Staying in touch with the realities of frontline nursing and clinical practice is key to successful management, says a senior nurse credited with helping transform the culture at her struggling trust.
Cathy Geddes, chief nurse at Mid Essex Hospital Services NHS Trust, was praised by the Care Quality Commission for driving improvements at the organisation both as chief nurse and during her time as interim chief executive.
“I had a fantastic team around me and really caring, compassionate clinicians”
The trust recently moved from “requires improvement” to “good” and has gone from “a culture of blame with staff not feeling supported or listened to, to one of openness and transparency”, according to the CQC.
Ms Geddes said her efforts to make changes had been aided by the fact she was well-known at the trust and often spent time working alongside nursing and support staff.
“I always try and work clinically every week and would go onto the wards even if it was just for a couple of hours to work with a healthcare assistant to wash a patient and make beds,” she told Nursing Times.
“That’s really important so you understand what it is like for staff on the shop floor. People knew me and I was very visible anyway, so when I became interim chief executive I encouraged all the execs to be more visible,” she said.
She stressed the improvement at Mid Essex could not have been achieved without the support of fellow managers and staff.
“There was no way I did this on my own,” she said. “I had a fantastic team around me and really caring, compassionate clinicians. I have always said I would be happy for any of my relative to be cared for here – that is my benchmark for care standards.”
“It was about really emphasising that we wanted to create a safety culture”
She said Mid Essex had achieved the shift through initiatives like “in your shoes” events where patients spoke about their experiences of care and staff shared what it was like to work at the trust. Developing a new “simple” set of values to promote a goal of being “kind, positive and professional” at all times had also helped.
New and existing staff were also encouraged to sign up to a pledge that they would never walk by an incident or interaction they would not want to happen to themselves or a loved one.
“It was about really emphasising that we wanted to create a safety culture, flattening the hierarchy within the organisation and making it okay for the most junior person to speak up if they see something of concern,” added Ms Geddes.
This included training more than 300 staff in so-called “human factors”, including the fact people make mistakes and are more likely to do so when under pressure. She said staff were using the confidential Freedom to Speak Up process and also raising formal and informal concerns, by saying “this isn’t in keeping with our values”.
“We’re still not there yet and there is more work to do in terms of getting it embedded, but it is giving people that framework and it is really good they are not just a set of words sitting on the shelf,” she said.
The trust is working with two other acute trusts – Basildon and Thurrock University Hospitals Foundation Trust and Southend University Hospital Foundation Trust – as part of the Essex Success Regime.
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“The three directors of nursing are working closely together and it’s a real opportunity to look at rolling out the best across the three organisations,” said Ms Geddes. “We all do different things well and it is about how we learn from each other.”
This includes re-shaping clinical pathways and looking at the workforce needed to support that. “Nursing has an absolutely key role to play,” said Ms Geddes. “However, we are looking at the whole nursing family.”
This could include developing more assistant practitioner roles, with the new nursing associate role also on the horizon.
“We can’t keep doing what we have always done because the workforce isn’t out there,” she said. “We have to look at doing things differently – the additional roles we can put in place to free up the nurse to do the role of the registered nurse.”
She hoped this joint work would help Mid Essex address some of its nursing staff shortages, especially when it came to chemotherapy nurses.
“We want to work in collaboration with the other two trusts at how to provide chemotherapy differently and closer to home,” she said. “We are also working with our community providers to look at ways to improve end of life care, such as supporting care homes and training staff so patients don’t get admitted to hospital that don’t need to be.”
In addition, the trust is looking at ways to boost recruitment to accident and emergency – where its vacancy rates are highest.
In November, health secretary Jeremy Hunt said he wanted more managers from clinical backgrounds and Ms Geddes agreed clinical experience was an advantage. “It does help being clinical as a manager because you have that credibility – especially with doctors,” she said.
“When I am out on the wards in my uniform, they love it because they think ‘yes, she does understand and is out there and can see what it’s like’.”
While there are several trust chief executives from nursing backgrounds, Ms Geddes said she would like to see more nurses in the most senior leadership roles.
“Nurses are a certain type – we’re people that step up and take on more and more,” she said. “We try and turn our hand to anything and support people. We’re resilient and have got tenacity and those are skills that are needed when you are stepping into a role like chief executive.
“As a chief nurse on a board you are expected to know pretty much everything about everybody’s roles,” she said. “You need to know finances, HR, workforce so you have that breadth of knowledge and it’s a good background and grounding to have. I think nurses make good chief executives.”
“Nurses are a certain type – we’re people that step up and take on more and more”
However, Ms Geddes, who previously served as acting chief executive at the former Whipps Cross University Hospital NHS Trust, overseeing the merger with Barts and the London and Newham hospital trusts, said she was not tempted to apply for the chief executive role at Mid Essex.
“I love nursing and think I have the experience to do a good job as chief nurse,” she said. “I feel it is such an important role on any board and I just love it,” she told Nursing Times.
“When I was interim chief exec it was more difficult to just put the uniform on and go and work on the wards and I missed the interaction with patients,” she said.
However, as reported by Nursing Times last month, Ms Geddes will have to step away from the frontline for a little longer, as her work at Mid Essex has put her in demand at a national level.
Not long after our interview it was announced that she would be leaving the trust this month to take up the post of improvement director with the CQC’s fellow regulator NHS Improvement.
Meanwhile, Basildon and Thurrock, Southend and Mid Essex are setting up a new “group” model to run their hospitals with a “joint executive” team. Under the plans, Diane Sarker will cover the director of nursing role across all three.
What the CQC said about Cathy Geddes:
Sir Mike Richards
“The leadership of the interim chief executive has driven significant improvements at the trust and this was evident during our inspection.
The trust has moved from a culture of blame, with staff not feeling supported or listened to, to one of openness and transparency.”
CQC chief inspector of hospitals Professor Sir Mike Richards
CV: Cathy Geddes
2014: joined Mid Essex Hospital Services NHS Trust as chief nurse in January from Barnet and Chase Farm Hospitals where she was director of clinical strategy
Senior nurse credited for boost in trust’s CQC rating
2010: accepted first role as acting chief executive at Whipps Cross University Hospital NHS Trust overseeing the merger with Barts and the London and Newham hospital trusts
2004: promoted to role of director of nursing at Newham University Hospital NHS Trust before moving to gain regional nursing experience at South Central Strategic Health Authority
Previous: Completed basic training at the Royal Shrewsbury Hospital and went on to specialise in orthopaedics at the Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust. Moved to St Mary’s Paddington in London before taking ward sister posts both at Whipps Cross and Oldchurch Hospitals. Became deputy chief nurse and acting chief nurse at Guys and St Thomas’ Hospital