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. Governance processes were highly effective and facilitated collaborative working and encouraged and rewarded innovation. 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 93 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a mission and vision that applied to all services 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.

The outpatient service was in the final stages of a project that centred patients as partners in care design. This focused on the patient voice and encouraged staff to explore their stories to deliver individualised care. The project demonstrated impact by generating continuous patient feedback across all 3 London sites.

Staff used electronic tablets to record feedback from patients during conversations at key stages of each appointment. Feedback was consistently positive, and the system meant senior staff could act quickly to address any issues.

Staff provided care and treatment under the provider’s ‘patient first’ strategy. Staff shared the provider’s strategy with patients openly during care, which helped support honest conversations about the standards of care. We saw this in practice during our inspection and patients responded well to such a transparent approach from staff.

The director of quality, safety, and patient experience led a monthly leadership round that included all departments. Senior staff chose a provider value and visited each department to ask staff and patients how their experiences reflected the value. They recorded responses digitally in real time and analysed the responses collaboratively, with a focus on qualitative, narrative information.

We joined a leadership round in outpatients focused on the ‘integrity’ value. The process was integrative and involved examples of engagement such as non-clinical senior leaders meeting nurses and patients to discuss their experiences. During the round, staff identified integrity in their work through the support they received from colleagues and linked this with how they delivered consistent care to patients.

The director of quality, safety, and patient worked closely with the clinical lead and the chief of operations to provide oversight and leadership. The chief executive officer met daily with the senior team to review challenges and performance.

Leaders, and the provider more broadly, had a focus on inclusivity, staff wellbeing, and continuous development. The senior team used evidence from international research to act on feedback and create a positive workplace. They linked this with care and demonstrated how motivated, empowered staff drove high standards of patient outcomes.

The chief nursing officer held responsibility for nursing teams and a clinical nurse manager (CNM) led outpatients, with a charge nurse on each shift. The CNM worked across all 3 outpatient’s sites and was immediately contactable by staff at any location through a digital communication system. Staff said the manager was available on demand and they felt well supported by them.

We spoke with a range of clinical and non-clinical staff and all told us they were happy with their manager. They had regular 1-to-1 meetings and described the supervision and appraisal processes as useful. Staff set their own annual goals and reviewed progress during the year. Leaders acted on staff survey results to make improvements. For example, the senior team reviewed how they calculated nursing levels and whether the feedback related to a medical specialty.

Staff told us they felt listened to by the senior team and that they had a voice. They said the chief nursing officer visited them regularly and they felt empowered that senior colleagues worked with them collaboratively on a day-to-day basis.

Senior staff carried out periodic ‘listening tours’ in which staff were invited to spend time ad-hoc with managers, either individually or in groups. The tours were focused on improving engagement and facilitating open and honest communication across all levels of staff.

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.

Clinical educators worked to make sure staff had equal and equitable access to continuing professional development opportunities. For example, they worked with experienced nurses to identify their areas of interest and aspirational career plans and then developed training opportunities to meet these. This approach meant experienced nurses received equal opportunities for development with their junior or newly qualified colleagues.

Diversity and inclusion were embedded across all aspects of the service, including in new staff onboarding, training, and governance systems. In the most recent staff survey, 93% of outpatient’s respondents said they understood their role in maintaining a diverse and inclusive environment.

Governance systems were integrated, with a committee responsible for coordinating compliance, quality assurance, and safety across outpatients. This system reflected the complex operating environment, in which multiple clinical specialties delivered care.

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 nursing director for quality and the nurse quality manager focused on shared governance, shared accreditation, and the quality aspect of service development. They provided support to staff who were research-active or who wished to become so.

Staff used a visual management board in the department to provide rapid access to key governance information, such as the top 3 current risks, the latest audit results, and learning from incidents and feedback.

Staff used risk registers to document, track, and mitigate risks in the service. There were 4 key risks at the time of our inspection, such as the risk of falls, which was a provider focus. The outpatient team had an overarching risk mitigation plan. For example, clinical educators worked with nursing staff to identify falls risks during the pre-assessment and arrivals process.

The senior team recognised challenges associated with succession planning and ensuring services were sustainable into the future through securing staff commitment to the values and service. They worked with staff to model positive leadership, based on evidence from research, designed to encourage staff to seek leadership development training and promotion

The provider was a non-profit organisation with a well-established focus on charity and community giving. Staff at all levels we spoke with discussed this as a positive aspect of their work and provided examples of how they could help the local community beyond patients in their care. For example, staff regularly volunteered their time in food banks and in a local homeless support service. This occurred during work time and the senior team provided protected time for such activities. Senior staff described a fundamental standard of the provider as making a difference in people’s lives. Incorporating staff and patients, this ethos was evident during our discussions with both groups, as part of a partnership approach to care and community.

The provider valued cultural diversity amongst staff and contributed to a number of annual celebrations and events. This included Pride and Celebrating Filipino Culture.

The service held ‘Pathway to Excellence’ designation in recognition of continual organisational excellence. An international quality accreditation programme, staff had demonstrated quality in 88 standards of nursing care. Staff spoke positively of the programme and its impact on standards of practice.

The pathway enabled staff to join academic courses and was reflected in innovative outcomes. For example, the hospital was the first provide provider in the UK to offer a new medicine to treat mild cognitive impairment and reduce the impact of Alzheimer’s disease.

The provider encouraged research that helped staff understand patient needs and improve their outcomes. Staff had access to a research fund, including mentorship, to develop their project. As outpatient’s staff worked across all of the provider’s London sites, the impact on patients was standardised across clinics.

Staff used a ‘continuous improvement rounding’ system, incorporating an international evidence-based tool, to monitor outcomes of interventions on improved care. Staff used this to measure the impact of innovation on patient outcomes.

The provider and senior team demonstrably valued the contribution, abilities, and professional development of each member of staff. The clinical educator team provided opportunities to staff in clinical specialties and leadership development.

Clinical educators had a lead role in inclusion and development. The team designed the rotation programme for new nurses and measured impact by monitoring how many nurses entered outpatients as a long-term career choice; a focus of the provider’s sustainability plan.

Staff continuously sought opportunities for innovation by adopting leading-edge new treatments to improve patient experience and outcomes. For example, the orthopaedic and sports medicine service had adopted a new treatment to improve functionality and significantly decrease pain in the treatment of tendonitis.