Three Shires 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

Managers and leaders were caring and compassionate and had the skills and experience to run the service. They were visible and approachable and supported staff to develop their skills and take on more senior roles. The service had a vision and strategy and plans to achieve them developed collaboratively with the team. Staff were passionate about their role in the vision and were empowered to develop quality improvement projects to develop the service. The senior team promoted a positive culture that supported and valued every contribution. Staff felt respected and supported and were focused on the needs of patients. The service had an open culture where patients, their families, and staff could raise concerns without fear. Governance processes were highly effective, facilitated collaborative working, and encouraged and rewarded innovation. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss, and learn from the performance of the service. Quality management systems were well developed and multidisciplinary.

This service scored 86 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff provided care within the provider’s purpose, principles, and values. Focused on shared beliefs, such as putting patients first and valuing collaboration, staff felt empowered by the culture and were confident in their contributions to success.

The Circle operating system (COS), reflecting the name of the provider, guided staff in their daily work and helped embed safety protocols and the hospital’s ethos and culture. Staff across the hospital had adopted champion roles to support colleagues in the use of the system.

There was an overarching culture and ethos of empowerment and development amongst staff.

Staff we spoke with at all levels understand the provider’s values, vision, and strategy. This extended beyond recognition of core aspects into a deep understanding of how each person contributed to goals and how they reflected values in their daily work. Staff were keen to discuss how the provider’s values applied to their own team and department rather than only at a corporate level.

A team of 3 staff and 2 patients reviewed results from the 2024 patient-led assessment of the care environment (PLACE) and audited areas for improvement to check progress. This reflected the patient-centred culture of the hospital. The team found improvements in the dementia-friendly design aspects of the environment and commented on the positive teamwork in surgery.

In addition to the provider-level vision, each team established their own version to reflect goals and the needs of patients. For example, the pre-assessment team had a vision to inspire confidence. The theatres team’s vision was based on maintaining professionalism, compassion and patient safety, and the ward team worked to a motto, “Good enough is never enough.”

The executive director led day-to-day operation of the hospital. The director of clinical services, the quality and risk manager, and the director of operations had key roles and all staff we spoke with described positive working relationships with the senior leadership team (SLT) and departmental managers. Staff said they felt senior colleagues were approachable and accommodating and were open to suggestions and constructive challenge.

Every member of staff we spoke with felt able to contact any member of the SLT and said they were confident of space to talk and get support for any issues.

Physiotherapists spoke highly of the leadership team and said they were supported to secure new resources and equipment. Staff said this helped them to develop new methods of care in line with changing good practice.

Staff said they knew they would always be supported for speaking up and stopping care delivery when they felt there was a risk to safety.

A freedom to speak up guardian (FTSUG) provided staff with the opportunity to discuss concerns or report unsafe practice confidentially. They were supported by the provider’s national freedom to speak up team. The executive director met with the FTSUG every 3 months to discuss trends and themes in reports.

Staff spoke positively about the culture and work environment in relation to their empowerment and ability to speak up. We spoke with staff in a wide range of roles and at different levels of seniority and found consistently positive views of the freedom to speak up. Staff said heads of department provided support to resolves concerns and they felt issues would be addressed no matter how they were raised.

Freedom to speak up was a mandatory training requirement for all staff, which reflected the provider’s focus on empowering staff to be open and honest about their concerns. At the time of our inspection, 100% of staff were up to date with this training.

Staff were empowered to speak up. The ‘stop the line’ function was always followed by a ‘swarm’, which referred to an immediate meeting of all staff involved in the procedure that was stopped. Staff used this process to review the cause of the incident, ensure patient safety, and agree on next steps. Staff involved in this process told us it was a valuable tool to keep patients safe.

Staff said they felt respected, empowered, and supported by colleagues and managers. They said this applied at local and national level and the provider’s efforts to create a positive place to work led to their long-term commitment.

All new nurses undertook a preceptorship programme and were assigned with a buddy for their first few weeks of employment. This was good practice because it provided structured support for new staff to develop their skills in the context of the local culture and patient groups.

The service treated bank and agency staff with the same degree of support and training as permanent colleagues. Diversity policies applied to all staff groups regardless of contract, including student nurses and physiotherapists.

The provider made reasonable adjustments to the workplace to ensure staff with different access requirements could contribute meaningfully.

A governance and assurance framework embedded safe and effective practice with a focus on interdisciplinary working.

