September 16 2021

No more tick boxes…

Even for those who have perfected the art of looking the other way, the last set of data NHS recruitment and promotion date was a shocker.

It was 1.61 times more likely that a White shortlisted candidate will be appointed rather than a candidate of Black and Minority Ethnic heritage who was good enough to be shortlisted.  Nationally, it is twice as likely that BME staff will not believe that there are equal opportunities for career progression and promotion as White staff. These gaps in experience have not improved since 2016 despite a blizzard of initiatives within individual employers and innumerable presentations about “changing culture”.

There has been some improvement. Boards are more diverse and there are significantly more middle and senior managers of BME heritage. But there is near universal acceptance across NHS leaderships that the pace of change is simply too slow.

I have lost count of the number of times I have had BME staff describe to me how they have watched White colleagues – whom they had welcomed, inducted, supported and helped to train – get promoted over them again and again. I have lost count of the number of time I’ve been told how “stretch opportunities” (such as acting up, secondments, and involvement in significant projects) which are the key to career progression have been filled by a tap on the shoulder followed by promotion. I have read many dozen Action Plans on Race Equality which are generally full of good intentions but were never going to make much difference not least because they could not answer the one simple but crucial question we ask of other interventions.

Crucially, the authors of such Action Plans were generally unable to explain why they had confidence that what they were proposing had a reasonable likelihood of achieving the goals their Plan outlined

The death of George Floyd and the evidence of deep workforce discrimination that Covid 19 has highlighted, seems to have prompted large numbers of NHS Boards (but certainly not all) to agree that they cannot carry on doing the same things and expect different results.

The NHS People Plan for 2020-21 states that

“employers, in partnership with staff representatives, should overhaul recruitment and promotion practices……… this should include creating accountability for outcomes, agreeing diversity targets, and addressing bias in systems and processes. It must be supported by training and leadership about why this is a priority for our people and, by extension, patients. Divergence from these new processes should be the exception”

But if that is going to happen we need more than good intentions. Progress will require leaders at every level willing to reflect on their own biases, assumptions, stereotypes and behaviours. It will require leaders to understand what sorts of interventions might work better and why. The search for one-off “silver bullets” such as diverse panels or diversity training must end. We should certainly call out Boards for failing to “move the dial” but we must also be able to demonstrate what might work better and explain why. We need an evidence-based strategy underpinned by both honesty about where we are and a credible theory of change to move us on.

That must include being driven by what research says will mitigate bias in recruitment at every stage – the job description, how it is advertised, appraisals, shortlisting, assessment, interview and ‘onboarding.”

“No More Tick Boxes” is the first attempt to review the evidence on how to make recruitment and career progression fairer. It summarises the research and sets out a framework that aims to establish a methodology to guide those seeking more effective strategies.

It sets out, heavily referenced, key steps organisations must take is they are to redress the current patterns of discrimination and waste of talent.

Firstly, without understanding what needs to improve, failure beckons. That means Boards need a “problem sensing” approach not a “comfort seeking” one with granular attention to data and listening to lived experience.

Secondly, we have to accept that the dominant HR paradigm on recruitment and career progression has failed. It has relied on a trinity of policies, procedures and training whose stated purpose is to set fair standards and make it safe and effective for staff to challenge unfair decisions. But research makes clear this is a flawed model, not just for recruitment and career progression but in other respects too – whether to promote the safe raising of concerns, prevent bullying and harassment or stop unfair disciplinary action. It is not just that it hasn’t worked, it was never going to.

Policies and procedures rely on individuals being brave or foolish enough to raise concerns when the evidence is that this rarely works and may well make things worse. Ask yourself: how many people in your own organisation who challenged an appointment or raised a bullying grievance won and were then thanked for doing so?

As for diversity training, a very large research project into workplace diversity by Kalev and Dobbin found “The most effective [diversity] practices are those that establish organisational responsibility: affirmative action plans, diversity staff and diversity task forces. ……Least effective are programs for taming managerial bias through education and feedback.” It does not mean training should be abandoned –like unconscious bias training it can certainly improve cognitive understanding. But it does mean we should stop assuming that in isolation it could decisively change decision making. It will not.

As innumerable researchers have discovered, when people are watched, have to account for their acts and omissions, and there are consequences for inaction their behaviour changes and so do outcomes. Accountability is key. Accountability can take many forms and evidence strongly suggests it is an essential element of improving fair recruitment and career progression practice. It may take the form of:

• Accountability nudges;
• Accountability for individual decisions such as panel decisions or appraisals;
• Data driven accountability such as through an “explain or comply” approach which scrutinises patterns of decision-making across an organisation or parts of it.

