Read In Practice: South Essex Partnership University NHS Foundation Trust [p. 49] in Shortell & Kaluzny's Health Care Management Organization Design and Behavior CASE STUDY: Thameside Community Healtcare NHS Trust (now South Essex Partnership University NHS Foundation Trust) mereged with another healthcare organization in April 2000. At the time, there were few remaining Executive Directors form the other trust, it had a track record of weaker performance, and there was a history of competition between the two providers. At the front line, there was a prerception among stadd, that the term "merger" had been sed to manage any potential "politcal" opposition to the change, and in fact it was "takeover".

At the same time there were some excellent clinical and nonclinical services in both trusts there were as well as a number of serious weaknesses in clinical service delivery and a faltering hospital closure program in the other trust. These included pockets of negativity in some teams and services, an overreliance on bed based services, fragmentation of community sercices, and a belief that community care was unlikely to succeed as a high-quality alternative in the longer term.

In addition to these issues, the local health and social care economy was facing serious financial challenges, reductions in funding were on the horizon, and one of the local authority areas served was on enhanced monitoring for mental health services. Initial analysis of the situation revealed poor and inconsistent leadership, poor communication and morale in many services, and lack of clarity regarding strategic direction and the desired state in terms of service model. Considering the sensitivity and overt resistance of some staff remaining in the other trusts services, the situation needed incisive but well-planned and sensitive intervention. In order to free up the capcity to move matters forward quickly, interim local management arrangements were put in place for the Thameside operational services and the executive team was freed up to focus their attention on the other trust services. Initial actions included:

- Face to face open and honest staff briefings outputs were undertaken as well as diagnostic and planning sessions involving staff from both trusts. The outputs from theses sessions were used to review the service strategy and plans. These were worked through and agreed with local authority partners, comissioners and other stakeholders. Revised plans were jointly published.

- Regular all-staff communication against the recised plans regarding service modernixation and service improvement activity were introduced;

- The executive team relocated to a building in the long stay hospital to signal that direct attention would be given to the closure program and problem services areas.

A change program of this scale required a challanging multilayered approach to organizational development and service transformation. Ultimately , however, the approch approves successful. The outcomes of this process have been tremendous, and have included:

- Sucecssful closure of the long stay hospital into world class accomodation - Modernization of services with significantly improved delivery as a result

- As staff gained confidence that there was strong management support for improvement, the incidence of "whistle-blowing" poor clinical practices increased; where this was proven, very clear action was take to reestablish accepatable standards of practice and drive out poor practice.

- Public confidence in the ability of the system to deliver safe services and transformation plans increased.

Ten years later, a SEPT is consistently a top performer in the delivery of mental health services. It has been selected to acquire another mental health trust and help transform local sercvices in another locality. As such, SEPTs experience highlights real-world applicaitons of several concepts discussed in this chapter. For example note how the SEPT leadership team made use of artifacts and feedback loops to change culture.

1. How the SEPT (South Essex Partnership NHS foundation Trust) leadership team made use of artifacts and feedback loops to change the culture? What other tactics did the leadership team use that may have contributed to their success? What, if anything, was the key to their success?