Tag: HRM

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Business & economics Social commentary

No quick fixes for fair recruitment

Shot of a group of businesspeople interviewing a candidate in an office

Joy Warmington is Chief Executive of BRAP and holds an honorary doctorate from Middlesex University. Roger Kline is research Fellow at Middlesex University Business School. Here they highlight some of the issues with recruitment processes that are preventing organisations from becoming more diverse.

With Ministers announcing targets for ensuring diversity amongst public sector leaderships, organisations are increasingly asking how can they diversify their workforce? A growing number of organisations are insisting on diverse panels as one means of doing so.

We know current recruitment practices repeatedly favour some groups of staff at every stage of recruitment, development and promotion leading to a loss of talent. We know that the evidence shows that diverse workforces and leaderships that are inclusive are likely to be more productive, creative, innovative and engaged. We now know that the reasons women, BME and disabled staff fail to get fair treatment in recruitment is because of multiple forms of bias that influence appointment panels to choose people who ‘fit in” or are “like us” so that too often individuals are hired because of who they are – rather than what they can do.

Understandably, the focus for helping change this lands on the recruitment process. How we shift this pattern depends on two simple things:

  • what we believe are the reasons behind un-diverse appointments?
  • what steps are we prepared to take to challenge the status quo?

The lack of diversity in appointment processes, has been, and often still is seen as the fault of the applicant. There are a range of measures employed to ‘fix’ this – including widening advertisement processes so that it is likely to attract more marginalised communities, using a range of innovative means (open days, tasters, shadowing opportunities) to help demystify roles and encourage applications, and getting further down-stream by reaching into schools to promote opportunities. This “deficit” model may be helpful but doesn’t tackle the core of the problem.

Unconscious bias in interviews

Interviewing has historically been seen as an essentially fair process, but research is beginning to recognise its inherent faults. In our attempt to address these faults, organisations have spent more time ‘tweaking’ the interview process than we have recognising that people work within a system that replicates unfairness, and that they too become part of this system.

Unconscious bias training is one step that organisations often take to address unfairness in recruitment processes. Fundamentally, it can be right to point out that all of us have biases, and that we actively replicate these in our lives – including as part of the recruitment process. This type of training is very varied – it ranges from the application of the implicit bias test (which analyses bias through an algorithm), power point workshops, through to more active training and development opportunities. As we have pointed out previously, and as the recent EHRC review shows, although some experiences are no doubt better than others, all come with the health warning that understanding our adverse biases doesn’t mean that we are capable or indeed willing to change them.

The ‘diverse’ panel

Another increasingly popular strategy is the inclusion of a ‘diverse’ individual as part of the interview process. This has become increasingly common yet the evidence base for it is pretty thin. The impact of ensuring selection panels include women, for example, is mixed. Some studies show that as the numbers of women on a panel increase, the more likely it is that women will be selected but other researchers have found the opposite. One study found that when a woman was the only female member of a high-prestige work group and was asked to vote on another candidate for the group, she is much more likely to choose a male candidate than a female one. In summary the evidence is mixed.

That does not mean diverse panels are a bad idea. Intuitively they can be a positive step, but its significance can easily be over-stated especially when done in isolation. We have unfortunately seen some organisations make this the cornerstone of their approach, yet it can easily risk becoming tokenism.

In one organisation BME staff were invited to be panel members but not be part of the shortlisting process.

In another organisation the main role for BME panel members was to ask “the equality question.”

In a third organisation, BME staff who were significantly more junior than panel members were invited to join panels, but without equal authority on the panel that would make up for their more junior status.

In a fourth organisation BME staff were mandated to join panels without more than token training and irrespective of whether they wanted to join the panel or felt able to contribute substantially.

All these approaches (and there are variants including one where the only panel members required to have unconscious bias training were the additional ones with protected characteristics) have at their core the idea that the responsibility for recruiting diversely is substantially remedied by the inclusion of someone who is diverse.

Interview processes are inherently flawed – even before you include someone in them who is more diverse. There is a tendency for those who interview not to have received any proper training on the specific ways in which bias creeps into the best-intentioned interview and their role on the panel is simply based on their position – rather than their skills in choosing good candidates. Furthermore there is no point in doing this training unless it is put into practice as part of the interview process. How many processes discuss and review biases and their decision making – and recognise this as part of the journey to a fairer decision?

This shortcoming is compounded by the seniority of the line manager who generally chairs and who can ‘trump’ other panel members. If the appointment is specialist in nature, then again, the final say on the appointment may well rest with the ‘specialist’.

There are all sorts of specific ways in which bias can be mitigated within the appointment process – from how the job is described, where it is advertised, what the “essential criteria” are, how shortlisting is done, how the core competencies and behaviours required are tested, and including the interview itself. Without serious attention to these, an additional “diverse” panel member will not make a serious difference.

Setting an expectation

At the heart of successfully building diversity into recruitment processes, including interviews, is accountability. When departments and professions are held to account over patterns of recruitment which show it is much more likely that men will be appointed, or white applicants will be appointed, or staff with disabilities rarely get appointed, then a “comply or explain” challenge – explain the data or change the outcomes, does work. That does not mean telling individual panels which individual to appoint. But it does mean setting an expectation – a performance indicator that says that irrespective of their backgrounds and characteristics, once shortlisted there should be no radical differences between the likelihood of different groups of staff being appointed. There is evidence that targets linked to accountability do work.

In an imperfect system run by imperfect people our willingness to recognise our “faults” can bring us closer to realising the opportunities that often lie right under our nose. Let’s think more critically about the whole process of recruitment rather than just trying to put in quick fixes that have limited fixing ability. And lastly, let’s be clear about the expectation – boards should be concerned about shoddy or unfair decision making – poor recruitment patterns are not ‘accidental’, they replicate the status quo.

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Business & economics

Is conflict declining in employment relations?

The number of strike actions taken in the UK has been in decline for a number of years. Dr Ian Roper, Associate Professor in HRM, sheds some light on the reasons for this reduction in strikes, and examines whether it means we’re happier at work or are simply expressing our dissatisfaction in other ways.

On 30 May 2018 it was widely reported that the level of strike activity in the UK in 2017 was the lowest ‘since records began in 1891’.  This makes for quite a dramatic headline. On the eve of Middlesex University hosting the annual British Universities Industrial Relations (BUIRA) conference, it warrants an examination of whether this is an indicator that a seemingly ever-present feature of the British workplace – conflict – is now a thing of the past.

The official statistics reported that the total number of stoppages – one measure of strike activity – was just 79. That is, indeed, the lowest on record. In terms of working days lost, that figure was 276,000 (the sixth lowest figure) involving 33,000 workers (again, the lowest figure on record). That these figures suggest a strong decline in strike activity is not in contention. Nor is it in contention that this is the latest figure amongst a general trend. Figures show how the latest figures compare to, for example, some peak years. In 1984, the year of the miners strike, 27.1 million working days were lost. In 1926, the year of the general strike, 162.2 million days were lost.

What the figures do not show, however, is whether the fall in strikes is a good indicator of workplace conflict itself declining or, its corollary, that workplaces are now more harmonious. There are good reasons to suggest that this is not the case.

Restrictive regulation

The reasons for falling strike levels have to take into account the circumstances in which a strike may take place in the first place which is, in fact, complex. First there needs to be a perceived collective grievance among the workers. Second, there needs to be the capability to mobilise – and this further requires a union with sufficient membership density; a capacity to organise its members and confidence that the action taken will be sufficiently disruptive to bring the employer back to the bargaining table.

In addition to the convergence of these factors, unions have to comply with some of the most restrictive regulatory mechanisms in the developed world brought in progressively since the Thatcher governments of the 1980’s, the most recent being the Trade Union Act 2016. This latest set of restrictions on strike action requires a union to not only win a majority of its membership to vote in favour of a strike; but that turnout in the ballot must be at least 50%; and that for those workplaces deemed to be “important public services” in addition to a majority, and a 50% turnout, at least 40% of the whole membership (rather than just those voting) must vote in favour of a strike. This series of conditions, it has frequently been pointed out, could not be applied to the votes obtained to elect the majority of Members of Parliament.

In contrast to much of the public discourse on strikes which emphasises the inconvenience to which it sometimes puts members of the public (particularly in the case of public transport or schools), there has been a less visible campaign to restore union rights to make union negotiating power something closer  to the veto power wielded by employers. Much of the regulatory framework on industrial action is concerned with employer rights to legally challenge union ballots. In 2007 the, then backbench MP, John McDonnell attempted to challenge much of this in the (unsuccessful) Trade Union Rights and Freedom Bill 2007

Displacement of dissatisfaction

Turning now to the second factor. If strikes could be said to be low because they have been suppressed by regulatory constraints, then where does the conflict go? Here the ‘displacement’ argument goes that conflict is now directed into informal and individualised forms. The most visible form of individualised conflict can be observed in Employment Tribunal (ET) statistics. Introduced as an add-on to training legislation in 1964, the ET system has increased in significance as a semi-legal means for workers (often via unions) to seek an external means to challenge employer decisions on issues such as unfair dismissal and discrimination issues. ET claims have increased in inverse proportion to that of the declining strike rates. As such, ETs have also come under some scrutiny by Government.

