It took an anti-bullying tsar to help hospital staff look out for each other, not just their patients
“People don’t set out in the morning to become a bully,” says Dr Makani Purva, consultant anaesthetist and director of medical education at Hull and East Yorkshire Hospitals NHS Trust. “But circumstances make some people behave unprofessionally, and the NHS has its fair share of high-pressured scenarios.”
In Hull and East Yorkshire’s case, overworked staff were turning on each other. In 2014, the Care Quality Commission (CQC) reported incidents of bullying and harassment; repeat offenders were left unchallenged and the alleged victims felt unable to raise concerns. Staff survey results indicated that employees felt undervalued.
“When I joined the Trust in 2012, the NHS was facing financial and performance pressure unlike anything staff had experienced previously,” says Simon Nearney, director of workforce. This sustained pressure was affecting the organisation’s values and culture, and causing some of its 8,000 employees to exhibit behaviours that Nearney admits were “not always consistent with a caring profession”.
“For several years there’s been an acceptance that it is really difficult to work in the NHS. The whole landscape has changed beyond recognition and the pressures push staff into extreme circumstances,” he says. But the arrival of a new chief executive in September set the stage for the Trust board to challenge the status quo. “For the first time in a long time, organisational culture was a priority,” says Nearney. “We had a chief executive [Christopher Long] actually standing up and saying certain behaviours were no longer acceptable – that ‘you may have behaved like that in the past, but no more’.”
The Trust brought in employment relations organisation Acas to investigate claims of bullying in the organisation, and it recommended several courses of action. Staff were invited to complete the Barrett cultural assessment, which identified that employees were looking for organisational values that closely mirrored their own personal ethics.
“We were operating in a culture of neglect, rather than bullying per se,” Nearney says. “We needed to do more to show staff that they were valued, and give them the opportunity to speak out when they had concerns about the culture and environment.”
Having had success modifying behaviour among junior doctors in training, Dr Purva was appointed as the Trust’s anti-bullying tsar to lead the culture change programme across the organisation. Taking inspiration from a colleague at Harvard Medical School, she developed the Professionalism and Cultural Transformation (PaCT) academy, which tackles individual incidents of unacceptable behaviour and provides compulsory training for all staff. Around 3,000 of the Trust’s staff have attended the 90-minute training session since Dr Purva’s appointment in July 2014.
Based largely on behaviour modification, the training sessions take staff through a series of simulated incidences and ask them to refine their interactions with each other. Each individual completes the course with a ‘pact’ that describes how they will improve their workplace and their working relationships.
“We hadn’t done enough timely intervention in the past. We let things fester,” says Dr Purva, referring to one incident that was left unresolved for 15 years. “No one had actually had an honest conversation with this individual. In the past, people had been nice to him because of his standing in the organisation, so when I said ‘you are a bully, you are disliked by your colleagues and I’m not sure what to do with you’, he realised his behaviour had to change.”
A complaints procedure was set up so staff could talk directly to Dr Purva, either anonymously or in face-to-face meetings. Since its implementation, 106 cases have been raised, information has been gathered and analytical interviews conducted. Agreed actions range from mediation to giving one-to-one feedback and, very rarely, disciplinaries.
“Every case takes up a huge amount of time and sometimes it takes a while to establish better working relationships,” she says. “But the key to some of our successes is quick intervention, getting people out of their busy worlds and talking to each other, and then helping them to work better, together.”
All the actions delivered by the cultural transformation programme are signed off by a committee chaired by the chief executive, which includes staff representatives. A huge part of the work Dr Purva leads is supported by HR. “Depending on which area the complainant comes from, I contact the relevant HR advisor and together we work out a means of tackling the issue. I do behavioural interventions myself with a team of doctors and other professionals inside the organisation, but I am relying on a huge number of volunteers,” she says.
Victims can be assigned mentors and even change jobs or departments if the relationship has truly gone sour, but Dr Purva says they rarely have to take such extreme action.
“Every NHS organisation wrestles with the difficulty of being really honest with its medical leaders and consultants, and saying ‘you are a leader in this organisation, you have to be more than a doctor caring for your patients’,” says Nearney. “But doctors spend their lifetime being taught to make split-second decisions and to take individual responsibility for saving people’s lives. They are put in charge of a theatre or operating room because of their skills and ability as a doctor, not because they are people leaders.”
More concentrated management training has become a necessity for all managers, says Nearney. As part of its commitment to its new values, the Trust holds senior leaders accountable for staff engagement and organisational culture. If departments fall below a certain target, it is the responsibility of those managers – with support from HR and training from Dr Purva – to improve.
“It’s not about chasing targets – it is about implementing a degree of rigour to how we measure and improve our organisational culture. We are putting a figure on what is important to the Trust, and we’re working with managers to help bring the working environment in line,” Nearney says.
“HR underwent its own PaCT training to ask: did we do enough to ensure staff were happy at work, or did we accept managers who displayed inappropriate behaviours when they were under pressure?
“We have a custodian role to play and if we don’t set our standards high, all our work will have been for nothing.”