Senior Lecturer in Computing & Communications Engineering Dr Mahdi Aiash describes what Internet shutdowns ordered by repressive regimes entail, and how they can be bypassed
Protesters in Iran last month, where the authorities have cut off mobile internet, WhatsApp and Instagram. Credit: AFP/Getty Images
A report recently published by the UN Human Rights Office highlights the fact that Internet shutdown is increasingly becoming a tool used by governments around the world in the time of crisis to supress protest and hide deadly crackdowns or even military operations against civilians. Most recently, Iranian authorities cut off mobile Internet, WhatsApp, and Instagram amid protests against the killing of Mahsa Amini.
What are Internet Shutdowns and how they happen?
Internet shutdowns are measures taken by governments or entities on behalf of these governments, to intentionally disrupt access to and the use of information and communications systems online. Internet shutdowns exist on a spectrum and include everything from complete blackouts (where online connectivity is fully severed) or disruptions of mobile service to throttling or slowing down connections to selectively blocking certain platforms. Some internet shutdowns last a few days or weeks, while others persist for months or even years.
To explain how this might happen, we need to know that the Internet (as a network) is made up of a number of Internet exchange points (IXPs) which are physical location through which Internet infrastructure companies such as Internet Service Providers (ISPs) connect with each other.
These locations exist on the “edge” of different networks, and allow network providers to share transit outside their own network. Governments might order local internet service providers (ISPs) to fully disconnect online access for a particular geographic region or throughout a country. Unfortunately, ISPs may comply with government orders out of fear of retribution of legal action.
The good news is that if a government does not own and control the whole Internet Infrastructure, it might need to ask another party (IXP providers) to collaborate, which makes it a bit more challenging to have an entire Internet Blackout. Therefore, countries like China, Russia and Iran are also developing individual, “closed-off” internets, which would allow governments to cut off the country from the rest of the world wide web.
Can people bypass the shutdowns?
Depending on the scale of shutdown (and the country), there might be tools and ways to bypass the shutdowns:
Virtual private networks (VPNs): These allow users to access many blocked sites by providing internet service based outside of a censored country using a proxy server. A caveat is that because VPNs are publicly accessible, governments can block them.
Also worth mentioning is that encryption is not enabled by default in all VPN services, and even with encryption enabled, not all your Internet traffic will be encrypted. Domain Name System (DNS) traffic, translating domain names like google.com or mdx.ac.uk to Internet Protocal addresses so browsers can load Internet resources aren’t encrypted, meaning that Internet Service providers (and the government) know what websites you are visiting even if you are using VPN.
The good news is that there is a way to encrypt DNS traffic, by configuring the browser to use DNS over TLS (DOT) or DNS over HTTPs (DoH) protocols.
Another concern related to the use of VPN is the element of trust, since VPN services keep your data.
A good alternative to VPN is serverless tunnels such as Ngrok-tunnel, which is an open source tool that does not tunnel traffic or rely upon third-party servers, meaning governments have a much harder time blocking them.
Deep Packet Inspection circumvention utilities such as GoodbyeDPI or Green Tunnel might be another option to bypass Deep Packet Inspection systems found in many Internet Service Providers which block access to certain websites.
Why this is important?
KeepItOn coalition, which monitors shutdown episodes across the world, documented 931 shutdowns between 2016 and 2021 in 74 countries, with some countries blocking communications repeatedly and over long periods of time. Not only do Internet shutdowns represent violations to human rights and freedom, they also inflict social and economic damage on citizens and limit their abilities to access much-needed services such as hospitals, educational institutions and public transport, which in turn deepens inequality.
Nurse Efe Obiakur, who says she has long faced discrimination and harassment working in the NHS. Credit: Matt Brealey/CNN
As well as a moral issue, tackling racism affecting NHS staff is a crucial part of improving patient safety and care, says MDX Research Fellow Roger Kline
There is equally a growing awareness of the scale of race discrimination in all aspects of the lives of citizens of Black and Minority Ethnic heritage including the quarter of a million Black and Minority Ethnic staff working in the NHS.
Not so well known is the impact of race discrimination against health and social care staff on the care and safety of all patients and service users.
