Tony is CEO of St Joseph’s Hospice, the largest hospice in the UK by bed base and the oldest on a single site. Here he talks to Heather Greatrex about managing the operational challenges while overseeing the wellbeing of patients and staff. Amidst the disruption, he reflects upon how community spirit and partnership has placed St. Joseph's back into the heart of the community.
The Hospice serves the population of the London Boroughs of Tower Hamlets, the City and Hackney and Newham and, for in-patient beds, Waltham Forest. Overall, the Hospice serves 2.2 million people across its core 3 boroughs and its additional six boroughs it takes admissions from, within a radius of 10 miles.
Tony started his career 39 years ago as a student before becoming a registered General Nurse, Psychiatric Nurse and Health Visitor. He became Director of Nursing and then CEO at the age of 36 at an NHS Trust before being headhunted to run what was then the largest PFI in Europe rebuilding the Colchester Garrison. He was out of mainstream healthcare for five years, returning to work in for-profit organisations in Learning Disability and Mental health before going on to manage his own turnaround consultancy for 6 years.
Tony has been CEO at St Joseph’s Hospice for the last 18 months.
What were your immediate priorities to tackling Covid-19?
We undertook a state of readiness check for our disaster recovery plans. We focused on steadying people’s nerves – we managed to confirm everyone as key workers and we did not furlough anyone. Many of our staff are dependent on public transport so we changed the rules about parking on site. We asked Hackney Council for more permits so that staff could park in the streets – they provided as many as we asked for so staff could drive in and be safer.
We messaged via the intranet to reassure people that the hospital itself was safe – using barrier nursing, reminding staff to keep up the new social distancing rules and the new hygiene procedures.
What has been the biggest challenge to date?
Opening up the additional beds. We had a call to arms from the local CCG’s but one of our wards had been mothballed so we had to work to open it up again. Although the fabric of the building was sound, some of the equipment had been used elsewhere. The CCG agreed to cover the cost of the re-opening so we had to find enough beds to fill the ward (at the same time as 4000 beds were being sourced for the Nightingale hospital close to us). The ward opened within three days of the beds arriving and within 10 days of being asked to expand our service. PPE was the next challenge as social care institutions were classed as adult social care and, therefore, at the end of the queue, whereas we are regulated by CQC as a hospital. We had to put a call out to the local community who responded unbelievably well andwe have managed to source enough PPE now.
What positives have your drawn from the crisis?
Firstly, the community spirit has been amazing.
Secondly all the teams have worked so hard together, for example, getting the beds in. The bed supplier sent many more fitters than normal to enable them to do in a day what would normally have taken 2-3 days. The camaraderie was amazing and our staff kept them well supplied with food and drink.
Thirdly, my ward round was a weekly routine in any case but, in this period, it has brought me much closer to the staff who are here every day. We have been donning the full PPE as would be expected but it has been a real reminder of life on the front-line. I’ve been going in to the wards and it has become much more natural for the staff to have me there and so they don’t panic now when the CEO pitches up
How will this crisis change the organisation?
- We may well keep the extra beds open to accommodate more people
- We are back on the map for the local community. This has been a call to arms to remind people that we are here – I hope that the increased community engagement will continue into the future.
- There will be changes in practice which will be for the good. We will undertake a ‘lessons learned’ review and integrate these into our normal operation going forward.
- The most important change will be that our income will fall – events that would have brought in c £500k in three months have had to be cancelled. We hope that some of the money that the Chancellor has announced recently will offset some of this loss.
What are likely to be your leadership priorities after the crisis has passed?
The welfare of our hard-working staff; we will need to encourage them to take time off. We will also need to keep people focused on our future plans. And, of course, we have all our volunteers to bring back. We have a delay CQC inspection because of the crisis so this should follow shortly once some sort of normality is reached later this year.
What have you learned about yourself during the crisis?
The resilience that I have been able to find in the past is still there! I think I have been a steady head in a crisis, being able to calm people down and focus. I have also become aware of family concerns about my role and the impact on them of me being out at work every day. Whilst I change and shower when I return I am aware of the fact that my actions worry them and the need to protect my home and my family.
What advice would you give to others?
- Don’t panic and, even if you are panicking internally, don’t show it!
- Always identify sounding boards as CEO still need to check out ideas
- Provide support; you don’t always have to problem solve
- Use the skills of those around you – good general managers don’t have to know everything – you just have to know who to go to
- Keep an eye on morale – walk round regularly, see if people look tired or stressed, keep an eye on tensions between teams, look out for falling productivity
- Stay strong and focused
- If you have a really good No 2, support each other.