Paradigm lost? Reflections on the effectiveness of NHS approaches to improving employment relations

Abstract

The National Health Service in England has largely relied on a human resources trilogy of policies, procedures and training to improve organisational culture. Evidence from four interventions using this paradigm—disciplinary action, bullying, whistleblowing and recruitment and career progression—confirms research findings that this approach, in isolation, was never likely to be effective. An alternative methodology is proposed, elements of which are beginning to be adopted, which is more likely to be effective.

The last resort: reducing avoidable employee harm by improving the application of the disciplinary policy and process

“…There is increasing scrutiny of the employee investigation process on a wider level – which highlights, at best, the process’s ineffectiveness in addressing issues and, at worst, its capacity to make situations infinitely worse ( Hussain, 2022 ). Within NHS England, Kline argued that “[…] disciplinary policies, procedures and training intended to set standards, which (in theory) emphasize learning but in practice may prompt blame, prolong processes, be adversarial and, like referrals to professional regulators, be prone to bias against BME staff” ( Kline, 2023 , p. 315).…”

The future of the NHS depends on its workforce

“…A major challenge is that human resource (HR) services in the NHS are not always fit for the challenges they have to deal with. HR departments vary widely in the quality and practice of local procedures for grievances, disciplinary processes, and whistleblowing 41. They are frequently characterised by an adversarial approach focused on organisational risk mitigation, often linked to avoiding expensive litigation processes with uncertain outcomes.…”

“…HR departments vary widely in the quality and practice of local procedures for grievances, disciplinary processes, and whistleblowing. 41 They are frequently characterised by an adversarial approach focused on organisational risk mitigation, often linked to avoiding expensive litigation processes with uncertain outcomes. Further problems arise because the seam with professional regulators is not always neatly stitched, causing confusion about which problems should be dealt with by employers and which by regulators.…”

“…42 Clearer, collaboratively built standards and the right support would be very valuable here. But also important is tackling the wider legal environment for employment practices, which is likely to be implicated in the emphasis on procedural compliance seen in NHS organisations, 41 and neither promotes positive workplace relationships nor is well suited to the specifics of healthcare environments.…”