The Royal Bournemouth 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.

This is the first assessment for this service. This key question has been rated requires improvement.

The service was in breach of legal regulation in relation to the governance of the service.

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 surgical service demonstrated a shared direction and culture through its strategic vision, values, and pro-active management of the ongoing transition. They addressed the challenges of merging previously independent surgical sites, located at Royal Bournemouth Hospital and Poole Hospital, by focusing on staff well-being, maintaining open communication, and fostering a ‘one team’ mentality.

This was evidenced by initiatives like shuttle services, listening events, and early team integration. The adoption of the ’Patient First’ model, indicated a structured approach to align the entire organisation. The Trust and service acknowledged the potential for cultural differences and expressed confidence that consistent policies and processes would ensure patient safety and operational efficiency.

Looking ahead, the organisation envisioned a more integrated and dynamic network, focused on delivering streamlined, patient-centred care through enhanced partnerships and a ‘Dorset can do’ approach.

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, and experience to lead effectively. They did so with integrity, openness, and honesty.

The surgical care group, under the leadership of its director of operations and a team of senior leaders, demonstrated capable, compassionate, and inclusive leadership through a structured and collaborative approach. There was a holistic approach to leadership development and cultural awareness that identified their dedication to fostering a supportive and effective environment for both staff and patients.

For instance, regular meetings were held across the different locations to ensure consistent communication. They had strategy meetings where they used information to make data-driven decisions. In these meetings, they actively engaged with executive directors to plan ways to improve things,like making it easier for patients to move through the hospital and reducing how long people had to wait. This involved training staff on how to improve quality and encouraging them to find and make changes themselves, like rearranging wards to help patients move around more easily.

The organisation had a detailed leadership program. This program helped leaders improve their communication skills. They had workshops on active listening and how to solve disagreements. Leaders also learned about emotional intelligence. This included training on understanding themselves and how others feel. The program also covered change management. Leaders learned how to guide their teams when services changed. Finally, they focused on values and unconscious bias. This was done through workshops and awareness campaigns.

The People and Culture Strategy emphasised the importance of an inclusive culture, a representative workforce, and a comprehensive leadership plan, acknowledging that these factors were crucial for delivering safe, effective, and compassionate care. For example, they aimed to increase diversity in leadership roles and implemented mentorship programs.

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

Staff told us they knew about the Freedom to Speak Up Guardian (FTSUG), how to make a referral, and felt able to raise their concerns without fear of retribution.

The FTSUG at the Trust promoted a culture where staff felt empowered to raise concerns, highlighted by the ‘#ListenUp’ campaign during FTSU month (October 2024). This included walkabouts, presentations, team discussions, staff huddles, the launch of a mandatory e-learning module and a visit from the National Guardian.

Trust wide, this resulted in 55 staff speaking up in that month, with 40% of these referrals relating to attitudes and behaviours. From April to the end of October 2024, 344 staff members raised concerns with the FTSU team, a 71% increase compared to the same period the previous year, with primary themes being behaviours (33%, involving 114 staff, and including issues like incivility at 37%, and toxic working environments at 35% and policy and procedure (32%, concerning 110 staff).

To address these issues, learning initiatives were identified, focusing on leadership and management (39% of staff), developing a civil and respectful culture (24%), well-being support (15%), and merger and team integration (9%).

The Trust developed a values-based behaviour charter, designed to ensure everyone (staff, patients and visitors) were treated the same way. The goal was to have a clear message about good and bad behaviour and help everyone feel able to address unacceptable behaviour. In September 2024, they held meetings to get people's ideas. This led to 5 statements emphasising a zero tolerance to bullying, harassment, discrimination, violence, and aggression. The charter also encouraged everyone to safely speak up if they saw this kind of behaviour.

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.

The Trust had a comprehensive Equality, Diversity, and Inclusion (EDI) policy aimed at creating a fair and respectful workplace. This policy aligned with the Equality Act 2010, which outlined 9 protected characteristics, and the Public Sector Equality Duty (PSED), which mandated eliminating discrimination, advancing equality, and fostering good relations.

To demonstrate compliance, the Trust committed to publishing equality objectives, workforce data including protected characteristics, gender pay gap reports, and a slavery and human trafficking statement. They worked to support international recruits through pastoral care programs, including pre-joining webinars, buddy systems, and assistance with accommodation.

The Trust also emphasised professional development for all staff, with a focus on leadership skills, including compassionate and inclusive leadership, coaching, and change management. They described a psychologically safe environment where staff felt valued and supported, aiming to improve staff survey results and Objective Structured Clinical Examination (OSCE) pass rates, indicating a focus on both employee experience and quality of care. In the NHS, OSCE is a type of exam used to assess clinical skills for trainees seeking registration.

The inclusion of a Diverse Ethnicity Network demonstrated an inclusive environment. We spoke with staff from different backgrounds who confirmed this, with employees consistently reporting a sense of equality, access to equitable development opportunities, and strong team integration. This positive feedback highlighted the hospitals success in cultivating an inclusive culture.

