embedding equality, diversity & inclusion into nhs … 2 integr8 nhs – board development...

Embedding Equality, Diversity & Inclusion into NHS Governance

Board Development Toolkit

November 2010

Integr8 NHS – Board Development Toolkit

Embedding Equality, Diversity & Inclusion into NHS Governance

1. Overview of Integr8 NHS Toolkit 3

1.1. Approach 3

1.2. Target Outcomes 4

1.3. Methodology 4

1.4. Timeline 6

2. Board Engagement 7

2.1. Programme Set up 7

2.2. Scoping Meeting 7

2.3. Full Board Meeting 8

3. EDSnap Audit 9

3.1. EDSnap Audit Report 10

4. Strategic Inclusive Leadership Review 11

4.1. Background 11

4.2. Completing the Factor 8TM DLAT 12

5. Board Development Workshop 13

5.1. Example of Workshop Agenda Template 13

6. Taking Action 15

6.1. We Implement 15

6.2. Evaluate and Review 15

Appendix:

1. Scoping Meeting Agenda Template

2. Integr8 NHS Board Overview Report

3. EDSnap Document Request Checklist

4. Sample Summary page – Factor 8 Assessment Report

1. Overview of Integr8 NHS Toolkit

In January 2010, the Diversity Practice was commissioned by the NHS Institute for Innovation and

Improvement to support a pilot programme to build Diversity and Inclusion into the Business of NHS

Boards.

The aim of the programme is to co-produce an accelerated development process which will support

Boards to focus on inclusion in a way that engages them in the reality of the challenges they face as

commissioners, providers and employers in the communities they serve. More specifically, the goal

is to support Boards in developing the critical connections between equality, diversity and inclusion

(EDI) and their core business; and identify what they need to do differently to ensure their “business

delivers effectively to all its customers”.

This report outlines the Integr8 NHS Board Development Toolkit for Embedding Equality, Diversity

and Inclusion into NHS Board Governance.

1.1 Approach

The issue of mainstreaming and embedding EDI continues to be an important aspiration for many

public and private sector organisations. To support NHS Boards in achieving this aspiration the

Diversity Practice has developed Integr8 NHS – a cutting edge approach that practically aligns and

effectively integrates NHS governance, leadership and overarching business models with EDI.

Integr8 NHS builds on the National Standards, Local Action Planning Framework, World Class

Commissioning, Integrated Governance and CQC Standards as the core foundation for embedding

and mainstreaming EDI into NHS governance policy and practice.

Working within the Cadbury, Turnbull and Higgs standards for corporate governance, risk control

and role and responsibilities of boards, Integr8 NHS seeks to increase each Board’s ability to more

effectively monitor, scrutinise and constructively challenge from the perspective of EDI the strategic

levers and drivers for quality, innovation and improvement, and to deliver inclusive health and

health care services whilst being an inclusive employer and providing inclusive leadership.

The overall approach is built on the principles of:

collaborative partnership to create robust processes that take account of individual

Board contexts, and ensure interactions with each Board maximise engagement and

time with the need for flexibility;

appreciative enquiry to build on the good practices already in place; inclusive action

that seeks out and incorporates the perspectives of the diverse staff, patients and

community representatives;

a “whole system” perspective in order to create change strategies and implementation

plans that take account of the complex adaptive nature of the NHS. Above all, the

approach seeks to ensure that there is an alignment between the key NHS strategic

drivers, governance & leadership, and diversity & inclusion.

1.2 Target Outcomes

1. Organisational shift – The Board achieves its aspirations and success measures for the

project

2. Embedding D&I – The Board has a better understanding and a shared point of view of the

critical business relationship between D&I, quality healthcare for all, its strategic priorities

and plan, and national NHS strategic drivers such as World Class Commissioning, and

Quality, Innovation, Productivity and Prevention.

3. Inclusive Leadership – Increased Board member competence and confidence in their

individual and collective ability to take the lead on mainstreaming and embedding D&I in the

organisation, the management of staff, and the delivery of services.

