Promoting partnership working in the NHS

Hull & East Yorkshire Hospitals NHS Trust - tackling Bullying and Harassment project

Why the project was undertaken

For many years Hull and East Yorkshire Hospitals NHS Trust (HEY), which employs over 8,000 people, has performed poorly in the National NHS Staff Survey. The trust has been in the bottom 20 per cent of trusts nationally in the last seven years and has never featured in the top 20 per cent of trusts. Since 2012, UNISON (the largest trade union in the trust) had raised issues of a widespread bullying culture that emanated from the top of the trust down through its management structure. In its February 2014 inspection, the Care Quality Commission confirmed issues of bullying at the trust as did an independent review by ACAS conducted in July/August 2014.

A values-based survey (using the Barrett Values Cultural assessment) was used to measure the cultural health of the trust. The survey asked participants to select values which describe the current culture of the organisation and values which describe the future desired culture - to give a sense of where staff believe the organisation currently is and where they would like to get to. The survey indicated that the culture of the organisation was not conducive to the delivery of great care. It also implied that there was an identifiable impact on staff as a result of being bullied.

How the project was developed 

The project developed from June 2014, when Rich Jones from ACAS was invited by the trust to conduct a survey of staff and establish whether there was an issue of bullying in the organisation. What started out as a piece of work to identify the causes of bullying, enable staff to report incidences of bullying and tackle cases of bullying and harassment, has evolved into a full-scale approach to shifting the culture of the trust’s two main hospitals: Hull Royal Infirmary and Castle Hill Hospital. Where issues of bullying were identified, steps were taken to work with senior managers and teams to change behaviours and, in some cases, changes were made to senior management positions.

This work was undertaken in partnership, initially with the BMA and UNISON, but eventually with all the trust’s recognised unions, alongside ACAS and a group of dedicated managers from across the trust.

With bullying issues confirmed by Rich Jones in his report to the trust executive team, it became clear that underpinning many of the poor behaviours being seen was a culture of neglect – where staff felt undervalued and where lack of accountability, leadership and good role-modelling was at the heart of some of the problems they were experiencing.

The ACAS report was critical as it was the first time that some of these issues had been aired openly and their independence was crucial in establishing that the longstanding complaints of a bullying culture across the trust were in fact true. A new chief executive had joined the trust and the support of the new management team to address the bullying and cultural issues was a key element in ensuring that the work was prioritised.

A permanent, chief executive-chaired group, was established with union and staff group membership a key factor in ensuring the work was conducted in partnership with the workforce and its representatives. The trust’s anti-bullying tsar, Dr Makani Purva, a respected member of the medical workforce, was a key member. Her role as someone staff can talk to, as a trainer for professional behaviours and in driving the work forward continuously, has been pivotal to the progress the organisation has made in the last 12 months. The group began with a remit to address the bullying issues specifically and has subsequently evolved to become the Professionalism and Cultural Transformation (PaCT) group.

Following discussion with the PaCT group, a four-point plan to change the culture at HEY was proposed to the board and approved in February 2015.

          1. Demonstrate to staff that we value them, including:

  • appointing to vacancies, reducing turnover of staff, reducing the frequency and number of staff moving between wards
  • improve management visibility
  • further develop the trust's management training programme to improve the skills and competence of leaders within the trust.

    2. Create an Employee Charter (bill of rights and responsibilities)
  • All staff to have clear roles and responsibilities (what is expected of them and what they receive in return).
  • Support and promote staff-led improvement. Devolve decision-making to the lowest level where possible.
  • Reduce incidences of bullying and poor behaviours and make it easier for staff to report bullying.

    3. Role-modelling
  • Run mandatory briefing sessions for all managers, outlining what is expected of them and pledging to support them in the delivery of the trust’s new culture.
  • Reduce bureaucracy at all levels and commit to modernising back office services.
  • Establish a clear performance framework (goal-orientated)

    4. Accountability
  • Identify clear objectives for the trust and ensure all staff understand their part in the delivery of these objectives.
  • Establish accountability for cultural health in services.
  • Appraisals to include the Employee Charter (values and behaviours).

What has been achieved so far

The national NHS staff survey contains an overall score for engagement, where five is the highest score possible. This has been used to assess whether any progress has been made in terms of shifting the culture of the organisation.

The overall engagement score is made up from nine component questions in the survey:

  • can make suggestions to improve the work of their teams and departments
  • have frequent opportunities to show initiative in their roles
  • can make improvements happen
  • believe care of patients is the trust's top priority
  • would recommend the trust as a place to work
  • would recommend the trust as a place to receive treatment
  • look forward to going to work
  • are enthusiastic when they are working
  • feel time passes quickly when they are working.

In the 2014 National Survey, the trust’s score was in the worst 20 per cent of organisations nationally:

  • 2014  Average for acute and specialist trusts                   3.74
  • 2014  Hull and East Yorkshire Hospitals NHS Trust            3.54

When staff completed the survey in November 2015, this score had shifted to 3.74.

Five top tips for organisations that want to run a similar initiative.

  1. Accept there is an issue that needs to be addressed.
  2. Once the issue is identified, deal with it (including those identified as bullies).
  3. Involve an independent body such as ACAS to carry out an in-depth and transparent review.
  4. Work in partnership with unions, management representatives, and occupational health to develop and manage a plan.
  5. Ensure cultural health has equal billing to safety and quality, performance and finance in terms of leadership accountability.

For more information contact:

Ray Gray (UNISON), r.gray@unison.co.uk

Myles Howell, Director of Communications and Engagement – myles.howell@hey.nhs.uk

Dr Makani Purva, Anti-Bullying Tsar – Makani.purva@hey.nhs.uk