Dean Royles: being transparent about transparency

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Dean Royles, chief executive of NHS employers blogs about transparency in healthcare. Can HR embrace a culture of openness?

Hands up those not in favour of transparency. Anyone? This month the Government launched a consultation on a ‘Duty of Candour’ on the NHS. Subject to review and legislation, this will require NHS organisations to be open and honest to patients and families who suffer death, severe or moderate harm as a result of NHS errors. It’s a legislative move that is also meant to have an impact in creating a more open and transparent NHS culture. In the wake of the reports following events at Mid Staffordshire Hospital, this is an important public confidence-building development that should help drive improvement in the quality of services. An opportunity to learn from mistakes. 

The duty is on organisations rather than individuals. But what does a culture of openness and transparency mean for HR? HR is a profession that has grown up with confidentiality, data protection, passwords and locked filing cabinets. Are confidentiality and transparency incompatible? No, but it’s not straightforward either.

I started my HR career (personnel back then!) in industrial relations and realised something relatively early on. Employers spent far too much time discussing and disagreeing with staff and trade unions on who should have known what and when. I also realised this was safe territory for trade unions. They generally won their arguments, receiving apologies from managers for not being more open and reassurances that it wouldn’t happen again. But of course it did, and the cycle continued with escalation and the lodging of disputes, grievances and occasionally industrial action.

I learned a big lesson in that era and have tried to operate in a very transparent way since. My general philosophy is that I would rather debate the substance of the issues than who should have known what and when. In the NHS, despite what the popular press may have you believe, my experience is that managers, staff and trade unions want the same thing – to improve the quality of services we provide to patients. How that happens should be the centre of the debate. Limited resources and advancement in technology and treatments mean that the NHS will always require change. In fact we can expect to live and work in an era of perpetual unrest. Talking about how we achieve that is more likely to result in success. An approach to partnership working with trade unions is rooted in this.

It doesn’t mean it’s easy. I have used Twitter to talk about NHS pay, staffing ratios and whistleblowing. Not everyone agrees with me, but I do feel that transparency is important, to explain these views in the context of patient care.

But at the operational level there can be some tough judgement calls to make. Like this case.

A relatively new member of staff on an elderly care ward was accused by another staff member of stealing a ring from a patient. The patient and family were understandably deeply upset. The incident had a number of witnesses and it looked like a prima facie case. The police were informed and the member of staff suspended pending further investigation. The ward had a really good reputation for care, great patient satisfaction rates and good clinical outcomes. The staff were also deeply upset. There was worry about what patients may think and how it would affect their care. The ward manager wanted to know what to say to staff. Should she say the member of staff was on special leave, or off sick?

The HR manager advised her to be honest. To tell the staff what had happened – that suspension occurred pending investigation, in line with protocols – but to ask the staff to respect the investigation and the confidentiality of the member of staff and patient. The HR manager felt this was the right approach, open and honest with staff and the family directly involved, while trying to protect the environment of care for other patients. The trade union didn’t like the approach feeling it would disadvantage their member. The manager was worried that the details may unnecessarily scare further patients and therefore impact on their care. She wanted to say the staff member was off sick. The trade union supported this.

What would you advise?

Openness and transparency should be the default position but we also need to ensure that staff have the training and managers are supported in leadership judgement. Effective patient care depends on it.

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