Inverting Hierarchy Within a Healthcare Social Enterprise

First Community Health and Care have one of the highest staff engagement scores in the NHS. They have been rated Outstanding by the CQC inspectorate and also have a Friends and Family rating (the NHS measurement of patient satisfaction) of 4.9 out of 5.

First Community provide frontline community healthcare services in East Surrey, as well as some parts of West Sussex, and were one of the first organisations to spin out of the NHS as a social enterprise rather than a care trust, using the Right to Request programme.

Liz Mouland is Chief Nurse at First Community, and recalls: “We wanted to design something that was not non-hierarchical but was an inverted hierarchy. We see the function of the Board and of management is to support those providing excellent care and services to the public.

“One example of how we do this is our ‘Floor to Board in five minutes’. Any of our 450 staff can contact a Board member within five minutes. Out of hours they can use the 24/7 On Call Manager phone number who can escalate to a Board member if appropriate.”

Another is the organisation’s open-door policy. Liz, as clinical lead for the organisation, literally has no door on her office. ”We have a behaviours framework which we expect everybody to role model. It is about showing emotional intelligence, with warmness and friendliness, where everybody’s voice matters.”

“It helps that, as a social enterprise, we aren’t governed by NHS England. As a commissioned provider we are not under the same scrutiny and it possibly makes it easier to innovate. And we really encourage autonomy to enable that.”

About Liz

Liz joined the NHS in 1983 and trained as a Registered Nurse at Guy’s Hospital London. She moved into community nursing in 1993 working in a variety of clinical and HEI roles. In 2009, Liz formed part of a staff ‘Right to Request’ under the Transforming Community Services agenda and successfully created a social enterprise community interest company providing NHS community services in east Surrey and parts of West Sussex. Since creation of First Community in October 2011, she is now Chief Nurse and Director of Clinical Standards taking the lead for patient safety and quality and experience. The company now employs over 460 staff and provides a range of NHS community nursing and therapy-led services and is already achieving its mission to make an impact on improving social value to local people. You can find her on Twitter @lmouland.

About First Community

First Community is a social enterprise started in the first wave of ‘spin-offs’ from the NHS primary care trust systems using the right to request programme. These social enterprises operate within NHS jurisdiction however manage themselves within that system — giving them a flexibility and structure outside of the traditional format.

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