Sarah Miller on remodelling complex services

Remodelling complex services and how crisis has acted as a catalyst for innovation, creativity and greater dynamism.

Sarah Miller is the Chief Executive of Papworth Trust. She has worked in the voluntary sector for over 30 years, joining Papworth Trust as CEO in 2018. She has worked in the past with organisations including Walsingham Support, Guinness Partnership, RNID and Sense, in a variety of roles, starting in the 1980’s as a support worker working up to a Registered Manager of services and Operations Director. Sarah has an NHS Healthcare Management Degree , MSc in Adults with Learning Disabilities and an MBA.

What were your immediate priorities in tackling Covid-19?

Our customers and staff and volunteers were our immediate priority and how we meet the needs of our customers whilst maintaining their safety and that of our staff and volunteers. The teams worked so quickly to identify what needed to be done and how we needed to do it. Ensuring the wellbeing of our customers, staff and volunteers were our first thoughts.

We closed our offices, our housing office, our employment offices and our day services (which are called OWL (Opportunities without limits)), however this was just the start. We then had to consider how we deliver services to customers. Our housing management staff work from home and have gone the extra mile, contacting and working with our tenants to reassure them and where they have experienced financial hardship, signposting and directing them to specific support agencies. Our employment staff are all working from home and doing an amazing job at working with customers via the telephone and in some cases there have event been employment opportunities, especially in supermarkets and warehouses. Our OWL staff have been so creative and innovative with how they are supporting customers virtually and in some cases, adhering to social distancing they are providing one to one support. Finally our care staff have just been exemplary, working so hard with our disabled care customers.

Business continuity and sustaining our quality of service delivery has been our utmost priority. The leadership and Management Team collaborated on reviewing and updating our continuity plans to reflect this just never seen in our lifetime pandemic.

We were exceptionally fortunate as for the last 12 months we have introduced new ways of working to support a more agile and flexible workforce. Although there have been some challenges, we have the capability for a good proportion of our staff and volunteers to work remotely and there have only been minor issues.

Managing cash flow and our immediate and medium term income was a high priority along with systems in place to capture the increased financial impact of the pandemic.

What has been the biggest challenge to date?

The uncertainty and I am sure that everyone will say the same. Projections and forecasts are very challenging and identifying the impact this will have on us both in the short and medium term is so difficult. We, as all are doing, are looking at a number of scenarios with a range of outcomes.

The workforce have been amazing but I don’t underestimate the dedication and challenge this is. Remodelling our service delivery to accommodate this unprecedented situation has taken a lot of effort at so many levels.

One of the biggest challenges is adapting to uncertainty, the timescales are so unknown and it is helpful to think of the situation in phases. The teams across the Trust are so positive and dynamic however I don’t underestimate the energy this takes and keeping up this level of momentum is hard on everyone.

Communications is a real challenge, using digital innovation, we are working differently (using video, email, zoom, skype, Facebook, twitter, WhatsApp) to update and reassure everyone, but not everyone has access to these mediums, and not everyone uses them. We are doing what we can but this is a real challenge, and sometimes it is about what is communicated as there is a balance between the right information (honest and transparent) and not overloading

What positives have your drawn from the crisis?

This has been the most amazing opportunity to think about what we want to be like in the future, how we want to work, how we will engage with customers, what we want to be known for. This pandemic has demanded that we scrutinise how we work and afforded us a real chance to change dramatically, for the better.

There are so many positives, when I look at the Trust as a whole, the innovation, creativity, dynamism and person centeredness is overwhelming, especially on the frontline. People are absolutely shining, going the extra mile to engage with our customers and help them to adjust to these challenging times. We have had so many suggestions from the frontline as to how we can work smarter, engage better and encourage improved practices. Our ears are more open now than they ever have been and we need to keep this up and act on suggestions. There is a lot we will be learning and taking from this time.

Social care has seen an elevation in profile which is a positive and (having worked in social care for over 30 years) I feel that we are nearing a parity with NHS which is long overdue.

There has also been a focus on community which is heart-warming, community has become so important in our current context.

There has been increased collaboration across the sector. I am linked into several WhatsApp, Zoom, Skype meetings and focus groups and the amount of sharing of information and resources, discussions and debate is transformational. It is very helpful.