Sadly, as with strikes, the solution to indicators of increased dissatisfaction has not been to seek out the causes of conflict, but to suppress the manifestation of it. So in 2013 the Conservatives ‘reformed’ the ET system by introducing up-front fees for claimants with the express intent of reducing the number of claims. This resulted in a dramatic fall in claims, particularly severe in cases of equal pay and discrimination. However, in 2017 upfront fees were deemed unlawful by the supreme court. The result was a similarly dramatic 90% rise in claims in 2018.

Other less formal indicators also support this ‘displacement’ theory. It is now regularly reported that the number of days lost to sickness absence far exceed days lost to strike action. Compare, for example, the days lost to strike action, above, to the 137.3 million days lost to sickness absence in 2016. Of course the breakdown of these sickness absence figures may be more revealing if it were possible. How much of it is genuine, but work-related? And how much may be ‘pulling a sickie’ by (disgruntled?) workers? Some of the overall figures are undoubtedly an indicator of conflict: industrial injury and work-related stress leading to an increase in mental health problems more broadly.

All in all, the reasons strikes are low, are at least partly due to the difficulty in meeting all the conditions needed to call a strike. Given that indicators of more individualist forms of conflict suggest a displacement of conflict, the lower levels of strike activity cannot be attributed to an increase in worker satisfaction.

A final thought

If there is a prevailing discourse suggesting that workplace conflict is a thing of the past, because strikes are a thing of the past – both assertions which we can now assert are inaccurate – how is this distorting how we see the activities of human resource management in practice? I have argued elsewhere that workplace conflict is an issue somewhat absent in national discourses of HRM, yet features much more prominently at organisation level. Aspiring HR professionals would do well to keep informed on what is going on in the field of employment relations, both professionally, through employment law updates provided by the likes of the CIPD, and academically, not least in such events hosted by BUIRA.

Plenary sessions at BUIRA 2018 will include a debate on strikes by John Kelly, Phil Taylor, Jo Grady, Rachel Cohen and Sean Wallis.

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Health & wellbeing

NMC Fitness to Practice: a radical change?

a mid adult doctor speaks with a colleague on the hospital ward ,with a young male nurse , patient , and relative in the background.

Roger Kline Middlesex UniversityIn this post Roger Kline, Research Fellow at Middlesex University Business School, examines a new consultation document from the Nursing and Midwifery Council, which includes long-overdue changes to the NMC’s Fitness to Practice processes.

On March 28th 2018 the Nursing and Midwifery Council agreed a public consultation document on Fitness to Practise that states there is a pressing need for further change to fitness to practise for the following reasons:

  • A growing body of evidence suggests that an unintended consequence of regulators’ current fitness to practise model is a culture of blame and denial. That runs contrary to the values of openness and learning that are central to a patient safety culture.
  • We know from our own research that black and minority ethnic nurses and midwives are more likely to be referred to us by employers. That disproportionality creates a perception of unfairness which, again, runs contrary to patient safety,” Paper NMC /18/33.

Step forward anyone who would have imagined this five years ago.

The regulators of UK healthcare professionals have been heavily criticised (including by me) in recent years. Those criticisms have included failing to get the balance right between blame and learning; an inability to hold employers and senior managers to account whilst drawing individual registrants into long and damaging processes which are not obviously in the interests of patients but are damaging to staff; not supporting whistleblowers who are referred to the NMC as punishment; not sufficiently taking account of the context (such as staffing shortages, or bullying) in which fitness to practice is questioned;  and failing to respond to patterns of the disproportionate referrals of black and ethnic minority registrants without questioning why patterns exist.

In some senses, the regulators have mirrored the failings of employers who themselves have too often focussed on individual blame rather than systemic failings, on individual lapses rather than the context which made shortcomings in practice likely. The pattern of disproportionate referrals of BME staff to regulators reflect the pattern of disproportionate disciplinary action against BME staff in the NHS.

Why a new strategy?

So what has led to this change?

Firstly, there is a growing understanding within healthcare that learning from mistakes and poor performance is rather more productive than finding scapegoats for what went wrong. Fifteen years ago An organisation with a memory emphasised the importance of understanding systemic shortcomings rather than individual errors. More recently the thinking of patient safety advocates such as Sidney Dekker and the relentless work of the Clinical Human Factors Group has been influential.

Secondly, is a growing understanding that how staff are treated is intimately linked to the care and safety provided to patients. Staff engagement, respect and compassion are good for staff and patient care and safety whilst bullying and discrimination are not just morally offensive but are unacceptable because they waste talent, damage staff health, increase turnover and absenteeism, and are linked to poorer and less safe care. In particular, strong correlation has been established between the treatment of Black and Ethnic Minority staff (one third of doctors and one fifth of nurses and midwives) and the treatment of (all) patients. This understanding has led to the NHS Workforce Race Equality Standard, and a strategy for leadership development that explicitly links this evidence to healthcare improvement.

Thirdly there is now an awareness that the previous (unevidenced) dominant HR paradigm of primarily relying on policies, procedures and training to enable individual staff to challenge bullying, discrimination or unfair treatment was unlikely to ever succeed.  Instead, the best employers are now emphasising the employer’s responsibility to proactively intervene, prevent (not just respond to) unfair treatment and to try to ensure staff are treated fairly.

Parallels with disciplinary action

There are important overlaps between these themes which can decisively help in reducing levels of bullying, tackling discrimination and reducing the scale of unnecessary disciplinary action in the NHS, and in particular the disproportionate impact of such action on BME staff.  Early evidence from a number of NHS trusts suggests, for example, that inserting some form of accountability prior to any disciplinary investigation being started would help shift the focus from blaming individuals to considering system failures that are the predominant causes of errors. Together with applying the science of “human factors” which focusses on system shortcomings not just individual failings might allow healthcare employers to follow the expectation of the courts that they stop their “knee jerk” use of disciplinary suspensions.

It is much more likely that BME staff will enter the disciplinary process, and research suggests a prime reason for this is the failure of managers, at the point at which when errors or poor performance occur, to have the same informal and honest conversations with BME staff that they should normally expect to have with white staff. A small but growing number of NHS Trusts have demonstrated that radical reductions in the levels of disciplinary action, and not only for BME staff, can be achieved in ways which also prompt learning, not blame.

The nursing regulator sees the light too

I know from discussions with the NMC that their new strategy is in part a response to these developments. It is also a response to research commissioned by the NMC in which Elizabeth West and colleagues confirmed the nature and scale of disproportionate referrals of BME staff from employers, but interestingly not from members of the public.

The paper approved by the NMC Council on March 28th rightly states that:

“We consider that effective and proportionate fitness to practise means putting patient safety first, and that an open, transparent and learning culture will best achieve this. We are not alone in thinking that a culture of blame and punishment is likely to encourage, cover-up, fear and disengagement.”

It goes on to explain that:

“To achieve these aims, we need to take a consistent and proportionate approach to fitness to practise. We also need to be fully transparent and accountable… We will need to deal with concerns when they are serious enough that we need to take regulatory action to ensure patient safety, or because they cannot be managed locally… In these types of cases we should take into account the context in which patient safety incidents occur and also enable registrants to remediate concerns at the earliest opportunity. Then we should only hold hearings where there are real areas of dispute to be resolved.”

New strategic principles

The proposed strategy sets out its two “desired regulatory outcomes” as:

  • “A professional culture that values equality, diversity and inclusion and prioritises openness and learning in the interests of patient safety.”
  • “Being fit to practise means that a registrant has the skills, knowledge, health and character to do their job safely and effectively.”

The consultation document sets out a number of (welcome) strategic principles which include:

  • “Fitness to practise is about managing the risk that a registrant poses to patients or members of the public in the future. It isn’t about punishing people for past events.”
  • “We will take account of the context in which the registrant was practising when deciding whether there is a risk to patient safety that requires us to take regulatory action.”
  • “We may not need to take regulatory action for a clinical mistake, even where there has been serious harm to a patient or service-user, if there is no longer a risk to patient safety and the registrant has been open about what went wrong and can demonstrate that they have learned from it.”

The paper argues there will always be instances where disciplinary action by employers and regulatory action by the NMC is appropriate:

  • “We will always take regulatory action when there is a risk to patient safety which is not being effectively managed by an employer.”
  • “Deliberately covering up when things go wrong seriously undermines patient safety and damages public trust in the professions. A registrant who does so should be removed from the register.”
  • “We will only take regulatory action to uphold public confidence if the regulatory concern is so serious that otherwise the public would be discouraged from using the services of registrants.”
  • “Some regulatory concerns, particularly if they raise fundamental concerns about the registrant’s professionalism, can’t be remedied and require removal from the register.”