We have a wealth of data demonstrating that BME staff in health care are disadvantaged in recruitment and career progression, in whether staff are disciplined, bullied and harassed at work, and are treated worse if they raise concerns or admit mistakes.
Such treatment demoralises staff, wastes talent, affects turnover, costs money, and damages staff health. But crucially it also undermines team working, incentivises blame, not learning, and adversely impacts patient health and safety.
Risk one: There is a serious risk that recruitment and promotion data means that selection panels may be choosing “people like us” or who can best “fit in” rather than the best candidates, thus depriving patients of the best possible talent.
The NHS has an ethnicity gradient in which the more senior the post the less likely we are to see BME staff. It is still 1.61 times more likely that a White shortlisted candidate will be appointed compared to a Black and Minority Ethnic shortlisted candidate. It is not surprising therefore that it is twice as likely that BME staff do not believe there are equal opportunities for promotion and career progression.
Risk two: A culture of blame not learning is a risk to patient care and safety
Literature demonstrates the risk of racial bias in investigations. In combination, such treatment means it is more likely that the mistakes we all make are seen through the lens of blame, not learning for BME staff, not least because of the difficulty some White managers have in having honest conversations with BME staff.
Risk three: Racialised patterns of work are a risk to staff health and adverse impact on staff health may have consequences for staffing absence, discretionary effort and staff turnover, any of which may impact on patient care and safety, especially at a time of pre-existing staff shortages
“Over and above socioeconomic effects, both experience of racial harassment and perceptions of racial discrimination make an independent contribution to health. For example, those who had been verbally harassed had a 50 per cent greater odds of reporting fair or poor health compared with those who reported no harassment”.
Race discrimination is positively associated with an extensive range of adverse conditions including coronary artery calcification, high blood pressure, lower birth weight, cognitive impairment, and mortality. Moreover, discrimination, like other stressors, can affect health through both actual exposure and the threat of exposure.
Risk four: If BME staff are more likely to be bullied that will impact on their health and their working lives as well, placing patient care and safety at risk
BME staff are 21% of the NHS workforce. An astonishing 28% of them reported being bullied and harassed by managers and staff last year, significantly more than White staff reported themselves as being (23%).
The adverse impact of bullying on staff health has been well evidenced by Lever and others and in turn impacts on performance, career progression, engagement, retention and team effectiveness, as well as harming the safety and physical and mental well-being of staff.
American medic Lucien Leape describes how a culture of disrespect in medicine is a threat to patient safety because ”it inhibits collegiality and cooperation essential to teamwork, cuts off communication, undermines morale and inhibits compliance with and implementation of new practices”. Staff who are bullied are less likely to admit mistakes, raise concerns or work effectively in teams – all with consequences for patient care and safety.
Risk five: If staff are less likely to speak out and raise concerns that is likely to directly impact on patient care and safety
Robert Francis’ Speaking Up report (2015) drew on a survey of 20,000 NHS staff which found very significant differences between the experiences of White and BME staff who raised concerns.
It was 50% more likely that:
BME staff raising concerns would be satisfied with the response to their concern about suspected wrongdoing
BME staff felt they would be victimised by management after raising a concern
BME staff felt they had been victimised by co-workers after raising a concern
BME staff were 23% less likely than White staff to report a concern again if the staff suspected wrongdoing
BME staff were 70% less likely than White staff to raise a concern about suspected wrongdoing, due to a fear of victimisation.
The NHS National staff survey 2020 reported a significant difference between White and BME staff views on raising concerns. It reported that staff from BME backgrounds are less likely (62.1%) to feel safe to speak up about any concerns than White staff (67.0%).
Risk six. Where staff of Black and Minority Ethnic heritage are not welcomed, their difference valued, and it is not a safe place for them to raise concerns, then patient care is likely to lose the benefit that improved representation can give.
“the experience of black and minority ethnic (BME) NHS staff was a good barometer of the climate of respect and care for all within the NHS. Put simply, if BME staff feel engaged, motivated, valued and part of a team with a sense of belonging, patients were more likely to be satisfied with the service they received”.
