Key findings from report published into bullying culture at University Hospitals Birmingham Trust

Isolation, safety at work and speaking out are some of the key findings from a review into the culture at University Hospitals Birmingham NHS Foundation Trust.

One in 10 staff said they never felt safe at work, while one in four said they felt discriminated against and 53% felt bullied or harassed.

Many said they experienced a lack of respect, while others said they were not confident in speaking up against poor behaviour.

But, the review also concluded, that the Trust staff generally had a positive relationship with their immediate line managers.

The independent review heard from more than 4,000 members of staff, through a range of methods including confidential surveys, anonymous digital routes, listening groups, site walkabouts and confidential interviews.

The review highlights how some unacceptable behaviours and poor working practices havedeveloped, which have caused many staff to feel isolated, discriminated against, unsafe and undervalued.

The trust has apologised and said it is committed to creating the best possible place to work, which supports all staff and enables them to flourish.

Here are some of the key findings from the report:

Belonging and sense of community 

The trust has several fragmented sub-cultures.

People come together and join communities which they feel most represent them within and outside of the workplace.

Sub-cultures are reflective of the diverse workforce, large geographical footprint, and communities the organisation serves.

The organisational change process of the mergers was also impacted by the Covid-19 pandemic.

The combination of these factors has led to staff naturally aligning themselves to their heritage organisations, ways of working and the groups that reflect this.

For those staff who cannot find a place in these niche and exclusive communities, there is often a sense of isolation and "othering".

The review team identified a strong sense of community within most local teams across the trust, however, there are instances where staff feel they do not fit in with their teams, resulting in them feeling excluded and unable to access cooperative and supportive communities at work. 

Respect and feeling valued

The findings indicated the reality of many respondents' daily work lives did not match their expectations and they expressed that their dignity was often compromised. 

When presented with the statement "I feel respected by my team", 65% of respondents to the survey answered "agree" or "strongly agree". 

Similarly, a combined 62% of staff agreed and strongly agreed when presented with the statement: “I feel respected by my immediate manager/ local leader.”

In contrast, the number of staff agreeing or strongly agreeing with the statement "I feel respected by UHB as an employer" dropped significantly to 27%.

"This is a significant challenge to any improvement or development programme undertaken by the trust, as it suggests a lack of connection between staff with the wider organisation," the report authors said.

Junior Doctors Wellbeing Project undertaken at the Queen Elizabeth site found 48% of staff answered no to "Do you feel that you could raise concerns about bullying or  inappropriate behaviour without fear of reprise?".

Physical and psychological safety and wellbeing 

The survey data indicated that 30% of staff did not always feel safe at work.

This was justified in the survey by commentary that referenced instances of patient safety being compromised, bullying between staff, and lack of support from managers in dealing with abuse from patients.

Regarding psychological safety and well-being, 25% of the staff surveyed felt discriminated against and 53% felt bullied or harassed.

While 62% of staff knew how to raise concerns, only 16% felt that the concerns they raised would be taken up by the Trust as an employer. 

Most staff expressed that the Trust does not place a strong focus on staff safety, including physical, psychological, sexual safety, and wellbeing.

The survey results indicate that 11% of staff do not feel safe at work at any time.

Many staff engaged with through observations, listening groups, and drop-in sessions, as well as the feedback received in the anonymous staff reflections, found a potentially larger proportion of staff feeling unsafe at work.

The review found key areas that the trust will need to consider, including: 

• Interactions with colleagues 

• Power and influence 

• Patient interactions 

• Working conditions 

• Sexual safety 

• Freedom to speak up 

• Accessibility of wellbeing resources 

During conversations and through written feedback, many staff expressed feeling unsafe due to physical violence and intimidation from patients and relatives.

The survey found patient abuse and intimidation to be one of the primary reasons staff felt unsafe at work.

Many staff reported they do not feel safe working late shifts or weekend shifts.

These shifts leave them feeling vulnerable as they may be one of few staff working, often without any managerial presence or in isolated areas.

Freedom to Speak Up

Many of those engaged were either unaware of the Freedom to Speak Up Guardian (FTSU) or did not view it as a safe and secure service to raise concerns or seek advice. 

In instances, staff felt that confidentiality was breached, raising concerns about whether this service is contributing further to a culture of fear of speaking up.  

Staff reported that they avoided speaking out to ensure they do not become a target for bullying by being labelled an instigator or troublemaker.

Management

Staff generally have a positive view of their immediate line manager and value the relationships and culture within their local teams.

This is a strength of the trust and staff recognise its importance in delivering a positive culture and working experience of safety. 

Even though there is a positive view of the line manager, staff felt the effectiveness of their line manager was often dependent on the relationship they were able to form with them.

Beyond the local team level, staff reported challenges in getting their improvement ideas or areas for learning taken forward.

Staff felt that general operational management does not always understand the problems raised by clinical staff, and therefore cannot always provide the best solutions.

Human resources

The review team found that the human resource policies and procedures were well written and generally in line with good practice, and this should be acknowledged.

However, staff expressed that there are no clear standards around consistent application of these policies and local line management was often unclear how to manage these policies.

Recommendations

There are four fundamental shifts that the board should lead that the review  recommends: 

1. A shift to openness and transparency 

2. A shift to valuing staff and ensuring equity and inclusion 

3. A shift to ensuring culture directly connects to effective patient care

4. A shift to ensuring a physically and psychologically safe working environment 

The report reads: "It is critical that the Trust and its Board understand that these  recommendations cannot be managed as just another programme of work. 

"They are a fundamental shift in approach, attitude and understanding as to  how to support a progressive and positive culture for the c. 22,000 staff, and the patients they serve."

What did the trust say?

The review highlights how some unacceptable behaviours and poor working practices havedeveloped, which have caused many staff to feel isolated, discriminated against, unsafe and undervalued.

UHB apologises for this and commits to creating the best possible place to work, which supports all staff and enables them to flourish.

The Culture Review also highlighted that, despite significant challenges in staff experience,staff remain committed and proud to provide care to the population they serve.

Jonathan Brotherton, chief executive, said: “We are very sorry for the unacceptable behaviours and working practices that the Culture Review highlights and welcome therecommendations, which we fully commit to implementing.

"They provide further, extensive and independent insight into how our colleagues think and feel about working at UHB.

“Whist the review makes very difficult reading, it resonates with what we have hearddirectly from staff. We have begun putting into place changes in structure, and in leadership, which will provide a good foundation for the further actions we need to take to improve morale and address staff concerns.

“I want to reinforce that we continue to listen, continue to respond to and are committed toacting on what our colleagues have told us, and will continue to tell us.

“Over 4,000 colleagues have clearly stated: They want to feel valued for what you do; they want to feel psychologically and sexually safe; they want zero tolerance of bullying, harassment, racism and all forms of discrimination; they want to be treated fairly, consistently and be confident to speak up and be heard.

“We want this too and will do everything possible to achieve this, as we strive to become the best possible place to work and the best possible place to receive care and treatment.” 

The report sets out four fundamental shifts as recommendations, which are all fullyaccepted by UHB’s Trust Board.

An associated action plan and progress tracker will be produced and reported on at future public board meetings.

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