Business sector: Healthcare
Number of employees: Around 6,000

 

Key themes from the case study

  • Implementing flexible working has had tangible benefits at this trust, in terms of retention and reduced sickness absence.
  • There are different ways of working flexibly, some of which do not involve a reduction in working hours, but are just about changing or flexing the time, place or pattern of work.
  • It is helpful to think about flexible working across the life course and consider the needs of younger and older workers, including options for professional development and ‘retire and return’ as well as flexing around caring responsibilities.
  • Culture, communication and individual conversations are all important for creating an environment in which flexible working is not only accepted, but also encouraged. Having champions and talking about the benefits are key to supporting people to overcome any resistance to flexible working.
  • Systems, processes and technology can all help make flexible working possible.

Overall lessons learned

  • Culture change takes time and ongoing explanation of why it works and what the key benefits are, as well as keeping an eye on the challenges and finding ways to overcome those.
  • No one size fits all and you don’t necessarily have to reduce your hours: ‘allowing someone to pick their kids up from school once a week by leaving two hours early … you can let them do that and make that time up sometime else, for example working from home… it’s about thinking outside of the box.’ Different people need different things – for example, time off on particular days for religious reasons.
  • The need for flexible working is going to grow over time: ‘Given how the NHS pension scheme is progressing, people are going to want to work for longer, so we need to think differently about how we do that… how can we create flexible working for people at that stage of their career when some of the physical impact is relevant?’
  • There is still more to be done – for example, creating more job-shares at senior level.
  • Flexible workers need to be organised and plan well to work successfully.

Organisational context

Calderdale and Huddersfield NHS Foundation Trust comprises two main hospitals, Calderdale Royal Hospital and Huddersfield Royal Infirmary, plus community sites, health centres and care provided in patients’ homes. The trust offers a wide range of flexible working arrangements, including: term-time-only contracts, part-time, job-share, flexible working hours, flexible days, compressed hours, reduced hours, the possibility to work from home when appropriate, annualised hours, career breaks and sabbaticals. There are opportunities to flex the days of the week, hours and times of work and place of work: ‘Work is something I do rather than where I go or a specific time to do it in.’

The trust also operates an internal flexible ‘bank’ for nurses. People who do not want a substantive contract, or who want to choose when they work, or to be paid weekly instead of monthly, can choose to work as part of the ‘bank’. These people are not contracted for particular shifts; they simply work when they can work (and when the work is available).

In addition, people are allowed to move up and down the grading structure, without it being seen as a negative. For example, if someone who previously worked at a higher grade decides, when they come back from maternity leave, that they want to move down a band (for example move from ward manager to junior sister) in order to manage their additional responsibilities and have a healthy work–life balance, they are supported to do that: ‘we say “you are not lost to us, we still recognise you as having potential talent,” so we will meet their needs now and have another career conversation at their appraisal.’ 

People can also move around the organisation and get support for qualifications through working flexibly: ‘people recognise that they might start in one place, but don’t have to follow a traditional path anymore; they can swap from specialty to specialty and we will support that and they can move around the organisation – they can do their CPD differently when they are working flexibly too.’

While the organisation previously wanted people to be able to rotate through the full pattern of shifts across 24 hours, it now recognises that people’s other needs, such as bringing up children or looking after ill parents, may mean that they can only work at particular times of day/week. They now aim to accommodate individuals’ needs, and recognise that these may change over the course of their working life. 

The journey started with recognising that, to have a good workforce, the organisation needed to focus on retention as well as recruitment. ‘Exit interview data showed that lack of flexibility was the number one reason for people leaving and that, although we thought we had flexibility at policy level, at ward level there was resistance.’ Meanwhile, a new person took over as chief nurse and changed the culture from the top to allow any working arrangement to be considered. The organisation has invested in a head nurse, who takes the lead on workforce planning and, as well as overseeing development for nurses, also interviews everyone who hands in their notice; so, if someone is planning to leave because their line manager is not allowing them to work flexibly, they can get an arrangement in place and discourage them from leaving.

The trust has a ‘retire and return’ programme, so that people who are retiring are offered to come back in flexible roles: ‘even if it is just one day per week or in a teaching role because they don’t want to be on the wards – it is a matter of looking at what someone wants and seeing what role fits with that.’

One senior nurse, for whom it made financial sense to retire, had a smallholding, but decided she wanted to come back to work; because of looking after the animals, she wanted to work afternoons/evenings, so she was offered to roll out the hospital out-of-hours team, and that has been a great success. The out-of-office team was set up to assist the other ward teams to provide more effective care during the nights, weekends and bank holidays. They recruited and expanded the night sister role and renamed it clinical coordinator and introduced the role of the clinical support worker. The clinical support worker can provide medical support, which means patients get a quicker response and reduced waiting times as compared with waiting for a doctor. This also releases ward staff to spend more of their time with patients.