A change of culture

The paper calls for “a professional culture that values equality, diversity and inclusion and prioritises openness and learning in the interests of patient safety” and explains that:

“When looking at harm, we need to differentiate carefully between accidental errors or failures in the system, and deliberate or reckless behaviour and those who conceal patient safety concerns… Maintaining public confidence in the professions doesn’t mean that we need to punish people when something goes wrong. Making a registrant go through a lengthy fitness to practise process just to punish them would be counterproductive, given that a blame culture undermines patient safety.”

The paper continues:

“Research also tells us that our current fitness to practise processes don’t contribute to a healthcare culture that values diversity, equality and inclusion. There is an overrepresentation of registrants from outside the EU and from black and minority ethnic (BME) backgrounds in fitness to practise proceedings, driven by disproportionate referrals from employers.”

This is not just an issue for nursing and midwifery registrants. The paper notes that:

“This is a concern in other parts of the regulatory sector. General Medical Council research found that BME and non-UK doctors are overrepresented in investigations, (General Medical Council: ‘The state of medical education and practice in the UK 2015’  (pp. 58- 83) ) while five years of General Dental Council hearings data reviewed by the British Dental Journal in 2009 showed that dentists trained outside the UK made up 42% of registrants charged (Singh et al ‘A five-year review of cases appearing before the General Dental Council’s Professional Conduct Committee’ British Dental Journal vol 206 no. 4 Feb 28 2009).

The PSA too

At its Board meeting the week previously the Professional Standards Authority (the regulator of professional regulators) finally moved in a similar direction by including a new draft Standard 3 on diversity, for consultation, which adds a new requirement that:

“The regulator understands the diversity of the registrant population and its service users and ensures that its processes do not impose inappropriate barriers or otherwise disadvantage people with protected characteristics”.

Reflection

This changed paradigm for the regulation of nurses and midwives is very welcome. However, setting out the new strategy is one thing, applying it may be another. To do so successfully will inevitably mean the NMC will need to:

  • Query why some employers have much higher levels of referrals than others and what the implications for a learning culture are
  • Ask some employers why BME nurses and midwives are being disproportionately referred. NMC investigation panels and staff will need to rethink how every referral is handled
  • Insist on greater diversity on panels and amongst senior staff at the NMC
  • Query employment practices within some employers which discriminate against some BME registrants (deliberately or otherwise)
  • As the strategy itself explains this will involve the NMC “holding full hearings only in exceptional circumstances”
  • Acknowledge the evidence that referrals can seriously damage the health of nurses and midwives most of whom are cleared eventually of any breach of the NMC Code.

There are elements of the report which need scrutiny, notably regarding transparency in those hearings that do still take place. But, in my view, this welcome consultation document signals that the NMC is now serious about adopting an evidenced approach which draws on human factors and the evidence of discrimination. At a time of immense pressures on front line staff and their managers it has never been needed more. The real test now is whether this change of direction in policy can be effectively translated into improved practice. For that to happen will requiring not only holding the NMC to account, but the leadership of nursing and midwifery throughout this land. Read it and decide for yourself.

Read the full consultation document ‘Ensuring patient safety, enabling professionalism’ on the NMC’s website

Roger Kline is Research Fellow at Middlesex University Business School. He was previously joint director of the NHS Workforce Race Equality Standard implementation team. He was co-author with Michael Preston Shoot of Professional Accountability in Social Care and Health: Challenging unacceptable practice and its management (Sage. 2012)

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Health & wellbeing Social commentary

Equality in the NHS: a work in progress

Portrait Of Female Nurse Wearing Scrubs In Hospital

Roger Kline is Research Fellow at Middlesex University Business School and was joint director of the NHS Workforce Race Equality Standard Implementation Team from its formation until September 2017. Roger is also the author of The Snowy White Peaks of the NHS (2014) that prompted the creation of the Standard.

The NHS Workforce Race Equality Standard (WRES) Data Analysis for 2016-17 records progress made in the world’s largest single current intervention intended to tackle workforce race equality.

Its publication comes weeks after the Civil Service adopted an approach to workforce race equality which draws on similar principles.

Both interventions are significantly different to most previous public sector interventions. There are some early signs that in the NHS the approach may be starting to work, albeit with much to do.

Portrait Of Female Nurse Wearing Scrubs In Hospital

First, the good news

For the third year running since the WRES was agreed in 2014, there was a significant increase in the number of black and minority ethnic (BME) nurses and midwives on more senior grades (Para 6.1.9). About half of all nurses and midwives are on Band 5, the entry Band, where the proportion of BME staff has been steady. However, the number of BME nurses and midwives joining Bands 6 and 7 in 2015-17 was double that of 2014; whilst for Band 8a the number of BME nurses and midwives joining trebled in 2015-17 compared to 2014, though improvement in the most senior grades was less marked. Almost 2000 more BME nurses and midwives have been appointed to more senior grades over this three year period than would have been the case if appointments had not markedly increased since 2014-15.

While the precise reasons for this improvement need further inquiry, the only significant driver since 2014 that might have impacted on the grading of BME staff was the WRES. There were no obvious demographic reasons to explain this change.

Secondly, while it remains 1.38 times more likely that BME staff will enter disciplinary investigations compared to white staff, this is a significant improvement on last year’s data which showed it was 1.56 times more likely they would do so. (Para 6.3.2). There is much more work to be done here, but innovative work is underway to level this particular field, some of which was summarised in Para 7.2.2 of last year’s report.

Thirdly, the 2017 analysis reports an increase in the number of Very Senior Managers (VSM) – above Band 9 – from BME backgrounds of 1.2%. This is welcome but for NHS trusts nationally, across the non-medical workforce (clinical and non-clinical), the proportion of BME staff in Bands 8a-9 and VSM was still only 10.4% compared with 16.3% in the workforce as a whole.

Finally, there is also a significant increase in the number of BME board members in Trusts but this increase is primarily amongst non-executive members, not employed executive Board members (Para 6.9.2).

Big challenges remain

Firstly, for BME staff the likelihood of being appointed from shortlisting has not improved at all (Para 6.2.2). It is still the case that white staff (across all grades) who have been shortlisted are 1.6 times more likely than BME staff to be appointed even once shortlisted, whereas the likelihood of white and BME staff being appointed should be the same. The scale of this challenge – a priority for the NHS – is shown by NHS staff survey data reporting that despite an improvement, it remains twice as likely that BME staff, compared to white staff, do not believe there are equal opportunities for career development and progression (Para 6.7.2).

Secondly, there is no significant improvement in the scale of bullying of BME staff, or on whether BME staff continue to report they are discriminated against (Para 6.8.2). The gap between the percentage of white and BME staff experiencing harassment, bullying or abuse from other colleagues in the last 12 months actually increased slightly (Para 6.2.2).

Finally, there remain marked differences between regions and types of Trusts. The London region remains significantly worse in its treatment of BME staff, something that is hard to understand given the self-evident importance of BME staff within London’s NHS. The ambulance sector remains an outlier on several indicators, though this is also the case for the treatment of white as well as BME staff.

An approach which is having an impact

Notwithstanding the scale of the challenge that still remains, the WRES is already having more impact than previous NHS interventions. What distinguishes the WRES from previous interventions in the NHS is that its approach is evidenced. It draws on three strands of evidence. The first was the Audit Commission report “The Road to Race Equality (2004) which I’ve discussed previously. The second was the impact of linking the Athena Swan Charter to access to NHS research funding. The third strand was partly summarised in a review of the wider international evidence on what works in equality, which emphasised mandation.

In light of this, the WRES was designed to:

  • be mandatory not voluntary
  • be subject to inspection linked to either sanctions or incentives
  • focus on measurable outcomes not just on improved processes
  • have a credible narrative, supported by leaders, that articulates diversity as a high institutional priority
  • place accountability at the centre of the development of specific initiatives to achieve these outcomes.

Such a question meant that clarity on what type of interventions might work became essential. The “shared characteristics” of effective interventions became a substantial part of the second WRES Data Analysis report on the 2016 data (April 2017) and sought to summarise the international evidence on “what works.” Seven key characteristics were identified:

  • Acknowledge the challenge – avoid the temptation to “ascribe more weight to positive information about the service than to information capable of implying cause for concern” (Francis 2013);
  • See workforce equality as integral to service improvement not just compliance – as an integral part of providing better services and improving staff well-being, not as a separate discrete task;
  • Insist on detailed scrutiny of data from Employee Staff Records and national staff survey data to identify the specific challenges that Trusts as a whole, or individual departments or services or occupations may have on race equality against the Standard. Accept that while data can identify patterns and hotspots of good and poor practice – root cause analysis may well be needed to understand it;
  • Ensure that the narrative underpinning strategy is specific to each organisation and work to ensure it is understood not just by Boards but by managers and front line staff;
  • Learn from previous failed approaches which relied on policies, procedures and training which will not work in isolation while relying on individual members of staff to challenge discrimination. Methodological individualism, which relied on individual members of staff raising concerns, complaints or grievances was not a strategy that was ever going to be effective. Leadership meant organisations must take prime responsibility, for example, for talent management and career development and be proactive in developing staff and challenging discrimination, in a radical break with the culture of allowing panels to appoint “people like us” or those who might  “best fit in”;
  • Specific interventions must be evidence driven and able to answer the question “why do you think this will work?” since unless that question can be answered replication is hit and miss;
  • Above all, accept that accountability is crucial. Unless leaders model the behaviours expected of others and face uncomfortable truths, and insist on evidenced interventions with locally developed targets, the best intentions will not bring about change.

