Bullying and Harassment Project

Final Report April 2009

Introduction

The following provides a summary of the research undertaken during the period January 09 to March 09 together with the findings as a result of Kensington and Chelsea PCT commissioning a project into workplace bullying and harassment in the workplace. The annual staff survey of 2007 showed an increase in the numbers of those experienced bullying or abuse at work from their line manager/team leader, from 8% in 2006 to 14% in 2007. The recent results of the 2008 survey showed a decrease to 6%, 2% less than the national average of 8% (2008 survey). The following incorporates both the preventative measures and proposed interventions in order to sustain the improvements as evidenced by the 2008 survey to provide a robust framework for the future.

Context It is recognised that Kensington and Chelsea PCT is about to undergo further transition as it moves towards the new Provider Alliance. In view of these forthcoming changes the brief was slightly broadened to consider staff engagement and communication which may be of benefit as the Trust addresses issues arising from the transition to the Provider Alliance.

Survey Analysis As a starting point a further analysis of the questions within the 2007 staff survey was undertaken in relation to all questions relating to bullying and harassment and a number of questions relating to communication and staff engagement. These were subsequently cross referenced to the 2008 staff survey. A breakdown of responses by both occupational group and ethnic group was undertaken and considered to establish whether any particular trends could be identified. 14% of those responding (52) stated they had personally experienced bullying harassment or abuse from their managers. Broadly comparable percentages (higher than national average of 8%) were found across a range of occupational groups including: Admin and Clerical, Adult General, Corporate Services, Commissioning Managers/Support Staff, District and Community, General Management, Health Visitors, Support to Allied Health Professionals and Other Qualified Allied Health Professionals. Broadly comparable

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percentages were found to the same question across all ethnic groups. The 2008 Survey showed a reduction across all occupational groups for individuals stating they had been bullied, harassed or abused by their line manager or team leader although amongst some groups the improvements were less marked than others. The 2008 Survey showed a reduction across all ethnic groups in those individuals stating that they had been bullied or harassed although for some ethnic groups the improvement was less marked. A breakdown of responses for the six specific questions on bullying and harassment for both the 2007 and 2008 survey is attached as Appendix 1 (to be attached).

Further data collection. A number of interviews were undertaken with key individuals who were engaged in dealing with bullying and harassment issues or who had an interest in this area. This was followed by a series of 5 focus groups meetings aimed at targeting a range of staff groups; including Admin and Clerical, Corporate Services, Community and District, Health Visitors and Other Allied Health Professionals. In addition the consultant also met with the Trusts Synergy Network group for a discussion on key aspects contained within the brief. Focus Group themes centred on defining bullying and harassment, management culture, staff engagement and communication, management capabilities and sources of support for those experiencing bullying including managers, harassment advisors, Trade Unions, Human Resources and Occupational Health. A total of 32 individuals attended the focus groups (including the Synergy Group) from a range of staff groups including administrative and clerical, nursing, health visitors, facilities, and general management. In addition a further 13 individuals were interviewed as part of the process.

Findings Findings - General. Based on the evidence of the focus groups and one to one discussions, there is nothing to suggest a widespread bullying and harassment culture exists within the organisation. Some individual concerns were expressed and anecdotal evidence provided in relation to the particular management style of a small number of line managers which could be perceived as bullying. These focussed primarily on overmonitoring, unrealistic deadlines and an uneven approach to members of their team. Jane Lacey-Hatton Page 3 of 13 30/04/2009

Individualised bullying with a single bully involved in bullying one or more victims of their team does however appear rare. The possible issues identified were more subtle with a particular theme emerging in respect of organisational pressures and the impact that these have on staff. One individual stated that the Trust was a high achieving organisation that operated in a competitive environment and was expected to achieve targets but that sometimes this came at a cost to individual employees. On a number of occasions during the course of both interviews and focus groups individuals suggested that there was a correlation between the results of the 2006 staff survey and the fact that this period coincided with a time when the organisation was experiencing significant financial pressures, the closure of services and the threat in some areas of redundancies. Three individuals described feeling bullied by the organisation, with the recognition that their line manager was not the problem but instead their negative perceptions related to the way the Trust had gone about its business. Prime reasons quoted were: lack of communication, unreasonable, inappropriate and excessive demands, and a lack of control over aspects of their working life. It is relevant to note that results from the 2008 survey show an improvement in questions relating both to bullying and to communication and involvement and this corresponds with a period of relative stability for the Trust. .
The quotes in the boxes below are direct comments from focus groups representatives on the particular areas that were explored.

