpinned by research, and the education of staff. Teamwork, integrity, innovation, and inclusion formed part of the provider’s values.

Imaging services staff had developed strategic priorities for 2023 – 2025 and worked towards these as part of the provider’s wider vision. Key goals focused on consistent access, exceeding national standards, patient-centredness, and quality improvement.

The department had introduced a ‘culture carrier’ role in which ambassadors supported the senior team and colleagues to live the organisational values and provide guidance on doing so.

The clinical manager imaging services and the chair of hospital services institute had full oversight of diagnostic imaging services, with support from the director of quality, safety, and patient experience.

Managers attended high reliability leadership training, which provided them with tools to improve services through excellent leadership and embedded team values and behaviours.

Leadership rounding supported staff to embed the provider’s values. This process involved leaders spending time in the clinical environment and observing the care environment, speaking with patients, and listening to their experiences at the point of access.

The senior team ensured each member of staff had a voice in the organisation and had the support to take ownership of their work and decisions. For example, the service encouraged staff to propose improvements and research to one of the councils that worked across departments. Where staff provided feedback to the leadership team, managers responded meaningfully.

A dedicated multidisciplinary freedom to speak up (FTSU) team supported staff across the department. Clinical and non-clinical staff worked in the team in addition to their substantive role and met weekly to discuss issues and concerns raised by staff to achieve the fundamental goal of resolving problems. The team worked to increase awareness amongst staff and the profile of the service, such as through speak up events. The team aligned itself with the provider’s culture of learning, development, and no blame when things went wrong, and worked collaboratively with human resources (HR) colleagues to ensure support was embedded. They included medical students in the FTSU induction, which helped to build understanding of the principles of speaking up.

The FTSU team reported themes and trends to the executive team, including directly to the chief executive officer. Executives we spoke with recognised the importance of the team’s work and supported departmental colleagues to address issues. For example, an early trend related to issues more commonly dealt with by HR. The team developed a co-working process with HR to address concerns and issues, incorporating the principles of confidentiality and anonymity.

The FTSU team supported third party staff, such as specialists who worked for another provider but delivered care in the hospital. This approach ensured everyone involved with providing care had access to support.

Guardians carried out walk arounds of each department to maintain a visible, supportive presence and empower staff to reach out to them if they needed help.

The provider had a strategic vision for diversity and inclusion, focused on ensuring staff felt a sense of belonging. Employee resource groups, including for ethnic minority groups, women, LGBTQ+ staff, and those living with disabilities, carried out initiatives across the hospital and staff were supported to join them.

Equality, diversity and human rights training was mandatory for all staff and clearly influenced the sense of community and team belonging we observed during our assessment.

Diagnostic imaging services were part of the imaging institute, and the integrated governance committee monitored risks as part of the provider’s overarching interprofessional approach to governance and management.

Diagnostic imaging had representation across the governance structure, which enabled clinicians and managers across specialties to understand the impact of incidents or service pressures.

Staff used monthly quality monitoring meetings to maintain oversight of audit performance and other safety indicators that provided a well-rounded view of the service.

Leadership and governance processes were structured to meet national radiation protection guidance and the Radiological Protection Centre’s improvements. Policies and guidance were up to date with changes in practice and staff benchmarked against national standards.

Staff used risk registers to document, track, and mitigate risks in the service. There were 8 key risks at this location, including the need for continuous 24/7 radiologist on-call cover. Each risk had a named responsible lead, evidence of regular updates, and intervention to reduce the impact.

Key members of the team joined daily, tiered meetings to review patient safety and governance, including information governance. The tiers were attended by progressively more senior staff and each meeting provided onward feedback to the next. This structure enabled the team to quickly act on risks, provide initial investigations of incidents, and to problem-solve or escalate issues. We observed this in practice, and it demonstrated the benefits of rapid action and information sharing without compromising care or the capacity of departments.

The integrated governance meeting enabled staff to identify trends and areas of concern from feedback and incidents. For example, clinical nurse specialists identified a need for improvement education about diabetes and blood glucose using this process, which they used to deliver updated training.

‘Community’ was 1 of the provider’s 4 care priorities and staff at all levels considered how they facilitated the community in their department and more broadly in the hospital’s local area. For example, staff were given time to contribute to community volunteer projects, which helped them understand more about the challenges in the local area, particularly reflecting the transient, business-focused population. For example, all 3 London sites were located in areas where some population groups reported high levels of stress and related lifestyles that could impact their health. Diagnostics staff worked to developed community-focused care, such as cardiac CT scanning, a new service to monitor the early signs of cardiovascular disease.

The imaging services strategy for 2023 -2025 included a focus on staff development through educational events for continuing professional development, as well as academic and research opportunities. The team worked with colleagues in other departments as part of an internal development partnership and shared invites to educational opportunities where this would benefit patients.

The imaging team maintained engagement with external stakeholders, such as patients, families, referring physicians, academic institutions, and professional bodies, to ensure they met the needs and expectations of the community.

The provider had care and treatment agreements with a number of embassies. Diagnostic imaging staff worked with the GPS team and embassy contacts to deliver care that was appropriate to their community.

The service provided opportunities for 1st year university students to undertake imaging placements as part of a rotation across the provider’s London network.

The provider was clinically led and research-focused and staff contributed to the development of care standards. The service’s research profile had been recognised as the first independent hospital in the UK to be awarded National Research Ethics Committee approval. This had an impact on patient care because it meant staff had the skills, competencies, and support, to design and deliver research driven by patient need.

The service followed the Radiologist and Radiographer Radiology Education and Learning Meetings (REALM) international standard for safety. Staff discussed and disseminated learning points from radiology cases that had educational value, in a blame-free, anonymised manner. Meeting minutes reflected a positive learning culture and a positive impact on patient safety through consistent standards of practice.

Imaging services had a cross-site quality improvement plan for 2024-2025. This reflected learning from audits and performance. The provider had developed its own improvement model. Staff were supported and empowered to use an objectives and key results process to set goals for themselves, their patients, and/or their colleagues.

Radiographers had developed a bespoke digital quality assurance platform. In the form of an online dashboard, staff recorded their quality assurance results and colleagues had instant access for peer review, monitoring, and benchmarking. The system alerted staff to overdue checks and enabled fast escalation of any issues. This reflected a significant development in the use of technology in the department to streamline services.

The service provided extended training and professional development opportunities, including for those working elsewhere in the hospital. The imaging team had introduced MRI safety training for all new care staff in the hospital as part of a focus on raising awareness of environmental safety.