Research and interviews with private sector organisations undertaken in 2016 confirmed such principles had some likelihood of success.

In the foothills of the Snowy White Peaks

The NHS is England’s largest employer of black and minority ethnic staff – 37 per cent of doctors, 20 per cent of nurses and 17 per cent of all directly employed staff are from black and minority ethnic (BME) backgrounds. Research has consistently shown the NHS treats black and minority ethnic (BME) staff less favourably than white staff not only in recruitment, promotion, career progression and discipline but also in referrals to professional regulators. BME staff are also more likely to be bullied at work and treated less well when they raise concerns. NHS Boards at every level, and in both executive and non-executive positions, are disproportionately white and often unrepresentative of the local populations served by NHS Trusts. The large scale NHS national staff survey (340,000 responses) suggests the perceptions of BME staff are well grounded.

If the approach taken through the WRES in 2015-2017 is sustained there can be some confidence in further improvement. It would have been good to have had an updated version of the section in the April 2017 data analysis report which set out at length the “shared characteristics” of effective interventions, since without such work there will always be a risk that work to improve workforce race equality can drift into an emphasis on good intentions and “cultural change” rather than practical support for interventions that work.

We are still in the foothills of the “Snowy White Peaks of the NHS” but this report suggests the original WRES architecture was sound and that sustained improvement is possible, even though there is still a very long way to go.

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Health & wellbeing

Rethinking disciplinary action in the NHS

Doctor With Stethoscope And Files

Roger Kline Middlesex UniversityRoger Kline is Research Fellow in the Business School at Middlesex University, and was joint Director of NHS Workforce race equality Standard implementation team until last month. Here, he outlines the cost of disciplinary investigations and puts forward a case for more learning and less blame when mistakes are made.

No one knows how much NHS time and energy is wasted on unnecessary disciplinary investigations, suspensions, hearings, and appeals, but it is a lot. When the National Audit office took a look at one small aspect of the cost in 2003, they found 1,000 clinical staff suspensions averaging 47 weeks for doctors and 19 weeks for other clinical staff at a cost of £40 million in just one year.

The total cost of unnecessary disciplinary investigations, suspensions, hearings, and appeals for all staff groups are included, and is many times higher today, especially when supplemented by unnecessary referrals to professional regulators and the additional cost of related sickness absence, staff cover, early retirement and turnover.

In too many organisations moving to a formal investigation has become the default position without there being proper consideration as to whether that is necessary.

The biggest cost of all is the impact on patient care. Unnecessary disciplinary investigations and hearings risk creating an environment where the response to a mistake or sub-standard behaviour is not “how do we prevent it happening again” but “who is to blame.” The steep authority gradients in much of the NHS as a whole, and within individual occupations, exacerbate the problem. As Mary Rowe explained nearly two decades ago, when “the organisational culture is too hierarchical and oriented towards punishment (it) may inhibit willingness to act or come forward.” An environment of blame is toxic for patient care and safety.

None of this means that there will never be a need for NHS disciplinary investigations or indeed suspensions or sanctions. But in too many organisations moving to a formal investigation has become the default position without there being proper consideration as to whether that is necessary.

There is very significant variation between NHS Trusts as to the likelihood of staff being disciplined or suspended. We know it is several times more likely that staff will enter disciplinary investigations in some trusts compared to others. We also know from the NHS Workforce Race Equality Standard 2016 Data Analysis Report for NHS Trust that disciplinary action is much more likely for staff from a Black and Minority Ethnic (BME) staff background. Yet there is no evidence that greater levels of disciplinary investigation and action in healthcare lead to improved care.

So what can be done to get the balance right?

Surgeon stock image

Moving from blame to learning

Eighteen months ago I asked “Can a simple patient safety tool help the NHS end its ‘blame culture’?”

I suggested that it was time to refresh the almost forgotten NHS Incident Decision Treeand combine the research evidence about the reasons for the disproportionate disciplining of BME staff in the NHS to create a new approach to tackling disciplinary action which would benefit all staff, organisations and patients.

The Incident Decision Tree was a by-product of Liam Donaldson’s landmark 2003 report ‘An organisation with a memory‘ It was a simple but sophisticated means of asking a series of structured questions about an individual involved in a patient safety incident with a view to deciding if suspension was appropriate.  The Incident Decision Tree uses very simple algorithm, to ask four sequential ‘tests’ when a patient safety incident occurred:

  1. Did the member of staff intend to cause harm?
  2. Did ill health or substance abuse cause or contribute to the patient safety incident?
  3. Were protocols and safe working practices adhered to?
  4. If protocols were not in place or were ineffective, how would someone from the same area of activity and possessing comparable qualifications and experience have been likely to deal with the situation?

The NPSA guidance then addressed the issue of whether to suspend staff when something goes wrong:

“We know from research carried out in the NHS and in other industries that systems failures are often the root cause of safety incidents. Despite this, where a serious patient safety incident occurs in the NHS, the most common response is to formally suspend the staff involved from duty and then deal with them according to disciplinary procedures. This route can be unfair to employees and divert managers from identifying contributory systems failures. Suspension of key employees can also diminish trusts‘ ability to provide high-quality patient care.”

Disproportionate disciplining of BME staff

In researching the causes of disproportionate disciplinary action in the NHS against BME staff, Archibong and Darr (2010) found in their report NHS Employers that

“….line managers found it difficult to deal with issues relating to disciplinaries and there were often inconsistencies in the application of disciplinary policies. It was acknowledged that the informal stage of the disciplinary process was critical in sorting out minor issues and that some managers were hindered in this process by a lack of confidence in applying informal strategies with BME staff. It was perceived that managers were more likely to discipline BME staff over insignificant matters and that disciplinary concerns involving staff from minority ethnic backgrounds were not always considered to have been dealt with fairly and equitably by human resources managers.”

“It was agreed that performance issues were not addressed in a timely fashion, often with a lack of effective feedback, performance appraisal, support and monitoring of progress with regard to BME staff. There was also a sense that line managers were incorrectly using a disciplinary policy to address performance issues. Part of the problem, it was perceived, stemmed from some managers not being equipped with the relevant skills and knowledge to be able to manage a diverse workforce and to deal effectively with conflict situations.”

Archibong and Darr highlighted the difficulty some managers had in conducting the same informal conversations with BME staff that they would have with white staff about their conduct, standard of work or mistakes. Some trusts have carried out root cause analyses of the differential treatment and have confirmed this is a significant problem. Some individual NHS trusts, in response to such evidence, have introduced a form of accountability which requires local managers to demonstrate that commencing a disciplinary investigation is really the appropriate step to take (for all cases not just those of BME staff).

How this is done varies between organisations, but all use what the HR Director for Barts Health calls a “triage” system to determine whether a proposed disciplinary investigation is really necessary or inappropriate. Increasingly those questions have been formalised into a checklist which combines Incident Decision Tree principles with what the research suggests is the particular challenge around BME disciplinary cases. I summarised this approach in the “what works” section (pp 110-143) of this year’s NHS workforce Race Equality Standard 2016 Data Analysis Report for NHS Trusts.

Once a disciplinary investigation commences, it is very distressing for the member of staff concerned even if they are cleared of any allegation.

There are other initiatives which can be helpful in removing the need for disciplinary investigations when the real problem is inadequate induction, supervision or support, especially for newly recruited nurses or staff trained overseas.

Finding fault

Once a disciplinary investigation commences, it is very distressing for the member of staff concerned even if they are cleared of any allegation; it is very time consuming for managers and HR; it can be demoralising for colleagues if they think the processes are unfair; and can run the risk of reinforcing blame, not a learning culture.  Investigations can easily lead to “tunnel vision”, where the determination to find fault will inevitably eventually unearth some shortcoming, as it would with any member of staff.

What the NHS organisations adopting this different approach have in common is

  • a determination to avoid, wherever possible, suspension and disciplinary action unless absolutely necessary and to prioritise learning how to prevent future shortcomings rather than individual blame
  • an acknowledgement that excessive disciplinary action may be taking place in respect of staff from all backgrounds and especially, unwittingly or otherwise, from BME backgrounds
  • accountability of decision makers, using data to check if change is underway
  • an emphasis on ensuring that, within induction, new staff (whatever their origins but especially if trained overseas) understand the trust values and are given support over time
  • early intervention by trained and committed senior staff to distinguish between blame and accountability is important, using a decision tree type approach.

NHS disciplinary processes do generally state their purpose is primarily to help improve the practice or behaviour of NHS staff, not to punish them. In practice this is not always the case. Too often the disciplinary process itself (including suspension) is an act of punishment whose focus and outcome is often not on learning and improvement, and which instead obscures systemic organisational failings in the name of holding individual staff to account. Disciplinary processes often confuse “accountability” and “blame”.

