Are opportunities still limited for black and minority ethnic staff in health care leadership?

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I was recently asked to chair a round-table event for the Health Service Journal on ethnic diversity and equality in health care leadership.

Out of interest I researched the origin of the term ‘round-table’ and discovered that it came from a speech made by HRH Prince Edward, Prince of Wales, to the British Industries Fair in 1927. He urged ‘young business and professional men… to get together round the table and adopt methods that have proved sound in the past, adapt them to changing needs and wherever possible, improve them’. Setting aside the gender focus of the original use, I would like to reflect on issues that were discussed at this particular round-table event in 2016 – namely what leaders in the NHS can adopt, adapt and improve to enable black and minority ethnic (BME) staff to achieve their potential as leaders.

Participants began by sharing their personal emotional response to the topic, an important recognition of the often painful experiences of being treated differently based on ethnicity. An exploration of the existing barriers to progression for black and minority ethnic staff touched on both unconscious bias and conscious bias; there was a recognition that failure to tackle this was in itself a barrier and that talking about the conscious bias that exists in the system is a significant step towards addressing inequality.

One of the known, visible aspects of conscious bias is in the processes and practices used to recruit, develop and retain talent. Recruitment in particular has been spoken about widely by Roger Kline, who most recently pointed out the lack of ethnic minority specialists operating in the executive search agencies who work with the NHS.

There is a lot to learn from the huge progress made at the United Nations on tackling gender inequality. Through setting cultural expectations and mandating the use of a system-wide action plan, the UN were able to bring about a change to global culture. Male shortlists are a thing of the past, and Secretary-General Ban Ki-Moon’s personal commitment to gender equality led to the appointment of 150 women to Assistant Secretary-General or Under-Secretary-General roles over nine years – and to nearly a quarter of UN missions being headed by women, compared to none when he took office.

We explored the issue of intersectionality – the theory of how different types of discrimination interact – raising a discussion about how practical action could be taken to increase BME representation at senior levels of the system. One simple and effective example was given from an acute health provider where the leadership team has invested in development workshops and masterclasses designed by BME leaders; decisions about what should be offered were made in a series of conversations held over a period of one month, often over lunch. Opportunities were offered in a number of areas such as interview practice, help with communication skills and coaching conversations. The short events were attended by staff from all parts of the organisation and at all levels. Repeated over a three-month cycle, these interventions combined to create a culture in which BME leaders had improved confidence and felt valued; an impact assessment is currently under way but anecdotally the organisation reports a threefold increase in applicants for internal vacancies at supervisory and middle management level. Increasing the talent pool in this way will potentially lead to this group being developed and supported to apply for roles at the higher levels. The crucial ingredient was senior leaders acting to promote the development and talent of BME staff in their workforce.

Black and minority ethnic staff make up a disproportionately large part of both the workforce and the patient population of today’s NHS, compared with their proportion in senior leadership roles. We accept a number of factors in modern motivation theory as being critical to the wellbeing and confidence of all people yet five of these factors (possibility of growth, opportunity to do something meaningful, a high level of responsibility, sense of importance to the organisation, recognition for achievements) are consistently being ignored in relation to our BME workforce. Achieving the recent requirements set out in the NHS Workforce Race Equality Standard may force compliance, but as the round-table conversation demonstrated, much more is possible with proactive change.

We can no longer accept the status quo. Within any power system there is always a moment when the act of people uniting to disrupt things that are simply wrong provides the resistance that moves towards righting that wrong. I’d like to think that participating in the round-table event was a small part of such an act.

Comments

sanmuganathan

Position
Stroke Physician,
Organisation
WANHST
Comment date
08 April 2016
It is my perception is that Organsiations are run like political parties. The senior management is interested in having yes men and women who will rally support for them within the wider Organisation. This will keep their working lives easier and they will survive without improving performance. This leads to a culture of closing ranks and secrecy. There is a glass ceiling within which you dont see it will knock against you!
Best wishes for any body who wants to change culture.

Vijaya Nath

Position
Director Leadership Development,
Organisation
The King's Fund
Comment date
08 April 2016
Thanks for reading blog and leaving comment . Our lived experiences are powerful influences on our perception and I have to believe,as a developer of leadership potential, that we can create new ways of being . If the next generation of BME talent are to realise their potential then we need to help clear the path. This needs all our efforts.

Ram Jassi

Comment date
09 April 2016
Thank you for continuing to raise the issue. It will require a number of initiatives to address the problems many BMEs face. We need a multifaceted approach and a complete rethink with regard to senior leadership role recruitment, period of office and talent management approach. We need to break-up the cultural clicks and remind every organisation that they are not a law to themselves but public servants appointed to carry out a specific role for the benefit of the patients. We cannot deliver for patients without inclusive leadership at every level, we are not delivering for patients today, but are processing patients in a system we have created. What we need to s national task force to address this problem through system re-design. I have some great ideas if those in power are willing to listen this humble BME member of staff.
Ram Jassi, views are my own.

