The working culture in the NHS has come under intense scrutiny in recent years after a series of failings in hospital trusts. Employers in the health service now want to make sure they recruit staff whose values match those of the organisation in order to improve patient care. Jo Faragher reports.
It has been more than 18 months since the publication of the the Francis report, which looked into poor patient care at Mid Staffordshire NHS Foundation Hospital Trust after claims that hundreds of patients died unnecessarily. The recommendations made by barrister Robert Francis QC have created a long-term legacy that it is hoped will turn around the culture of the NHS for the better.
One of the key recommendations of the report was that health service should recruit staff whose personal values align with the core values of the NHS, and that anyone recruited onto an NHS-funded training scheme and subsequently into a role in the service should be hired for their values, on top of their qualifications and experience. Currently, NHS Employers – the charitable business that supports HR professionals in the health service – is working with Health Education England on a national programme to promote and share best practice around values-based recruitment.
Ultimately, it is hoped that all staff recruited into the NHS will be hired using this approach, but, at the moment, it is limited to a network of around 100 partners. According to Lydia Larcum, project manager for values-based recruitment at NHS Employers, some trusts had already started reviewing their hiring practices before the Francis report, and these employers are now sharing their experiences with others that are just beginning.
“The NHS as a whole is made up of local organisations with their own local values,” she explains. “They may have their individual values or approaches but there is still a set of core values at the heart of the NHS Constitution. Local interpretation of those values might be slightly different between organisations but working together for patients will be just as relevant for a large acute hospital as a small community hospital.”
Values in practice
Case study: Recruiting bank staff in Brighton and Hove
Sussex Partnership NHS Foundation Trust is one of the largest mental health trusts in the country. It wanted to create a bank of staff in Brighton and Hove that could be tested against the trust’s values and managed locally.
This would be followed with a group discussion exercise where assessors would look at candidates’ behaviour more closely.
Over a series of assessment days, the trust has hired more than 40 bank staff as well as a number of permanent staff. “No-shows” are down from 58% to 13% and time to hire has been reduced to two weeks in some cases.
The trust feels it now has a high-quality pool of bank resources that match its values, and feedback from service users includes “this should be the future for all recruitment”.
It now uses this approach every two months to recruit bank staff, nurses and healthcare assistants, and other regions within the trust are looking to replicate its success.
On a practical level, values-based recruitment means adjusting the processes involved in everything from role design and personal specifications to how applicants are interviewed and then inducted into the organisation. For example, an HR team might continue to use similar tools, such as structured interviews or situational judgement tests, but the questions or scenarios presented to the candidate would be designed to elicit information around values and behaviour.
“With the traditional approach, you might be focused on what someone has, such as qualifications or experience, rather than why they did something or how they felt about it,” says Larcum. In addition, asking probing follow-up questions to “standard” interview questions, such as “Tell me about a time you handled a difficult situation”, will encourage candidates to discuss their motivations for behaving in a particular way, rather than simply how they behaved.
Making it measurable
But doesn’t this make the selection process more subjective? Not so, argues Larcum. “Organisations have done a lot of work around making it clear the behaviours they expect to see which underlie their values, and many have behaviour frameworks in place. You can embed these into your recruitment process to demonstrate objectively whether someone has demonstrated those behaviours,” she adds.
Asking more probing questions can increase the time spent interviewing, but a number of employers have found ways of eliciting information about candidates’ values through other aspects of the recruitment process. Some ask values-led questions in their application forms, for example, or embed them into job specifications before they even advertise a role.
One trust recruiting healthcare assistants implemented a mandatory open day, which was effective in two ways: it provided an education session in the realities of what it is like to be a healthcare assistant, so those who felt it was not for them could withdraw from the application; and it required potential recruits to attend an open day before they could apply, so the additional effort required would put off less serious candidates.
Sitting at the heart of the values-based recruitment push is a partner network for sharing best practice. This includes workshops (for example “train the trainer” sessions for in-house recruitment or learning specialists), and an online hub of case studies, podcasts and videos where organisations can learn more. “Anyone who’s been part of this process has been happy to share certain elements, for example how they trained staff to use values-based questions in an interview,” explains Larcum.
The organisations that were looking at values-based recruitment prior to the Department of Health’s mandate to improve culture in the NHS are now starting to see the rewards. Those that have been recruiting medical staff according to their values for some time now report impressive feedback, not only from medical staffing bodies but also from the teams that work with those individuals.
On a broader level, many NHS employers have seen a number of positive outcomes, including a reduction in sickness absence, greater employee retention and – most importantly – better patient care through better employee engagement. This is backed up by research from the Involvement and Participation Association (IPA), which says that “for every ‘ordinary’ (one standard deviation) increase in engagement, mortality rates among patients would be 2.4% lower”.
Some employers have also witnessed a reduction in their recruitment costs thanks to lower turnover – one organisation that implemented a values-based recruitment model for a specific staff group it recruited at volume has been able to hire these employees on a quarterly basis instead of monthly.
But while these results are impressive, values-based recruitment has a limited impact if it is not sustained through the employee’s lifecycle at an organisation. “Yes, it will bring people in who align with the values that you as an organisation say you have, but it has to be reciprocal,” says Larcum. “Once they’re in employment, the organisation needs to demonstrate that they live up to the values they’ve promoted. That means promoting training and managing people with the values in mind. Even down to softer things like the day-to-day interaction between staff and managers and whether this reflects the behaviour frameworks.”
NHS Employers and the partner network have drawn inspiration from both the private and the public sector in taking this route. The Fire Service, for example, has used this approach to recruitment and employment for some years now, while some partners have linked to commercial employers such as John Lewis to share their insights.
There is a long road ahead for the NHS, but by bringing in people with the right values and encouraging them to share and be transparent about what they do, this is an encouraging start.