This different approach will not prevent the need, sometimes, for disciplinary investigations and sanctions. But early results suggest the use of a “triage” or “filter” to prompt reflection and challenge prior to any disciplinary investigation starting can make a very significant improvement to the prevailing practices in large parts of the NHS, to the benefit of staff, patient care and safety, and the organisation itself.

Categories
Business & economics

A suitable case for treatment

Newborn little hand hold by adult hand

Roger Kline Middlesex UniversityRoger Kline, Research Fellow in the Business School and Joint Director of the NHS Workforce Race Equality Standard Implementation team, welcomes a new report into the relationship between ethnicity and disciplinary referrals in the NHS.

At last a good report that shines a light on the disproportionate referrals of black and minority ethnic (BME) nurses and midwives to the Nursing and Midwifery Council (NMC). Elizabeth West and colleagues have done the NHS a favour.

Why is this report so important? One in five of all registered nurses and midwives working in the NHS are from BME backgrounds. Udy Archibong and colleagues reported in 2010 that BME staff in the NHS are twice as likely to enter the disciplinary processes than their white colleagues.

Alongside detailed work by NHS London in 2014, the Royal College of Midwives in 2012 and 2016 indicated that 60.2 per cent of the midwives who were subject to disciplinary proceedings in London were black/black British, however only 32 per cent of midwives in London were black/black British i.e. they were more than three times more likely to be disciplined. They were also more likely to receive higher impact decisions (dismissal and suspension) and less likely to have no further action taken.

Newborn little hand hold by adult hand

 

Concerns

Nursing Standard’s survey of 2014 found that although BME nurses make up 19 per cent of the nursing workforce in England they make up 25 per cent of disciplinary cases and they were more likely than white nurses to be reported to the NMC (Spinks, J. Nursing Standard 28(22), 14-15).

The NMC has had such concerns raised for a number of years. Two years ago the NMC finally agreed to take a serious look at the issue. At the time it was strongly argued by the stakeholder group of professional bodies and unions they convened that the primary focus of research should be the pattern of disproportionate referrals by employers rather than (or at least as well as) the internal NMC processes i.e. why BME nurses and midwives were disproportionately entering the ‘Fitness to Practice’ (FtP) process, not just what happened once they were referred.

This is perhaps the most stunning of the finds

The resulting report by Elizabeth West, Shoba Nayar and Taina Taskila of the University of Greenwich is nevertheless a good one and captures some of that concern too. Their report on ‘The Progress and Outcomes of Black and Minority Ethnic (BME) Nurses and Midwives through the Nursing and Midwifery Council’s Fitness to Practise Process’ confirms what previous surveys and anecdotal reporting have found.

In summary, West and her colleagues’ findings include:

  1. “Ethnicity is related to the risk of referral to the NMC. Black nurses and midwives as well as those of unknown ethnicity are disproportionately represented in the population of referrals to the NMC. Having qualified in Africa, as opposed to other continents, is also a risk factor for referral.”
  2. “There are many sources of referral to the NMC but the most common are employers and members of the public. BME nurses and midwives are disproportionately represented in referrals by employers, whereas white nurses and midwives are disproportionately represented in referrals by members of the public. Source of referral is extremely consequential in terms of progress and outcomes of the FtP process.” This is perhaps the most stunning of the finds.
  3. “Ethnicity is also related to progression through the FtP process. Cases brought against nurses and midwives of white, other or unknown ethnicities are more likely to be closed at screening than are cases brought against Asian or black nurses and midwives whose cases are more likely to be closed at the investigation stage.”
  4. “Region of training is also related to progression through the FtP process. Having trained outside the UK increases the likelihood of the case going to investigation and having trained in Asia or Africa increases the risk of the case going to adjudication.”
  5. “There is a significant relationship between ethnicity and gender with more BME male nurses and midwives being referred to the NMC than would be expected. Male nurses and midwives may experience a double disadvantage in that they are a minority in society by virtue of their ethnicity and a minority in the profession by virtue of their gender. The observed number of females referred to the NMC is less than the expected number for each ethnic group.”
  6. “Referrals by employers in which BME nurses and midwives are over-represented are unlikely to be closed at screening and most likely to be closed at investigation. A significant number of employer referrals go on to adjudication which contributes to the increased likelihood of BME nurses and midwives going all the way to the last stage of the FtP process.”
  7. “The final stage of the FtP process results in a decision about whether or not the individual can continue to work as a nurse or midwife. All ethnicities, with the exception of those whose ethnicity is not known to the NMC, are likely to be allowed to continue to work. White nurses and midwives are more likely to be barred from working than are black or Asian nurses and midwives.”
  8. “Employers are more likely to refer BME nurses and midwives and referrals to the NMC that come from employers are more likely to progress to the final stage. However, at adjudication, BME nurses are the least likely to receive a penalty that prohibits them from working. This suggests that the FtP process does not discriminate against BME nurses, but that there is some evidence of discrimination in terms of the disproportionate number of referrals by employers.”

All senior nurses should read those findings carefully and reflect on what they mean, not least for BME staff who may have suffered career-ending referral for no good reason.

Photo by Benjamin Ellis - Creative Commons 2.0
A London ambulance responds to a 999 call – Photo by benjaminellis.org/photography (Creative Commons 2.0)

Recommendations

West’s findings have considerable overlap with those of Archibong et al (2010) on NHS disciplinary processes. That is reflected in their recommendations which include (verbatim):

  • “The urgent need to gather accurate data on ethnicity, characteristics of the job, such as area of practice and level of seniority, and type of allegation (which may change through the FtP process).”
  • “Training for staff, managers and university students in areas such as unconscious bias is also recommended.”
  • “Further research could also illuminate the relationship between the difficulties that BME and IRN nurses and midwives experience at work and referrals to the NMC.”
  • “More comprehensive induction programmes for new BME staff, especially internationally recruited nurses (IRNs).”
  • “The literature evidenced that issues of racism and discrimination are prevalent throughout the NHS. Addressing discrimination requires a change in workplace culture and this can only be effective if led by management. It may be that managers are unsure of how best to support BME staff or what processes to follow if an employee raises a complaint against a BME colleague. Thus training to help staff understand the difference between performance management and disciplinary issues is necessary. The quantitative analysis described in this report has shown that employers are the most common source of referrals to the NMC and that ethnicity seems to be a factor in the referral process.”
  • “There is an identified need for regular equality and diversity training sessions, including the concept of unconscious bias, for staff members as a way to remind those making decisions of their responsibilities in relation to the requirement of race relations legislation.”

Apart from the misplaced enthusiasm for diversity training and unconscious bias training, these recommendations are good as is the wider report. The report’s publication is a sign of progress from the NMC. There is, however, a serious risk that the report will gather dust unless the issue of disproportionate referrals by employers is addressed.

The NMC will be judged by whether, finally, and expeditiously, it helps that process

The NMC has statutory duties under section 149 of the Equality Act 2010 which requires it to have due regard to eliminate unlawful discrimination, harassment and victimisation. The NMC Equality and Diversity report for 2015-16, paragraph 23 states: “We will be receiving and taking stock of our research into BME registrants referred to fitness to practise, and the findings are likely to prompt actions from the NMC and potentially, for others. We will also work with other bodies in the health environment to influence change that will lead to fairer and non-discriminatory outcomes for BME nurses and midwives.”

It assures readers that the NMC will:

  • “Use our influence to promote wider improvements in equality, diversity and inclusion practice” (Para 37.4) and;
  • “Build the trust of service users, registrants and others that share protected characteristics by showing understanding of their needs and preferences and challenging discrimination where evidence comes to our attention” (Para 37.5).

Tackling disproportionate disciplinary action against BME staff and the disproportionate referrals of BME staff by employers requires an expeditious system-wide initiative as well as a robust look by the NMC at its own systems.

The NMC will be judged by whether, finally, and expeditiously, it helps that process and in particular whether it acts to stop the (now evidenced again) pattern of inappropriate employer referrals of BME registrants.

Categories
Business & economics

Is a robot after your job?

Robots - Photo by Salford Institute for Dementia (CC BY SA 2.0)
"The ‘full automation’ and post-capitalist schools of thought assume an ever-increasing thirst for new digital technology and a limitless supply of the necessary hardware and software."

In this extremely topical blog, Martin Upchurch, Professor of International Employment Relations at Middlesex University, discusses digitalisation and robotics in the new workplace.

Earlier this month MEPs in the European Parliament debated a call for comprehensive rules for how humans will interact with artificial intelligence (AI) and robots. The fear expressed by the politicians is that advances in AI could elevate robots to the status of an electronic ‘person’ with rights and privileges in law. It is surprising that such a prospect has taken so long to enter public discourse as ever since the birth of the computer seventy years ago commentators have been writing on the prospects of technological singularity – the point at which intelligence would become ‘non-biological’, and creativity would be unbounded by human limitations. Machines would dominate production through processes of self-improvement, re-writing their own software to outstrip the functional capabilities of the human brain.

