In 2021, The Shrewsbury and Telford Hospital NHS Trust (SaTH) faced a cultural crossroads. Results from the NHS Staff Survey revealed below-average scores across key areas, including staff engagement, appraisals, morale, and support for work-life balance. Scores around compassionate leadership, flexible working, and bullying and harassment placed SaTH amongst the lowest in the sector.

Recognising that culture is central to high-quality care and staff wellbeing, SaTH launched a strategic, Trust-wide cultural transformation journey. The foundation of this journey was a commitment to listening to staff, using data meaningfully and embedding inclusive, compassionate leadership at all levels.

To drive this change, SaTH worked with NHS England and the NHS Leadership Academy to develop our Leadership Development Programmes. SaTH further based the cultural change around the principle of the NHS Culture and Leadership Programme (CLP) NHS England » The Culture and Leadership programme— an evidence-based framework developed to help healthcare organisations to understand and shape their culture through inclusive, compassionate, and collective leadership.

What the Trust Faced

The 2021 staff survey results painted a concerning picture:

  • Staff reported feeling undervalued and
  • Burnout and high levels of bullying and harassment were
  • Engagement and advocacy scores were
  • Flexible working options were seen as limited or inconsistently

This signalled the urgent need for an evidence-led culture change, centred on inclusion, wellbeing, and leadership accountability.

Strategic Response: Culture and Leadership Programme (CLP)

SaTH structured its transformation around the four key phases of the CLP:

  1. Scope: Reviewed the current organisational state, people data, leadership behaviour survey and existing leadership and cultural interventions.
  2. Discovery: Collected soft intelligence and staff feedback through the Making a Difference platform, staff surveys, and external reviews to understand the desired future state.
  3. Design: Developed a Leadership Framework, tailored strategies including the Culture Dashboard and a behavioural framework aligned to the organisation’s values.
  4. Delivery: Rolled out SaTH 1- 4 leadership and inclusion programmes, training facilitators, and embedded consistent evaluation methods.

As part of the discovery process, SaTH used the Culture Web to explore and better understand underlying cultural drivers, blockers, and assumptions across different teams and departments. This tool provided rich insights into how culture was experienced in daily work and supported the creation of targeted interventions.

Flagship Programmes and Interventions

Three core programmes were launched as part of the Trust’s Cultural Transformation Strategy:

  1. Civility, Respect and Inclusion (CRI): Designed in collaboration with Dr Chris Turner of Civility Saves Lives, Home | Civility Saves Lives, this programme created a social movement encouraging staff to challenge incivility and adopt respectful workplace behaviours.
  2. Flexible Working: Based on staff feedback, a revised flexible working policy was introduced, supported by online engagement via the Making a Difference Together platform. Flexible working success stories and toolkits were widely shared.
  3. Talent and Appraisal Development: A new approach to appraisals focused on career development and wellbeing, underpinned by the Talent Conversation framework, supported by a new Talent Portal offering self-assessments, career resources, and planning tools.

Visual: Roadmap of Strategic Interventions

Additional enablers included:

  • The Culture Dashboard, tracking cultural progress against themes such as Vision & Values, Teamwork, Compassion, Learning & Innovation.
  • Strengthened Freedom to Speak Up mechanisms, promoting inclusion and trust.
  • Launch of leadership development programmes such as Galvanise and STEP to increase representation and management capability.

Outcomes and Impact

The impact of this sustained and inclusive approach was reflected in successive improvements in the NHS Staff Survey results:

  • Staff Engagement and Morale: Both have increased year-on-year since 2021. Staff Engagement has increased from 6.29 to 6.59, Morale has improved from 5.31 to 5.84.
  • Flexible Working: A 08% increase in satisfaction with flexible working.
  • Appraisals and Talent Development: Greater focus on recognition and
  • Retention and Recommendation: The percentage of staff recommending the Trust as a place to work has increased year-on-year since 2021 from 40.3% to 48.77%, and whilst this is still low compared to the sector average, it demonstrates that the cultural improvement work is beginning to embed.
  • Inclusion and Belonging: Increased staff network engagement and reduced bullying
  • Regulatory Recognition: Improved CQC rating from Inadequate overall to Requires Improvement overall, reflecting the work of the ‘Getting to Good’ programme. SaTH also received letters of recognition in 2022 and 2023 for improvements in staff survey results.

In 2024 a further turning point: 51% Staff Survey participation – highest in a decade.

 In 2024, SaTH achieved 51% staff participation in the NHS Staff Survey – the highest in ten years. This milestone is more than a number; it’s a powerful signal of growing trust, engagement, and belief in the organisation’s direction.

It reflects a workforce that is starting to feel heard, valued, and invested in shaping its future.

Challenges and Lessons Learned

While progress was significant, challenges persisted, particularly around emergency care pressures and slower uptake of civility and leadership programme. Feedback indicated the need for more accountability and continued reinforcement.

Key lessons included that leadership visibility, local ownership, and consistent communication are key to sustaining momentum and the importance of patience when embedding change.

As we continue our journey, we recognise the scale of the challenge that lies ahead. With unprecedented levels of change and complexity, and with this comes pressure on our people, systems, and cultures.

We know that cultural transformation is not a one-time initiative but an ongoing commitment — one that requires us to regularly reflect, review, and realign our priorities in line with both local and national contexts.

While we are proud of the strong foundations we have laid, sustaining this progress will demand continued focus, adaptability, and collective ownership at every level.

Next Steps in Our Culture Journey

By staying grounded in our values and open to learning, we are committed to ensuring that the culture we shape today is one that can sustain, support and evolve through whatever challenges tomorrow brings.

Conclusion

SaTH’s journey demonstrates how embedding the Culture and Leadership Programme within a strategic framework—rooted in staff voice and real-world data—can shift organisational culture meaningfully and measurably. The Trust’s use of tools such as the Culture Web, the Culture Dashboard, and the structured CLP phases has helped turn insight into action, and action into sustained impact.

By aligning leadership behaviours with cultural goals and creating spaces of belonging, SaTH has laid the foundation for continued improvement in staff experience, patient care, and organisational performance.