Senior Medics’ Assessment and Review Trial (SMART) Initiative

West Hertfordshire Hospitals NHS Trust

Andrew Barlow, Divisional Director – Medicine Division

This is an OD initiative, streamlining the journey of medical patients attending emergency departments. It promised and delivered, raising standards of care and giving a better experience for frontline staff. It was so successful that the Trust achieved the greatest national reduction in 4 hour waiting time in A&E.

SMART was a key piece of OD, fitting within the Trust’s strategy of being a clinically led organisation. Divisional directors’ roles were expanded to give them the authority and skills to lead this new OD project.

Key points:

  • 3 consultants – cardiology, respiratory and general medicine – placed in A&E so reducing need to admit patients
  • Better faster outcomes for patients, improved performance in A&E, fewer admissions
  • Wide impact on services e.g. improving ambulance handovers, reducing re-admissions
  • Total success, hugely improving A&E’s performance indicators, best in UK
  • Upended traditional model of patient slowly referred upwards by having senior specialist at the door to direct patient on best pathway without delay.

Judges’ view

The panel loved this entry involving the entire multi-disciplinary team. The barriers to success were clearly broken down as the impact on patients was clear; a reduction in waiting times and length of stay, meaning that resources could be utilised for other patients. Clinical leadership demonstrated a tangible impact on patient care.


OD transformation in HMP Liverpool

Merseycare NHS Foundation Trust

Wendy Burton, Senior Organisational Effectiveness Practitioner

Melissa Holt, Strategic Organisational Development Practitioner

The team needed to transform the prison mental health service quickly. They placed an OD practitioner inside the prison alongside the team, supporting new leaders with rapid transformational change. A year later they are beginning to see the benefits of embedding OD at the heart of prison healthcare during change.

Key points:

  • Transformed ‘bullying macho blame culture ‘by intensive OD intervention
  • Included basic management skills, resilience sessions, team away days, coaching skills, leadership development
  • Resulted in real innovation and improvement across all areas of mental health pathway (CQC and Quality Review)
  • Approach does not appear to have been tested before in prison health care.

Judges’ view

This showed real investment in improving care for patients literally from the inside. The team invested time and emotion in changing mental health practices for the better, with a wide impact. It started as a focused OD project but resulted in a breadth of culture change across the prison.



#makeithappen at Dudley – co creating a culture of listening and action

Dudley Group NHS Foundation Trust

Becky Cooke, Inclusion and Culture Lead

Rachel Andrew, Head of Development and Learning

A tea trolley, people to listen and a tour around the staff helped find what would make them happier at work and for the Trust to start to fix the things they wanted to be better. Listening, love for their people and making things happen.

A small team of interested people ,”pirates” ,with experience in communications, engagement, and development and with a passion for wanting things to be different  knew the focus needed to be on how staff were supported so they could support each other.

Key points:

  • Took tea trolley on tour to get staff talking about what improvements would enhance their life at work
  • Project team planned series of trolley tours, successfully engaging staff, using feedback to shape actions
  • One result was Behaviour framework setting out appropriate and inappropriate behaviours.
 Judges’ view

The panel loved this entry – a simple idea to engage with staff directly. Staff clearly loved the initiative which gave them an opportunity to talk about what is important to them. The team managed to dispel some myths to help improve staff health and wellbeing at work


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