Leadership and Engagement. The senior team are fair and reasonable They (the executive team) are good role models No-one is accountable when there is an issue that needs sorting out you end up feeling very demoralised I feel very separate to senior management I never see any of them There is a lack of visibility at senior level when there is difficult organisational change. We are poor relations compared to St Charles often feel quite isolated The senior team dont always understand the service issues so resources go on the wrong things. When theres a problem theres a meeting - communication is not good

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Findings Leadership and engagement. The majority view expressed by those interviewed was that the senior team displayed positive behaviour, were approachable and would intervene as necessary if they became aware of bullying or harassment. A key concern expressed by two focus groups was a lack of visibility amongst the senior team with a number of individuals stating they (the senior team) were not always around when there were difficult messages to communicate. The majority of those involved in both interviews and focus groups expressed the view that they were well aware of both individual and team goals and objectives and that appraisal was well embedded within the organisation. A general view expressed by the majority of those interviewed was that corporate communication could be improved. Team Briefing was not always felt to effective with it being described as haphazard or it doesnt go past a certain level. . The Trust newsletter Broadcast was not widely regarded as a useful means of getting a message across with a significant number believing it was not relevant to them. Two individuals quoted a meeting they had attended about the new Alliance but neither had been clear what it might mean for them stating that lots of jargon and complex language had been used. A view expressed by two groups was that not enough genuine efforts were made to engage with all sections of the workforce and as such many felt excluded. A concern raised by members of the Synergy Group was that some individuals felt isolated and experienced a sense of non-inclusiveness because they did not fit in and this did not support an organisational culture where diversity should be promoted and valued. Two individuals quoted the recent customer service training which they suggested was not relevant and patronising. It should be noted however that the issue of communication and involvement is one which is traditionally an issue for most Trusts and Kensington and Chelseas staff survey results are generally more positive than other comparable organisations.

Line Management. Middle managers are often piggy in the middle doing their best in a difficult situation Sometimes individuals with clinical backgrounds lack confidence they have no management skills

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Some new, more junior managers dont get the necessary support Managers dont tackle difficult issues as they are afraid of the counter attack There is a lack of respect from some line managers they command you rather than request politely Managers do nothing when problem arises as they are not sure what to do I feel bullied, over-monitored and overloaded by my manager

Findings Line Management The majority of individuals felt supported by their line manager and believed they did a good job often under difficult circumstances. Individuals stated that often managers were piggies in the middle passing on difficult and unwelcome information. Some concerns emerged in respect of some line managers abilities to deal with bullying behaviour. These tended to focus upon the levels of confidence and competency for first line and some middle managers. Upward bullying was quoted on 3 occasions as a real issue that required addressing. It was suggested that some inexperienced managers neither had the time nor inclination to deal with challenging behaviours in the workplace. One suggested that individuals were promoted to managerial positions but without the necessary skills and competence to manage effectively. As evidence of this one individual explained that she had gone to the manager to complain that she had been really unhappy about the way she had been spoken to by a colleague but her managers response was unless there was a witness there was nothing she could do. Another individual stated that some line managers were hesitant to deal with individuals who were off sick with stress as if they tried to tackle it, they would be accused of bullying. Two individuals stated that they had experienced their manager not taking concerns seriously in relation to incidents involving their personal safety or that of their colleagues and had been disappointed at their response. There was general support to the view that management development support for first line and some middle managers should be strengthened.

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Support for individuals who feel bullied or harassed.

I know my manager would intervene and support me if I had problem If I felt bullied Id talk to my colleagues not my line manager- I dont feel confident theyd do anything I think the B&H advisors are very useful they listen and sometimes that is all that is needed. Often bullying is seen as clash of personality so there is no support Im not sure I would talk to a bullying and harassment advisor Id be worried about confidentiality

Findings Support for those who feel bullied or harassed.

