Using improvement to prevent avoidable employee harm

As improvement specialists, we have a wealth of tools, expertise and experience at our fingertips. What happens when we apply the same methods and approaches that we use to improve patient care, to workforce processes and systems? Can we better understand issues that affect our staff, and then develop and test interventions to improve their wellbeing? In NHS Wales this is something we’ve been discovering. 

And in the same way that we use patient stories to identify issues, we also need to be listening to our colleagues and the processes we put them through, in order to reduce the harm that they may cause.

Let me share a story about Alex. It’s a story which has informed and shaped a workforce improvement programme within NHS Wales. A senior manager in a large organisation, Alex was accused of financial mismanagement and told that disciplinary action was likely, following an investigation.

After a failed attempt to organise a follow-up meeting, there was no communication for six weeks before a new date was arranged. A few days before the re-arranged meeting, the organisation shared the basis for the allegations and Alex was able to demonstrate that they were groundless.

However, the organisation continued the process, missing four deadlines before informing Alex that it would not be taking the case forward. But it was not prepared to say that there was no case to answer. 

During this time, Alex had been on sick leave with stress, anxiety and depression, struggling with sleep and persistent ruminative thoughts. In an assessment carried out 14 months after the investigation was concluded, a psychologist described Alex’s level of trauma as being consistent with post-traumatic stress disorder (PTSD). 

After returning to work, Alex received a series of commitments from the organisation’s Chief Executive, as well as a confirmation that there had been ​‘no case to answer.’ The commitments, however, were not met.

Eighteen months after the accusation was first made, feeling poorly treated and having lost all faith in the organisation, Alex left for another job.

I share this story in a chapter of a new book, Under Investigation: Transforming Disciplinary Practice in the Workplace. With my colleague and co-author, Khadija Rouf, we examine the impact disciplinary processes can have on individuals, like Alex. Edited by NHS Wales colleagues, Andrew Cooper and Adrian Neal, the book shows how improvement methods can be used to improve employee wellbeing.

It used employee relations data to inform the programme. In reviewing investigations that took place, it was identified that over 50 per cent were concluding without a sanction. This highlighted a concern as to whether the correct processes were being used to address issues.

The work to improve employee investigations was supported by a psychologically safe environment in which to make the change, supported by executive leadership. This builds on Psychology 4 Improvement, a Q‑supported project which highlighted how aspects of culture, like psychological safety and leadership, are central to the success of improvement work.

The insight generated from our latest work influenced a review of the existing disciplinary process and the tools that were in place to support decision-making on whether to proceed with a formal process. A new version of an initial assessment went through a series of Plan-Do-Study-Act cycles (PDSAs) to ensure that it was collecting the correct details to enable managers to make the right decision. The revised document played a key part in the reduction of avoidable investigations.

The harm of poorly applied disciplinary investigations is not limited to the individual at the centre of the process. They affect the people conducting the investigations, the culture of the teams and organisations in which they work and can hit both the reputation and bottom line of businesses and organisations.

As a result of this programme, more than 3,300 sickness days were prevented in the health board, with savings of over £700,000 a year. [ref]Cooper A, Teoh KR‑H, Madine R, Neal A, Jones A, Hussain A and Behrens DA (2024) The last resort: reducing avoidable employee harm by improving the application of the disciplinary policy and process. Front. Psychol. 15:1350351. doi: 10.3389/fpsyg.2024.1350351 https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2024.1350351/full[/ref]

The harm is avoidable. There are practical steps that every business and organisation can take to make employee investigations a last resort, using them only when really needed. 

The book sets out actions for improving disciplinary policy and process as well as organisational culture. It’s a call to the HR profession to lead the change by promoting employee wellbeing alongside procedural compliance.

And as with any improvement programme, the work is never finished. There’s more to learn, more learning to spread and more people to get on board.