The scenario of singularity signals a complete collapse of human employment.  Researchers at Oxford University have already calculated that almost half of all jobs in the US are at risk from new forms of automation in the coming decades, while journalist Paul Mason has written a best seller on the nirvana of a new ‘post-capitalist’ society. While most routine jobs would disappear, the destruction would also overlap into professional work. Doctors may be replaced by smart phone apps. that diagnose a patient’s symptoms and robots that perform operations. The collection of big data and its processing by algorithms (machine learning) may also enable correlations of behaviour, genetic disposition, or symptoms to predict a person’s health. Even IT specialists would not be safe, as much of the ‘knowledge’ which enables them to hold down employment may be transferred to a central cloud computer accessible by all from any location.

The restraints of limited mobility and flexibility of robotic ‘arms’ have been eased by new technologies which enable a humanoid robot to grip and to turn with less pre-programming. Advances in algorithmic programming utilise the principles of neural networks that enable AI to discriminate, to ‘remember’ past decisions and to make finer judgements. In the early days of development such ‘thinking’ was measured by the degree to which the robot or computer passed the ‘Turing Test’ (after the celebrated British computer scientist Alan Turing). The test is based on the proposition that a machine would be able to think if it could hold a conversation that was indistinguishable from one with a human being.

FIRST Dallas Regional 2015 - Photo by Greg Heartsfield (CC BY-SA 2.0)
The International Federation of Robotics estimates that there were 1.5 million robots in operation worldwide in 2014.

Image recognition technology has improved, as well as text to speech (and vice versa). Robots can now be programmed remotely from the cloud computer, an advance that is equivalent to the launch of the first ‘free standing’ Progamma101 personal desk top computer by the Italian firm Olivetti in 1965. Combined with the falling cost of robots in the product market it is not surprising that their numbers are on the rise. The International Federation of Robotics estimates that there were 1.5 million robots in operation worldwide in 2014. China now absorbs an increasing proportion of the total, spurred by rising labour costs and shortages with a falling ‘payback’ period for investment of 1.5 years. But we should not get carried away with the rise of the robots, while their numbers may well rise to over 2 million, this compares with a worldwide workforce of 3 billion. In the country with the highest density of robots (South Korea) there are still less than 500 for every 10,000 workers.

The false dawn of singularity?

If we adopt a socio-technical approach to examining AI and robots we may see that claims of total singularity may well prove to be a false dawn. For more complex tasks, robots still need to be minded by humans lest they break down or miscalculate precision movements. Efforts by a leading robotics manufacturer to create an affordable ‘plug and play’ robot capable of mimicking human movement for widespread use in industry also appear to have stalled.

A simple way of understanding the problem is to imagine a robot attempting to catch a tennis ball in flight. Not only the speed and angle of flight need to be finely calculated in a split second, but also the weight of the tennis ball (which a human would have remembered from previous experience) will determine how hard the robot needs to grip the ball once caught to avoid the ball bouncing back out of the hand. Such a seemingly simple task for a human is a logistical nightmare for a robot. Mercedes-Benz, which is a lead player in developing autonomous cars, has now begun replacing its robots with humans in its factories due to this very lack of flexibility in the robotic machine.

Moves are now afoot to develop ‘cobots’ which operate side-by-side with humans to enable flexibility and creativity to flourish. While algorithms might replicate past human behaviour in robotic form they are a long way off from ‘consciousness’ and the ability to ‘think’ at the level of a human. Returning to the ‘Turing Test’ the ability of robots to ‘think’ as humans do is only a remote possibility. Turing also identified a ‘halting problem’ whereby a computer using AI may never ‘know’ when it is ‘right’, and so will continue to compute. The algorithms they feed from remain subject to human input in programming and coding and repeat the mistakes and false assumptions that humans may have made in the past, but may consciously check against in the present. So, for example, the algorithm-fed robot Beauty.AI only chose women of light skin when asked to judge an international ‘beauty contest’, suggesting an unconscious (or even conscious) racist agenda among those humans creating the algorithm.

Robots in the workplace - Photo by Ben Hussman (CC BY-SA 2.0)
Moves are now afoot to develop ‘cobots’ which operate side-by-side with humans to enable flexibility and creativity to flourish.

A further obstacle we need to address is that of economics and the related political implications of choices made by employers. Computers are a relatively small proportion of capital stock, and  investment in computers has been declining since the height of the ‘IT Revolution’ of the 1990s. The overall impact on productivity, growth and jobs appears less dramatic than might otherwise be assumed. Evidence published in 2015 by Michaels and Graetz from a dataset of companies in 17 countries gathered between 1993 and 2007, suggests that while productivity increases with robotic innovation and some semi-skilled and lower skilled jobs are abandoned, “there is some evidence of diminishing marginal returns to robot use – ‘congestion effects’ -so they are not a panacea for growth……this makes robots’ contribution to the aggregate economy roughly on a par with previous important technologies, such as the railroads in the nineteenth century and the US highways in the twentieth century.” Neither do robots do away with the contradictions within capitalist accumulation. This is because as capital-bias and labour shedding takes place proportionately less new value is created (as labour is the only source of new value) relative to the cost of invested capital, added to which, as the economist Michael Roberts reminds us, worker resistance to the dystopia of permanent joblessness would surely ensure that the road to ‘full automation’ if it is ever constructed, would be a very rocky one.

Indeed, the ‘full automation’ and post-capitalist schools of thought assume an ever-increasing thirst for new digital technology and a limitless supply of the necessary hardware and software. Yet these assumptions also need to be questioned.  Predictions of the coming of singularity have been based on extrapolations from co-founder of Intel Gordon Moore’s ‘law’, by which the number of transistors that can be inserted into a computer doubles every two years, both lowering the cost and vastly increasing computing power. However, this depends on a finite supply of rare earth metals, and Moore has himself acknowledged that there will also be a physical limit to how many transistors you can squeeze into an integrated circuit. As reported by the OECD in 2016 “…the introduction of new technologies is a slow process due to economic, legal and societal hurdles, so that technological substitution often does not take place as expected”. For example, the development of autonomous or driverless cars is subject to regulatory concerns over insurance liability, which will act to slow down or even impede development.

Robots - Photo by Salford Institute for Dementia (CC BY SA 2.0)
“The ‘full automation’ and post-capitalist schools of thought assume an ever-increasing thirst for new digital technology and a limitless supply of the necessary hardware and software.”

A sober analysis of the economics of singularity has been undertaken by William Nordhaus at Yale University. Using econometric methodology on both the supply and demand side for digital technologies and AI he attempts to predict when singularity might occur. He argues that two ‘accelerationist’ mechanisms could develop, either from accelerating supply or from accelerating demand, and then applies a series of time-linked tests to both hypothetical scenarios, focusing on the key input variables such as wages, productivity growth, prices, intellectual property products and R&D. Five of his seven tests for the likelihood of singularity proved negative (including that for ‘accelerating productivity growth’ and ‘rising wage growth’)  while the two that proved positive (including a ‘rising share of capital’) indicated that singularity, if it did occur, would be at least 100 years away. And as previously positioned, a rising share of capital may simultaneously lead not only to decreasing rates of productivity growth, but also trigger a crisis of profitability in the longer term.

We might suspect that the coming of singularity may falter, be delayed, or never happen because of the economic, social and political factors that stretch beyond the technology itself.  Despite these limitations, the prospects of Irving John Good’s 1965 musings of a ‘last Ultraintelligent’ machine ever being constructed, which will “surpass all the intellectual activities of any man however clever … (so that) the intelligence of man would be left far behind”, will no doubt continue to fascinate many. The dream of singularity would, however, be faced with a simultaneous collapse of the underlying dynamic of capitalism. The only surviving ‘human’ industrial sectors might be defence and space exploration, to guard against terrorist or foreign hostile cyber attack, and against attack on humans by the super intelligent machine!

Categories
Business & economics

Race equality remains a major policy challenge

Black businesswoman looking at paperwork in folder

Roger Kline Middlesex UniversityResearch Fellow Roger Kline, Joint Director of the NHS Workforce Race Equality Standard Implementation team, highlights an archived report that helps us understand recent evidence that race discrimination is still a widespread issue in UK employment.

The last few weeks of 2016 saw a stream of evidence that race discrimination in UK employment remains a major policy challenge. Whether in specific sectors such as engineering or for specific communities or on specific issues such as access to senior positions almost two decades on from the 1999 MacPherson Report on institutional racism, evidence of improvement in employment is sporadic.

In our work to implement the NHS Workforce Race Equality Standard in the UK’s biggest employer (and biggest employer of BME staff), two documents were particularly influential. Promoting equality for ethnic minority NHS staff – what works  was a literature search led by Harvard colleagues with ourselves, whilst the 2004 Audit Commission report, The Journey to Race Equality was a reminder of lessons learnt (and then lost) a decade ago, since when the Audit Commission itself has been abolished.

