Inverting Hierarchy Within a Healthcare Social Enterprise
After ten years working as a registered NHS nurse, Liz Mouland decided to change her path and begin a journey through community nursing. Now, as the Chief Nurse and Director of Clinical Standards, at First Community Health and Care, she is making a major impact through Happy principles and a team-led feedback hierarchy.
Hi, we are Happy
We are leading a movement to create happy, empowered and productive workplaces.
How can we help you and your people to find joy in at least 80% of your work?
First Community Health and Care have one of the highest staff engagement scores in the NHS. They have been rated Outstanding by the CQC inspectorate and also have a Friends and Family rating (the NHS measurement of patient satisfaction) of 4.9 out of 5.
First Community provide frontline community healthcare services in East Surrey, as well as some parts of West Sussex, and were one of the first organisations to spin out of the NHS as a social enterprise rather than a care trust, using the Right to Request programme.
Liz Mouland is Chief Nurse at First Community, and recalls: “We wanted to design something that was not non-hierarchical but was an inverted hierarchy. We see the function of the Board and of management is to support those providing excellent care and services to the public.
“One example of how we do this is our ‘Floor to Board in five minutes’. Any of our 450 staff can contact a Board member within five minutes. Out of hours they can use the 24/7 On Call Manager phone number who can escalate to a Board member if appropriate.”
Another is the organisation’s open-door policy. Liz, as clinical lead for the organisation, literally has no door on her office. ”We have a behaviours framework which we expect everybody to role model. It is about showing emotional intelligence, with warmness and friendliness, where everybody’s voice matters.”
“It helps that, as a social enterprise, we aren’t governed by NHS England. As a commissioned provider we are not under the same scrutiny and it possibly makes it easier to innovate. And we really encourage autonomy to enable that.”
Liz joined the NHS in 1983 and trained as a Registered Nurse at Guy’s Hospital London. She moved into community nursing in 1993 working in a variety of clinical and HEI roles. In 2009, Liz formed part of a staff ‘Right to Request’ under the Transforming Community Services agenda and successfully created a social enterprise community interest company providing NHS community services in east Surrey and parts of West Sussex. Since creation of First Community in October 2011, she is now Chief Nurse and Director of Clinical Standards taking the lead for patient safety and quality and experience. The company now employs over 460 staff and provides a range of NHS community nursing and therapy-led services and is already achieving its mission to make an impact on improving social value to local people. You can find her on Twitter @lmouland.
About First Community
First Community is a social enterprise started in the first wave of ‘spin-offs’ from the NHS primary care trust systems using the right to request programme. These social enterprises operate within NHS jurisdiction however manage themselves within that system — giving them a flexibility and structure outside of the traditional format.
Why not sign up to our newsletter?
Sign up to our monthly newsletter, full of tips, tricks and news to help you to be happier and more productive at work.
Next Conference: Happy Teams and the Buurtzorg Way
We are very excited to be partnering with Buurtzorg for this online event! If you haven't heard of them, Buurtzorg is a healthcare organisation in the Netherlands with over 15,000 staff that receives top marks from care inspectors and has a current patient satisfaction rating of 9.3. It's also been rated five times as one of the top places to work in the Netherlands. Why? Their staff is made up of hundreds of self-managing teams supported by regional coaches and a back office of just 50 people — with overheads accounting for just 8% of its total costs!
At this workshop from 10am to 4pm on 27th May 2021, you will hear from nurses and a coach working the Buurtzorg way in both Britain and the Netherlands. You will also be introduced to some of the techniques Happy uses for more effective staff involvement in decision-making.