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Tees, Esk and Wear NHS Foundation Trust



Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) provides mental health and learning disability services in County Durham, the Tees Valley, York and North Yorkshire. Covering more than 3,600 square miles, TEWV has 1,000 inpatient beds, 200 community teams and employs more than 6,500 people.


The Challenge

TEWV have had a strong Quality Improvement methodology in place for more than 10 years.  As part of the routine process of observing staff in their workplace they’d noticed  that many senior staff were handing off responsibility to their own managers. There was an increasing sense that ‘command and control’ styles of management had become too strong and that there was an associated level of helplessness amongst staff.

There was evidence of significant variations in team performance which wasn’t explained by resourcing alone. The functioning of the leadership group within each team was increasingly seen as core to this and so, any future changes in relation to coaching were framed within their new leadership strategy which will support staff to move to a model of collective leadership.

They wanted to further engage their people and create a sustainable culture of empowerment and in their words, “Where staff can reflect on their own thoughts, problem solve and make more effective decisions for themselves and with the people they work with.” With a focus on staff well-being, the aim was to impact on productivity through people taking responsibility and being accountable for making the right decisions at the right place.


The Solution

As their business partner, using our brand name ThinkOn®, we committed to a three-year project to enable all 6,700 people in the Trust, from front line to executive level, to use Solution Focused Thinking in their day-to-day work. This bespoke ‘freedom’ licence which enables the widespread use of our intellectual property means the project will become self-sustaining past the three years.

This involves more than 30 licensed Master Coaches being trained and supported by ThinkOn® to continually develop to spread and embed the use of our Solution Focused Thinking tools and methodology. The approach has been to organically create the culture change through asking high quality questions in meetings and conversations, thus embedding a shared common language throughout the organisation. This has helped to create the space for thinking time to, develop clearer goals, be creative in idea generation and problem solve.

TEWV provide internal leadership and oversight with vital relationships with Quality Improvement  and Organisational Development. They’re also developing a layer of 'internal' coaches.  Coaches are working at all levels of the organisation, supporting individuals, facilitating events, and helping leaders to develop the purpose of processes and meetings.

The Results Framework and Solution Focused Thinking tools have been integrated into many areas including; business planning, meetings, appraisals, talent management, quality improvement and leadership training. Even more exciting is that the methodology and tools have also been used when working with partners and service users. We’re very proud to play a part in helping people improve their mental well-being. This ripple effect demonstrates the power of the methodology and sits well with our purpose of 'making the world a brighter place'.



“We have used this solution focused thinking methodology to engage and empower people to make a difference throughout our entire workforce and beyond with many of our patients. The practicality and support it provides enables us to think, act and be more productive in achieving our goals, making change happen quicker and easier. Examples of the broad range of results include using it with my Executive team to think differently and find new ways of identifying an additional £1.5m p.a. budget for more Registered Mental Health Nurses in our Inpatient services. This investment helped us improve the effectiveness and safety of the wards. Our team of licenced Master Coaches have been the catalyst for spreading and embedding the shared language and practical thinking tools across the organisation to improve employee retention and wellbeing, achieve over 30% reduction of time spent in meetings as well as improving the clarity, creative thinking and productive outputs from meetings at all levels. All of which has enabled us to provide even greater patient care.”

Colin Martin - Chief Executive


Differences Made

Some of the key themes emerging from the partnership are:

