Changing the culture of bullying in the NHS

When I arrived at Hull and East Yorkshire Hospitals Trust, the organisation was facing a number of issues including a perceived culture of bullying and intimidation. This issue had initially been noted by inspectors during the trust’s 2014 Care Quality Commission inspection, and was later reinforced by the findings of an independent review carried out for us by the conciliation service ACAS.

‘I was keen to lead this work and to send out a clear message that bullying and intimidation would not be tolerated’

National NHS surveys report that about a quarter of all staff have experienced or witnessed bullying, so this issue was not unique to Hull, but it was my job, and that of the new and incoming trust board members, to do something about it.

• An educational intervention to tackle NHS bullying: early results and experiences

The effects of bullying within organisations are well known: low morale; poor performance; increased absence; and staff turnover. Unprofessionalism and poor cultural practices can also hamper the growth of any organisation. These were things which we could ill afford, and both our staff and patients deserved better, so there was an urgent need to act.

I was keen to lead this work and to send out a clear message that bullying and intimidation would not be tolerated. In August, I began chairing an anti-bullying group, the membership of which included nursing and medical directors, union representatives, occupational health, human resources, and a patient representative. I also took the more unusual step of appointing one of our senior clinicians as the trust’s anti-bullying tsar; someone to lead and champion this work across the trust.

One of the key outcomes from the anti-bullying group was the formation of a professionalism and cultural transformation (PACT) academy. This was designed not only to help address issues of bullying, but also to educate staff around expected behaviours and deliver a shift in the culture and values of our organisation.

In the first six months (December 2014 to June 2015), more than a quarter of our 8,446 employes underwent PACT training using a specially designed 90 minute workshop. These were employees from a whole range of backgrounds who were, probably for the first time, in receipt of specific training on the importance of professional behaviour and raising concerns in the workplace. The results speak for themselves, as the majority of those attending said they were more confident after the training about identifying bullying (67 per cent), raising concerns (79 per cent) and tackling concerns (91 per cent).

The PACT academy is already attracting interest from other trusts, and the training delivered has been commended by the CQC in our latest inspection report, but the early successes we’re reporting are not just down to this.

‘Twelve to 18 months ago, the trust was in quite a dark place but I do believe we are turning a corner’

We have introduced a new set of values which have been shaped by our workforce, and which clearly set out what staff can expect of the organisation and what the organisation can expect of staff in return. We have also invested in our senior clinical leaders, and continue to give them the freedom to implement changes to improve their services. Together, these changes are helping us to move away from a culture which was focused largely on targets and finance, and move towards one which is led by care of our patients first and foremost, and for each other.

Evidence of “green shoots” came recently via our local Friends and Family Test Staff Survey, which attracted a record number of responses for our trust of 1,647 last month. In the past, engagement in this kind of work had been low, but now it seems staff are keen to tell us that things are moving in the right direction. Almost three quarters of our staff said they were likely to recommend our care to loved ones, for example, and six out of 10 people said they are able to make improvements happen in their work areas; both of these scores ranking above the national average. In fact, in most of the question areas, we are now seeing an upward trend to either meet or exceed national average scores.

Twelve to 18 months ago, the trust was in quite a dark place but I do believe we are turning a corner. Changing the culture of any organisation is not something that happens overnight, but by being clear about expected behaviours, providing staff with the tools they need to challenge unprofessional behaviour and making a zero tolerance statement on bullying, we’ve taken some very positive first steps on that journey.

Chris Long is chief executive, Hull and East Yorkshire Hospitals Trust