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Blog > An interview with Dusty Millar; Head of Organisational Development and Transformation at Lincolnshire Community Health Services NHS Trust.


An interview with Dusty Millar; Head of Organisational Development and Transformation at Lincolnshire Community Health Services NHS Trust.

Lincolnshire Community Health Services NHS Trust (LCHS) is the primary community healthcare provider in Lincolnshire, supporting people to manage their own health at home. In partnership with other health and social care organisations, the trust delivers joined-up care in community settings spanning 2,350 square miles and a population of over 740,000 people.

Dusty Millar works as Head of Organisational Development and Transformation at the trust. Following an ‘outstanding’ rating from the CQC and improvements in NHS Staff Survey data from 2018, Dusty talks us through some of the initiatives taking place at the trust, and how using staff experience data is central to improving organisational culture.

Tell us about what it’s like to work at Lincolnshire Community Health Services NHS Trust.
We have over 1,800 staff, comprising a mix of Urgent care, medical, district nursing, community hospital, transitional care, AHP, specialised services, sexual health, students, apprentices, administrative and clerical, corporate etc. As other organisations working within the health and social care system, we have our challenges such as building collaborate systems and relationships in an environment of organisational regulation and governance, and enhancing the ‘prevent’ and ‘self-care’ agenda amongst differing patient and staff cultural expectations. We have a lot to be proud of too; we work hard to actively build capability in others to support the delivery of ‘outstanding’ care to patients.

Lincolnshire aimed to improve three key themes; patient satisfaction, staff sickness and turnover, and patient mortality. How does the Trust decide upon areas of focus?
The key to this is twofold; being obsessed and restless with improving services to patients and valuing spending time looking outwards at who’s doing well, not just in the NHS but much wider.

Recently we had Google in to speak to 100 of our leaders about organisation culture. Finding information is not just about reading; it’s about building relationships with other organisations, NHS employers, regional networks, ‘best in class’ organisations and inviting curiosity from others; you never know what they might know!

The NHS National Survey has always been an important measure of how well we are going as an organisation, but we also have many other staff engagement vehicles to test the organisational temperature.  Our Staff Engagement Tube Map describes how we pay attention to staff experience at so many levels, and is now discussed at all inductions to ensure that it’s really embedded into our organisation.

LCHS Staff Engagement ‘tube map’

Innovation is one of our five Strategic Aims and is also a station on our staff engagement tube map.  We develop our leaders in a coaching approach, so we are continually seeking to develop capability in staff to resolve issues and innovate.  The CEO mantra of ‘seek forgiveness not permission’ is modelled and always ‘leaders at all levels’; something which was noted as outstanding practice by the CQC.

The trust has introduced a broad range of initiatives to improve these key themes. How did the various initiatives come about? How are they decided upon and then managed?
The staff engagement tube map was developed and agreed with our leaders and staff, and is essentially our compass to continue to pay attention to staff experience. A fundamental shift in how we manage staff engagement was to make our leaders more accountable. For two years, we have held a leaders forum entitled ‘Responsible Together’, which brings 100 leaders together every four months. The agenda for Responsible Together is designed and informed by a planning team made up of staff and leaders. Every event starts with looking back at what we said we would do and holding ourselves to account for delivering against what we said we would do.

Does the Responsible Together forum consider staff survey results, and identify its programme of work based on staff feedback? 
The staff survey results feature in terms of showing how well we are doing/not doing, but the focus is almost in reverse. We pay attention to things which impact on the results rather than react to the staff survey results. The staff survey results are managed at a local service line level based on the findings. Each service line develops their own focus for improvement.

An example of this in action is that just two years ago our staff appraisals were viewed by staff as being close to being ‘bottom in class’ when compared to other community trusts. We paid attention to changing this (simplified the form, developed leaders in holding great conversations, incorporated values based objectives etc.). This year (2019) the Trust has scored ‘best in class’ across 16 Community Trusts.

The trust has created the LCHS  cultural map – a way of displaying the various initiatives that make up key areas of focus. Talk us through the creation of the cultural map, and why it suits the trust better than a more traditional strategy document.
Our cultural map was developed as a way to evidence to the Care Quality Commission (CQC) the many ingredients that make the LCHS Way culture. The map fits with one of our organisational values, The LCHS Way, ‘emphasis on simplicity’, so is another way of modelling our values rather than using more traditional strategy documents.

The map is not so much a document for staff to interact with; it’s more of a simple way of showing regulators or other organisations the way we pay attention to our culture – The LCHS Way.  From the CQC feedback, we are confident that staff describe the organisational culture through the many areas we’ve focused on.

LCHS cultural map


The map highlights that developing talent management programmes for future potential leaders at all bands and grades is a key focus for the upcoming year. How will the programme use staff experience data to inform the contents of the management programme?
We use additional questions on leadership and talent as part of our staff survey work, so this will inform our thinking.  In addition, we’ve already started to engage with our leaders through responsible together about potentially using the talent management ‘9-box grid’ approach as a way to support talent conversations.


For more information about the topics raised in this interview, please contact Dusty Millar:

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