The Winterbourne 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

WELL Led Commentary

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question as requires improvement. At this assessment the rating has changed to good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

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 evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The provider had a published purpose to provide high quality, safe and compassionate care their patients needed and expected. This was underpinned by a set of principles and values. The principes were: We believe that patients come first; We believe in our people; We believe that ‘good enough’ never is and: We believe in being open-minded; and innovative. The values were: We value people who are selfless and compassionate; We value people who are collaborative and committed; We value people who are agile and brave; and We value people who are tenacious and creative.

The provider also had an operating system known as the Circle Operating System. This was a set of methodologies and tools to set up and run the healthcare facilities in the ‘Circle Way.’

During the inspection both senior leaders and some staff spoke about the principles, values and the Circle Operating System. All staff described how motivated they were to give the best care possible to their patients. Daily hospital meetings, which included representatives from the outpatient department, used the Circle Operating Principles to evaluate the safety and running for the hospital for that day.

The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The outpatient department was led by a clinical services manager. The clinical services manager was accountable to the hospital’s director of clinical services who was part of the hospital’s senior management team. The hospital’s senior management team and the hospital executive director were accountable to the provider, Circle Healthcare’s executive leadership team.

All staff spoke positively about their immediate leader and the hospital senior management team and told us they had good working relationships with all leaders. Most staff said the senior leadership team was visible and supportive. We observed respectful interactions between leaders and staff.

Discussion with leaders, both at the service level and hospital level, demonstrated they had a good understanding about the delivery of the outpatient service and how staff in the service addressed any challenges in the service.

Staff had access to training opportunities to support their development as leaders.

The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The service was proactive in supporting staff to speak up. Staff felt able to escalate concerns to their immediate leaders or the hospital senior leadership team.

The Freedom to Speak Up Guardian for the organisation held regular sessions at the hospital. A Freedom to Speak Up Guardian is a designated individual in an organisation who supports workers to raise concerns they may have, especially when they feel unable to do so through normal channels. The guardians act as a safe point of contact and help ensure that workers are heard, their concerns are addressed, and feedback is provided on any actions taken.

Staff could either make an appointment to speak with the guardian or speak with them without an appointment. Staff confirmed they knew when the freedom to speak up guardian was at the hospital and confirmed they could speak with the guardian with or without an appointment. Staff said they were encouraged to speak up and were not afraid to speak up.

The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The service had an Equality, Diversity and Inclusion policy that set out their commitment to diversity and inclusion for both patients and staff. The policy referenced national guidance and legislation, including the Equality Act.

Internationally educated nurses spoke positively about the support they received both when they initially commenced employment and with their ongoing development. This included the hospital appointing a dedicated member of staff to support internationally trained staff to adjust to the cultural differences of living and working in England. Some staff spoke about how they had been supported, with reasonable adjustments, to return to work after long term sickness.

Policies all included an equality impact assessment to ensure they did not disadvantage any groups of people based on their protected characteristics.

The service did not have any defined staff network groups such as disability, LGBT and race equality networks. However, informal groups were set up and supported by senior leaders and the hospital held events to celebrate the cultures of the diverse group of staff working in the hospital.

The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes,.

There was a governance structure with lines of accountability through the service, the hospital senior leadership team and the provider, Circle Healthcare leadership team.

Records of outpatient department meetings showed there was a standing agenda that included review of risk register, review of patient experience (including complaints and compliments), clinical outcomes including safety incidents, staffing including compliance with mandatory training. Records of clinical governance and senior management team meetings showed demonstrated the quality, performance and safety of the hospital, including the outpatient department, were monitored and reviewed.

Risks were well managed and regularly reviewed. Our review of the risk register showed risks described by staff were included on the risk register, including actions taken to lessen the risk. This included risk associated with the aging call bell system.

The service followed processes to gather information to gain assurance staff were delivering safe and effective care that followed national guidance. This included but was not limited to medicine management audits, record keeping audits, infection prevention and control audits.

The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

The hospital understood the demographics of the local area and developed services, including the outpatient service, to meet the needs of the local population. The hospital, including the outpatient service, also provided NHS work and worked in partnership with the local integrated care board and the local NHS trust to determine the scope and delivery of NHS work.

The service used feedback from patients to identify areas for improvement and development. An example included the introduction of structured system for reception staff to monitor the waiting area. Feedback was gathered through online patient feedback, compliments and complaints. Patient forums had been held to give patients the opportunity to directly feedback to senior leaders and influence the development of services.

The hospital, including the outpatient’s department, also supported local charities. Each year staff held events to raise money for a local charity they had chosen to support.

The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system.

There was a quality improvement strategy for the organisation that included the use of a nationally recognised quality improvement method. Examples of quality improvement in the outpatient service demonstrated staff followed this model.

Quality improvement in the department was focused on improving the experience for patients. The service provided examples of 2 recent quality improvements made in the department. One included the provision of signposting to appropriate support services for patients identified as possibly struggling with their mental health wellbeing after surgery. The second in response to patient feedback about not being informed of clinic delays and feeling their waiting was not being monitored. This resulted in the implementation of a structured system for reception staff to monitor the waiting area. They now checked every 30 minutes to ensure patients were acknowledged and delays were communicated to them.