4. Improved Governance – The Board increases its effective governance and oversight of D&I.

5. Organisational benefits – The creation and implementation of a clear action plan and initial

improvements in the diversity of the workforce, the development of an inclusive workplace,

and equality in service provision to patients and the public.

1.3 Methodology

The Integr8 NHS methodology is an 8 step process for embedding equality, diversity and inclusion

into NHS governance.

Foundation

The initial steps in the process are focused on project set up, engagement and ownership with the

Board; analysis of the current situation and aspirations; and individual inclusive leadership support

to each board member.

i. Board Engagement – Initial consultation with Chief Executive/Chair, followed by

engagement with the full Board to introduce and take ownership of the Integr8 NHS

development process.

ii. EDSnap Audit - an Equality, Diversity and Inclusion Snapshot audit to determine the current

positioning, integration and impact of D&I on the Board and the organisation, comprising of

documentary review, short interviews with a few Board members, and an online survey of a

small sample of key staff, patient and community representatives. The output from EDSnap

is a 40 page EDSnap audit report, outlining where the Trust is on its EDI journey from

“compliance” to “delivering outcomes” to “being an exemplar high performing inclusive

organisation”, and indicating areas where the Trust or the Board could benefit from further

development or intervention.

iii. Strategic inclusive leadership review – each Board member receives a personal, confidential

session with an executive leadership coach, to support and develop their inclusive leadership

commitment and understanding. A unique aspect of the review will be the use of the Factor

8 Different Leaders Assessment Tool. This is an innovative, cutting edge 360 online tool

which provides an assessment of the leadership competences critical for leading a diverse

workplace serving diverse patients and communities. Through the individual 34 page report

they receive and the executive coaching, each Board member has the opportunity to

develop a personal action plan to grow their competence and confidence as inclusive

leaders.

Board Development Workshop

Using the output from the foundation steps, a Board Development Workshop is then held. The next

3 steps in the Integr8 NHS process are applied during the workshop.

iv. E-QIPP – the first part of a facilitated Board workshop, develops the vision for EDI, the

business case for building D&I into the Board’s business, and examines the critical

connection between D&I and achieving QIPP.

v. I-Lead – the second part of a facilitated Board workshop, examines what it means to lead

effectively on D&I and develops a common framework of inclusive leadership competencies,

behaviours and values for Board members.

vi. We Govern – the final session of a facilitated Board workshop, builds effective mechanisms

for Board leadership and oversight of D&I, for example through identifying and developing a

Board level Diversity Scorecard to track progress against pre-determined success measures.

Taking Action

The final steps involve drawing up and implementing actions from the Board development workshop

and reviewing the Integr8 NHS process.

vii. We Implement – all the agreed actions are consolidated into an implementation plan, and

the consultants attend meetings with the Trust to coach and facilitate the Board in executing

the plan.

viii. Evaluation & Review – an overall final review and evaluation of the success of the

Intervention

1.4 Timeline

In an ideal context the Integr8 NHS process would be undertaken over a 12 to 18 month timeframe.

This is primarily to give time for the intervention to translate into sustainable and impactful

outcomes. However, where necessary it can be condensed into a shorter timeframe. An indicative

timeline and reflection of investment required from the average Board member is shown below:

The rest of the Toolkit breaks down each of the major steps and provides guidance as to how to

undertake this Board D&I Development intervention, along with examples and other materials.

2. Board Engagement

2.1 Programme Set Up

1. Invitation to participate: A letter is sent from NHSI to selected Boards to invite them to

participate in the Programme. Alongside the letter, an outline of the Integr8 NHS

methodology and terms of engagement letter are also sent.