Flexible working in non-traditional and/or senior roles

Non-traditional roles

Flexible working is happening throughout the whole of the organisation: nurses, doctors, nurse consultants, senior managers, Band 7 and Band 8a nurses.

Senior roles

  • Assistant directors working part-time.
  • General managers working nine-day fortnight.
  • Senior people working flexibly at home.
  • Senior consultants with portfolio careers.

Gaining senior and line manager buy-in

  • National shortage of nurses: Offering flexible working was a way to increase recruitment when there is a national shortage of nurses: ‘When it is hard to fill posts, it is better to have a day of someone good than to have no days.’ Once it could be seen that that applied to nurses, it filtered out to all types of staff.
  • Share success stories: Where flexible working works well, talk about the success stories to show that it does work, and build on those to encourage others to implement flexible working too.
  • Overcome line managers’ fears: Line managers need practical support; for them, having additional people, rather than a smaller, full-time team, seems like more work – more appraisals, more holiday to sign off; however, the organisation is aiming to lessen the load by supporting managers to delegate people management tasks, making the appraisal really simple (more about the conversation than the bureaucratic process), and providing mandatory training online so the onus is not on the manager to provide or monitor the training.

    It is also about helping managers see the benefits of having more people available to work; for example, if you have people on part-time hours, when you need additional resource, they can flex up and fill the gap.
  • Support from the senior team: When the chief executive and the chief nurse are role-modelling and advocating flexible working, that makes it easier for line managers to buy in.

Facilitators to implementing flexible working 

Champions and support from the top

  • Visible support from the chief executive and the director team: ‘It has got to come from the top.’ As a manager said, 'it’s about leading from the front on it and being consistent in that leadership message to others.'
  • The appointment of a new chief nurse changed the dynamics of the board. His positive attitude to flexible working rubbed off on other board members and changed the perception of flexible working to being open to everybody, whatever their reason for wanting to work flexibly.
  • You need to have champions, for example, people for whom flexible working is working well, who can describe how it works and support others to think about how it could work for them. ‘The more creative we are and the more stories we can tell, that’s what builds momentum.’

Structures and processes

  • Flexible workforce department: A team of 21 people, who look after bookings for bank and agency staff. They have a constant advert out for bank staff and try to fill slots from the internal bank; and the trust is now using more of its own bank staff than agency people.
  • At recruitment, if several good people come to interview for a particular job and there is only one job on offer, the others can be asked to join the bank, so that they are ready and available to be given work when it is available.
  • Internal moves procedure: If people request that they want to move wards, 
    for whatever reason, the head nurse for workforce meets with them and helps facilitate that to stop people leaving at that point. ‘That saves loads of work on recruitment and it means we can move them quicker and we don’t lose them.’
  • Use all the different structures, meetings, training for front-line, middle and senior managers to support the narrative about flexible working: ‘it’s about ensuring that we create the right and consistent narrative that people in the organisation are the most important resource and allowing them to work in ways that are flexible is really important.’

Culture and communication

  • Have a culture that supports flexible working: ‘You can have all the policies in the world, but if people are not committed to it and it is not in the culture, it isn’t going to work… it has to be a culture that it is better to have one day of a good colleague than five days of someone who is not good.’
  • Communicate with people about the options and the possibility to have flexibility without reducing working hours.
  • Maintain conversations with individuals and managers: ‘checking out with ward managers that they feel enabled and supported to allow flexible working in their team, and recognising that it is not always easy. It is important as senior leaders that you are connecting with the front line to see what else you might need to do to enable them to offer flexibility; sometimes it is just a conversation to talk it through and a fresh pair of eyes helps.’

National-level factors

  • National shortage of nurses.
  • Public awareness and research about the different needs and attitudes of millennials and younger people, and how peoples' wants and needs have changed. For example,‘people coming out of uni want different things from what we wanted. We have doctors now coming out of training who want to go travelling for a year; ten years ago that was unheard of … now we say, “well, you go, and remember us when you come back.”’
  • Use national examples of best practice about flexible working and how to create the right culture – and network with peers in other organisations to share examples.

Trust

  • There has to be trust between the flexible worker and their line manager. A flexible worker said, ‘they have to trust I’m doing the hours, that I am working even when I am not visible in the office/on the floor.’
  • There also has to be trust and understanding between the flexible worker and their team. The flexible worker said, ‘I answer emails promptly, my staff can get hold of me whenever they need me. They don’t abuse that … they respect that if I say no, it means no; it’s about being honest.’

Look at individual and team needs

  • Consider individuals’ needs and implement flexible working with fairness and flexibility.
  • Constantly review whether flexible working is working well for the individual and the team, using the appraisal system and informal opportunities to have the conversation: ‘understand from the individual whether it is working for them and what is not working as well; and recognising when it’s not working well whether that is something that needs addressing or it is something that just needs accepting because the benefits outweigh the challenges.’