“the % staff believing Trust provides equal opportunities for career progression or promotion… was a very important predictor of patient satisfaction in all three analyses (2014, 2015 and across the years). The more staff believe this to be the case, the more satisfied patients will be on average.”
Racism and bullying undermine psychological safety at work. This matters because as Carter and colleagues demonstrated, inclusive and compassionate leadership helps create a psychologically safe workplace where staff are more likely to listen and support each other, resulting in fewer errors, fewer staff injuries, less bullying of staff, reduced absenteeism and (in hospitals) reduced patient mortality.
An inclusive work team recognises, as Edmondson (1999) puts it, the deep human need to belong, and the anxiety anyone may feel when speaking up or sharing ideas in front of others for fear of saying something that may appear stupid or wrong.
Inclusion may be regarded as the extent to which staff believe they are a valued member of the work group, in which they receive fair and equitable treatment, and believe they are encouraged to contribute to the effectiveness of that group. Inclusive workplaces and teams value the difference and uniqueness that staff bring and seek to create a sense of belonging, with equitable access to resources, opportunities and outcomes for all, regardless of demographic differences.
As Shore (2018) put it, Inclusive organisations are more likely to be ‘psychologically safe’ workplaces where staff feel confident in expressing their true selves, raising concerns and admitting mistakes without fear of being unfairly judged.
Or as Professor Scott E Page describes in The Diversity Bonus: How Great Teams Pay Off In The Knowledge Economy (2017) – when more diverse representation is underpinned by inclusion, demographic diversity can improve team performance. The evidence for this is more nuanced than is sometimes presented, but is convincing nevertheless. An evidence base supports the proposition that effective leadership is diverse, inclusive and compassionate.
Psychological safety and inclusion impact positively on organisational effectiveness. When more diverse representation within teams and in leadership are underpinned by inclusion, it is likely that performance will improve, creativity and innovation will be greater, turnover will reduce and risks will be better highlighted.
One senior BME nurse put it to me, “I’ve spent my entire career walking on eggshells knowing that should I make a mistake or raise a concern I will be held to a higher standard than my White colleagues. I have more than once joined teams where I am not fully valued for the difference I bring or the insights I can share. Inevitably this affects patient care and safety”.
Conclusion
Tackling racism is first and foremost a moral issue but it is also a crucial part of improving the care and safety of patients and service users whatever their ethnicity.
Covid 19 and Black Lives Matter have finally, I think, led to many NHS leaders (not all) asking HOW they can address this issue as a priority, not WHY. To do so we have to stop leaving it to those adversely affected by discrimination to be the ones challenging it. We have to recognise that while overt racism is not normalised in the NHS, the patterns of bias, stereotypes, assumptions and behaviours that characterise systemic racism are well embedded and that they significantly damage patient care as well as healthcare staff.
Roger Kline is Research Fellow at Middlesex University Business School. An earlier version of this blog formed a presentation to The Healthcare Improvement Studies Institute, University of Cambridge November 2021 conference
Research Fellow Roger Kline reviews a paper on the impact of joint-evaluation methods in NHS recruitment
With changes to the recruitment process, one Trust more than doubled the number of applicants reaching Unconditional Offer stage
In a discussion with a group of NHS staff recently I was asked what their Trust might do to speed up progress on race equality in recruitment and career progression. I shared some of the evidence on removing bias from processes and inserting accountability, and in passing suggested that if the Trust wanted to be adventurous it could remove the future line manager from the final appointment decision in order to reduce affinity bias as there was some evidence this could be effective.
They laughed and said. “Ah, that is just what happened by accident here when the line manager was off sick. The interviews went ahead and we got a much more diverse set of appointments”.
A fascinating short paper by Sheila Cunliffe and Catherine Wilkinssuggesting this approach might be more widely effective has just been published. I recommend you read the original paper but with the authors’ permission I summarise it here and suggest why they may have found what they did.
The case study
A high profile NHS Trust identified a number of issues with their existing process for recruiting Band 5 nurses and midwives. 63% of applicants were invited to interview and 12% of those received an unconditional offer. The Trust found:
Some managers were taking too long to shortlist leading to high non-attendance at interview and too long to return appointment paperwork after interview
Managers wanted the ‘perfect’ candidate and were unwilling to take someone who needed development.