2. Provider communication with Board Chief Executive /Chair: Following the invitation letter

there is an introductory conference call with the Chief Executive of the Trust. The purpose of

the call is to:

a) Introduce the Provider to the Chief Executive

b) Outline the aims, objectives and process for Integr8 NHS, as outlined in the

methodology document previously sent to Chief Executive

c) Determine readiness and commitment of Chief Executive and the Board to undertake

Integr8 NHS in a timely and productive manner

d) Establish parameters for scoping meeting including agenda, participants, and timing

e) Agree on operational points of contact and communication

2.2 Scoping Meeting The objectives of this initial meeting are to clarify expectations and define the scope of the

programme, gain insight to Board readiness and raise Provider awareness of the specific context and

issues that need to be taken into account. Working with a key group of stakeholders the Provider co-

creates a programme agenda and plan of events that fits with the priorities and needs of the Board.

The actions that are taken are as follows:

a) Participants at the scoping meeting to include key individuals critical to successful

implementation of the project, and likely including:

i. Chief Executive

ii. Chair of the Board

iii. One or two other Board members e.g. Diversity Champion

iv. Equality and Diversity Lead

v. Director of Human Resources

vi. Secretary to the Board

b) A Scoping Meeting Pack is to be sent out beforehand and this is to include:

i. Agenda template and key questions for discussion – A sample template is

provided in Appendix 1.

ii. Information request for overview of Board, pen picture of members, roles and

responsibilities, how it is structured etc, over and above what is publicly

available on the website

iii. Document supply request template to show the documents/information

required for the EDSnap Audit

c) At the scoping meeting, participants discuss and agree the Integr8 NHS process as it will

be applied in the context of the specific Board, including:

i. Providing options for where more flexibility may be required

ii. Identifying the critical issues that will be the focus of attention, discussion and

actions for the Board

iii. Identifying which Board members should participate in the EDSnap interviews

iv. Developing a communications plan for sharing/updating information with the

full Board following the scoping meeting and for the project as a whole.

v. Determining the schedule of dates/meetings for the Integr8 NHS steps

2.3 Full Board Meeting The first meeting(s) with the Board will set the scene for the rest of the programme. The aim is to

get the Board to collectively take ownership of the Integr8 NHS programme and the process. A

report of the Intergr8 NHS aims, objectives, process and desired outcomes will be circulated prior to

the meeting. An example of such a report is provided in Appendix 2. An overview of this will be

presented and used as a platform for discussing and agreeing the specific development agenda.

The objectives for the Board Meeting are to:

a) Establish a shared understanding of the purpose and scope of the programme and to shape

and refine the proposed plan

b) Explore what will work with regards the implementation of the programme, what are the

barriers and how can they be addressed, and communicate the underlying principles and

rules of engagement

c) Engage Board members in an exploration of the role of D&I as a strategic lever for achieving

the goals of Quality, Innovation, Productivity and Prevention (QIPP) as laid out in the Next

Stage Review vision

d) Explain to Board members the Strategic Inclusive Leadership review and the use of the

Factor 8 Different Leaders Assessment Tool

e) Identify how success will be measured and the programme evaluated

It is highly likely this is scheduled as an agenda item at one of the Board meetings and therefore the

time allocated may be quite short - 15 to 20 minutes, in which case item c) may be deferred to the

Board Development Workshop

3. EDSnap Audit

The Integr8 NHS EDSnap Audit seeks to gather information on the current status with regards the

positioning, integration and impact of EDI for each individual Trust. Broadly, this includes:

An understanding of the Board’s perception, engagement and leadership of EDI

An analysis of policies, programmes, and outcomes relevant to the workforce and workplace

A review of health care service delivery, access to health care and engagement with diverse

stakeholders and communities

The EDSnap Audit is not intended to be a comprehensive audit of all EDI activities and issues at the

Trust or to identify what is “right or wrong” from an EDI perspective. Rather, the objective is to

make a quick assessment of where the Trust is on its EDI journey and capture the direction of

travel from compliance - to process - to delivering outcomes - to being exemplar. It is to provide a

snapshot of the current situation, and a high level understanding for a baseline assessment of where

they are today.

