HCA Healthcare UK The Harborne 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 – 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.

This is the first assessment for this newly registered service. This key question has been rated Good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

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 provider 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 Staff within the service were aware of the shared direction and the values of the organisation. Senior staff demonstrated the values of the organisation in respecting all as individuals and treating them with kindness and compassion. Staff felt valued and respected. Staff at all grades treated patients mirroring the values of the organisation. Recruitment was undertaken with a focus on potential staffs’ ability to live the values of the organisation. Leaders were very cognisant of the needs of people using their service and the communities they served. The service was growing to meet the diverse needs of the people it treated.

The provider had exceptionally 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 always did so with integrity, openness and honesty. We saw in several meetings that senior staff consistently reviewed the support they could provide to staff. Examples of this include following an unexpected death and following an accident in which a member of staff was injured. There were robust discussions held to explore options for the provision of support to individual staff.

All leaders had the experience of managing at a senior level. Support was provided by the organisation, and a network of peers could provide ongoing support. Whilst some senior leaders were new to private healthcare others had many years of experience. The team worked well together, they valued and respected each other’s contribution. There was a focus on the safety and quality of patient care alongside supporting staff. Leaders were visible within the organisation either by working clinically alongside staff or by undertaking a tea trolley round to engage staff and patients and get feedback. The CEO with some of her team delivered refreshments on a Friday afternoon primarily to staff but also to patients. This was seen as an opportunity to update staff and to hear how they were feeling and any issues that they may want to highlight.

Training was available to staff to develop management skills. Appraisals occurred and areas for development identified. Staff told us that they had good access to training. One member of staff stated that they had asked for further training and was then encouraged to get on the next available course. In the meetings we attended there were several training opportunities discussed for staff. We heard that a Career development workshop and expo was scheduled in October this would highlight training and development opportunities for staff. Career mentors would be available to talk to staff and the organisation was planning on issuing sustainable lunchboxes to staff to remind them about the importance of training and development needs.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. There was an organisation wide Freedom to Speak up Guardian supported by several champions on site. The number and type of contacts with the service was monitored and fed back to senior staff. The CEO held regular meetings with the Guardian to understand the themes and trends arising from staff making contact. There was a mutual understanding that some issues which the Guardian could not raise with the CEO as to do so would identify the person who wished to remain anonymous. The organisation had an ethics line which staff could telephone to report issues. The number of contacts were monitored and the Harborne Hospital had none made in this way in the lasty quarter. Contact was made either through the guardian or through the champions. This indicated that staff were confident in contacting a person. We spoke with staff who told us that if they had an issue, they would raise it with their manager or a member of the senior team.

Patients were provided with a feedback form to complete. This was analysed and reviewed to improve services. Leaders could see real time data and comments from patients in the system they collected information on. This enabled staff to address issues in a timely manner. The service was exploring the use of patients in forums to make any changes to service design or delivery. They had identified two people who had been patients who may be interested in supporting the hospital in this venture.

The service valued diversity in their workforce. Staff work towards an inclusive and fair culture by improving equality and equity for people who work for them. We reviewed the hospitals equality, diversity and inclusion policy. The service monitored the diversity of the workforce, and this met the diverse needs of the patients’ attending services. Staff we spoke with were able to discuss how an individual’s personal needs would be met within the hospital. The service offered translation services to those patients who required this. There was disabled access to the areas where patients would be treated. Two multifaith rooms were available on the second floor and where patients needed to be lying facing a certain direction this would be facilitated where possible.

Staff generally worked a twelve-hour shift pattern, but consideration could be given to flexible working as the need arose. One member of staff told us that to meet patient needs they worked later into the evening and had a day off in the week. Staff and leaders talked about the use of flexi working across the organisation. This meant that when the service was quieter staff were offered time off in lieu and repaid under hours by either working bank shifts elsewhere or at a time that suited the service. Staff told us that this worked well for them.

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. There was a weekly CLIP (Clinical Learning and Improvement Plan) meeting. We attended this meeting and saw and heard robust discussion on learning from incidents. These discussions also included providing feedback to partners to drive improvement across the system. The CLIP meeting reviewed incidents that had occurred within the previous week in order that a timely resolution could be sought. This information was fed through to the executive management meeting we attended at which there were further discussions about a range of management information.

