Risk Management Health Safety & Environment

Risk Management Health & Safety EnvironmentWe contend that the way to achieve a healthy work environment in modern Britain and elsewhere in Europe is to have the appropriate structures and responsibilities for healthy working practices at all levels in the organisation. At Board Level there is a particular need for Board Members and Non-Executive Board Members to provide the same level of oversight of Employee Wellbeing that is given to other Health, Safety and Environment issues. In the same way that an audit subcommittee ensures that the fiduciary responsibilities get the right focus, and External Auditors attest to this, Wellbeing should also be audited by professionals at arms length.

Progress is made on addressing the causes of Stress and Break Down at work, caused by work overload, unsafe practices or bullying when the following elements are in place:

  • A Board that is motivated to get to grips with the factors that generate negative stress and obtain unbiased, scientifically valid diagnostic data.
  • A courageous and empowered Occupational Health and Wellbeing Manager who has clout and authority
  • An arms-length audit conducted by competent professionals
  • An obligatory follow-up of the findings and recommendations so that progress towards active redress of the problems is monitored and measured.
  • A willingness to be open and honest with stakeholders and communicate the findings and what will be done to remedy any problems that have been verified.

NHS Trust Case Study: Remedies for bullying

Taking action in diagnosed hotspots

Taking action to address identified problems causing distress among staff takes courage and conviction. One of the most challenging issues to tackle is bullying. If left unattended, a culture of bullying will pose a growing threat to health and wellbeing and blight lives in your organisation. “For evil to flourish, it only takes a few good men or women to do nothing.” The same can be said for bullying.

All employers must conduct a risk assessment to identify threats to employee health and wellbeing. Bullying and harassment pose one of the most severe threats, as the impact on individuals can be devastating. Selecting the appropriate tool for the risk assessment is critical to the value of the diagnostic findings and we recommend the Work Related Quality of Life (WRQoL) survey tool developed at Portsmouth University which is a well-researched scientifically validated instrument for measuring Employee Wellbeing and assists in identifying any dysfunctional elements impacting on organisational health. The following scales provide diagnostic information:

  1. General Well-being (GWB)
  2. Home-Work Interface (HWI)
  3. Job and Career Satisfaction (JCS)
  4. Control at Work (CAW)
  5. Working Conditions (WCS)
  6. Stress at Work (SAW)

The following case study reveals how an organisation moved through various stages from research and risk analysis, through inertia to action and continuous improvement. Four factors enabled this progression:

  • A courageous internal Health and Safety Manager acted as a catalyst and drove the process.
  • Reliable research data obtained from a validated diagnostic instrument to measure Employee Wellbeing and diagnose hotspots in the organisation.
  • A forward looking Board committed to continuous improvement and achieving excellence through people.
  • The objectivity of independent professional support.

The problem

In organisations with a high concentration of specialists and professionals such as Hospitals, Universities and Professional Practices, one often finds reluctance to interfere in departments, even where there is concern about possible harm being done to staff. A professional “stand-off” can develop in which there is conflict between the value of respecting organisational and professional boundaries and the need to ensure that core values are seen to apply across the organisation.

Board members at an NHS Trust were aware of the existence of problems of bullying causing psychological distress, but were cautious about taking action. In two successive years the results of the Employee Wellbeing Survey had highlighted poor psychological health relating to bullying and harassment in the theatres, anaesthetics and intensive care directorate. However, action was only taken in the third year when the Health and Safety director raised the level of urgency by:

  • Presenting unambiguous research evidence of the problem.
  • Showing that the cost of intervention was far less than the probable cost of litigation or damage to staff morale.
  • Proposing that a neutral external change agent could defuse the political issues that caused the affected managers to “go into denial” or resist an intervention programme.

What were the obstacles?

  • Although the results showed which groups were at risk, departmental heads evaded action by questioning these data – were the findings reliable?
  • The departmental HR manager for the area had interviewed staff but insufficient probing and fear of victimisation kept the problems under wraps.
  • Corporate political sensitivity and prickly egos prevented direct intervention in the problem area.
  • There was confusion about the source of the problem and lack of clarity on what staff defined as “bullying”, with some inclined to dismiss the issue as reluctance to accept instructions.

Assessing the risks and finding solutions

Survey trends showed deterioration in core dimensions of Psychological Health and Job Satisfaction over three consecutive years in this directorate. In the third year, with additional independent professional support, focus groups and interviews were conducted in the “hotspots” The sources of bullying were identified:

  • Some problems arose from ineffective management practices in which workload in the form of operating theatre lists and overtime were distributed unfairly.
  • In other instances, novice intensive care nurses experienced severe distress because their more experienced peers were behaving in ways which undermined their confidence.

The solutions

A newly appointed senior manager resolved the workload problem by providing a buffer between the demands of surgeons for longer lists and the capacity of staff to deliver. The bullying problem proved more difficult to resolve.

Bullying of novices in stressful occupations like nursing, law-enforcement and prisons is particularly damaging to fledgling staff, particularly to those who are most conscientious and eager to learn. During the follow-up work, it was found that staff with many years experience in that area acknowledged a “culture of bullying” had evolved. Although some had progressed to a stage where they coped with the bullies, they had never confronted them.

Bully behaviour included:

  • Unwillingness to allow new staff to try out procedures or ask questions.
  • Tutting and gossiping behind their backs.
  • Forming cliques, which isolate and keep out new-comers.
  • Grabbing equipment from learners and taking over without explanation.
  • Harsh criticism and blaming, which is disproportionate to the mistake made by the trainee.
  • Frequent venting of complaints and hostility in order to marginalise people.

Management were remote from these issues (in some instances the bullies were part of the manager´s social circle), which allowed the culture of bullying to flourish. The result was that each new intake of young, conscientious professionals suffered distress, to the point of breakdown and did not know where to turn because serial bullies are often highly regarded by their superiors and manage their upward relationships very well.

The solutions were identified and management practices were changed by:

  • Placing the spotlight on negative behaviours such as “tutting”, sarcasm, impatience, unwillingness to allow others space to learn, forming cliques which exclude new comers, engaging in gossip and secretiveness.
  • Identifying source of bullying and the dynamics of what was happening in social relationships.
  • Assessing the level of insight showed by bullies (to what extent could they become aware of the impact of their behaviour and were they willing to change?)
  • Training managers to maintain a professional distance but become fully engaged in establishing a climate of learning.
  • Developing training programmes for novices including the use of mentors, ensuring that learning follows a logical graded exposure to (life-threatening) risks.
  • Ensuring that initial training takes place in a safe, unthreatening environment.
  • Making sure that all staff, including bullies, were absolutely clear about what constitutes bullying and management´s determination to enforce a policy of “zero tolerance” of harassment and bullying

The outcome

The value obtained from the intervention programme was greatly enhanced by the appointment of senior managers who were committed to creating a safe working environment by systematically introducing good management practices. This created a new openness to implement a series of changes that would bring about a shift in culture and better working relationships. These included:

  • Closer involvement of senior management in the management of each department.
  • Greater care in selecting leaders who have the intellectual profile and personal qualities to solve problems rather than muddle through or live with them.
  • Workshops on sources of stress and solutions that alleviate tensions and conflict.

The outcome is that a safer working environment has been created for nurses leading to reduced staff turnover and better mental health. At that time, the Trust was recognised by the Council of Health Improvement as having adopted best practice for consulting with staff in managing stress at work and this contributed to their achievement of Three Star rating. This NHS Trust has taken the bold step of publishing the results of the Wellbeing Survey in the canteen area where all staff and the public can scrutinise progress.