The role of the harassment advisor was discussed in interviews and focus groups. There was almost a 50/50 split in respect of views as to their effectiveness. A number of those interviewed believed the role of harassment advisor extremely useful: an excellent tool for informal solutions and necessary as people want to feel listened to. Anecdotal evidence from those interviewed suggested that initially they had been used on a regular basis but that there had been gradual decrease in individuals coming forward over the last 12 months. Whilst a system was in place to monitor numbers of those raising informal queries to the harassment advisor through the submission of monitoring forms to an HR lead, this was not always complied with. As such there was no reliable quantitive data available which detailed the level of activity. One individual explained that the role did not have any bite and was frustrated at the fact the advisor performed a listening and advisory function only. Three individuals expressed concerns in relation to confidentiality and said they would prefer to speak to a colleague or their line manager. About a third of those attending the focus groups were unclear about the harassment advisor role or had not heard about them at all. It should be noted however no-one in the course of the focus groups confirmed they had used the services of an harassment advisor. Both Human Resources and Occupational

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Health were quoted as possible sources of support that individuals may choose to access if they had any problems. A range of views were expressed about the effectiveness of both functions in dealing with personal issues with a mix of both positive and negative opinions being expressed.

Findings - Monitoring Information.

There were high levels of awareness amongst members of the senior Human Resources Team in respect of bullying and harassment issues and the possible preventative measures that should be adopted in order to reduce formal complaints. Information on the number of informal issues raised under bullying and harassment does not however get routinely collected neither does it appear that information on formal cases is routinely collated and monitored by a workforce strategic group. The monthly Key Performance Indicator workforce report does not appear to encompass information on this area. The Governance department confirmed that they regularly monitored information contained within incident reports and would raise any relevant issue with the Director of HR and appropriate committee should any significant trends emerge in relation to bullying and harassment. A robust and integrated approach to monitoring would be helpful in order to support key strategies and to estimate the organisational costs, both direct and indirect to the Trust of bullying and harassment. Information could encompass staff turnover, staff absence, the cost of investigations, and litigation.

Findings - Dignity at Work Policy.

The dignity at work policy was implemented in November 2007 and provides detailed information on the process for taking forward bullying and harassment issues, both informally and formally from both members of staff and patients. It also incorporates a section on those individuals experiencing domestic violence. In addition to a series of awareness sessions to launch the policy further training is provided as part of the induction process to new members of staff. Approximately 50% of those involved in the focus group discussions were unclear about the policys purpose. One of issues Jane Lacey-Hatton Page 8 of 13 30/04/2009

discussed at both focus groups and interviews was whether the Trust should look at incorporating into their strategic vision a behaviour pledge or, code of conduct which sets out core organisational values and defines positive behaviours expected in respect of staff. There was an even split of opinion on this suggestion with a number believing it would be helpful at setting a standard that everyone would need to abide by whilst a number of others thought it patronising and just meaningless words.

National NHS Context

The recent farewell interview from Sir Ian Kennedy (Chair of the Healthcare Commission) caused significant media interest following his statement that Bullying is a corrosive problem that the NHS must address. He suggested that Bullying more than anything else was permeating the delivery of care. The overall national results of the 2008 staff survey showed that 12% of staff surveyed stated that they had suffered bullying or harassment or abuse at work by colleagues and 8% said this was by managers and team leaders. A Department of Health report from 2005 calculated the cost of bullying and harassment to the NHS taking account of sickness absence, replacement costs, productivity losses, management investigation costs, litigation costs and damage to the employers reputation was an immense 325 million a year. Whilst it is difficult to assess how much of this figure is directly attributable to employee to employee bullying there can be no doubt that bullying represents a substantial cost to many NHS organisations and that there is a real business case for tackling the issue. The recommendations set out below support a broad approach to dealing with this issue and require clear senior management ownership and commitment. As a recent report from the CIPD indicated tackling a difficult and complex issue like bullying at work is about much more than having a policy . Its not just about an absence of negatives but about actively defining and promoting positive working relationships.

Recommendations Based on the findings and recent research, recommendations are set out below which are subject for discussion and agreement with the Project Leaders. It is proposed that

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this work is progressed under the auspices of the Trusts Improving Working Lives group.

1. Consider a review of the organisations strategy in relation to engagement of staff in order to focus upon developing/maintaining a positive climate at work. This could build on the NHS Constitution: staff pledges and responsibilities and encompass a review of some of recent best practice in this area (e.g. Guys and St Thomas NHS Foundation Trust) to establish if this could be tailored to suit the Trusts needs. Such a review could include exploring whether the cultural values of the organisation should be defined and used as an indicator of the behaviours that is required of its employees. The table below sets out a sample bill of rights and responsibilities which could be a starting basis for discussions in order to evolve something locally that meets the Trusts particular needs. Such a code or bill or rights needs to be considered against all existing policies and procedures relating to discrimination, equality and diversity, bullying and harassment and conduct to ensure they project a positive and active position i.e is the policy respectful, open, truthful, fair, inclusive and recognises employees contributions?

