HCA Healthcare UK The Harborne Hospital

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• 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

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 the diagnostic imaging 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 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 clear shared vision, strategy and culture, underpinned by principles of transparency, equality, diversity and inclusion, respect for human rights, and engagement with the communities it served. Staff within the service were aware of the organisation’s direction and understood its core values.

Senior staff demonstrated these values in their approach to leadership, showing respect for individuals and promoting a culture of kindness and compassion. Staff told us they felt valued and respected within the organisation. We observed that staff at all levels reflected these values in their interactions with patients.

The recruitment process placed emphasis on identifying candidates who could demonstrate behaviours aligned with the organisation’s values. Leaders showed an awareness of the needs of people using the service and the communities they served. The service was continuing to develop to meet the diverse needs of the population accessing care.

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.

Senior leaders demonstrated an understanding of the context in which care, treatment and support were delivered and promoted the organisation’s culture and values. They had the skills, knowledge and experience to carry out their roles effectively and led with openness and integrity.

The leadership team had experience of working at a management level and were supported by the wider organisation and peer networks. Some senior leaders were newer to private healthcare, while others had extensive experience in the sector. Staff worked collaboratively and described positive working relationships within the team. There was a clear focus on maintaining the safety and quality of patient care while also supporting staff.

Senior leaders were visible within the organisation and regularly engaged with staff and patients. Staff told us that members of the leadership team carried out regular walkarounds, including a weekly tea trolley round, which provided opportunities for informal conversations with staff and patients. Staff said this helped them feel valued and told us that senior leaders made an effort to know staff by name.

Training opportunities were available to support staff in developing management and professional skills. Appraisals were completed and used to identify development needs. Staff told us they had good access to training and felt supported to undertake relevant learning opportunities.

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 hospital had designated Freedom to Speak Up champions who staff could contact for advice and support. A Freedom to Speak Up Guardian also provided an independent route for staff to raise concerns safely and confidentially. Staff told us they were aware of these roles, understood their purpose and felt confident they could approach them if needed. The organisation also had an ethics line that staff could use to report concerns.

The provider promoted a culture where staff felt able to speak up. Contacts with the Freedom to Speak Up service were monitored and themes were shared with senior leaders. The chief executive officer met regularly with the Guardian to review themes and trends arising from concerns raised by staff. In some instances, specific details could not be shared to protect the anonymity of staff members.

Information shared with Care Quality Commission after the assessment raised concerns about aspects of organisational culture. These included concerns relating to staffing levels within some support services, perceived lack of management response to staffing concerns, limited training for some doctors on systems before starting work, and reports of poor staff attitudes, including allegations of bullying or harassment. During the assessment we did not identify evidence to support these concerns. However, a couple of consultants told us they were not sure how to access patient notes on the new electronic system, which indicated some staff may benefit from further familiarisation with the system. Staff we spoke with otherwise described positive working relationships and told us they would feel comfortable raising concerns with their line manager, a member of the senior leadership team, or through the Freedom to Speak Up process if needed.

Patients were encouraged to provide feedback about their experience of the service through feedback forms. This information was reviewed and analysed to identify opportunities for improvement, and leaders could view patient comments and feedback data in real time.

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

The service promoted equality, diversity and inclusion through policies and mandatory training which set expectations for respectful and fair treatment in the workplace. Staff we spoke with told us they felt comfortable being themselves at work and described a culture where colleagues treated each other with respect.

The organisation recognised and valued diversity within its workforce and aimed to promote an inclusive and equitable working environment. We reviewed the hospital’s equality, diversity and inclusion policy, which outlined the organisation’s commitment to promoting equality and preventing discrimination. The service monitored workforce diversity to ensure it reflected the needs of the patients accessing the service. Staff we spoke with were able to explain how individual patient needs would be supported within the hospital. For example, translation services were available for patients who required them, and there was disabled access to clinical areas. Two multifaith rooms were available within the hospital, and staff told us they would try to accommodate patients’ cultural or religious needs where possible, such as facilitating positioning for prayer where appropriate.