Support and guidance from HR

  • Have an excellent, supportive HR team who can give guidance, help managers and find ways to meet people’s needs.

Technology

  • Being a ‘fairly digital organisation… technology has been a key facilitator over the last few years’.
  • For a flexible worker one of the key facilitators was being able to control their own diary and to have all their diaries on one device.

Benefits of implementing flexible working (including any data/evidence collected)

Flexible worker perspective

  • Benefits to the individual: It ‘allows me to be a whole person. I can fulfil my roles in work and outside work.’
  • Benefits to the organisation: The work gets done: ‘sometimes I work way beyond my hours to get the job done, but the benefit for me is that I can flex that back at another time. … It does benefit both ways.’ ‘If I couldn’t work flexibly, I would have to reduce my hours substantially.’

Line manager perspective 

  • Recruitment and retention: Being able to attract different people into the profession because of recognition of different working patterns: ‘people that previously wouldn’t have chosen us as an employer because of having to work different shift patterns are now able to come into the organisation.’

    Attrition is lower – for example, amongst new graduates. And people on ‘retire and return’ are able to come back at senior levels on flexible hours/working patterns, so ‘we don’t lose that skill and knowledge. … We do have three to four examples of colleagues in my team who have come back on that basis and it is fantastic because they are so skilled and knowledgeable that it is a pleasure having them in the team.’
  • Productivity and performance: When people’s needs are met, they are more willing to go the extra mile; for example, ‘we have a senior nurse who works flexibly on reduced hours, and we see her go the extra mile all of the time because of the relationship in the team and, because we have met her needs, she will work extra hours at home when needed.’

    Sickness absence is reduced and there are indicators of employee wellbeing; and research shows that having employee wellbeing impacts on patient experience and compassionate care.
  • Matching capacity and demand: Flexible working offers the opportunity to link organisational and individual flexibility: ‘there are busy times and quieter times and with flexible working you can respond to that.’ For example, in paediatrics, more people are needed in winter than in summer, so some people are on annualised hours and work more hours in the winter months, and less in the summer.

HR perspective

Turnover and leavers

  • In the year to August 2016, 244 nurses left the organisation, whereas in the year to August 2018, there were only 120 leavers.
  • Turnover has gone from 13.55% to 7.55% in two years.
  • For the first time the organisation had had more people start than leave (in the most recent quarter). ‘We are doing a lot of stuff [around flexible working] and it is hard to say what has the biggest impact, but we do know that the number one reason for leaving was lack of flexibility… and, while the reasons for leaving haven’t changed, the number of leavers has halved, so it is not a massive leap of faith to say that that is because of the flexibility.’

Sickness and absence

  • Sickness absence has dropped from 5.16% to 4.12% in two years and it is now below 4%. 

Performance and engagement

  • Recently, the trust received a CQC ‘good’ rating. ‘It’s a nicer place to work and, if people are happy and can have a good balance, it makes them a more productive and engaged workforce.’

Challenges/barriers to implementing flexible working

Flexible worker perspective

Workload and being ‘always on’

  • Being entirely responsible for the workload: ‘if I’m not there, no one picks up my workload; I just have to do the work at another time.’
  • Needing to be in several places at the same time.
  • Tendency to do too much – sometimes staying up late at night to complete work assignments and meet deadlines.
  • Being ‘always on’: ‘Laptops and mobiles make it possible to work anywhere… sometimes you might be there in person, but you are not there in mind for the children.’

Visibility

  • There can be a perception that if you are not there, you are not working.

Line manager perspective

Volume of flexible working requests

  • It can be difficult to roster people when there are multiple people in a team.
  • When there are a lot of people working flexibly in a team, it can create tensions within the team: ‘when you have got people who will work any time and then you have people with flexible work patterns and different needs, it can be difficult to make the rosters work. There can come a critical point where if you have too many people working flexibly, it can become very inflexible for those that haven’t got a flexible working agreement.’

Inflexibility on the part of flexible workers

  • Sometimes, flexible workers do not recognise that the arrangement needs to be reviewed annually as part of an ongoing conversation about whether it is working or not.

HR perspective

Attitudes and assumptions

  • Peoples' resistance, ‘…thinking that it is a full-time job and that you can’t do a good job unless you are doing that; and some people think “I had to work full-time, so why shouldn’t you?”’
  • Expectations and assumptions – people thinking it is okay to work part-time 
    because of bringing up children, but not okay to work flexibly just because you want a good work–life balance.
  • Fears around ‘retire and return’ that people will potentially stay on until they are 100 and not be working effectively.

