Lord Carter identifies better workforce management as the first candidate for scrutiny in his recent review of NHS provider productivity. It’s an understandable choice, given that workforce accounts for over 60% of provider spend. There is now a growing urgency for Trusts to put flesh on their efficiency programme plans in response.
What does grappling with workforce management look like in the current stormy season of recruitment and retention for providers?
One component is the perennial challenge of sickness absence. The theory goes that a workplace that is ‘unhealthy’ will at some point begin to experience above average absence. Staff begin to take longer to come back into work after illness, are absent more frequently or periods of absence are managed less well by a frazzled (or causative?) manager. Problems in a particular department can slowly develop beneath the radar of routine trust-wide monitoring.
Conversely, a ‘healthy’ workplace is likely to have the opposite effect.
One definition of a healthy workplace can be found in the World Health Organization’s Healthy Workplace Framework. There are two elements that seem particularly pertinent for the productivity challenge. The first is the importance of a collaborative approach between ‘workers’ and ‘managers’ and the second is the importance of the ‘psychosocial environment’ alongside the physical.
This raises an important question: in what ways might your policies be encouraging a psychosocially positive and collaborative environment and in what ways might they be doing the opposite?
Antagonism can arise as Boards and managers, feeling the pressure of the productivity challenge, seek to improve the stats and minimise absence, to the point that staff feel mistrusted and unsupported when absence is legitimate. Conflict can also arise within teams, where some employees unnecessarily delay their re-engagement with a stressful environment, perhaps encouraged by the NHS’s generous approach to sick pay. Where there is already poor relationship, attendance management policies can easily become a weapon wielded by workers and managers alike, despite the clear intention on paper to promote a collaborative approach.
Conversely, a positive ‘psychosocial’ working environment clearly makes a difference to the management of sickness absence. In a place where staff are flourishing and engaged, absence decreases. In a place where there is trust between manager and team, back to work interviews are a supportive and affirming process. Sickness is a temporary annoyance and barrier to employees’ enjoyment of a fulfilling and productive workplace. Work is a place people want to return to as quickly as possible.
Engagement, fulfilment and mutual trust should be hallmarks of working in the NHS. In many cases they are, but the rather sputtering attempts to establish proper support for whistleblowers and the stubbornly high harassment and bullying stats amongst NHS provider staff don’t really paint a reassuring picture.
How can a Trust promote and maintain the sort of healthy workplaces that will make a tangible difference in the productivity challenge?
For a large organisation, it is important to be able to confidently identify where the frontline relationships are under strain and where this is having an impact on sickness absence. Another key aspect is to look carefully at employee fulfilment. Clear indicators are for staff to have sufficient influence in their relationships, a strong alignment of purpose with those around them and mutual understanding of each other’s challenges. Each of these can be deliberately built by addressing underlying relational and system dynamics.
Where an organisation is explicitly improving the workplace environment, sickness absence is much less likely to be a problem.