Harley Street Specialist 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. We checked that the service had suitable framework in place to check on the quality of the services being provided and make changes accordingly. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated and person-centred.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant risks were understood and acted on to keep people safe.

This service scored 43 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion.

Senior leaders described the journey the service had been on over the last six years and in particular, the last year, including a long standing senior manager leaving the organisation. Over this period of time, changes in ownership had created periods of unsettledness which were being addressed by leaders. The business strategy had been renewed, with clearly identified types of procedures and patient groups the service was focused on including treating pain, podiatric surgery, hip preservation and upper limb surgery. We were given examples of these and how this had led to increased activity.

A refreshed senior leadership team had placed renewed emphasis on improving structure and clearer defined process. They described partnership working under new ownership arrangements as bringing more stability to the culture of the organisation.

Part of this strategy had been to support clinical teams deliver. This had included reducing the number of consultants with practising privileges in line with the change of focus on types of procedures. Also partnership working with MRI services to fit the strategy of building a better day case profile. New ways of supporting staff on the ground included more visible and accessible leaders and more inclusive daily meetings. Leadership in parts of theatre activity had been identified as an area of focus to improve teamwork, coordination and flow. The new organisation chart showed renewed lines of accountability and line management, with recently created posts of recovery lead and theatre coordinator posts, joining the outpatients’ manager to create a more coordinated team reporting to the director of clinical services. These posts had just been appointed to at the time of our visit.

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.

There were capable and experienced leaders who provided coordinated leadership. For instance, the chief operating officer, the director of clinical services, the non clinical operations manager, head of HR, medical director, governance lead and responsible medical officer all performed different functions of leadership and together formed the senior leadership team. These were well coordinated through a shared vision, good communication and governance. Each department had a head of department and reported to the director of clinical services. This ensured that the organisational vision was delivered and risks were well managed.

Leaders were visible and led by example, modelling inclusive behaviours. There was a culture of transparency and inclusivity which had been developed to match the size of the service. For instance, the director of clinical services and chief operating officer had moved out of their offices to sit at the desks in communal areas with other staff to increase visibility and accessibility. The two combined to do early and late shifts so one was always on site. The human resources lead had an open-door policy 5 days a week, 2 of which were on-site.

The service had a culture of inclusivity. The daily morning meeting was open to all staff to attend and staff were encouraged to bring any emerging themes or issues for discussion and action. All key staff were encouraged to join the daily bookings meeting to prepare and plan for future procedures. The chief operating officer held an all-staff monthly meeting where monthly data was presented to all staff. This included performance data, incidents, training, what went well and more.

The strategy also mentioned the service’s values; ‘compassionate, innovators, collaborative, bold’. We were told by leaders they were devised in 2020 and the same principles still applied. We were given some explanation of how the service lived the values. However, it was not clear how these were understood or lived by staff and examples outdated.

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

Freedom to speak up guardians were in place with access and contact details available to all staff. One of the FTSU guardians chaired the staff forum and brought issues raised to the senior leadership team meeting. We were shown examples where issues had been raised and acted on. They included dealing with consultants, visitor passes, staff breaks and wellness room.

The service had nurtured a culture of transparency and openness. There was a daily morning meeting known as the 10 at 10 meeting which was now open to all staff to attend and bring any emerging themes or issues for discussion and action. All key staff were encouraged to join daily bookings meeting at 2pm to prepare and plan for future procedures.

The director of clinical services and chief operating officer had moved out of their offices to sit at desks in communal areas with other staff to increase visibility and accessibility. The two combined to do early and late shifts so one of them is always on site. The human resources lead had an open-door policy.

We spoke to three registered nurses and three health care assistants. All offered positive comments about working for the service. All staff were aware of how to speak up, make complaints and felt valued. They did not feel it was a problem to speak up because management were receptive to staff concerns.

We did not look at Workforce equality, diversity and inclusion during this assessment. There is no previous rating for the Well-led key question so we cannot yet publish a score for this area.

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 act on the best information about risk, performance and outcomes.

There were clear and effective governance arrangements to manage performance and risk.All quality monitoring outcomes and actions were reported through the governance system and into meetings which included a monthly senior leadership team (SLT) meeting with shorter weekly meet ups. SLT used to be fortnightly but was adapted to work with the small size of the teams and the regularity of communication in other formats. Heads of department meetings and governance meetings occurred monthly, medical advisory committee meetings and infection control meetings all occurred on a quarterly basis. We reviewed the most recent minutes from each and found there was good management of performance, risk and accountability. There were also regular departmental team meetings.

The service maintained an up to date risk register which detailed risks and their potential impact. Each risk had an owner responsible for ensuring any actions for the risks were completed. We saw evidence of risks being discussed in governance meeting minutes.

The quality management matrix demonstrated a full audit programme that met the quality and risk monitoring needs of the service. The digital reporting system notified relevant staff when audits were due and were raised for action. Audits such as WHO checklist, NEWS2, health and safety checklists in theatres, facilities and pharmacy occurred monthly. Others such as medicines management and bins were quarterly and others annual.

Performance data was presented in governance meetings. All staff monthly meetings were held by the chief operating officer who presented key information from governance meetings such as risks and emerging themes. Staff were also kept up to date on emerging themes, what had gone well and what needed attention by the monthly staff bulletin.

The medical advisory committee (MAC) was chaired by a longstanding consultant who was also the RO (Responsible Officer) for the hospital and took accountability of conduct and performance of medical staff who worked at the service under practising privileges. There was also an experienced medical director and both were described as valuable to the service and supportive of the renewed strategy, which helped provide service stability.

We did not look at Partnerships and communities during this assessment. There is no previous rating for the Well-led key question so we cannot yet publish a score for this area.

We did not look at Learning, improvement and innovation during this assessment. There is no previous rating for the Well-led key question so we cannot yet publish a score for this area.