Listening into Action cultural & service transformation change programme

The Trust has actively adopted the Listening in Action (LiA) approach since 2014. This has been key to our journey of improvement transforming the Trust through empowering staff and our service users to improve key aspects of our services. We have now completed three waves (two in 2015) where we asked our staff what would make the biggest difference to their lives and those of our service users and carers.


  • From start: No
  • During process: Yes
  • In evaluation: No


  • Peer: Yes
  • Academic: No
  • PP Collaborative: Yes

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What We Did

We have now completed three waves (two in 2015) where we asked our staff what would make the biggest difference to their lives and those of our service users and carers. They often have the best ideas, enabling services to be tailored to make real improvements. The teams have delivered results within a 20-week programme of rapid change.

Since the start of the programme, we have supported: 44 clinical improvement teams; Held 70 ‘Big Conversations’ and Involved more than 1,000 staff across all of our directorates. The programme has involved a number of approaches to involve staff. As well as Big Conversations, there have been dynamic ‘pass-it-on events’ to showcase the team’s achievements, problem solving meetings and the sharing of quick wins. 
The results have been outstanding – making a real difference to the care of patients and people who need our services.

These have included: Our place of safety ward has seen an 85% decrease in people taken into police custody under the Mental Health Act; We’ve improved access to our services with a new 24/7 crisis and urgent response; Our Improving Access to Psychological Therapies (IAPT) has seen an increase in self referrals from 21% to more than 70% in 12 months; All staff now have regular clinical supervision; A digital hit squad focussed on improving technology across the Trust has enabled wifi across all our 30 sites.

Wider Active Support

As part of our overarching change strategy, we have engaged with all parties that change will impact upon and who can influence our direction in order to provide a seamless service and smooth care pathways.

To date, this has included our commissioners as well as third sector services in Stoke-on- Trent and North Staffordshire such as Brighter Futures, DEAFvibe, ASSIST, Asylum Seeker and Refugee Services, the Living Streets project, Lifeworks Staffordshire and Staffordshire Adults Autistic Society.


All of our 44 LiA teams involved service users, carers and staff in partnership to deliver change. Activities have included:  Deaf awareness involving deaf community. We trained staff to sign ‘Hello my name is’ and provision of interpreter services, iPads with BSL Apps and interpreter links for use with the deaf community; Staff and service users were fully involved in developing our new Trust values for the organization; Our dementia services were reshaped involving service users and carers; A team focused on bringing service users with mental health problems back into employment, defining and shaping a pathway of entry with a dedicated approach to use their skills; Service users took part in videos for our teams to illustrate the outcomes of each phase of the 20 week waves; Service users and carers were involved in a project reshaping walkways/paths and gardens to improve the wellbeing of those working and using our services; Service users and frontline staff attended fortnightly group meetings to mobilise teams and unblock the way.

Looking Back/Challenges Overcome

We would have used technology more frequently, for example, screen savers and other means of communications to increase staff awareness and engagement. We didn’t fully explore and exploit social media. We recently trained nurses in Twitter at our Nursing Conference to mark National Nurses Day which generated positive energy. We would have used video and short clips (soundbites) more often to capture powerful messages which could have been played at team meetings.

We would have invited other mental health trusts to open days to share our success and built a better website to share best practice. We would have tried to involve user council representatives earlier and more frequently, they did however, have limited capacity.

We have overcome barriers by: Delivering CEO-led Influencer meetings elevating the urgency injecting pace into the need for change and providing a forum to unblock the way.
• Developing LiA influencers as ambassadors and enablers of change through the LiA approach, these 350 people are involved and re-energised as our agents of change in the workplace, promoting the LiA way to be embedded into the DNA of our organization; Leading master classes designed to engage our workforce focusing on “what matters to our staff service users and carers”; Using our executive sponsors and occasional hierarchical influence to challenge status quo and effect change quickly
• Recruiting a lead role person from our front-line clinical workforce into a recurring secondment position to spearhead change and influence from ground root level; Maintaining and increasing a positive culture, always striving to support others and saying yes even when resources are stretched; Having the whole organisation on board from CEO has been key to its success and staff at all levels spot opportunities to adopt the LiA framework for positive change; Delivering a weekly CEO Blog to share good news and positive changes for patient care; Delivering monthly LiA newsletters to every Trust member of staff


Using LiA in partnership meetings to bring multiple diverse agencies together for a shared vision; Up skilling and empowering others to see that they can elicit change by asking good questions just as easily as those who originally led the process; Working with teams to improve Care Quality Commission (CQC) outcomes by engaging with all levels of staff and giving them a voice; Creating a bespoke sustainability plan by continuing to listen, including offering ongoing support for longer term objectives.
6. Going with the energy – as innovative ideas emerge and people are on board, we adopt a “just do it” approach to maximise the energy and momentum; Embracing National Change Day as an opportunity to celebrate and showcase all levels of change in order to cross all staffing boundaries. Small changes can have a big impact; Continue to gather quantitative and qualitative data to evidence the improvements that have been achieved using LiA. Then communicate and celebrate it; Ongoing CEO and Executive Team buy in!


We performed a baseline Pulsecheck in line with the national LiA teams. 12 months later, this was repeated and we succeeded in increasing our scores across all 15 questions as well as increasing our scores above the national average. The questions focused on areas such as staff engagement, feeling valued and being involved in change. We are about to repeat the Pulsecheck again having completed Wave 3.

We had similar improvements within the parallel domains of the national Staff Survey, with staff engagement scores improving by over 15%  Over the past five months, we have been generating “Powerful Stories” from each of our teams demonstrating our achievements. So far five have been published in the LiA’s top 100 powerful stories campaign.

We have held three ‘Pass it on events’, the last one saw the highest number of attendees, with the broadest cross section of staff, with the highest involvement from service users and carers and partner agencies.  We continue to listen to staff and, at their request, we are planning further Trust-wide Big Conversations to re-evaluate our direction and to continue to improve where the energy is.


Through West Midlands-wide networks and local sharing with neighbouring trusts, through social media, websites and electronic media and by sharing our powerful stories on the LiA Optimise website.


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