Practicalities

  • Rostering – if you have 20 staff that are all part-time, it seems more difficult to roster than 10 people who are full-time.
  • If someone reduces hours, the tendency is to use that as an opportunity to make savings (cost improvement), but that makes it difficult if that person wants to become full-time again, because the budget is no longer there. 

Overcoming the barriers and challenges

Flexible worker perspective

Switch off when possible

  • For example, have a rule of ‘no devices at the dinner table’, and take up leisure activities that help you switch off from work.

Communication

  • Let people know what you have been doing, go into the workplace when you can, and try to be as visible as possible.
  • Having good relationships and trust; for example, being responsive: ‘If I ring my line manager, I know she will call me back… she knows I wouldn’t ring her if it wasn’t important, and likewise I know that she wouldn’t ring me if it wasn’t important.’

Learning, adapting and accepting

  • Learn to live with ambiguity and flexibility; be able to flex at the last minute.
  • Work out what suits you and work around that: ‘some people never work from home … but that doesn’t work for me. I have an office at home … and it’s about accepting that that is part of life… it works for now.’

Line manager perspective

Openness and transparency

  • It is important to be open and transparent in the team about the challenges and discuss how to manage it, ‘to say, “we can do this most of the time, but when we can’t, we need a bit of give and take,” and if people see the fairness of that and how everyone can get flexibility, not just for them, but for others as well, that helps.’
  • The new e-rostering system helps with visibility as everyone gets equal visibility: ‘everyone can see everyone’s patterns and what everyone has requested… and request their own patterns.’

Communicating the benefits and creating a positive narrative

  • Help managers recognise the changing needs of the workforce and that ‘having a blended workforce with different forms of flexibility is far more valuable than having lots of vacancies or absences’.
  • Create a clear narrative in the organisation: ‘really get people to talk about what it means for them, so that you can put the narrative through the organisation that we can work differently.’

HR perspective

Build the culture over time

  • Take a range of approaches to changing culture and recognise it’s a long journey: ‘it doesn’t happen overnight.’ Initiatives include: buddying upwards where flexible working is happening successfully with those who have not yet implemented it; HR going out and talking to people and communicating all the options that are available.
  • Explain the need to be flexible to what different people, and different generations, want in order to attract and retain them at different times in their lives. ‘Millennials have a different mindset and we have to change if we want to attract and retain them.’

Practicalities

  • Rostering: There is an e-rostering system on the wards now, so the key things are to make sure the system supplier is meeting the needs of the different teams using it and to provide training on how to use it. The e-roster team are going out to give specialist training to people on how to use the electronic system to make the rostering process easier.
  • Retaining budgets: ‘When someone goes part-time, we need to not get rid of that budget.’
  • Ensure that there are good performance and capability reviews in place and support for managers to have difficult conversations. In terms of the ‘retire and return’ workers staying on beyond when they can work effectively, ‘it’s about being sensible. Most people know when they are ready to finish… and you can have capability and conduct matters at any age… so it is about having sensible conversations about it… let’s treat people as adults and the majority of people behave that way.’

Understand and address line managers’ fears

  • To overcome resistance, sitting down and understanding why a particular manager is not supportive of flexible working can help. They may have had an experience that has led to them feeling unable to offer flexible working or they may have fears and anxieties based on no experience; either way, the key thing is to understand and discuss their concerns. ‘When individuals feel unable to be flexible around working patterns, sometimes it is about myth-busting.’

Talk to particular groups and individuals

  • The organisation is holding retirement workshops, aiming to talk to people two years before they get to retirement about ‘retire and return’ and help them consider the options. It is also looking to streamline the ‘retire and return’ process to make it a lot easier.
  • The head nurse for workforce is constantly intervening with those who hand in their notice and finding ways to retain those who ask for flexible working and resign because they don’t get it (though this has to be balanced with not undermining the manager who has made the decision not to offer flexible working, so it is often about finding the person work on another ward/team).

How to measure and evaluate the impact of flexible working

  • Review the statistics: There are statistics that are reported to the board on a quarterly basis: ‘just looking at FT [full-time] and headcount tells a story in itself… If you look at the headcount for 21–25, the FT figures and the headcount is about the same, so there is really nobody working flexibly at that age; but the biggest gap is around 41–45, so more people at that age are asking for flexible working… You would think it would be younger, when people are having children, but actually it’s when people are more financially secure and evaluating their lives.’

    It is important also to look at sickness, turnover, leavers, and starters to show the benefits (see benefits listed above). Also, looking at patient experience (for example patient feedback and complaints) and triangulating those with workforce metrics can help show that there are links between data about employees and about patients.
  • Ask questions about flexible working in employee surveys: There are questions in the Investors in People survey and the staff survey about flexible working and work–life balance, so the organisation will get the results of those surveys and understand more about people’s views.

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