Candidates applied for multiple roles and, if invited to interview for several of these, only attended interviews for one.
There was substantial attrition of candidates after unconditional offer which meant the number of applicants finally onboarded was below 10% of applicants.
The Trust wanted to know why only 12.3% of candidates reached Unconditional Offer stage. A deep dive into 32 past recruitment campaigns was undertaken by the Nursing Workforce team doing an exercise in which candidates who had applied for these roles were shortlisted for both –
Suitability for the particular role advertised, and
Suitability for a Registered Nurse (RN) role somewhere in the Trust.
The data produced from this exercise was then compared with the data from the original recruitment exercise. The outcome was quite extraordinary. 89.1% of applicants were assessed as suitable for a RN role somewhere in the Trust, but in the original recruitment many were being rejected at shortlisting stage as they were not considered suitable for the specific role applied for. In addition, others were not considered to be in the top 4-6 candidates for that role and rejected in order to have a ‘manageable’ shortlist. This was then followed by candidates who were unsuccessful for the role on offer being rejected after interview with no attempt to offer them a role elsewhere in the Trust. The cumulative effect was that only 12.3% of candidates reached Unconditional Offer stage.
This exercise led to substantial changes in recruitment processes in Adult Nursing including:
Reviewing the ‘Killer Questions’ criteria in the recruitment system to ensure only candidates who were professionally qualified and registered (or about to be) could apply
Stopping shortlisting. Instead all applicants were automatically invited to book into a generic Assessment Centre at a date suitable for them (the centres were run on a 3-weekly basis)
The Assessment Centres were established on the principle of ‘wrapping our arms around the candidate’, ie with a focus on a more positive candidate experience and giving information about the Trust as a whole, including discussion of potential future career progression
Applicants attending the Assessment Centre were given a generic interview and Situational Judgement Test. The interviews were conducted by panels who were assessing suitability for a RN role in the Trust as a whole and not for a specific post. All candidates were assessed against a common standard. This future line manager was not always on the panel and even if they were, they were assessing for generic roles rather than simply for ones they would be managing in future
A Values and Behaviours 10-minute online test developed with a Psychometric company which reported against the Trust Values and Behaviours framework was also trialled, but this was stopped as a result of insufficient HR resource being available for analysis and evaluation
Individual clinical teams had ‘stalls’ at the Assessment day, enabling candidates to speak with specialists and find out more about their work and then have the opportunity to state their preference for specific areas they wished to work in and/or discuss the areas they were interested in from a career progression perspective
Successful candidates were then placed according to the Assessment Centre results and their preferences where possible
A more flexible approach was taken with candidates – eg if a candidate wished to work in a particular specialism but wasn’t considered ready, they could be offered a role which would give them that additional experience in a 6-to-12-month period
Many candidates received an offer on the day of the Assessment Centre.
The Trust gained an immediate benefit which addressed the original rationale for the exercise. The volumes of applicants recruited improved substantially with 30.3% of all applicants now getting through to unconditional offer compared with 12.3% before these changes were made.
However, when the team designing these changes then reviewed the success rate of applicants of different ethnicities for Band 5 and 6 posts (as part of a separate investigation into bias in recruitment) they discovered something quite astonishing.
They found that whilst the differences by ethnicity in the likelihood of applicants who applied being shortlisted were significant but small, at interview stage the outcomes were very different.
Fig 1 shows the difference between the interview success rates overall, and by ethnicity, before and after the process changes were introduced.
Fig 1. Success rates of different recruitment processes by ethnicity
Ethnicity
% Success Rate from Application when interviewed for specific Trust job (12 months)
% Success Rate from Application when interviewed for an RN role somewhere in Trust (6 months)
Ratio of White Offers to BAME Offers
Asian
16.1%
43.68%
0.76
Black
12.9%
35.15%
0.94
Mixed
16.7%
25.58%
1.29
Not stated
18.7%
73.53%
0.45
Other
14.5%
33.33%
0.99
White
24.5%
33.01%
1.00
The changes recorded in interview outcomes are striking, resulting in the proportions of ethnic minority applicants getting unconditional offers being much closer to the proportion of white candidates at each stage.