  • Recognising the value of goal defining, with clear understanding and links being made to organisational goals, through teams to individuals. Business Planning has improved using goal defining tools and effective questioning has produced quality input for the plans. People know where they fit and are working on the right things.
  • Enhanced leadership skills and team management, moving from command and control to collective leadership, so people feel more engaged and empowered. Morale has improved as people choose to problem solve for themselves. People are welcoming the opportunity to take personal responsibility to make decisions and choices, requiring less management involvement.
  • Productivity of meetings at all levels from the Executive Management Team to daily huddles. Meetings are taking less time, are more focused and now involve increased thinking and idea generation. For example, a 3 day meeting with 12 participants was cut to 2 days through the use of Solution Focused Thinking tools. There are many more examples of this across the Trust and this is currently being collated to be measured as a cost saving.
  • Feedback from managers and teams reports that the communication of change is more effective. Considering the hindering and helpful thinking of people within the organisation leads to more involvement and less resistance.
  • Indication of improved staff retention as people feel engaged and empowered in making career choices. Plus, feedback points to enhanced well-being through people taking responsibility for their choices, be that their career, tackling issues or achieving a better work/life balance.
  • People are using the tools outside of work to make a difference for themselves, their family and the wider community. This personal application helps them to see the value that can be added.
  • Cost and time savings being made in all areas by individuals applying the principles of solution focused thinking.

"I personally think this is one of the best things we have done in the Trust. I was one of the people who probably thought that we could have done this ourselves because we had so many coaches in the Trust already. What I totally underestimated was the applicability of the Framework across the entirety of the organisation, from the senior team, through to individuals working with service users.

And where the coaches have worked with teams, the shift in team culture, individual motivation and staff well-being has impacted greatly on how people are working with service users.  It’s given people the confidence to work with service users around what the service user wants rather than the pressure of what the organisation wants to happen – it’s been fantastic to see."

Sarah Dexter-Smith - Director of Therapies & Lead Master Coach

In addition to measuring the financial  impact, work is ongoing to build on the feedback and evaluate the impact on staff confidence, well-being, ability to manage teams and ability to problem solve and define goals. Of the many differences being made that do have a financial impact, here’s a few examples:

  • Executive Management Team helped to think differently and find new ways of identifying an additional £1.5million p.a budget for more Registered Mental Health Nurses in Inpatient services.
  • Facilitation by Master Coaches and use of ThinkOn® tools resulted in the identification of  cost savings for 2 service areas that equated to the targets for 2019/20 for one, and double the savings needed for the other. In addition to this, 20 other potential cost saving schemes were identified. 


  • Involving people at team level in possibility thinking for waste reduction in one locality resulted in the production of 1000 ideas of which nearly 100 were unique. These ideas are currently being evaluated for cost saving purposes.
  • Specific stories of where coaches have worked with individuals or teams resulting in people deciding not to leave the Trust, which has the impact of savings on recruitment and development costs. 
  • Securing permanent funding by using the methodology to develop a new process for clearing waiting lists for assessment of Autism in Children Services.


"The methodology has helped refine our thinking approach – and this in turn has positively impacted on staff engagement and empowerment. By having better conversations we are now exploring possibilities, understanding what personal responsibility people might take for actions and considering in more detail the issues, risks and challenges that might be part of our plans and processes. The beauty of the methodology is that it gives tools to “think big” so that we can consider the wider strategic issues that could influence our work, but it also gives tools to hone the detail and work through the actions and timescales for delivery. I hear different and more helpful conversations with staff who have been involved in this approach and receive regular positive feedback from staff who are using the framework to good effect.

On a personal level it has helped me and the leadership team reframe issues and this has enabled us to more constructively consider difficult and challenging feedback and think about how to positively move forward. This has helped the leadership team to be clear about the issues and how to communicate this to all our staff.”

Ruth Hill - Chief Operating Officer


Feedback from others within the Trust


"I'm being more effective as a leader and manager, as increasingly people come to talk to me with solutions already thought out..."


"I have more confidence, feel valued and useful, I have clear goals and overcome my self-doubt. The experience has far exceeded my expectations and provided outcomes I had not imagined."



"One to ones used to focus on 'have you done x meetings?', where I simply trotted out excuses until it was time to go, and nodded at suggestions/instructions, only to forget them afterwards. Now, I am asked questions, and when my answers are shallow, I am challenged to think more deeply. I find one to ones are now harder work, but also more stimulating and fun, and I implement more changes as a result."


"I now feel that I am becoming more engaged and involved at a service/organisational level. By directing my focus, I feel more involved, connected, valued, skilled and confident."



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