Black businesswoman looking at paperwork in folder
Race discrimination in UK employment remains a major policy challenge

Ahead of the forthcoming Government response to the MacGregor Smith Review on the obstacles BME people face in the labour market, both documents are a reminder that without a coherent narrative, focused leadership and real accountability, good intentions on race equality in employment are simply not enough.

The Audit Commission report had three starting points:

  • Race inequality is visible and stark, yet local agencies find it difficult to identify race equality outcomes. Much activity is focused on policy and process, without a clear vision of the end result.
  • Race equality is critical to delivering good-quality public services and better quality of life for everyone
  • The Race Relations (Amendment) Act 2000 requires public services to identify where inequality exists and address it in a systematic and coherent way and have a positive duty to promote race equality

Many of its findings are as relevant today as they were then. Government policy makers giving speeches about public sector race equality might usefully want to consider why the framework it established was allowed to wither on the vine – and the Audit Commission with it. Its main points are well worth summarising.

  1. Difficult conversations.

“people can feel uncomfortable about discussing race equality openly and …..consequently, race equality is often viewed as a negative issue consisting of multiple ‘problems’ that are the direct result of overtly racist attitudes and behaviours. People who have different needs and aspirations are viewed as a problem rather than a resource, creating ‘extra’ work, additional to mainstream business.” (Para 9-11)

  1. Addressing the specific local issues

“Although the significant areas of discrimination are known, many local agencies still struggle to be specific about what race equality means locally” (Para 32)

  1. A focus on process rather than outcomes

“Local agencies say that race equality is an important part of improving services. However, many are unclear about what they are trying to achieve, and are focusing on compliance with the requirements of the Act” (CRE: Towards Racial Equality, An Evaluation of the Public Duty to Promote Race Equality and Good Race Relations in England and Wales (2002))

“We found that progress is often measured in terms of process, rather than the delivery of outcomes that will impact upon quality of life. Although many local agencies are feeling confident, this is based on a low level of ambition to really deliver outcome change.” (Para 41-43)

  1. “Achieving organisations”

The report sets out a five stage improvement journey, still useful today:

  • Resisting
  • Intending
  • Starting
  • Developing
  • Achieving

Achieving organisations:

  • “have a clear vision for where they are trying to get to and have set out and prioritised improvements to specific local outcomes. Achievement is recognised by peers and information and advice is regularly sought
  • are highly motivated and driven to improve their performance, using national agendas to help them deliver local race equality outcomes.”
  1. Key challenges

The report summarises several flawed assumptions (they feel very familiar a decade later) that prevent progress:

  • “addressing race equality explicitly will inevitably result in a ‘backlash’ from the white community as some groups are perceived to be receiving more favourable treatment than others;
  • race equality has little significance because of the small black and minority ethnic population being served;
  • there are rules about what language to use;
  • the organisation has a ‘colour-blind’ approach that it believes ensures equal treatment. Information to confirm or deny this is not sought, perpetuating the belief that there are no issues”.

The report usefully reminds us that public services have a duty to respond in a way that is proportionate to the level of need, rather than to the size of the population.

  1. Confusion about mainstreaming

The report warns of the risk that having specialist equality advisers can mean leaders may regard race equality as separate and unrelated to their job – they will leave race equality work to someone else; they also warn about thinking that once integrated into existing systems and processes race equality is no longer an issue that needs to be tracked and monitored.

 “It should not be an ‘either/or’. It is also crucial to remain vigilant, even when race equality has been mainstreamed overall, checking that unequal outcomes continue to be tackled”

  1. Leadership

Delivering race equality “requires a strategic, systematic and coherent approach led from the top. Visible and committed leadership from officers, members and non-executive directors is critical to getting started and sustaining progress”.

“Those at the resisting and intending stage of the journey (see above Para 4) must focus on developing a robust rationale, describing why race equality matters locally and how it benefits everyone. Those that are starting must create a vision for where they want to be that is shared with black and minority ethnic groups and the wider community. Those who are developing must concentrate on increasing their capacity and working with partners. Those who are achieving must ensure that they keep on track by managing their performance. This needs to be underpinned by visible and committed leadership from officers, members and non-executive directors at all stages of the journey.”

These factors were identified as being similar to those the (now abolished) Commission for Racial Equality had already identified as being fundamental to any successful change management (CRE. Equality and Diversity: commitment, involving users, mainstreaming equality and diversity, monitoring performance data and sustainability) and previous Audit Commission research (Audit Commission, Change Here! Managing Change to Improve Local Services, 2001). Paras 71-73

  1. Culture and rationale

The report lists four key factors which helped to create a more open and honest learning culture by:

  • being clear about why race equality matters and how it benefits the wider community;
  • creating an open environment by providing opportunities for ‘safe’ discussions and being clear about (and enforcing) appropriate behaviours and competencies;
  • drawing on black and minority ethnic staff as a valuable source of information and knowledge
  • recognising and rewarding improved performance in race equality (Para 80)
  1. Managing performance

The reports stressed the importance of accountability – a key theme emerging from our own literature review a decade later.

“It means being clear about who is accountable for each part of the work and measuring progress. ……Those who are making good progress have gone one step further by integrating the management of race equality within existing performance systems and indicators. This is another way of reinforcing the message that race equality is everyone’s business. Key breakthroughs for managing performance in race equality are:

  • using existing business planning and performance management systems;
  • setting targets and allocating responsibilities in the action plan, monitoring it regularly; and
  • ensuring that race equality work is integrated with other activities and remains visible. (Para 93)

Interestingly, for our own work in health, the Audit Commission found in 2004 that

“Overall, health organisations have made less progress than the other sectors we looked at. This echoes the CRE’s evaluation (Ref. 16) The CRE acknowledged that this may partly reflect the recent NHS organisational changes. Health staff told us that they often struggled to balance achieving national targets with achieving race equality. This is frequently underpinned by a poor understanding of how delivering race equality can improve services overall.” (Para 98)

The failure of the subsequent Government initiative as summarised by The Snowy White Peaks of the NHS led to a radical rethink about what works.

  1. A role for national agencies

Part of that rethink was to reinstate the importance of national bodies in driving equality. In the NHS it led to improvement on workforce race equality being a contractual requirement on healthcare providers and a focus of CQC inspections of the quality of care – and to a sustained effort to identify and share “what works” – and perhaps just as importantly what doesn’t.

The Audit Commission noted:

“Achieving race equality is a complex activity and there is little robust knowledge about what works where. Commission research has shown that in these circumstances an explicit national aspiration can help to encourage experimentation, learning and local comparisons (Audit Commission, Targets in the Public Sector, Audit Commission 2003.) 100

Many organisations have made positive first steps, helped by the legislation. It may now be appropriate to build on this further by setting a broad, national aspiration to achieve race equality within a specific timeframe, supported by a few explicit national targets to set clear expectations”.(Para 99)

The report went on to recommend that

“Regulators must explicitly assess whether the needs of black and minority ethnic communities are being adequately addressed and, in partnership with the CRE, take action where this is found not to be the case. The CRE itself is preparing to take a tougher approach to enforcement, particularly where organisations are in wilful non-compliance with the Act.”

The Audit Commission set itself the task of:

  • “assessing the risk of non-compliance with the Act as part of the national risk assessment framework for health, local government and criminal justice sectors;
  • a set of equalities indicators for voluntary use by local authorities, developed by the Library of Local Performance Indicators, a joint project of the Audit Commission and IDeA;
  • developing an improvement tool to support local agencies’ progress towards race equality, based on the framework outlined in this report;
  • integrating equality and diversity into local government inspection methodologies, including the CPA. This will help to make the case for using existing resources to deliver race equality objectives, requiring organisations to demonstrate how equality and diversity is integrated into overall organisational priorities. It will also ensure that organisations cannot receive higher performance ratings if they are failing to deliver on race equality” (Para 109) (emphasis added).

Much of that architecture was dismantled with a change of government in 2010. The necessary and sufficient conditions for sustainable progress on race equality may be clearer now than then, though more work remains to be done on understanding the shared characteristics of successful interventions on race equality and how they are made sustainable. But this report is a reminder that revisiting reports like this one, almost lost in government archives, can be an invaluable reminder of what previous research found and should be built on.

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Business & economics

Lessons from Argentina

daniel_ozarowDr Daniel Ozarow examines Europe’s current economic situation in relation to Argentina’s economic crisis a decade ago.

Leading economic think-tank the institute of Fiscal Studies has warned that “middle-income families are the new poor” – a damning indictment of the way poverty in Britain has spread far beyond groups that are traditionally considered poor. It’s the same story across much of Europe and is a product of the austerity agenda that has squeezed the middle class since the financial crisis.

The statistics in the European Union are depressing. Official figures report that 24% of its non-poor population (122m citizens) are currently at risk of descending into poverty or social exclusion. This means that they were either at risk of income poverty (their disposable income was below their national at-risk-of-poverty threshold), severely materially deprived and/or living in households with low work rates.