These three approaches, especially in tandem, are far more effective than relying in individuals to challenge specific decisions retrospectively or hoping training will prevent bias. An “explain or comply” approach does not equate to an organisational mugging. It asks department and divisional leaders to explain disproportionate outcomes for staff with protected characteristics. Unless there is a satisfactory explanation (possible but unlikely) they are expected to engage with colleagues (including HR and OD) to change their processes and improve outcomes. This makes this no different to how any other KPI should be approached.

Thirdly, the organisation’s focus should be on removing bias from systems and processes, rather than relying on removing bias in human beings. We need to remove or mitigate the numerous ways in which bias affects decision making at every stage of recruitment, development, promotion and support once employed. That means replacing the frequently sloppy recruitment processes in the NHS and elsewhere with an evidenced approach to creating a post; identifying essential criteria; advertising; shortlisting; appointment methods; scoring and decision making; and onboarding.

For example, that means a small number of key competencies underpinned by the evidence of what makes for effective, inclusive, compassionate staff since they are the ones who in an inclusive environment will be the most effective staff as well as the best leaders. That means shortlisting and interviewing that is well structured, with a clear success profile and a clear scoring matrix alongside other assessment methods such as situational judgement tests which research suggests have both good predictive and equality outcomes. And that requires granular attention to how to mitigate bias.  This should be done alongside effective positive action and appraisals as part of a talent management process.

Fourthly, research is clear: leaders (at every level), who understand and reject discrimination can make a fundamental difference to sustainable outcomes on diversity. They need to model the behaviours they expect of others, understand the importance of diversity and inclusion, listen with attention and hold themselves and others to account on the outcomes of their interventions and strategy. To be able to do this effectively, leaders need to understand their own biases, stereotypes and assumptions, accept challenge and gain insight into how they need to change personally in order to do this.

Fifthly, most Equality Action Plans still emphasise positive action not institutional change – a ‘deficit model’ – focusing on helping the staff who are discriminated against rather than the institutional practices that discriminate. Yet whilst encouragement and support are important for under-represented staff groups, without changing institutional blockages and biases they will have limited impact

Sixth, ensure transparency and positive action in relation to ‘stretch developments’. The NHS has adopted the 70:20:10 model of staff development, which suggests that stretch developments and their consolidation are the most important drivers of career progression. So acting up posts, secondments, and involvement in project teams should never be filled informally, and access should be monitored and, where appropriate, filled preferentially through positive action for under-represented groups to help level the playing field. And where disproportionate access exists an “explain or comply” approach should be mandatory.

Seventh, for diversity to be sustainable and make a difference to staff experience and patient care, inclusion – not just improved representation – is essential. Whether specific interventions (including those rated as more effective) are actually effective depends on the extent to which teams feel psychologically safe, difference is welcomed, and all staff are listened to and valued. Without inclusion, staff from under-represented and disadvantaged groups will be less engaged, become outsiders be held to a higher standard than other staff, and be at risk of higher turnover –with adverse impact on organisational effectiveness and patient care and safety.

Eighth, a “command and control” approach, in which front line managers are simply told what to do, won’t work. It will lead to pushback unless senior leaders are seen to model the behaviours they expect of others, take time to discuss the new strategy and the evidence behind it, and why it will make the services provided to patients and users better. It will backfire unless serious effort is put into improving inclusive behaviours so that new joiners, of whatever background are welcomed into a safe environment where their difference is seen as an asset. Inclusive recruitment needs to be seen as a crucial part of service improvement, not simply a matter of compliance

Finally, this approach, strongly underpinned by research evidence, requires trade unions as well as HR directors to move away from relying on individual casework driven by complaints, towards proactive and preventative work to embed accountability and interventions backed by evidence. It means welcoming the renewed interest in social justice, but demands that we move on from just talking about the need for “culture change” towards understanding and acting on the evidence of what is most likely to work.

The existing approach to recruitment and career progression has sometimes felt like trying to navigate the London Underground with a map of the Paris Metro – we were never going to get where we wanted to. There are signs that this different approach set out in this review is gaining some traction. But the window of opportunity will start to close unless we start to change at pace whilst recognising change is complex and will take time.

No more tick boxes: a review of the evidence on how to make recruitment and career progression fairer was published on Thursday 16 September by NHS East of England

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Tags: BME nurses, disabled, doctors, NHS, NHS racism, nhs staff, nurses, Roger Kline

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