Rights To be treated with dignity and respect To be treated fairly and without discrimination To disagree and present alternative views To challenge & be assertive To be consulted on decisions that affect my work To have my contribution recognised

Responsibilities To treat others with dignity and respect To challenge inappropriate behaviours in others To respect the authority and decisions others To deal with conflict constructively To recognise the needs of the business & others To thank and recognise the efforts of others

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2. Consider a review of the Trusts corporate communication strategy in order to strengthen arrangements in respect of team briefing, the corporate newsletter and the potential for staff to have more opportunities for direct communication with the executive team particularly those groups of staff working in locations across the Trust where the opportunities for such interaction is rare.

3. Consider how to effectively disseminate a revised dignity at work policy which will include the development of separate management guidance to support the informal resolution of harassment and bullying issues. This would incorporate a review and re-launch of the role of Harassment Advisors and the possible introduction of trained mediators. To consider running a programme of road shows which could highlight the work being developed around dignity and respect. The aims of these events could be as follows: Raise awareness of the programme of work around dignity and respect Raise awareness of the roles of the harassment advisor, Human Resources, Staff side and Occupational Health. Promote individual responsibility around dignity and respect (see pt 1, sample bill of rights and responsibilities) Demonstrate executive commitment to the programme of work Engage staff and obtain their views around dignity and respect issues Update staff on the progress following earlier focus groups and obtain further suggestions from staff Raise the profile of the National Staff Survey and encourage staff to complete.

4.

To consider the development of additional training and education support for first line/middle managers ensuring effective integration with other initiatives such as the current mentorship scheme and conflict resolution training. Line Manager behaviour is regarded as having the most impact upon the successful implementation of bullying and harassment policies. Disagreements, differences of opinion, misunderstandings, poor communication and emotional

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flare-ups can all lead to disputes and conflict between individuals and groups. It is important to find ways to deal with small conflicts so they do not fester and escalate and nip in the bud perceived slights and injustices. Being able to do this is a vital skill requiring assertiveness, appropriate listening and responding and a willingness to co-operate in problems solving. This area has already begun to be addressed by the Trust through the introduction of Institute of leadership and management programmes covering elements such as problem solving, decision making, building the team, leadership and managing performance. It should be recognised that this type of support may also be relevant to others in positions of responsibility who may benefit from developing skills in conflict resolution, handling difficult conversation etc.

5. To consider the possibility of introducing trained mediators to support the informal resolution of appropriate grievances, complaints or conflicts. Mediation is particularly suited to grievances and complaints surrounding relationships and behavioural issues. The mediator performs a pro-active but neutral role helping areas of common interest to be identified in order for both parties to reach their own solutions. Both sides of the disagreement need to recognise the problem and be prepared to work for a win-win solution. Mediation is not successful when one or both parties dont want to take part or when there has been serious bullying, victimisation or physical violence. The use of mediation as part of informal process has been shown to be highly successful in reducing numbers of cases that have gone on to formal processes or ended up in Tribunal (CIPD 2005 Bullying at Work- beyond policies to a culture of respect.). Recent changes in legislation (ACAS code of practice April 2009) also encourage the greater use of early dispute mechanisms through mediation. Should this recommendation be supported consideration will need to be given to how mediation should be delivered internally through trained individuals or by buying in expertise or a combination of both.

6. Consider a review of current monitoring arrangements in respect of bullying and harassment and implement more robust mechanisms in order that both informal and formal cases are regularly reported to a suitable committee for Jane Lacey-Hatton Page 12 of 13 30/04/2009

scrutiny. If not already in existence explore the possibility of regular anonomised reports from occupational health in relation to stress at work referrals being submitted in tandem with sickness absence rates, exit interview data, and bullying and harassment cases (informal and formal) to ensure a detailed overview is obtained and any hot spots are identified. The Health and Safety Executive provides a web based tool that can be used to monitor levels of work related stress including the contribution made by workplace relationships which the Trust may wish to use as a basis for developing future strategies. Access to robust data is a fundamental issue in order that an appropriate workforce committee can inform decision making and identify priorities.

The author would welcome the opportunity to present the findings detailed in this report and hear feedback at a suitable Trust forum. In addition a draft action plan based on the recommendations above which can provide a working document for the Improving Working Lives group to progress this work together with a revised draft of a new dignity at work policy will also be supplied.

Jane Lacey-Hatton April 2009

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