Tuesday, 7 November 2017

Light at the end of the tunnel: re-thinking disciplinary action in the NHS

At present a manager informs HR that s/he is planning to suspend a member of staff for what they claim is gross misconduct.  The HR manager presumably checks that what is being alleged, is actually gross misconduct (though there is no evidence that I know, to suggest that) and then the awful process unfolds.  The worst case scenario is that the innocent victim is called to a meeting with their manager, without knowing what the meeting is about – congratulations for their hard work in very difficult circumstances maybe? 

What follows puts them into a state of shock and the direction is now downhill all the way – vague allegations, exclusion from the work premises (with the embarrassment of being marched off in many cases), long delays, no fairness or transparency in the process and finally some punitive outcome.

Patient care suffers – one less member of staff, other staff demoralised by their colleague’s disappearance, vague rumours. 

BUT there is hope.  A few managers are stopping this awful waste of staff and time.  Roger Kline, Research Fellow in Middlesex University Business School, has described the different approach in his seminal work, re-thinking disciplinary action in the NHS.  See https://mdxminds.com/2017/09/19/rethinking-disciplinary-action-in-the-nhs .  See also https://www.england.nhs.uk/wp-content/uploads/2017/03/workforce-race-equality-standard-data-report-2016.pdf for more examples of different approaches summarised by Roger  (pp 110-143).

At last some trusts are recognising that the disciplinary route is usually not appropriate or even necessary (though sometimes it is of course), that preliminary investigations need to be more robust and that most often, any clinical ‘never or near miss’ events have a strong element of systems failure when root cause analysis is used.

Using the Incident Decision Tree series of questions as an initial guide helps to clarify the issues and the course of action needed. 

The new processes move away from the destructive and futile culture of blame which usually fails to achieve a single positive outcome.  Looking at the possibility that there has been systems failure, using root cause analysis, any critical incidents are dealt with in a constructive manner and ‘lessons truly are learnt’ as trusts like to say, when it usually means quite the opposite under the present system.

These new approaches may also prevent unnecessary formal disciplinary procedures where unsubstantiated allegations have been made because of personality clashes, or worse still, bullying behaviour by inept, incompetent even possibly psychopathic managers.  The damage to people’s health, relationships and career to name just a few outcomes of the destructive nature of suspension and all that follows, is immense.  Employees disappear into the NHS ‘Black hole’ a place  little recognised by the public till recently, thanks to the high profile whistleblowers and the reporting of the often illegal actions taken against them to silence them.

What now needs to happen is that these improvements are rolled out throughout the NHS and made mandatory, with reports to a central agent to identify where there are problems in an organisation.

What a hope and what a difference it would make.  Thank you Roger.
Julie Fagan  

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