There are three elements to the EDSnap information gathering process:

1. Documentary Review – an analysis of existing information and data. To ensure that we use a

quick and systematic approach to gathering head-line data and relevant information we

have developed a Document Request Checklist, which is attached in Appendix 3. This

checklist provides an indication of the minimum types of information required to conduct

the EDSnap audit.

2. Telephone interviews – the purpose of the interviews is to provide an initial assessment of

Board members understanding of EDI, the Board’s engagement with EDI from a governance

and leadership perspective, and to establish their views and perceptions on what needs to

be different for EDI to be integrated into the way the Board does business, the associated

behaviours and measures of success.

The objective should be to interview 6 Board members, the Chair and 2 other Non-Exec

Directors, and the Chief Executive and 2 other Executive members of the Board. In addition,

other significant individuals could also be interviewed, for example the Equality & Diversity

Manager and the Heads of diversity staff representative groups.

3. The Integr8 NHS EDSnap online survey is intended to gather the views of a cross section of

stakeholders with regards to EDI at the Trust. More specifically, the objectives are:

To examine EDI issues critical to the Trust, and stakeholder views on the extent to which

they are being addressed, outstanding challenges and barriers, and how they can be

overcome

To explore perceptions of the significance placed on EDI by the organisation and assess

Board and Senior Management leadership of the EDI agenda

To gain an understanding of the impact that current EDI practices are having on the

workforce, the workplace, service delivery, and in ensuring equality of health outcomes

to all communities

The request to participate in the survey is sent to a small sample of staff, patients and community

representatives for completion. The survey is completed online, unless it is absolutely necessary to

use hard copies of the questionnaire, for example where staff may not have access to the internet in

the normal course of their work. The intention is to gather 100 plus completed surveys.

3.1 The EDSnap Audit Report Having gathered the data, it is then analysed and reviewed under four broad areas for assessment:

1. Board Governance of EDI

2. Patients, Communities and service delivery

3. General Leadership and Management around EDI

4. Workforce and workplace

Within each area an assessment should be made against a set of EDI good practice statements as a

baseline for comparison. The Diversity Practice has created a proprietary set of good practice

statements representing what an “Exemplar EDI Organisation” or “High Performing Inclusive

Organisation” would have in place and be achieving. The good practices are drawn from a range of

published guidelines/frameworks for good EDI Standards including the Department of Health

“Equality and Human Rights in the NHS, a guide for NHS Boards”; The Local Government Equality

Standards; Care Quality Commission Standards; and the Diversity Works for London Diversity Gold

Standards.

A critical output from the Integr8 NHS process is the production of the extensive EDSnap report

outlining areas of good practice and recommendations for areas requiring further development

and intervention. As a stand alone report it provides a basis for further action on the part of the

Trust, and additionally it feeds into the content for the Board Development Workshop.

4. Strategic Inclusive Leadership Review

A key step in the Integr8 NHS process is the Strategic Inclusive Leadership Review. The objective is

for each Board member to receive a personal, confidential session with an executive leadership

coach, to support and develop their inclusive leadership commitment and understanding.

A unique aspect of the review will be the use of the Factor 8 Different Leaders Assessment Tool. This

is an innovative, cutting edge 360 online tool which provides an assessment of the leadership

competences critical for leading a diverse workplace serving diverse patients and clients. Through

the individual 34 page report they receive and the executive coaching, each Board member has the

opportunity to develop a personal action plan to grow their competence and confidence as inclusive

leaders.

Additionally, the use of the Tool allows for a collective representation of the strengths and areas for

development of the Board as a whole with regards inclusive leadership, and the development of a

language and framework for inclusive leadership behaviours and competencies.

4.1 Background By way of background, the Factor 8™ Leadership Framework emerged from a groundbreaking study,

Different Women, Different Places (2007) the first research of its kind to focus on the career and

leadership strategies of successful black and minority ethnic (BME) women in the United Kingdom

and Europe. The framework draws on the fundamental premise that diversity is a distinctive

leadership strength that must be leveraged by individuals, teams and organisations for competitive

advantage.

