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Race and organisational culture in the NHS

News, 14 January 2015

From April all NHS employers will be required to show progress towards the new Workforce Race Equality Standard (WRES), mandated by NHS England last year.

Public World strongly supports NHS England in its determination to tackle racial discrimination in the service, as we showed by publishing Discrimination by Appointment, a report that influenced the new policy.

  • Whereas 17% of all NHS staff identify as non-white, only 8% on higher grades do so. The proportion is lower still in very senior management and at board level.
  • Around 20% of NHS nurses but only 3% of nursing directors are from black or minority ethnic (BME) backgrounds.
  • Black and minority ethnic (BME) shortlisted applicants for NHS positions are significantly less likely to be appointed than white shortlisted applicants.

We recognise the valuable role a Standard can play in catalyzing action. Our preference, however, is to steer people way from striving for basic compliance and towards using the standard as a catalyst for creating workplace communities rooted in autonomy, dignity and well-being for all who come into contact with them.

That is why we invite NHS employers to work with us to create the culture changes necessary to implement the spirit of the Standard by working with boards, managers and staff in developing dialogue about racism and racial discrimination and the wider contexts in which they flourish.

Our approach is:

  •     To focus on leadership everywhere in the organisation – with each individual taking a lead to be responsible and hold themselves and others accountable.
  •     To be driven by the work itself, the work essential to cultural change, rather than by number crunching.
  •     To explore how we talk with each other about sensitive issues such as injustice and racism in the workplace, rather than on communicating a lovely sounding message.
  •     To get people thinking “oh, we need to talk openly about values, morals and ethics", rather than business cases.
  •     To consider the role empathy must play in changing beliefs and behaviours.

Of course we know that staff and patient wellbeing can only benefit from tackling racism and racial discrimination, but at the same time we insist that these are fundamentally ethical issues.

The road to unity and common purpose generally involves experiencing conflict and taking risks. When we navigate these conflicts and risk-taking constructively, we generate the necessary shifts in beliefs and behaviours.

It means creating workplace communities in which staff support each other to critically question their beliefs and behaviours, and how we relate to ourselves, others, the work we do, and the people we serve.

In a nustshell, we see the NHS Workplace Race Equality Standard as a welcome nudge to kick-start people into doing the work of rooting our creativity (ability to bring into being) and power (capacity to take action) in love (or compassion if the word ‘love’ makes you feel uncomfortable) and justice.

And this means EVERYBODY. No exceptions. No us, no them – just WE in this all together and having to wake ourselves up, speak truth, listen to one another and take responsible action.

We recommend a three-stage approach:

Stage 1: Review and Reflect

To understand organisational culture it is essential that information is gleaned from already available sources, including those that are relevant to the WRES indicators and metrics, such as:

  •     Staff survey, recruitment statistics, anonymised disciplinary and grievance reports.
  •     Review of national and trust level policies and how local practice compares.
  •     Interviews with a variety of key informants such as representatives of the different groups and levels of staff.
  •     Review of clinical governance reports to identify trends in reporting and management of critical incidents and patient complaints.
  •     Assessing non-mandatory training sponsorship records.

We offer expertise in qualitative and quantitative research, including surveys, focus groups and one-to-one 'deep dive' interviews, and in Social Network Analysis (SNA), a methodology with particular relevance in this context.

Stage 2: Developing dialogue

Our international experience has shown that the route to shared values and common purpose is awareness and acceptance of difference, and this is vital in creating an organisational culture that values autonomy, dignity and pluralism.

Talking about race equality honestly and constructively is not without risk, but there are greater risks in adopting administrative solutions to diversity and equality deficits without creating space for the dialogue that can lead to unity.

We will help you to co-create a map of cultural norms and dynamics through a range of methodologies, including exploration of the role of unconscious bias in informing the culture of an organisation.

Stage 3: Translating dialogue and understanding into responsible action

We will train facilitators in your organisation to take on stewardship roles in supporting people with the daily collective practices that are essential in creating a healthier culture.

This involves building capacity to deal with the range of scenarios in which bias can find expression, such as:

  • recruitment and selection processes;
  • access to training and promotion opportunities;
  • performance management and disciplinary processes;
  • dealing with bullying and harassment; raising concerns; and
  • management of sickness absence.

Data and indicators play essential parts in an organisational action plan and how it is implemented, but the key is to tackle the organisational culture challenges that obstruct change.

Our team at your service

Public World's team for this work includes highly experienced dialogue facilitators and change management specialists, led by consultants with particular expertise in this field:

  • Grace Makonyola has worked at all levels of health care services in Britain and Malawi. Her career began as a nurse and midwife, continued as a health visitor and developed further as assistant director of a community health care trust in London, responsible for 280 multidisciplinary staff and a £10m budget. Holder of an advanced management consultancy certificate from the Institute of Directors, Grace is especially interested in motivating individuals and teams through engagement, mentoring and facilitation to achieve their full potential in their working lives and in the care they provide.
  • Veena Vasista is the author of Snowy Peaks -- ethnic diversity at the top, and and has worked at a senior level with the Runnymede Trust and as a consultant to the Equality and Human Rights Commission. Formerly Vice-Chair of the British Institute for Human Rights, she works with people on strengthening their capacity  to be empathic, to be an ally, to stand confidently in their values and to root their creativity and power in love and justice. Veena specialises in reflective listening, one to one coaching, small group workshops and narrative culture mapping, and she is a qualified and practicing mediator.
  • Brendan Martin is Public World’s founder and managing director, with a background in communications, labour relations and facilitating the development of shared narratives about change among diverse stakeholders. With experience in more than 70 countries on all continents, Brendan is particularly focused on improving governance through employee involvement. He commissioned and edited Discrimination by Appointment and led Public World's team supporting follow-up by the NHS Leadership Academy.

For a preliminary conversation about how we can help you, please contact us.

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