The service did not have clear responsibilities, roles, systems of accountability and good governance. Staff did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

We identified shortfalls in the hospital's governance processes, impacting both patient safety and operational sustainability. Although governance structures and policies were in place, use of these were inconsistent and this led to significant risks. There was a need for stronger governance oversight, more pro-active risk management, and a greater focus on employee well-being and consistent policy enforcement.

There was a lack of service-led auditing which meant frontline staff did not always have the relevant risk information to act on. There were no audits undertaken in the surgical services about the management of suspected sepsis. There was no oversight or monitoring of whether staff used personal protective equipment correctly as per policy and national guidance. There was lack of oversight about whether staff followed consent processes correctly. There were minimal audits about safe medicine management.

Matron walkabouts had recently been introduced trust wide and were planned to be undertaken weekly. Where issues were identified, they were escalated to the ward or area concerned. The trust understood there was further work to be done to ensure systematic review of all areas to identify risks and issues in the clinical areas.

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The service had not fixed the issues through routine safety audits and inspections, showing a lack of effective monitoring and enforcement of safety standards. For example, we observed fire hazards, and the hospital's November 2024 fire risk assessment, showed a limited assessment and lack of reduction of risk. The immediate actions needed to address shortfalls showed a reactive approach to safety management instead of a proactive, preventative approach, which is a fundamental requirement of good governance.

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The hospital did not always address equipment issues. The reliance on crash trolleys for essential equipment in acute areas, showed a reactive approach to patient safety, rather than a preventative strategy. Our review of 13 Learn from Patient Safety Events (LFPSE) data from March 2023 to March 2025 within the surgical core service, showed issues with equipment availability and timely replacement. For example, frequent oxygen cylinder shortages on wards, delayed replacement times for crash trolley cylinders and the absence of oxygen and suction setups at bedspaces were a risk to patient safety and posed a potential risk to patients receiving timely care and treatment. Although we did not see any patient impact as a result, this showed a lack of robust risk assessment protocols. The hospital showed us a risk assessment dated the day we raised the issue, which indicated a prior lack of awareness or consideration by leadership regarding these risks. The hospital told us oxygen and suctioning at bedspaces was based on ‘clinical need', but we were not provided with evidence that showed how this had been assessed.

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The medicines self-administration policy only included administration of insulin. This was a restriction that limited patient independence and was not in line with best practice standards that encourage patient involvement in their care. The absence of a broader policy indicated a lack of pro-active policy development and the wider implications for patient independence and empowerment.

While many of the safety concerns were individually fixed quickly after we had highlighted them, the high number of issues showed a lack of senior leadership oversight.

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Our review of the risk register showed risks described by staff were included on the risk register. This included staff vacancies in theatres, shortages in maxillofacial consultants and lack of uninterrupted power supply in theatres. Detail on the risk register evidenced leaders regularly reviewed the risks and actions were taken to reduce the risks.

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

Hospital groups engaged in partnerships and community outreach, exemplified by their collaboration with local health organisations and the public. They attempted to inform the community through open events before Christmas, although public attendance was low.

Effort was invested in preparing the public for the relocation of the Emergency Department from Poole, with hopes of increased engagement. Their future plans included continued public engagement and active collaboration with other hospitals for patient transfers, such as the necessary co-ordination between The Royal Bournemouth Hospital and Poole Hospital for critical care and post-operative care to support a planned surgical hub.

This collaborative spirit extended to the Surgical Care Group's participation in the Clinical Acute Network Dorset (CANDo), overseen by a main health board, and their joint work through the Dorset Urology Network, established in July 2022 by the hospitals in Dorchester and Poole. This network fostered regular meetings between doctors, nurses, and managers to standardise urology services, share treatment plans, and improve patient pathways, demonstrating a commitment to shared learning and enhanced patient care.

Similarly, the Surgical Care Group partnered with a hospital in Southampton to improve the integration of stomach and bowel services across a wider region. CANDo itself operated as part of a larger partnership involving all Dorset hospitals, aiming to improve patient outcomes, ensure equitable treatment, strengthen services, and optimise resource use through collaborative projects supported by senior doctors from different hospitals.

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 contribute to safe, effective practice and research.

The organisation’s focus on learning, improvement and innovation was evident in their pride in a ‘fantastic team’ who actively adapted to change with compassion and care, alongside a formal ‘Patient First’ Quality Improvement Strategy 2023 to 2026. This strategy aimed to cultivate a culture of continuous improvement by empowering frontline staff to identify and implement positive changes, supported by leadership who listened and improved barriers to communication.

The ‘Patient First’ strategy outlined key principles like patient partnership, a focus on culture and relationships, compassionate leadership, building improvement capabilities through training and tools, and establishing a coherent management system to drive learning and innovation across the organisation. Examples of this focus in action included theatres successfully recruiting and reducing vacancies.

The commitment to learning was demonstrated by their openness to new ideas and the improvements in staff recruitment, which saw a reduction from high vacancy rates 18 months prior to very low levels, with some areas like Trauma and Orthopaedics reaching full staffing. The successful integration of Internationally Educated Nurses and the numerous thank you cards received in surgical services highlighted the positive impact of their learning and improvement efforts on both staff and patient experiences.