Everyone has a story: why NHS managers must adopt a people-first approach

By Dr Melissa Carr, Director of EDI at Henley's World of Work Institute.

The NHS is a social and cultural monolith[BL1] . As the largest employer in England, and the sixth largest in the world, most of us know someone employed by the NHS. And all of us have received care at the hands of its workforce

Employee wellbeing should be a key priority within every workplace, but no more so than in the NHS where research shows that it is intrinsically linked to quality patient care[i]. As The Francis Inquiry into Mid Staffordshire NHS Foundation Trust revealed, a toxic and exclusionary workplace culture can lead to systematic failures and compassion fatigue[ii]. When it comes to health outcomes, workplace wellbeing can literally be a matter of life or death.

Don’t forget the people that make up the institution

The issues facing NHS managers are undeniably complex. Not only is the workforce the largest in the UK, it’s also the most diverse. In England, 25.7% of staff are from ethnic minority groups[iii] and around 19% of staff are from overseas[iv]. How can you engage, support and motivate such an extensive network of professionals, all with different skillsets, experiences and backgrounds? A standard one-size-fits-all approach isn’t going to cut it.

As a sprawling public service under immense pressure, the NHS could fall into the trap of viewing employees as homogenous units of productivity. The reality is that the workforce is made up of people – people with complex family situations, people with ongoing health conditions, people with young children, people with challenges that affect their everyday lives. Understanding, valuing and accommodating employees as individuals can foster both wellbeing and a sense of inclusion

How EDI can transform the everyday experience of NHS staff

Equity, diversity, and inclusion (EDI) practices can provide the framework for values-led, people-focused leadership. It’s not enough simply to acknowledge the diverse experiences of staff. EDI must be fully integrated within processes and policies to ensure teams feel valued. It’s crucial that personalised support, positive employment models and opportunities for staff development are adopted across sectors and services.

The King’s Fund reports that the top two reasons for NHS workers leaving are to improve work–life balance or because of health issues[v]. A holistic approach to management, which addresses the real-world situations of individual employees, can make all the difference when it comes to staff retention.

Viewing HR and management practices through an EDI lens can shift the focus and place the individual back at the centre of the conversation. Flexible working policies, staff development programmes, regular pay gap reviews and clear pathways for career progression create workplaces where staff can thrive, not just survive.

Although its size makes the NHS an outlier, in one respect it’s no different to the smallest start-up business. Empathetic and inclusive line management can make an enormous difference. Unsurprisingly, a workforce that feels appreciated, supported and listened to is more likely to feel a deep commitment to, and engagement with, their work.

Driving change and creating a culture of trust

Above all, managers shape the culture. Previous scandals show how fear of speaking up can lead to failures of care. Equally, institutional bullying and discrimination can have a devastating effect on staff morale and mental health, particularly for those from minority backgrounds. Fostering a culture of honesty, trust and collaboration, where people are empowered to raise concerns and suggest improvements, can have a transformative effect on both staff engagement and quality of care.

In the latest NHS Staff Survey[vi], one of the most encouraging findings was that 71% of staff reported that their immediate manager takes a positive interest in their health and wellbeing. Alongside the more sobering feedback about staff burnout, workload and satisfaction with pay, this is encouraging. However, taking an interest doesn’t always translate to making an impact.

To enforce lasting change within an organisation as labyrinthine as the NHS, leaders must understand the behaviours and practices that underpin workplace inclusion. Managers who are fluent in the latest EDI policies can advocate meaningfully for their staff. They can provide a seat at the table for those who have previously been underrepresented, and they can offer support which addresses the diverse needs of their teams.

Not just cogs in a machine: using EDI to support individuals

The NHS equality, diversity, and inclusion improvement plan[vii] provides a best-practice framework to be implemented across the organisation. A central premise of the plan is that leaders set the tone. Individual managers can support their own teams on the ground, but organisational change cannot happen in a vacuum. A top-down approach is needed, with executive level support to ensure policies are strategically implemented and embedded.

It can sometimes feel like the NHS is defined purely in terms of scale. As a huge institution facing enormous challenges (not to mention millions of staff and a nation of service users) it can be easy to forget the humans at the centre of the systems.

There might be strength in numbers, but it’s crucial that NHS staff aren’t reduced to overworked and underappreciated cogs in the machine. A tailored approach to management, robust EDI practices and inspiring, people-first leadership can ensure staff feel valued at all levels.

Take the next steps on your leadership journey

At Henley, we recognise that the NHS needs managers who can light the touchpaper for change and champion their teams. That’s why we’ve partnered with NHS England to launch the first cohort for NHS colleagues pursuing careers in EDI. Professionals at the beginning of their leadership journey, with no more than three years of experience within a management role, will learn the skills to influence behaviours, implement EDI in practice and manage change within the NHS.

Find out more about our Developing Future Leaders in Equality, Diversity and Inclusion programme.

[i] https://www.nhsemployers.org/a...

[ii] https://www.bmj.com/content/380/bmj.p513

[iii] https://www.ethnicity-facts-fi...

[iv] https://commonslibrary.parliam....

[v] https://www.kingsfund.org.uk/i...

[vi] https://nhsproviders.org/media...

[vii] https://www.england.nhs.uk/publication/nhs-edi-improvement-plan/

[BL1]Institution?