In Greece, Spain, Portugal and other countries that have been especially affected by debt crises and ensuing austerity policies, millions of medium to high-skilled workers, professionals, middle-managers, public sector workers, university graduates and small business owners face hardship.

These white collar workers are a new problem for governments and welfare agencies to deal with and they are often ill-equipped to support them. Their superior levels of education and professional experience and networks should bestow them with significant advantages in the labour market.

But public sector redundancies, a growth in precarious patterns of work, increased global competition for labour, rising indebtedness and spiralling housing and childcare costs have all contributed to falling living standards. And the ranks of a “new urban poor” in Europe are swelling.

Standing on the precipice

Getting this group back on their feet is vitally important – for the citizens in question, but also for the economy as a whole. While it presents a new problem for Europe, there are some lessons to be learned from Argentina, which experienced a similar problem a decade ago.

Like many of these European states, Argentina is a liberal democracy with a market system, a welfare state tradition and G20 membership. It has also historically had a large middle class, comparable in size and political influence to that of many European societies.

Private school teachers in Greece protest austerity measures. EPA/Alkis Konstantinidis

Following its 2001-02 sovereign debt crisis – the most severe in global history prior to Greece’s – 7m of Argentina’s highly-educated citizens were thrown into poverty. Despite a decade of unprecedented macroeconomic growth when the country became the fastest-growing economy in the Western hemisphere, and 2m jobs were created, a third of them struggled to recover and remain unemployed or in low-paid, dead-end jobs.

Poisoned chalice

The plight of those affected can partly be explained by structural factors such as the economy’s failure to create sufficient quality employment or by age discrimination – but their experiences suggest that a more obscure explanation was at play. Paradoxically, many struggled to transform their abundance of educational, professional, physical and cultural assets into real-life benefits.

Indeed, in some cases it was these very resources that proved to be a poisoned chalice and prevented their recoveries. Unlike the long-term poor, many of these middle-class citizens were traumatised and completely disorientated by their sudden social descent, with no experience to draw from about how to deal with it.

Many refused to take low-paid or less prestigious jobs because they represented a degradation in their employment status.

Others remained in denial, seeking to maintain luxury spending patterns and ostentatious consumption. Though they could not afford it, keeping up the pretence that “all was well” to peers was judged the priority. Yet maintaining membership of their golf club, for example, while sacrificing basic necessities such as meals, utility bills or health insurance was worse for their health and finances in the longer-term. Ironically it was their access to affluent family members or close friends to borrow money that facilitated these counter-productive strategies.

The struggle to change

My research into the thinking of many of Argentina’s jobless professionals showed that they often endured long periods of unemployment. Many refused to take low-paid or less prestigious jobs because they represented a degradation in their employment status. They would look for work in the wrong places, focusing their job searches on answering adverts in only highbrow newspapers and trade journals.

In contrast they expressed great reluctance to use their networks to ask around for job opportunities (“personal referrals” is actually how employers most commonly recruit high-quality employees), for fear that the shameful reality of their unemployment would be unmasked. One unemployed accountant told me a heartbreaking story of how he would dress up in his suit and tie each morning and wander the streets all day before returning home to avoid admitting his predicament to his wife.

Job centres are not designed for middle class demand. EPA/Andy Rain

Due to the profound association that some placed between their professional and personal identity, some point-blank refused to retrain in a different occupation, even after several years had passed without work and there was obviously no longer a demand for their profession. One person told me: “I have been a fashion designer all my life; I am not going to change now.”

Others could have sold their home to resolve their material hardships. But this was deemed taboo, even when several bedrooms lay unoccupied. Participants preferred to live as paupers rather than forfeit what they viewed as a symbolic marker of their membership of the middle class.

Those that did qualify for welfare support (and overcame the self-imposed stigma of applying for it) often fell into a “well-being trap.” At the first sign of material improvement they would hurriedly remove themselves from the scheme (because of their sense of stigma) before they had regained financial independence. Consequently they underwent a perpetual cycle of moving in and out of subsistence.

These and other scarring effects of unemployment contributed towards a downward spiral for many professionals and stunted the country’s economic recovery and growth.

Of course, Europe is not Argentina. It is made up of multiple countries, many of which have more robust social security systems. But the struggle is increasingly real for many middle-income families. They have not enjoyed the same recovery as top-line growth figures suggest and have been at the sharp end of austerity policies. The lessons from Argentina are therefore worth paying attention to.

This article originally appeared on The Conversation.

Categories
Business & economics

More of the same simply won’t do

Doctor With Stethoscope And Files

Roger Kline Middlesex UniversityResearch Fellow Roger Kline welcomes the new Equality and Human Rights Commission report on race equality in Britain, but fears that soundbites may take precedence over evidence-based action in the workplace.

Seventeen-and-a-half years ago the MacPherson report identified institutional racism as “the collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture, or ethnic origin. It can be seen or detected in processes, attitudes and behaviour which amount to discrimination through unwitting prejudice, ignorance, thoughtlessness and racist stereotyping which disadvantage minority ethnic people.”

This week the Equality and Human Rights Commission (EHRC) published a report suggesting little has changed. The EHRC said the report reveals a “very worrying combination of a post-Brexit rise in hate crime and long-term systemic unfairness and race inequality”. It added that “the new Prime Minister’s statements are very encouraging but previous efforts to address race inequality have been piecemeal and stuttering with more one nation platitudes than policies”.

Doctor With Stethoscope And Files
The data on NHS disciplinary proceedings shows it is twice as likely that BME staff will enter the disciplinary process as white staff.

Token measures

If ministers are to respond seriously then they need evidence-based strategy not soundbites or token measures. One challenge the government could certainly do better on is public sector employment – both in terms of access and how black and minority ethnic (BME) staff get fair treatment and opportunities once employed.

‘The Snowy White Peaks of the NHS‘ highlighted the scale of racial inequality within the NHS. A National Audit Office report last year was critical of the civil service arguing that “the Cabinet Office is not using the data it holds on staff demographics and perceptions to manage workforce changes and hold departments to account.”

There is a real risk that plans to tackle race equality will flounder unless the influence of class on educational opportunity is reduced.

Across the public sector – including local government, the police and fire and rescue services, schools, higher education – racial inequality is striking. Five years ago the Department for Education revealed that there were just 30 male black headteachers in England’s schools and that that just one in every 125 heads is a black man or woman. In the same year there were 50 black British professors out of more than 14,000. Five years on the numbers remain tiny.

The EHRC calls for “a comprehensive, coordinated and long-term UK Government strategy with clear and measurable outcomes to achieve race equality”. Part of that strategy must be, as the EHRC states, to tackle the gap in educational access and attainment of BME pupils which in part is also driven by class and family wealth. There is a real risk that plans to tackle race equality will flounder unless the influence of class on educational opportunity is reduced.

Evidence-based

So what is to be done, specifically in employment? Without a serious discussion about what sort of initiatives work, we will see a repeat of previous initiatives which were unlikely to make a significant impact, such as the previous Prime Minister’s announcement that organisations will pledge to recruit on a ‘name blind’ basis to address discrimination.

It is early days for our work around the NHS Workforce Race Equality Standard but it is driven by the international evidence on what works in challenging discrimination at work and by practical examples, such as the impact on women in science of the 2011 UK National Institute for Health Research announcement that it would not shortlist any NHS or university partnership for grants unless the academic department held at least a silver Athena Swan award (recognising policies to promote sex equality).

The NHS Workforce Race Equality Standard is:
• Mandatory– it is a condition of providing healthcare services to the NHS and applies to private healthcare providers to the NHS;
• Has measureable outcomes – progress is tracked against nine published metrics;
• Is externally inspected against;
• Has an evidenced narrative, setting out why race discrimination impacts adversely not just on BME staff but on organisational effectiveness and patient care;
• Has metrics which are difficult to game and require root cause analysis to understand the causes of the inequality the metrics will reveal and then change them.

Accountability

Perhaps most importantly, those NHS organisations which are starting to make progress have adopted approaches in line with the evidence about how workplace culture can change on equality. That in turn requires a departure from the traditional HR reliance on policies, procedures and training (including unconscious bias training) since the evidence is that in isolation these simply don’t work either for discrimination or for or for other aspects of culture change such as on bullying.

Instead these organisations have placed accountability at the heart of their approach, insisting employers must be proactive in using data to identify and tackle problems, not rely on brave individuals to raise concerns.

The evidence suggests that simply doing more of the same won’t work.

The EHRC do not say what they believe the government should do. But if ministers are to go beyond fine words, they’ll need to address issues of class and race in ways that their predecessors have failed to. The evidence does exist as to what sort of approaches might really impact on employment. The government already has underway a consultation on ‘The Issues Faced by Businesses in Developing Black and Minority Ethnic Talent‘.

Only time will tell if the government wants to move beyond fine words. Seventeen years on from MacPherson, change on race equality in many parts of the public sector has been glacial. Ministers could start with public sector employment and those who provide services to the public sector. If they do so, the evidence suggests that simply doing more of the same won’t work.