Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT) has sought to reduce its disciplinary gap by seeking to cultivate a restorative, just and learning culture which enables staff to have 'conversations that make a difference' and resolve issues informally.
BHRUT provides care to three of London's most diverse boroughs. The acute trust operates at King George's Hospital in Goodmayes and Queen's Hospital in Romford, as well as providing outpatient services across four sites. The trust specialises in neuroscience services to the whole country. BHRUT has a workforce of approximately 7,700, 56% of which are from an ethnic minority background.
The trust's annual NHS Workforce Race Equality Standard (WRES) submission for 2021/22 showed that, against metric three (the relative likelihood of ethnic minority staff entering the formal disciplinary process compared to white staff), BHRUT ethnic minority staff were 1.02 times more likely than white staff to enter a formal disciplinary process (where 1.0 is equally as likely), meaning there is no disparity between ethnic minority and white staff entering a formal disciplinary process. This is also lower than the London average (1.47), acute provider average (1.07), and national average (1.14). Previously, the trust reported a figure of 0.51 in 2021, and 1.12 in 2020.
The NHS Providers Race Equality programme and Hempsons team spoke to Janine La Rosa, chief people officer (CPO), and Sara Najjuma, head of equality, diversity and inclusion (EDI), at BHRUT to hear more about the organisation's work to address disparities within the disciplinary process. This case study shares details of the interventions they have implemented, their impact, the challenges faced, and advice they would give to other board members.
- Cultivating a 'restorative, just and learning culture' (RJLC) that is led by the board and senior leadership.
- Ensuring that all employment relations and EDI staff are trained in facilitating RJLC approaches.
- Reviewing and updating the 'dignity at work' policy to create a clear process and guide for managers to follow, encouraging informal resolution in the first instance and greater specificity about when to trigger a formal grievance. Where a formal process is required, processes have been reviewed to ensure rapid escalation to the appropriate teams, greater clarity of next steps and an increased sense of urgency.
- Investing in external mediation providers so managers can easily access their support to resolve grievances via informal routes.
- Providing 'active bystander' training to support and upskill the workforce, allowing them to take positive steps in challenging discriminatory behaviours from both patients and staff.
- Redesigning the appraisal process to encourage staff to share how they are experiencing the organisation. This includes a private page within the appraisal that goes directly to the CPO's team rather than the line manager. This information is analysed and used to inform the development of targeted organisational development and culture interventions across individual business areas. This data also provides oversight regarding equity of access to development opportunities.
- Revising the organisation's 'corporate welcome day'. The new format will provide a deeper focus on the trust's values and what they expect from their people. Half of the day will be for all new starters and half will be focused on new managers. All new managers must complete this training which introduces line management including how to have 'conversations that make a difference' (previously known as 'uncomfortable conversations'), and equitable application of policies.
- Fostering a culture of psychological safety to enable staff to speak up and raise concerns, highlighting the importance of this feedback in informing improvement. This includes monthly insight meetings between the board and trust Freedom to speak up (FTSU) guardian to review data and key themes from concerns raised. This feedback is considered as part the people and culture committee and twice a year at the trust board.
- The trust is in the process of restructuring the organisation to create clearer objectives and lines of accountability, where every member of the workforce has clarity on what their manager is responsible for and what staff are expected to deliver on. Work has already started at Queen's Hospital, and the executive board members have their key high-level objectives on display for the organisation to view. It is hoped that this transparency will enable staff to hold themselves and each other accountable – reducing the need to enter disciplinary processes.
In 2021/22, the trust had separate roles for both the director of EDI and executive director of workforce. In 2022, the responsibilities for both roles as well as the associated resources and budget were amalgamated into a single CPO role, increasing the level of accountability and oversight at an executive and whole board level. The CPO is a member of the executive board with clear objectives focused on recruitment and retention and creating a RJLC. Addressing disparities within the disciplinary process is an integral part of these objectives. The increased budget and resources available to the CPO have supported implementation of identified interventions.
After the tribunal of Ms P Mntonintshi and Ms U Jama v Barking Havering and Redbridge University Hospitals NHS Trust and Ms C Beck, BHRUT reviewed its disciplinary processes, identified learning opportunities and strengthened the support offered to line managers.
In 2022 the trust reported no disparity between ethnic minority staff and white staff entering the formal disciplinary process.
The trust's FTSU data demonstrates that the number of concerns reported has increased, while the proportion of people asking to remain anonymous through the process has reduced. BHRUT feel this reflects an improvement in the culture of speaking up - that people feel safer to raise concerns and are more confident they will be heard.
By taking a learning approach to concerns and grievances, BHRUT are now able to actively identify the hotspots across the trust and provide more targeted and timely support to address identified issues informally through the EDI team and HR business partners.
The trust has experienced significant turnover at senior leadership and board level. This has impacted the trust's ability to make sustainable improvements to processes and organisational culture. However, the chief executive, Matthew Trainer, has now been in post for two years and this has provided consistency for the organisation and new members of the board. In addition, for the first time in six years, the trust now has a fully recruited substantive executive team.
The trust has been operating within the financial constraints of being in system oversight framework - segment 4 (SOF4) since July 2021, and receives mandated support from NHS England as part of the recovery support programme. Despite the additional scrutiny on the trust budgets, the board recognises the importance of addressing both the disciplinary gap and encouraging a 'confidence to speak up' culture, and the impact these have on both staff and patient safety. The trust has continued to prioritise and invest in this work by creating greater resource (merging the previous director of EDI's budget and responsibilities into the CPO role).
This, paired with the work done in the EDI team to re-engage staff networks, further supports BHRUT's messaging around organisational culture, expected behaviours, and inclusion practices.
A proposed increase to the EDI team's capacity will allow greater focus on community and outreach work, such as their place as an anchor institution. This is important as BHRUT staff are predominately made up of people from the local communities. This work can, in the longer term, have generational impact by ensuring access to good quality jobs, with opportunity to progress – tackling income inequality and inspiring future generations through ensuring diversity at all levels of the organisation.
BHRUT hope their workforce's confidence to raise concerns will continue to improve.
Leadership from the board is key to driving organisational culture change. Having an executive sponsor for staff networks has allowed the board to be more in tune with the lived experience of staff and allowed them to become more active allies. For example, the chief executive is an executive sponsor for the race, ethnicity and cultural heritage network (REACH) - they regularly attend meetings and help offer solutions to concerns that are raised. This has helped staff feel more confident to speak up and provided an active space to raise concerns, with the hope that this will reduce the need to seek disciplinary action.
BHRUT's top tip for board members
Resist the temptation to be the 'hero' leader. Cultural change requires collaboration and buy-in not just from the board but at all levels. Recognising this transforms the way people work.