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Two male physiotherapists sit on a table discussing patient notes

How we’ve improved appraisal rates, to help us deliver improved outcomes

Health and care is, at its heart, about people. And while it is right to focus on the millions of people who rely on NHS and local authority services every day, we also have to remember that building a positive place for people to work has just as much impact on these services as buying the right equipment, keeping waiting times down and investing in our buildings and technology.

Simply put, a happy team delivers better outcomes.

So that means that as an employer we have a responsibility to make sure that the people who work here have an environment that enables them to bring their best self to work, every day – and to keep inspiring and encouraging them to enjoy their job year after year. The key enabler to this is great leadership which is enhanced through effective people process and tools!

Great leaders aren’t just there to sign off leave and manage budgets, but to have regular and quality conversations with their team – checking in on how they are, what it’s like to work around here, their performance and future plans or aspirations. As People Director it’s my one non-negotiable – all colleagues deserve and should have protected, regular and quality time with their manager to talk about them!

And whether you’re a porter, a cleaner, a nurse, a receptionist, a team leader, a district nurse, a social worker, a GP, an administrator in our call centre or you support in our back office corporate functions actually having the opportunity to discuss how you are, how you’re currently performing, agreeing an up to date personal development plan or having a plan for your future career really helps.  It reminds our people that they are cared for, valued and of equal importance, they have a role in helping us shape how we do things around there.  The outcome –  not only will you be happier, you’ll also be in the best place to help the people we support, who rely on the services we run and make a real difference.

Appraisals, getting them done and making sure they’re high quality, is an issue for all employers and as an NHS provider we are no different. Improving the quality of these annual conversations has been an ask of NHS employers / providers for some time and sits firmly within the aspirations of the NHS workforce plan too. Last year the Government and unions again agreed that improving the quality of appraisals was a priority for the service. [i]

But despite this push, it’s still a challenge in a stretched, busy service that needs to put service users first to carve out the time needed – especially if the value in doing it isn’t always clear. In fact, in community trusts last year, only 21% of colleagues report having had an appraisal conversation with their manager that helped them to improve how they did their job, against the NHS national average of just 22%.

And it’s not surprising that driving this rate up is proving a challenge. Quality conversations take time to prepare, both for colleagues and managers, and having good systems to keep track of the promises we make and really clear organisational aims that have been cascaded effectively are essential ingredients. They aren’t always easy to achieve, though. Yet the results: ensuring colleagues and managers are aligned, working towards the same goals and yes – dare I say it – ensuring people are enjoying their job, are all worth it.

Two male physiotherapists sit on a table discussing patient notes

So that’s why I’m incredibly proud that our efforts to do better over the last three years are paying off; in our annual appraisal round this year we managed to achieve a record-breaking 90% of our colleagues having had this important conversation with their manager.

It’s a hard-won record, and it has required investment in training our managers and colleagues so that we all know how to have a quality conversation and, importantly, how to turn it into action and having a long hard look at the process. We sometimes make this tool too focused on the process or the system and not the person or the outcome we are searching for. We are in no means perfect and there are still things we need to do to make it easier, slicker and better for our colleagues but these figures show the difference we have made so far!

What we had three years ago was a clunky system, with complex forms and minimal guidance. We also hadn’t made the “so what” clear so people didn’t buy in to what was effectively seen as just another paper exercise. But working together with managers we now have a much more simplified system, with an easier to use form. And the results show why having quality conversations, career plans and a common mission matters.

People who use our services rate them highly and 93.5% say they’d recommend them to others who might need similar services; a large majority of our services are now rated ‘good’ or ‘outstanding’ by the CQC – and that figure is growing with every inspection – employees are happier and more engaged in continuing to improve what we do too, as part of our team.

Sixty seven percent of our colleagues took part in our most recent staff survey (20% more than took part in the most recent NHS one), showing an incredible willingness of our colleagues to tell us what we are doing well and what we need to do to continually improve. 65% said that their appraisal was useful, compared to the 21% seen in community trusts, and 84% said they had a plan for their future career. Over 70% of our colleagues have told us they get regular feedback, positive recognition and their development is encouraged and discussed with their line manager. This is leadership at its best – nurturing, encouraging and supporting our workforce to be the best that they can be.

Operationally, we’re seeing the results too. Having a common mission and priorities has meant we’ve not just talked about transformation; we’ve actually delivered it – and it’s having a positive impact.

In Wiltshire, for example, we moved colleagues from working in service silos into three hubs – making it easier to talk to one another, and for services serving the same child to work better together. The move was a massive upheaval, but we’ve seen reductions in waiting times and our colleagues are telling us that they’re more engaged in their work (from 56% in 2018 to 70% in 2019).

All of this together shows why the hard work of making appraisals a culturally important part of your organisation is important in helping managers and colleagues invest their time in having these kinds of quality conversations each year. Some people are tearing up the way they have performance conversations – and you won’t hear me disagree that the conversation is far more important than the form, but without the right process, I worry that these conversations can get missed. We run critical, high quality but very busy services and so it’s easy to see how things could fall off the to-do list.

I am however, really proud, sitting here today as people director of an organisation of this size and scale, delivering the range of services we do. I truly believe we’ve achieved a great deal and that this is having a positive impact on the lives of people across England who rely on the services we run. We couldn’t do this without our colleagues and without their leaders who strive to make this a great place to work. It’s why we put our people at the heart of everything we do, and always strive to build a positive place for people to work to ultimately deliver better outcomes.

[i] https://www.nhsemployers.org/-/media/Employers/Documents/Pay-and-reward/2018-contract-refresh/Framework_agreement_27_June_2018.pdf

Virgin Care
Virgin Care
Virgin Care
Virgin Care

Brian Kinsella is Clinical Lead and Clinical Nurse Continence Specialist in East Staffordshire. Over the last 18 months, Brian and Learning Disability Nurse Steph Brinklow, have been visiting care and assisted living homes together, educating staff about continence issues and helping to change the lives of people they care for.

Virgin Care
Virgin Care

Much has been written and said about the procurement process which the NHS in Surrey ran back in 2016 to find the best organisation to deliver vital children’s services until 2022. A lot of what has been written is misleading or misinformed, and all of it has lost the key point: a procurement process is meant to be about picking the right provider – a principle we agree with.

Virgin Care
Virgin Care

Carmen has been with Virgin Care since the company began its partnership with the NHS in the area in May 2017, stepping up from nurse practitioner to clinical lead nurse a little over 12 months ago. She works across the Skelmersdale and Ormskirk sites, splitting her time between clinical practice and managerial work.

Virgin Care
Virgin Care

Adele Dick is a healthcare assistant at dermatology centres in Grimsby and Scunthorpe. She was nominated for a Feel the Difference award by her area manager for her unwavering cheerful demeanour.

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