Vijaya Nath

Position
Director - Leadership Development,
Organisation
The King's Fund
Comment date
09 April 2016
No idea too small or humble these often have huge impact. Please do offer your ideas , through 100s 'being the change' we can make a ripple that creates a wave.
Thank you Ram .

Umesh Prabhu

Position
Medical Director,
Organisation
Wrightington Wigan and Leigh FT
Comment date
09 April 2016
Very well written article Vijaya Nath.

The most important thing for NHS is to appoint values based leaders. Values based leaders are individuals with very high core values and beliefs who are kind, caring, compassionate but also courageous. These are individuals who are good role models and staff trust and respect them and feel inspired. Value based leaders are very self-disciplined and aware of impact of their own behaviour on others. They are good human beings and good team players. They respect fellow human beings irrespective of race, gender, ethnicity and sexual orientation. They treat everyone fairly and equally.

Sadly NHS culture and system of appointing senior leaders and managers is what stops NHS from appointing good value based leaders. NHS Board has 80% of members who are non-clinical leaders. Many are appointed for technical skills than for values and not trained in leadership. Most of these leaders genuinely try their best to do a good job but sadly finance and targets dominate. In such a culture patients and staff suffer.

NHS must appoint values based leaders, remove culture of naming, shaming, blaming, disciplining, bullying and must promote 'fair and open' culture and supportive and learning culture. There must be robust governance and accountability for leaders and managers for their own values, behaviours and leadership skills. There must be robust governance for staff. There must be robust staff and patient engagement.

NHS leaders must always promote patient safety and quality of care as the top priority and staff happiness as the most important thing. NHS leaders and managers job is to make staff job easy. Happy staff - happy patients.

In a value based organisation diversity and inclusion thrives and both staff and patients are safe and happy.

Vijaya Nath

Position
Director - Leadership Development,
Organisation
The King's Fund
Comment date
09 April 2016
Umesh ,
All that you say is true and we know that values based leadership has still managed to breech on equitable treatment of the potential talent that resides in the BME community of leaders. For the next generation we need to do better . Thank you for reading and leaving your comment .

Samit Majumdar

Position
Consultant Surgeon; Deputy Lead for quality improvement (FMLM) Scotland; Fellow of the Scottish Patient Safety Pragramme,
Organisation
NHS Tayside
Comment date
09 April 2016
How can we help black and minority ethnic (BME) staff to achieve their potential as leaders? Is a question in my observation remained unanswered for decades if not centuries! Why don't BME staff get to their goals as frequently as their non-BME colleagues? The answer is very simple but the problem is a very Wicked One. Institutional Racism is rife even in the 21 century! shame on us, the members of the so called civilized societies. The system i.e. society is delivering perfectly what it is made to do. Sadly vast number of incidences of inequalities are frequently faced by the BME staff. In the eyes of the social anthropologists these will be examples of Structural Violence!
When we judge the world with our 5 senses; when our heart is disengaged; we make fundamental mistakes in our lives. As a medical professional I can promise you that we all have the same colour blood in our veins and under the skin we look all the same. It is such a pity the myopia has most aggressively hijacked the heads of many decision makers and multiple levels of many organisations (including the NHS) who find it impossible to accept the talents and potentials of a BME staff.
We are all equals but some still remains more equal than the others. This observation is pretty old. If we cannot change this aphorism can we really call ourselves civilised??!!

Varsha

Position
Patient Leader,
Comment date
09 April 2016
The situation is even worse when we see appointments of Non Executives or Lay Persons on NHS Boards. Members from BAME groups need to prove they have the right connections and happy to emulate rather than values and the diverse thinking and insights they bring. Some people who are good role models are Lord Victor Adebowale.

Umesh Prabhu

Position
Medical Director,
Organisation
Wrightington Wigan and Leigh FT
Comment date
10 April 2016
Dear Vijay Nath,

I am really sorry to disagree with you. In any organisation where there are truly values based leaders, inclusion and diversity thrives and right people are appointed to do the right job by leaders and organisational culture is such that they value each and every staff irrespective of race, gender, ethnicity, disability or sexual orientation.

Sad reality is in most Institutions and even in NHS leaders get confused between their own individual values with NHS values!

Institutional values are simply mission statement and talking the talk but value based leaders are those who walk the talk.

This is what has transformed Wrightington, Wigan and Leigh FT and we are not perfect and still long-way to go. But results speak for itself.

Vijaya Nath

Position
Director-Leadership Development,
Organisation
The King's Fund
Comment date
10 April 2016
Sam thank you for reading blog and for leaving comment . We are as you say more alike than different , building on areas where we have successes in advancing BME / BAME talent on merit is the job to be done . Looking at the work you are contributing to in patient safety & quality improvement reinforces the invitation to the system to do more , to do the right thing.

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