The service used a risk register to manage risks. At the time of our inspection, surgery had 14 risks, 5 of which were specific to theatres. Each risk had a named accountable member of staff with evidence of continuous review and actions to reduce the likelihood of harm. For example, 1 risk related to inconsistencies in the surgical instrument trays supplied by another organisation that had the potential to disrupt surgical lists. The service worked with the contractor and identified a training need in the team preparing instruments. Staff were monitoring improvements and had back-up plans in the event a change of supplier was needed. Risks in the inpatient wards related to aging equipment or facilities systems. All risks had active mitigation in place.

Morbidity and mortality meetings took place every 3 months and monitored long term trends in patient outcomes and safety. The meetings highlighted good working relationships between the permanent clinical team and those working under practising privileges. A consultant general surgeon chaired the quarterly medical advisory committee, supported by consultants from each clinical specialty and the senior leadership team.

Each department displayed a quality board depicting the most recent ‘swarm’ and its outcome. The SLT used a corporate version to discuss service adaptations that had not resulted in the intended change. The team used this process to review Controlled Drug processes and changes in guidance following an incident with stock control.

A member of the team from each surgical service joined the monthly clinical governance meeting with the SLT. Minutes reflected a comprehensive system in which a multidisciplinary team maintained oversight of incidents, risks, feedback, and other influences on the service. The team reviewed clinical incidents, including those that use the ‘stop the line’ process as well as departmental audit results.

During department huddles staff discussed recent incidents, complaints, and other issues that impacted patients and the service, as part of the learning culture. Staff extended this process by incorporating it into their workplace culture and wellbeing. For example, during hospital and department huddles, we saw staff were mutually supportive of each other and took a proactive, problem-solving approach to help identify learning opportunities.

The service had a good working relationship with local NHS providers, which enabled staff to jointly address challenges. For example, the services worked together to address the closure of local point of care testing services by providing a joint solution. An NHS service hosted multidisciplinary meetings for patients living with cancer and members of the surgery team attended to maintain oversight of care and discuss changes in health trends and demands.

Surgeons and consultants working under practising privileges worked substantively at the local NHS trust. The director of clinical services maintained good links with the trust, which helped the organisations to address challenges and share learning that led to better patient care.

The quality team met bi-monthly with the integrated care board (ICB) and the mental health hospital that shared the estate. This reflected the drive in the service to work as part of the regional health system to drive improved processes.

Staff had a good understanding of the local community and the changes in health needs and risks in the region. For example, a team was developing plans for the hospital to be a designated safe haven centre for people experiencing domestic violence. Discreet information in the wards provided signposting.

The team maintained good relationships with colleagues working elsewhere in the provider’s network and shared knowledge and professional development to the benefit of patients. For example, the ward manager had spent time at another hospital to learn about their processes for day case joint replacement surgery. As a day case approach to this surgery was relatively new, the experience enabled staff to learn from the experience of others and to minimise risks.

The service maintained working relationships with regional universities to provide opportunities for student nurses and physiotherapists. Support programmes empowered students to develop leadership skills and build evidence-based competencies.

The service valued opportunities for learning and improvement. Staff were empowered to develop innovative ways of working. For example, the physiotherapy team had set up a ‘physio command centre’ on the ward to enable more effective working with patients and nurses.

The health and safety manager (HSM) focused on continuous fire safety improvement. New staff training built on a track record of fire safety, including an evacuation in which staff evacuated 210 people in less than 5 minutes. The HSM was undertaking a ‘train the trainer’ course in the use of evacuation equipment and they based evacuation exercises on learning from fires and emergencies in other hospitals.

Staff adapted care and treatment plans to meet the changing needs of patients, of which they demonstrated an advanced understanding. Physiotherapists noted patients undergoing joint replacement were typically younger than in the past and more frequently presented with comorbidities such as dementia and cardiac problems. The team used this information to update treatment policies and ensure care was delivered at the leading edge of national practice.

Staff embedded health promotion strategies. The service had adopted NHS England’s ‘CORE20PLUS5’ programme. This was a structured programme aimed at reducing health inequalities. This significantly extended the scope of the service and provided patients with access to health support to enhance recovery.

Staff planned and delivered quality improvement projects (QIPs) in response to audits and feedback, reflecting a culture of continuous learning and improvement. The ward clinical services manager led a patient voice QIP to drive improvements identified through an audit. Using a QI model, the project resulted in the creation of a patient champion, patient focus groups, and work with a patient advocacy group. The QIP process involved reflective practice, which staff used to identify unexpected outcomes and learn for future pilot planning.