Health Service Focus

14.07.16

Cracking down on all types of workforce bullying

Source: NHE Jul/Aug 16

NHE’s David Stevenson reports from an NHS Confederation session which focused on workforce productivity and tackling bullying in the system.

In early June the NHS Equality and Diversity Council published the inaugural NHS Workforce Race Equality Standard (WRES), which exposed the degree of racial discrimination and bullying across the service. 

The report, providing the first comprehensive data for all trusts in the UK, found that at 75% of acute trusts black and minority ethnic (BME) staff reported higher rates of bullying, harassment and abuse from colleagues than white staff. There were similar complaints at 50% of ambulance trusts, 78% of mental health and learning disability trusts, and 65% of community trusts. 

Tracie Joliff, head of inclusion and systems leadership at the NHS Leadership Academy, said: “This is something which has always been bubbling away in the background, but it really needs to be brought to the forefront with purposeful leadership actions to change the culture of the NHS so that all staff are appreciated and valued.” 

Wrong mentality 

During a panel session at NHS Confed, which included Nigel Edwards, the CEO at the Nuffield Trust, Stephen Dorrell, NHS Confederation’s chair, and Paul Scandrett from Allocate Software, a delegate noted that after recently joining his trust, bullying, despite being reported by 23% of staff, was not mentioned in the board’s report on the  NHS staff survey. 

“Last year, my staff reported that 23% of them had been bullied or abused by another member of staff,” he said. “When I looked at the board report on staff survey, it didn’t appear because it was an NHS average. We were no better or worse than anywhere else.” 

Edwards said that “it is mad” that nearly a quarter of staff get bullied across the NHS, and this has led to an environment where “being average is fine, and so long as you are not ahead of the pack it is OK”.

He added that in the last 15 years he has been concerned about the impact that robust and, at times, aggressive performance management from the top is having on the workforce: “Bullying at the top of an organisation will permeate five to six layers down. The question is what can be done about it?” He asked delegates how many had introduced measures to tackle bullying, but there were few responses. 

Fixing the problem 

The panel had been discussing Lord Carter’s Review and how organisations should organise their workforce to deliver productivity efficiencies and happy staff. 

Dorrell noted that performance management, as it has been felt though the health service, has, too often, been about managing cost, and someone else looking after the consequences. 

“It is blind management,” he said. “What we are seeking to develop is a concept of value and quality of the service that link back to the cost. It is only when you manage cost and quality together that you can deliver the aspiration that we all have.” 

Paul Scandrett highlighted major variations in the use of rostering systems and the pressure that this puts on some wards and departments. But he added that done properly, the opportunities in this area for the NHS are “enormous”. However, this has to be taken seriously from the top-down. 

Edwards noted that the Carter Review didn’t actually say anything that surprising, and that the future is probably going to centre on a “large number of very effectively executed smaller changes over a wide range of activity”. 

But he added one of the tricks to delivering this is delegating higher levels of control “much closer to the frontline than we are often comfortable with”.

“If you try and centralise the control of agency staff, costs often go up rather than down,” he noted. “One of the reasons for this is that we haven’t really, in many cases, trained our middle managers with the right skills to do some of the things we require them to do. If you are asking them to redesign the pathways to reduce variation or manage the rosters, we probably have not put enough effort into training that supervisory role.” 

Psychological contract 

He added that what worries him most is that quite a lot of the change work requires buy-in from staff, particularly clinical staff, who may feel disillusioned. 

“This requires you to have a firm and clear ‘psychological contract’ about what the deal is to be a member of the management team,” he said, adding that at Virginia Mason the physician contract looks at what the organisation’s expectation is of the worker, and what they should  expect in return.

Edwards added that in the “current situation with the anxieties about the financial state of the NHS, the growing workload people are exposed to, and the sometimes frenetic and sometimes bullying culture it inhabits in the system”, the concept of the psychological contract is even more important. 

He concluded: “My starter would be to start having conversations with people about what they find is working, where they are bumping into barriers and where they can be overcome.”

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