This week: David R Williams, professor of public health and of African and African American Studies at Harvard University

Why he matters: His extensive research and academic work focuses on social influences on health: specifically, how socio-economic status, race, behaviour and religious involvement can affect health – as shown in his powerful presentations at the recent NHS Providers and NHS Confederation conferences. He has shaped health policy at a federal level in the US and been influential on NHS attempts to tackle racial inequality.


How can Professor Williams convince a pressured NHS management that a greater focus on workforce health can drive better-quality care?

“We have NHS data showing that if employees are not well cared for”, Professor Williams replies, “they are not able to provide optimal level of care.

“It’s in the interests of the NHS or any other healthcare organisation that employees are in the best of health – not just physically, but also [possessing] positive psychological wellbeing – in order to go the extra mile for patients.”

The NHS is currently going through a vogue for ‘resilience’. Is this agenda about staff learning (or showing) more resilience, or about them being treated better?

Professor Williams does not see the two things as necessarily exclusive. “I think people need to be more resilient, but we also need to ask what the determinants are and working conditions that facilitate resilience.

“In western societies in general, people think of resilience in terms of individual resources and effort. And there is an individual bit. But there are also larger organisational and policy bits. How can we create the conditions that bring the best out of employees and make them maximally engaged?

“A lot can be done in the context of workforce and workforce development, to generate a multiple context to create environments of greater civility and psychological safety where people feel supported and can do their best.”

These aspects of staff resilience are, he adds, “two sides of one coin – the individual bit, and the social and system responsibility to create the conditions in which it can flourish and grow”.

His powerful 2017 NHS Providers speech on diversity caused a stir at the time, but relatively little seems to have changed, judging by the NHS staff survey and Workforce Race Equality Standard data. In his experience, what drives durable change?

“I’d refer you to the work of [King’s Fund academic] Michael West on high-functioning staff teams. And I would not agree that nothing [has] changed. I have been working peripherally with the WRES, and data I have seen suggest change on some indicators, such as of representation, applicants appointed, [and] reductions of BME [staff] entering into dispute.”

But the professor agrees there are causes for concern on the indicators reflecting conditions in the workplace; organisational culture; harassment and discrimination; and perceptions of equal access to opportunities.

He counsels a balanced view: “Shifting the organisational culture can be done, but it takes longer, and takes commitment, and dedicated, explicit strategies to create conditions of greater affirmation for individual staff and greater support. And it takes work by the leadership at the local level of an NHS trust.”

Asked which strategies he thinks can drive culture change most effectively, Professor Williams quickly reels off his top three.

“Number one: cultural change has to be articulated as a value central to the organisation, so it has to come from the top: the CEO and chair. The leadership has to let people know [it is] important to us and central to who we are. It takes rhetoric and vision from the top of the organisation.

“Number two: [action on cultural change] cannot be an occasional or annual thing. The message has to be steadily repeated, what communications experts call a ‘steady drumbeat’. Organisations which succeed at this find multiple ways to keep this agenda before their employees.

“Number three: it has to be embedded into organisations. If an organisation has high levels of instability, talk won’t be enough – it’ll need initiatives and training for local leaders in the organisation of how to change culture and relationships with each other.

“It has to be an embedded explicit programme, and you have to reward progress – from incentives to provide [leadership and involvement] to showcasing success.”

Professor Williams continues: “You need to get leaders from non-traditional diversity/HR [backgrounds], non-traditional voices, like the chief financial officer, talking about this. Get them talking about the value and importance of diversity, culture and how you create Michael West’s ‘culture of compassion’.

“Unexpected allies create the organisational message ‘this is who we are and is central to us’ and provides staff with alternative ways of relating to each other. Every organisation has its own culture: shifting culture takes deliberate initiatives to build and sustain the new culture over time.”

Professor Williams says that research studies into durable change “find a combination of initiatives with [the] leadership to implement [them]. One key to success is embedding it into the fabric and policies of the organisation, so when a leader who championed diversity and inclusion departs, it’s part of business as usual of how that organisation works. Many times, it was one leader, but when they leave, the organisation easily goes back to how it functioned before.”

Coming up: Sir Norman Lamb MP, NHS VAT campaigner Karin Smyth MP, and public health guru Professor Michael Marmot

If there is any political or influential figure you would like us to interview, please email or if you are reading this on the website leave them in the comments box.

The past five Bedpans

“Super-ageing” expert Ryoji Noritake

Department of Health and Social Care permanent secretary Sir Chris Wormald

Bishop James Newcome

Nicky Morgan MP

NHS England chief executive Simon Stevens

You can read all 30 Bedpans here