Following the assessment, we received information raising concerns about equality within the organisation, including reports of higher staff turnover among some ethnic minority staff groups. During the assessment we did not identify evidence to support these concerns. Staff we spoke with did not raise concerns relating to equality or inclusion and described positive working relationships with colleagues and managers.

Staff and leaders described how flexible working arrangements were used across the organisation to support both service needs and staff wellbeing. For example, staff could take time off in lieu during quieter periods and repay hours by working additional shifts at times that suited the service. Staff we spoke with told us these arrangements worked well for them and helped support a positive work–life balance

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, and share this securely with others when appropriate.

The service had clear governance, management and accountability arrangements in place. Staff demonstrated a good understanding of their roles and responsibilities, and governance systems supported the delivery of safe and effective care. The service operated within an integrated governance framework that included the Medical Advisory Committee , Clinical Learning and Improvement Plan (CLIP) meetings and corporate governance forums. We attended a weekly CLIP meeting where incidents, complaints, audit findings and activity data were reviewed. Discussions were constructive and focused on identifying learning and improvement opportunities, including sharing feedback with partners where appropriate. Information from these meetings was escalated to executive management meetings, where leaders reviewed performance, risks and compliance with key organisational requirements.

Leaders used information about risk, performance and outcomes to support decision-making. A performance dashboard monitored key indicators and enabled leaders to track progress against targets, with some data available in real time. Executive meetings also reviewed safety alerts, complaints, compliance with practising privileges requirements and other governance information. At a local level, daily safety huddles and staffing review meetings enabled teams to discuss staffing levels, patient activity and emerging risks. Learning from incidents and other important information was shared with staff through these meetings, helping to maintain situational awareness and support safe service delivery. However, there was limited oversight of booking processes and appointment management, which reduced assurance around how effectively these systems were operating. However, although leaders held weekly meetings to discuss imaging availability, there was limited oversight of booking processes and appointment management. This included a lack of audits relating to cancellations and delays, which reduced assurance regarding how effectively these systems were operating.

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 service worked collaboratively with a range of external healthcare providers to support the delivery of care. For example, radiotherapy services were delivered by a third-party provider operating within the hospital, and the outreach and cardiac arrest team were provided by an external organisation. These services worked closely with hospital staff to maintain patient safety. The third-party team also checked resuscitation equipment, and clear arrangements were in place to respond if a patient deteriorated, with an initial response team available within the hospital until the cardiac arrest team arrived. Regular meetings were held with third-party providers to share information, including lessons learned from incidents, and staff described positive working relationships with these organisations.

Leaders also met with consultant groups to seek feedback on service developments. Staff told us they had constructive relationships with equipment suppliers, who supported the introduction of new procedures through training and the provision of equipment where required. As a newer service in the area, leaders had also undertaken engagement with local partners to raise awareness of the hospital and its services. This included meetings with GP practices, NHS organisations, charities and local businesses, as well as educational events such as basic life support training, continuing professional development sessions and “Lunch and Learn” events for local clinicians.

The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

The service demonstrated a commitment to learning and improvement. Leaders encouraged staff to contribute ideas that could help improve services and the patient experience. Staff told us they felt supported to share suggestions and were encouraged to take part in initiatives aimed at improving efficiency and patient care.

For example, one member of staff described proposing the introduction of an artificial intelligence system to support aspects of the imaging service. They told us that senior leaders listened to their suggestion and took the proposal seriously, demonstrating that staff ideas were valued. Staff also described contributing smaller practical improvements to enhance the patient experience. For instance, a staff member suggested using a music streaming service rather than a video-sharing platform when playing music for patients undergoing scans, to avoid advertisements interrupting the music. Staff told us leaders had responded positively to this suggestion and were in the process of implementing this change. This demonstrated that staff ideas were listened to and acted upon where appropriate.