Explanations?
Why might the outcomes change with a change of process? There are a number of possible reasons.
One explanation is Bohnet’s insight that joint-evaluation of candidates succeeds in helping employers choose, irrespective of an employee’s gender and the implicit stereotypes the employer may hold. Bohnet found employers tasked to choose an employee for future performance were influenced by the candidate’s gender in separate evaluation. Bohnet’s findings have implications for organizations that want to decrease the likelihood that hiring, promotion, and job assignment decisions will be based on irrelevant criteria triggered by stereotypes. In contrast, in joint-evaluation, gender was found to be irrelevant – employers were significantly more likely to choose the higher rather than the lower performing employee.
They concluded that research in behavioural decision-making suggests that employers may decide differently in joint than in separate evaluation because they switch from a more intuitive evaluation mode based on heuristics in separate evaluation to a more reasoned mode when comparing alternatives in joint-evaluation. In addition, joint-evaluation might also affect choices by providing additional data that employers can use to update their stereotypical beliefs about a group to which an employee belongs. By definition, an employer has more data points available in joint than in separate evaluation. Bohnet found that only about 8 percent of the employers engaging in joint-evaluation, as compared to about 51 percent of the employers engaging in separate evaluation, chose the underperforming employee. It seems quite possible that the same principle might apply to the influence of ethnicity on decision making.
This is one possible explanation for some of the difference the change of process made, though without additional information it is not possible to say how significant this change might have been.
A second possible explanation is suggested by research on whether having more than one candidate who is female or is from an ethnic minority affects their likelihood of being appointed from interview. Johnson and colleagues suggested it makes a very considerable difference. Pooling results from three studies they found that when there was only one woman or minority candidate in a pool of four finalists, their odds of being hired were statistically zero.
However when they created a new status quo among the finalist candidates adding just one more woman or minority candidate, the decision makers did consider hiring a woman or minority candidate. The difference that increasing the number of female or minority candidates made was remarkably large. Why does being the only woman (or ethnic minority person) in a pool of finalists matter? The researchers suggest this is because it highlights how different they are from the norm “and deviating from the norm can be risky for decision makers, as people tend to ostracize people who are different from the group. For women and minorities, having your differences made salient can also lead to inferences of incompetence.”
Clearly in batch recruitment of the sort in the Trust studied, half[SC1] of those shortlisted prior to the change of process were White applicants, so it is possible this was a factor, although it is unlikely to be the main one since substantial numbers of individual shortlists would have had two or more BME candidates (Harvard Business Review).
The third possible explanation, and probably the most significant one, is that the removal of the line manager from the decision making process for specific roles they would manage in future made a difference. Using an assessment centre in which the future line manager was not always present, and even if a manager with a vacancy was present they were they were not necessarily interviewing ‘their candidates’, is likely to have substantially reduced affinity bias. In No more tick boxes I summarised some of the powerful evidence that affinity bias is an important factor in creating biased recruitment and career progression decision. There is evidence that the absence of the future line manager can help to prevent some of that bias. Google follow that approach even though “Managers hate the idea that they can’t hire their own people. Interviewers can’t stand being told that they have to follow a certain format for the interview or for their feedback.” (Wired)
Conclusion
It is likely that a combination of a very structured process, without the future line manager’s decision being key, possibly assisted by either or both the impact of joint evaluation and more diverse shortlists, helped make the remarkable difference, Cunliffe and Wilkins found.
Either way, there appear to be important lessons for other NHS employers where batch recruitment is possible since, when implemented properly, it may make a very significant contribution to diversity as well as the overall effectiveness of recruitment.
The authors would be really interested in other examples of batch recruitment and the use of assessment centres for such recruitment at enquiries@citou.com, and so would I.
Roger Kline is Research Fellow, Middlesex University Business School
If you found this interesting, you might want to read Roger’s blog about No more tick boxes, his extended review of “what works” and what doesn’t in creating fair recruitment and career progression
Despite a blizzard of initiatives, inequalities in NHS promotion remain, writes Roger Kline
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 Septemberby NHS East of England
