Spire Washington 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

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

At our last inspection we rated this key question good. At this inspection the rating has remained good.

We have not awarded this service a score for Well-led.

Find out about when we will not publish a key question score and what we look at when we assess Well-led.

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 service had a clear shared vision, strategy and culture based on transparency, equity, equality, human rights, diversity and inclusion. Staff understood the service’s vision and strategy, which focused on delivering high-quality care in a timely and effective manner.

Staff spoke positively about their roles and expressed pride in the facilities and the care provided to patients. The service actively engaged with staff and service users, fostering an environment where feedback was welcomed and valued. Most staff reported feeling respected, supported and appreciated. The hospital director produced a weekly news sheet. Staff told us that they looked forward to reading this and even did so when away from work because they valued its contents and level of engagement.

There was a transparent and open culture that encouraged staff to escalate concerns and report incidents without fear. In the annual staff survey, 86% of staff stated that they felt able to speak up without fear or consequence. Managers attended monthly departmental meetings which contributed to hospital strategy and operational oversight. Meeting minutes were shared with staff and other hospital locations to promote transparency.

The service worked in line with Spire Healthcare’s stated purpose of making a positive difference to people’s lives through outstanding personalised care, with quality at the centre of decision-making. The hospital director repeated a mantra to staff that ‘culture eats strategy for breakfast’. There was a strong sense of engaging with staff because success and safe patient care was determined by shared values and behaviours. Since his appointment at the hospital, the site was rated the best for colleague engagement across the whole Spire brand.

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.

Comprehensive and successful leadership strategies were established to ensure and sustain delivery and to develop the desired culture. Leaders had a deep understanding of issues, challenges and priorities in their service and beyond.

Leaders demonstrated the skills, knowledge and experience required to lead effectively and embodied the organisation’s values. Staff felt supported and described leaders as approachable, attentive, visible and responsive.

Leaders were knowledgeable about service priorities and encouraged improvement. Roles, responsibilities and lines of accountability were clear, and leaders had access to development opportunities to maintain and build their skills.

Leaders empathised with colleagues and understood the challenges they faced. They were committed to supporting staff and focused on enabling those they led to be able to thrive at work. We heard several examples of leaders going above and beyond to care for staff when they needed extra support in both their domestic lives and in the workplace.

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

The service fostered a culture where people felt confident to speak up and raise concerns. The hospital had a Freedom to Speak Up Guardian (FTSUG) supported by trained Freedom to Speak Up Ambassadors across the hospital.

Staff understood how to raise concerns and told us they felt confident doing so. The FTSUG team held monthly sessions and reported themes directly to the senior leadership team, supported by corporate processes. Leaders promoted openness and encouraged staff to speak up. The annual staff survey reported that 86% of staff were able to speak up without fear or consequences.

Staff felt that any concerns were raised and acted upon. A team of staff undertook a review of one surgeon’s practice and escalated their concerns to managers who took immediate action.

The service valued diversity in their workforce. Staff worked towards an inclusive and fair culture by improving equality and equity for people who work for them.

There were policies and processes to ensure the service was inclusive and fair in the way they operated. Staff received training in equality and diversity and had a good understanding of cultural, social and religious needs of patients and demonstrated these values in their work. Equality and diversity champions were recruited and given enhanced training to promote and train others in various topics such as unconscious bias and civility.

The service promoted equality and diversity in daily practice. Staff reported positive working relationships within departments and described the team as highly supportive. A calendar of events and initiatives celebrated different cultures and traditions throughout the year. These events created opportunities for colleagues to learn from each other and to acknowledge the diverse backgrounds of the team. There were many examples of diversity events shared with the inspection team such as the Africa day. The catering team served African cuisine which caused a staff member to comment that she had never been served food from her own culture within the workplace at any other time.

A map of the world was displayed showing where staff and families lived as an attempt to connect the world to Washington and vice versa.

Staff networks had been established to provide a safe space for staff to connect, share experiences and provide pertinent support and resources. The service had developed a ‘be a consciously inclusive manager’ training course for staff to recognise the impact of behaviours and interactions within the team environment.

The service had clear responsibilities, roles, systems of accountability and good governance. Staff used these to manage and deliver good quality, sustainable care, treatment and support. Staff acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

The service had clear governance arrangements, roles and systems of accountability. Leaders monitored quality and operational performance and acted when risks were identified. We observed a weekly governance meeting and leaders were fully informed and aware of all incidents and risks whether emerging or ongoing.

The governance framework was supported by the Medical Advisory Committee meetings and Clinical Quality and Safety meetings. Departmental risk registers fed into the hospital risk register, providing oversight at all levels. Risks were reviewed regularly and updated quarterly, with actions clearly recorded. The top 3 hospital risks and their associated actions were displayed on notice boards for staff awareness.

A ward-to-board committee structure aligned operational performance with organisational strategy. Data dashboards and reports were used to maintain transparency and identify areas for improvement. Learning from incidents and outcomes informed ongoing training and service improvement.

The service had a knowledge and learning framework. This was used to drive change that would be embedded and sustained. It meant that the hospital benefited from widespread shared learning across all Spire sites and as a result leaders then developed safe improvement plans.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. Staff shared information and learning with partners and collaborated for improvement.

The service worked collaboratively with external partners to improve patient outcomes and ensure joined-up care.

The service worked in partnership with its local NHS trust, including providing commissioned services to support waiting times. The Director of Clinical Services shared regular updates with the local Integrated Care Board. In the event that there were issues of concern about individual clinicians working across organisations, leaders worked in conjunction with other providers and professional bodies.

The hospital had service level agreements with a range of partners, including ambulance services, pathology and critical care networks, to support safe transfers, diagnostics and emergency care. Patients and community representatives, including Healthwatch, were involved in forums to support improvement.

The service had plans for future site development to expand capacity and improve access to care, supported by engagement with local planning authorities.

The service focused on continuous learning, innovation and improvement across the organisation and local system. Staff encouraged creative ways of delivering equality of experience, outcome and quality of life for people. Staff actively contributed to safe, effective practice and research.

The service demonstrated a commitment to continuous learning, innovation and improvement. The quality improvement programme used at the hospital had seen improvements in a number of quality measures. Quality improvement projects included reducing the length of patient stay, ’pain to trigger’, improved patient food choices and improving patient experience.

Staff had access to development opportunities, including leadership programmes. There was an eagerness to develop talent within the service. Leaders used appraisals to source staff who would become the ‘superstars’ of the organisation. They invested time, effort and money in staff development. Low staff turnover at 6% reflected how staff valued opportunities afforded to them.

The Governance Team produced a weekly hospital-wide newsletter to share governance information and key learning. A monthly governance clinic supported staff through face-to-face drop-in sessions.

The service responded to staff feedback from the 2024 survey by increasing training opportunities across clinical departments during 2025. This included advanced clinical training and apprenticeship programmes within theatres.

A venous thromboembolism (VTE) audit had concluded that Spire Washington were an exemplar site for low numbers of VTEs occurring post surgery. In the 3 months prior to the inspection VTE audits were at 99% compliance. Staff had developed the ‘sip til send’ method that required patients to hydrate before surgery as dehydration was shown as a risk factor in embolism management.