Building a Values-Based Healthcare Organization

Health Care




United Kingdom



Bolton NHS Foundation Trust is a major provider of hospital and community health services in North West England, delivering services from the Royal Bolton Hospital and also providing a wide range of community services from locations across Bolton.

For two years, as part of cost-saving measures, staff engagement work was paused while their new CEO led a financial recovery process. Once it was clear that the Trust would emerge from special measures, staff engagement activity resumed. 

The main driver for their renewed focus on staff engagement was to move the narrative within the organization to address the challenges and opportunities afforded within Greater Manchester by the devolution of health and social care. The Trust needed to have the confidence to face the changes ahead.


The first priority was to refresh their Trust Values as they were not seen as particularly aspirational. They selected the Barrett Values Centre’s Model as the basis of their re-design process. Using feedback from over 200 staff, together with input from some external stakeholders, they selected five new values:






As the new Values were being finalized, the Trust had a Care Quality Commission Inspection. The results rated Bolton as ‘Good’, confirming that their performance had improved. At the same time, they undertook Divisional Action Planning using their Staff Survey results to create a Trust-Wide Improvement Plan with 38 specific commitments to develop staff experience. Bolton NHS Foundation Trust also undertook some local analysis of Staff Friends and Family Test (FFT) and Patient FFT/Complaints data to understand the links between staff and patient experience at Bolton.

The new Trust Values were launched at their ‘Start the Year’ event and were well received by staff. Awareness sessions were held across the organization and they developed a set of supporting Practices (behaviors).

Bolton NHS Foundation Trust undertook a Culture Assessment later that year. The survey offered unique insights into the Current and Desired organizational culture across all of their divisions. It confirmed that they needed to move from a primary focus on systems, process, and performance to a Level 4 (Evolution) and Level 5 (Alignment) one. 

The choice of V.O.I.C.E gave the organization not only a powerful acronym but also representation at Levels 7, 5, and 3 of the model. These would support their aspirations to be a high-performance, values-based healthcare organization.

To achieve this, they have defined a new ‘Developing Our Culture’ theme within their People Strategy. This will include further embedding of their values, improving staff & patient experience, encouraging innovation, promoting staff well-being, and creating a more compassionate workplace.

The Trust Values are a golden thread that runs through recruitment, induction, and appraisal. They are also developing values-based decision-making tools and support for values-based leadership. The Divisional Action Planning process will use Staff Survey results and the local Culture Assessment profiles as the basis for developing a second Trust Action Plan.


“We had made a conscious decision to adopt a Values framework to underpin the design process. The use of the Barrett Model gave us a structure and a standard values vocabulary, within a leveled model that will enable us to measure cultural shifts through time,” says Sandy Wilkie, Bolton NHS Foundation Trust Staff Engagement Lead. 

The launch of their new Trust Values gained acceptance and buy-in from staff. The continued use of the framework as the basis for their Culture Assessment reinforced the importance of values. Embedding the values in HR processes, and through the development of practical tools to support a values-based approach, is ensuring the values have become central to the organization’s purpose. By defining a ‘Developing our Culture’ theme in their People Strategy, they have been able to plan a range of activities which will deepen the use of values at all levels of the organization.

The initiative of developing and embedding new Trust Values is helping them understand and strengthen the workplace culture at Bolton NHS Foundation Trust. The majority of staff come into the NHS because they have clear personal values around compassion and care. Harnessing that energy by building a values-based organization makes a lot of sense. Staff engage with the concept of values and using tools like the Barrett Culture Assessment enables the organization to understand how Personal Values align with Current and Desired Cultures.

Understanding the different local cultures within divisions/teams is crucial to planning any supportive interventions. For example, it has given them insights into which areas of the Trust have the most appetite for continuous improvement work. This has enabled the Project Management Office to plan the rollout of their new Quality Improvement Strategy, starting with the areas that have the most desire for improvement initiatives.

The work to strengthen the staff experience and understand the specific nature of its relationship to the patient experience onwards has given the Trust the learning insights to understand which components need to be strengthened to help improve both experiences.

“Our work with the Barrett Culture Assessment has illustrated the potential value in Trusts sharing cultural data to learn from each other and identify improvements. A tool like the Culture Assessment offers the prospect of benchmarking across healthcare organizations as we all strive to make improvements for the benefit of our staff and our patients,” explains Wilkie.  

Bolton NHS Foundation Trust plans to complete another Culture Assessment survey to assess the level of cultural shift. The continued measurement and action planning are important elements of their journey to be a values-based healthcare organization.

There have been a number of measurable impacts of their work around the new Trust Values and the staff/patient experience:

  1. Staff Friends and Family Test (FFT) scores improved from 78%/64% (Recommended for Care/Recommended for Work) to 83%/72% over 12 months.
  2. The NHS Staff Survey staff engagement index showed improvement from 3.81 to 3.89 and looks to have consolidated this gain once more.
  3. Correlating local staff experience factors, which have the most impact on the patient experience, was profiled in a case study by NHS Employers and was shortlisted under the Staff FFT category in the Patient Experience Network National Awards. Their approach to the development of the new Trust Values was also featured in a second case study by NHS Employers.
  4. Three actions in the Staff Survey action plan aimed to reduce the perceived threat of violence & abuse from patients to staff and increase the number of incidents that were formally recorded. Early results from the Staff Survey indicate a positive shift in both indicators.
  5. The new Values have enabled them to explore a number of themes related to well-being, sickness absence, work/life balance, and bullying under the banner of the ‘compassionate workplace’. Focus groups using this title were formed to support a number of recommendations for their Workforce Committee to help further strengthen the quality of staff experience during a period of unprecedented service pressures.
  6. The Culture Assessment results are now being used directly to help with local issues in two divisional services. The Values data has quantified problems that were suspected to have existed within the local culture.  They are now working in partnership with staff to identify supportive interventions and improvements.
  7. The work around the design & launch of V.O.I.C.E is currently being researched by Dr. Carol Brown of Bolton University, as an academic/practitioner case study [Brown, C and Wilkie, S. ‘Developing our new Trust Values; an evaluation of improving NHS Trust performance’ Paper in preparation for publication].

 Most recently, Bolton NHS Foundation Trust won a Lotus Award, established by Engage International to recognize organizations around the world who are working to create a positive workplace culture with high levels of engagement. 

“We are delighted that Bolton NHS Foundation Trust is one of only three NHS organizations to be recognized in the inaugural Lotus Awards. We set out on our journey with values & culture, using the Barrett Model, in the belief that it would make a positive difference to both our staff experience & patient experience. We are beginning to see the benefits of our approach and it is fantastic to see this recognized in the Awards. Thanks to Engage International and all the judges for highlighting some great examples of best practice across the globe,” says Wilkie.  

Health Care




United Kingdom