From early 2008, The Diversity Practice started to use the Factor 8™ framework in a variety of

consulting, coaching and learning & development interventions. Since then, over 2000 people have

experienced Factor 8™ as a learning tool across the public, private and not-for profit sectors, in the

UK, US and Europe. It has been validated training courses by the Institute of Leadership and

Management. The evidence has built up to show that Factor 8™ contributes to the success of a

broad group of leaders. The term “Different Leaders” is used to encompass all those individuals,

regardless of their gender, race, ethnicity, or other dimension of diversity, who draw on diversity as

an authentic strength to maximise leadership impact and deliver results.

Factor 8™ and the Different Leaders Assessment Tool have been used to support the leadership

development of BME individuals, managers of diverse teams, and senior management of large

complex organisations. It has also provided a framework for whole system organisational dialogue

and change, and successfully contributed to the development of high performing inclusive

organisations across a variety of industry sectors.

In addition to providing individuals with the opportunity to self assess against the eight Factors,

it also gives managers of diverse individuals and teams the opportunity to 'step into the shoes' of

Different Leaders and provides a common language and appreciative model for engaging in dialogue

that focuses on the value of difference and those leadership behaviours that create high performing

cultures.

The Factor 8™ DLAT has been used by a wide cross section of organisations including Kings College

Hospital, North West Ambulance Service, NHS North West Strategic Health Authority, NHS Yorkshire

and Humber Strategic Health Authority and Senior Leaders from Trusts across the region. Outside of

the NHS it has been used with organisations as varied as Imperial College, Oxford University,

PricewaterhouseCoopers, Ernst & Young, Kent County Council, Bank of America Merrill Lynch, and

the National School of Government to name a few.

4.2 Completing the Factor 8™ DLAT The Factor 8™ DLAT is available online through the Diversity Practice Ltd at

www.factor8assessment.com. Once set up, the Board member and between 4 and 10 observers are

required to submit a completed online questionnaire. Selection of observers should be based on

inviting as broad a spectrum as possible – peers, subordinates, current/former managers and need

to know the individual well, have seen them in action and can be trusted to provide objective

feedback. For the purposes of this particular review, at least 2 observers should be colleagues on the

NHS Trust Board on which the member is currently serving. The questionnaire takes about 20

minutes to complete.

Completion of the 360 version of the Tool provides a comprehensive report on the extent to which

individual Board members display the characteristics of an inclusive Leader.

The results from this questionnaire are then reviewed and discussed as part of the Inclusive

Leadership Review, a one to one confidential Executive Coaching session to be held with each Board

member prior to the Development Workshop. The objective is to highlight the learning from the

Factor 8™ DLAT, areas of strength and for development, the application of the learning in a Board

and Trust context, and creation of a personal development action plan.

An example of a summary page from an individual Factor 8™ DLAT report and a team chart is

provided in Appendix 4.

Note, only certified Factor 8™ DLAT coaches are licensed to use the Tool and conduct the review. A

list of these coaches is available by contacting the Diversity Practice at www.diversitypractice.com

http://www.factor8assessment.com/

http://www.diversitypractice.com/

5. Board Development Workshop

The Board Development day marks the half way point in the Integr8 NHS process and is a key

milestone in the journey the Board has embarked upon. The overall aim is to use the facilitated

workshop to further build or embed EDI into the business of the Board and the organisation.

Broadly, there are 3 critical areas that need to be covered:

1. E-QIPP – to develop the vision for EDI, the business case for building D&I into the Board’s

business, and examine the critical connection between D&I and achieving QIPP;

2. I-Lead – to explore and examine what it means to lead effectively on D&I and develop a

common framework of inclusive leadership competences, behaviours and values for Board

members, building on the results of the Factor 8 Different Leaders Assessment Tool and the

Inclusive Leadership Review;

3. We Govern – to build effective mechanisms for Board leadership and oversight of D&I, for

example through identifying and developing a Board level Diversity Scorecard to track

progress against pre-determined success measures.