Leaders acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate. A dashboard was produced which displayed key performance indicators. Some of these could be seen “in real time” through an IT programme which collated information. Risks which had been reviewed and the score reduced or changed were discussed at the executive meeting. This meeting included any safety alerts, complaint figures and detail, compliance with the practicing privileges documentation under Article 22, shared learning, planned accreditation processes and human resource information. Leaders could clearly see when they were achieving targets and when further action was required. We saw that risks were reduced appropriately, complaints were dealt with within the 20-day turnaround target, 98% of doctors had submitted all the required documentation for their practicing privileges and that turnover whilst above the company average was on a downwards trajectory. A significant amount of staff turnover occurred in the early phase of a person’s employment and was due to independent healthcare not being a good fit with the person. The nursing vacancy rate was 5.7%. However, we noticed and were told that advertising for further clinical staff was underway.

There were twice daily staffing review meetings which discussed the needs of the service. Other important information was cascaded through this route. The local area was then briefed by the person attending this meeting. This served as the basis for a ward huddle each morning. The Huddle included important information such as learning from incidents and any changes to ward management. Staff were aware of their departments risks and future plans and could discuss these with us.

The service had several contracts in place with other healthcare providers. This supported the service provided. The radiotherapy service was provided by a third party but utilised space within the hospital. The outreach and cardiac arrest team were provided by a third party but worked closely with the hospital to ensure that patient’s safety was maintained. The third party checked the resuscitation trolleys and were connected via a link corridor. If a patient deteriorated and required resuscitation an initial response team was available within the hospital and supported the cardiac arrest team once they arrived on scene. There were regular meetings with all third-party providers and the hospital shared information such as lessons learnt so that all enterprises could benefit from the review of incidents. Staff told us that there were good working relationships with the third-party providers.

The service ensured that consultants with practicing privileges were also informed of shared learning. There was a newsletter that went to consultants to inform them of updates to the service. The leaders met with different groups of consultants to seek their views on the developments within the service. Staff told us that they had good working relationships with providers of equipment and when a new procedure was being undertaken in endoscopy, for instance, suppliers supported this with additional training and supply of instrumentation.

Being a relatively new service in the area a large amount of work had been undertaken to raise awareness of the services available at the hospital. This also enabled the service to understand any additional needs across the region. The senior team had held meetings with GP’s, leaders at NHS hospitals, charities and local businesses. The hospital offered a programme of events open to the general public. As part of this engagement with GP practices the hospital supports basic life support training, continuous professional development sessions with expert speakers and Lunch and Learns. The GP’s could request specific Lunch and Learn sessions and the hospital provide the relevant consultant to provide this development.

The provider had a strong focused on continuous learning, innovation and improvement across the organisation and local system. Where incidents occurred a RECALL investigation would be undertaken within 24 hours. This enabled timely sharing of learning and improvement across the service. Learning from sister hospitals was also shared throughout the service. Leaders encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They used a patient information service which provided standard information for patients undergoing procedures. However, this was being expanded to include the ability for individual consultants to upload videos and information for their own treatments. They actively contributed to safe, effective practice. For example, when a surgeon wanted to undertake a new procedure those staff who would be involved were invited into a planning meeting to walk through the process and enable adequate preparation for the new treatment.

Staff had time and support to develop opportunities for improvements. The service had a quality improvement process for the development of services. Training for leads in the Qi Programme was in progress. Ther were several projects currently underway across the service, including reviewing the end-to-end patient journey to look for opportunities to improve patient experience. The matron told us that they were given time and support to undertake this piece of work. Similarly, staff in endoscopy told us about developments in their department that they had received support for. The endoscopy unit was working towards receiving the Joint Advisory Group on Gastrointestinal Endoscopy accreditation for the unit in 2026. In endoscopy we were given an example of learning from a complaint. This was about the discrepancy between the number of samples taken and those analysed. After consulting with the lab it was discovered that some samples can be caught in the mechanism of the sample container. Therefore, the unit has moved to a paper-based sampling system in which the sample is stuck to the paper. Since the change in process no samples have been lost.

A further quality improvement included the standardisation of the bedside handover. This used a structured Qi approach. The standardised approach sought to put the patient at the centre of their care, improve efficiency and clarity between nursing shifts and ensure that safety critical information is passed between nursing staff. This would ultimately enhance the experience for both patients and nursing staff. The effectiveness of this process is still under review as the plan was to do this for six months to ensure it was embedded. The oncology service had recently been one of the first independent providers to offer the breakthrough bispecific antibody therapy for people with lung cancer. This bispecific T-cell engager therapy represents the next generation of immunotherapy, building on the success of monoclonal antibodies and harnessing the natural defences of the immune system in a more targeted way than ever before.