Why It Matters
Health care needs to listen and learn from the experiences of our workforce to avoid poorly applying human resources policies and causing avoidable harm.
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To Reduce Harm from Human Resources Processes, Listen

By IHI Team | Wednesday, May 31, 2023
To Reduce Harm from Human Resources Processes Listen Photo by C D-X | Unsplash

Not everyone would be eager to share the details of a difficult experience with people they do not know. But Alex (not their real name) hoped that doing so would help provide a deeper understanding of how employee investigations can cause significant harm. Alex, a senior manager in the NHS, faced an allegation of serious misconduct. We share Alex's experience in the case study at the heart of our recently published paper, “The impact of poorly applied human resources policies on individuals and organisations,” to explore how failing to follow human resources (HR) procedures can harm individuals and negatively influence organisational culture and effectiveness.

The flawed process Alex went through caused considerable psychosocial harm because of how it had been managed and led. An evaluation suggested that Alex’s level of trauma from this incident was consistent with a diagnosis of post-traumatic stress disorder 14 months after the investigation had concluded.

There is currently little research on the impact of employee investigations on those being investigated or those involved in the process, including HR professionals, managers, witnesses, or staff representatives. However, through our work, we are increasingly seeing that the employee investigation process has the potential to cause much wider harm than we might have anticipated.

Barriers to Deeper Understanding

One of the main reasons for the limited insights from employee investigations is the desire of individuals and organisations to “move on” after the conclusion of often challenging processes. The individual concerned wants to quickly regain control of their life and find relief from the crushing pressure they have been under. Organisations will always have many other issues in need of resolution. Those who have witnessed or otherwise been involved in the process are also keen to put the experience behind them.

It can also be difficult to see the full picture of an investigation and its impact on those involved. One person might start a course of action, another may pick it up, and yet another may bring it to a conclusion. These processes often take a long time to resolve. This increases the number of people involved and the possibilities for greater confusion.

Over recent years, health care has been increasingly committed to mapping and understanding the patient’s journey through the system. We have been slower to do this with employees going through HR processes. When we do, however, we can see issues we may not have fully considered. In Alex’s case, this included the impact of poor communication, assurances provided and broken, and failure to provide appropriate care and support.

Poorly delivered processes can also have a wider impact, including on those observing the investigation process. As we have learned, there is real potential for damage to the very valuable, but highly fragile commodities of trust and confidence within an organisation. For example, some familiar with Alex’s situation expressed concern over how they may be treated if they ever found themselves in a similar position. Without psychological safety, this kind of damage to trust and confidence can spin out to others and ultimately the patients and communities the NHS exists to serve.

The Value of Lived Experience

Insights we gained from Alex’s sharing of their lived experience has already shaped a training programme in our health board (“Employee investigations: Looking after your people and the process”) and changed how we commission and run our employee investigations. Along with the work of our HR colleagues, who have shared an equal passion to improve our investigations, we have seen a reduction in the number of investigations being run and the amount of time taken to conclude them. We have also seen a reduction in employee sickness days which has led to financial savings during constrained economic times.

Alex wanted something positive to come out of their difficult experience and sharing their story has certainly achieved that. Through the ongoing work of many colleagues in our health board and now across NHS Wales their legacy could be far greater than we had thought possible. In the same way telling patient stories has helped to improve the delivery of health care, we now need to listen and learn from the experiences of our workforce to bring about meaningful change.

Dr Adrian Neal is the Head of Employee Wellbeing at Aneurin Bevan University Health Board (NHS Wales, UK) and Andrew Cooper is Head of the Avoidable Employee Harm Programme at Aneurin Bevan University Health Board in NHS Wales (UK).

You may also be interested in:

Improving Investigations to Reduce Avoidable Employee Harm

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