We have also noted that internally, it has forced much more cross departmental working which just increases the interest and productivity of the workforce.

We have seen an increase in our recruitment, which is incredible and have had such an interest in our vacant positions in care which is very positive.

Our fundraising events as you can imagine have been devastated, however our fundraising efforts have been channelled into digital activities which have served to raise funds, but also motivate our teams, have fun, share photos and experiences and hopefully raise our reputation locally.

How will this crisis change your organisation?

We will see a financial hit, of that I’m sure. It is going to hurt, but we will get through it and we will be more resilient because of it. We don’t know the extent of the financial impact (we have a range), and are obviously assessing this and reviewing any and all financial support that is available to us.

We are starting to consider recovery plans, and what this will look like. We are revising our business plan, as although the targets and objectives remain salient, the timescales I am sure may be adjusted.

Our ability to scenario plan and manage budgets that reflect dynamic changes will require constant scrutiny and sensitivity planning.

We were already in the process of introducing enhanced software systems to support us with our management information, which is going to be more critical now than ever. The demand for more data intelligence is going to be acute, to enable us to navigate our path through the next months and years as we and the sector recover from this crisis.

Our communications has really been under the spotlight, as we must be engaging with our customers, staff and volunteers. We have introduced increased digital activity and are looking to recruit to a role that will have a direct interface with our customers to advocate their views and feedback in addition to the systems we already have in place.  With continued uncertainty we need to ensure that people are reassured and their wellbeing is supported.  

I am sure that our new ways of working where we are working in a more agile and flexible way (for those who where this is appropriate) will be increased

We are already reviewing our service delivery models and how we effectively meet our customers’ needs in the most effective way, this I am sure will continue to be a focus.

What are likely to be your leadership priorities after the crisis has passed?

To maintain the positive effort and momentum.  

I’ve heard people refer to this crisis as a marathon, or a continuation of weekly sprints. We can’t dip in dynamism going forward. There has been so much in the way of innovation and motivation which I am keen to harness and develop.

The wellbeing of customers, staff and our volunteers is critical and will be an absolute priority.

We will obviously be looking to our future, how we maintain business as usual however there is potential for the pandemic to return so we need to ensure we are prepared for a round 2 or 3.

This crisis has shown how much we need highly competent people, and there have been some real stars who have shone during this time. We have also seen some gaps in our systems and processes which need to be addressed and need to be done urgently in the event of another peak.

Our recovery planning is key as we move away from responding to the crisis. We have to ensure cash flow and work with our funders to make sure that our ability to plan our short and medium term income is a priority. As said before, we are planning scenarios going forward and there are uncertainties ahead so these will need to be managed as much as possible. Scenarios will never be exact but is does create useful debates and leads to potential options. 

We need to understand customers’ expectations and what they need for the future and how this may have changed so that we can meet that changing need.

What have you learned about yourself during the crisis?

Although I enjoy working from home, I am quite a people person and do miss being with my team which has surprised me. Again, it goes to that balance.

Also, I was reminded of a saying ‘crisis doesn’t respect hierarchy, it respects character’. Leadership is about encouraging others to lead and shine and having the desire and drive do that.

Maybe it’s an age reflection now that I’ve turned 50 but I have reflected on how calm I am during this crisis. I am reasonably new to being a Chief Exec, coming up 2 years so I would have expected to have certainly levels of anxiety leading through this crisis, but actually I am quite calm. This I am sure comes from having such a resilient, creative and customer focussed workforce, my direct team are just superb and the management team, registered managers and service managers have been exemplary. I am so very fortunate.

What advice would you give to others?

There will always be tensions, especially between financial decision making and quality / social impact, and this is OK. Positive tension can lead to the most robust decision making and outcomes. The need to consider all aspects, the really painful ‘what if’s and worse case scenarios.

Whenever there is a crisis or issue, you can guarantee there will be positives as well as negatives, both require equal consideration.

There is a raft of information out there, sometimes confusing, conflicting and duplicating. You have limited bandwidth so you really need to identify what forums you need to be in and what you need to be scanning.

Don’t lose sight of empathy, when working so remotely a person really needs to consider what others whether this is customers, staff, and volunteers are going through and the local and national picture. There is an absolute need to focus on the strategic picture, but don’t forget to think about how it is for individuals.

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