Implementing teams-based working in an ambulance service

Context

In 2022, an ambulance service commissioned TN to help identify and implement solutions to improve challenges impacting staff wellbeing and satisfaction, including:

Staff didn’t feel part of a team: When staff were asked at engagement workshops what constituted a bad day, over 100 people listed ‘poor teamwork’ as a key factor
Staff and manager working patterns didn’t align: Many staff reported that they almost never saw their line manager, or if they did see their manager, it meant that they were in trouble
Poor work-life balance: High turnover rates suggested that road operations staff didn’t have a sustainable work-life balance under the existing ways of working

Following preliminary scoping work, the ambulance service, supported by TN, identified teams-based working (TBW) as a potential solution

Approach

TN facilitated a series of workshops with Trust leadership and union representatives to scope a high-level design for ‘teams-based working’ (TBW) including:

Aligning working patterns within teams of staff and managers
Introducing protected time for team development to foster a collaborative work environment
Improving efficiency of staff management by devolving responsibility to local Group Stations

Following these workshops, TN worked on the ground with Group Station managers and staff to co-design and implement tailored solutions, accounting for local nuance and giving local teams ownership over the change. This included:

Supporting local engagement with staff and union representatives
Designing new teams-based rotas for each station, aligning the working patterns of staff and managers within a team, and creating ‘overlay’ rotas to account for diverse staff needs (e.g. for staff who can not work night shifts)
Designing SOPs for newly created huddles and team days

TN started by supporting a small group of early adopter Group Stations to design and implement TBW in their stations, before expanding support to all Group Stations across the Trust.

Impact

Sickness

2.7%

12-month rolling sickness rate

Compared to the same period last year, sickness is ~3pp lower after implementing TBW

Turnover

1.8%

12-month rolling turnover rate

Compared to the same period last year, staff turnover is ~2pp lower after implementing TBW

Team ethos

31%

agree or strongly agree that they feel part of a team

9-weeks after implementing TBW, almost a third more staff feel part of a team compared to pre-TBW

Work-life balance

30%

agree or strongly agree that they have good work-life balance

Compared to pre-TBW, almost a third more staff feel that they have a good work-life balance

Other impacts of TBW also included:

All 3500+ frontline staff now work in teams whose shift patterns align with their named manager, so now all staff know and see their manager on a regular basis, and teams train and work together, building morale and capability
NHS Staff Survey results in 2024 showed improvement in every People Promise theme amongst Road Operation staff (Figure 1)
Increased number of Team Days and education during huddles means staff are more confident in providing the best possible care to patients
Staff satisfaction increased compared to pre-TBW across all six measures of staff satisfaction (Figure 2)
Responsibility and ownership for performance sits at the local level with teams

Figure 1: NHS Staff Survey results