Ideally, a full day is required to do justice to the issues that need to be addressed. In practice, most

Board’s are only prepared to offer half a day for the workshop. Therefore, more detailed preparation

and dialogue with key Board members – or the team leading the intervention – is required to ensure

that the maximum use is made of the time and the sought after outcomes are generated.

A successful workshop requires skilled facilitators with in-depth knowledge and understanding of

EDI, change management skills, an appreciation for working systemically and expertise in working

with Boards and Senior Managers.

Prior to the workshop, all Board members should receive a copy of the EDSnap Audit Report.

5.1 Example of Workshop Agenda Template Aims and Objectives

1. Restatement of the vision for EDI; gaining agreement and shared ownership of the vision

and the road to exemplar

2. Connecting EDI to the Board’s strategic agenda and priorities; and clearly articulating the EDI

business case

3. Use the EDSnap findings and Factor 8 Leadership review to identify key areas of focus to

become more effective as a Board in terms of strategic leadership and governance of EDI

4. Acknowledge what is working and agree steps to sustain and accelerate progress

5. Explore how EDI can be fully integrated into the Trust’s Scorecard or Strategic Performance

Measures, and identify solutions to eliminate the barriers to progress on EDI

Integr8 NHS Agenda

Board Development Workshop 3.5 hours

Time Activity

Framework

13.00 EDI Vision and the road to exemplar: where are we now and where are we going?

Introduction & foundation for the Workshop

What is our collective vision for EDI?

How does EDI at the Trust connect to the broader NHS strategic agendas?

The EDSnap Audit and what it tells us

Where are we on the road to being exemplar?

14.30 Strategic Leadership: you as a Board

What does Strategic Leadership in EDI look like?

What’s really working for us as a Board and how we lead on EDI?

How do we sustain and move this forward?

What are the barriers to progress and how do we eliminate them?

15.30 Priorities for Action, Collective commitment & Next steps

What do we need to focus our attention on?

How do we ensure EDI is fully integrated into the Strategy and Balanced Scorecard?

What actions are we committing to undertake as a way forward?

How will we track and monitor our progress?

How will we hold each other to account?

16.30 End

6. Taking Action 6.1 We Implement Following the Board Development Workshop, the Provider and the Board will consolidate the

actions agreed from the previous sessions and create an implementation plan. The role of the

Provider at this point in the process is to act as an expert coach to the Board or the working group

responsible for taking forward the output from the Board Development Workshop and the Integr8

NHS process.

In addition, drawing on action learning methodology and appreciative inquiry, their role will be to

facilitate and sustain the ongoing learning of the Board and to assist in addressing any issues that

might arise as they take action and put the changes and improvements in place.

The Board will then be required to approve the implementation plan and take responsibility for the

ongoing monitoring of the agreed actions. It will be important for the Board to also give thought to

the organisation in the context of its wider social system and that any changes are considered in the

light of the complexity of the NHS and the various relationships that exist across the system.

Additionally, a communication plan will need to be devised to ensure that relevant staff and patient

or community representatives affected by any of the changes are kept informed.

6.2 Evaluation and Review The evaluation and review focuses on the effectiveness of the methodology and suggestions for

improvement; on the impact of the programme in terms of personal learning and development of

the Board members; and the effect of the changes on the leadership and governance of the Board.

In the spirit of action learning and a solutions focused mindset, progress against agreed key success

indicators are reviewed at each stage in the programme. This will ensure that the learning of “what

works” is captured and embedded into working practice as the Board progresses on its D&I journey.

The final evaluation takes the form of a short semi structured questionnaire sent to the Chief

Executive/Chairman and other Board members for completion and analysis before the final review

meeting. This meeting is to feedback the data from the evaluation and provide an opportunity for

collective reflection and recommendations on the value and contribution the programme has made

to the ability of the Board to build D&I into its business practice.

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