An all-inclusive NHS is achievable

The NHS is sustained by a set of core values, including respect and dignity, compassion, and, significantly, inclusion. Everyone who needs care, regardless of age, ethnicity, religion, sexual orientation, gender, disability status or profession is to be treated with equal compassion and respect.

Sadly, our new report, Making the difference, shows that many NHS staff do not believe they are treated this way, particularly if they are (for example) black African, disabled, Muslim or gay. What are we to do about it?

We can wring our hands in exasperation that, even within an institution committed to care, professionalism and compassion, discrimination is widespread and damaging the health and wellbeing of its victims – but that is not enough. Particularly when we know more and more about what we can do to reduce discrimination and create climates of inclusion.

We shall overcome

What can each of us do individually? First is recognising that we can overcome our own biases by being aware of the value and uniqueness of every individual we encounter – each of them, like us, wants to be happy.

And virtually all NHS staff want to deliver high quality, compassionate and continually improving care. And we can act as allies for those groups who are discriminated against.

When I observe a black person being treated rudely or aggressively, I can speak up and challenge such behaviours – or indeed for any other disadvantaged group that I am not a member of.

Such “ally behaviour” is particularly powerful in changing discriminatory behaviours. And asking myself “what would it be like to be a Muslim member of staff for a day in this organisation?”

And setting myself goals to change my own behaviours such as committing to building relationships with and listening to members of staff from discriminated groups in my organisation.

Ally behaviour is particularly powerful in changing discriminatory behaviours

Inclusion and discrimination play out most profoundly in teams. Intriguingly, research shows that high team diversity, compared to uniformly composed teams, is either associated with significantly better performance (in terms of effectiveness and innovation) or with worse performance.

There is no middle ground. Climates of inclusion, mutual respect and supportiveness ensure the benefits of diversity are gained. In poorly functioning teams, characterised by blame, status and professional conflicts, diversity is associated with poor performance.

We must “listen with fascination” to diverse voices in our teams and value differences of perspective, which spur creative thinking and effective decision making. We also have to nurture team climates of optimism, humour, a sense of efficacy (we are an effective team), cohesion and compassion.

Such positive climates lead to reduced stereotyping – we see less difference between ourselves and dissimilar others – and to higher quality care. And taking time to review the functioning of the team in relation to its role in providing high quality care encourages deeper learning that increases trust and mutual acceptance.

Research suggests that such reviews improve team effectiveness by an astonishing 25 per cent. And effectiveness leads in turn to greater team inclusion and cohesiveness.

Within our organisations, we must encourage cultures of compassion. This means cultures in which staff members learn to be present and listen to each other (as well as patients/service users); where we have empathic responses to patients and to our colleagues, especially those most subject to discrimination; and taking intelligent action to help each other.

Collective leadership

And we must encourage collective leadership where hierarchical command and control forces, which reinforce blame and exclusion, are progressively weakened. We have to encourage a recognition that all have leadership roles to play.

Leadership in teams must be shared depending on the task at hand and the distribution of skills, regardless of who is the hierarchal leader. And leaders must be encouraged to work across the artificial boundaries that reinforce cultures of exclusion, prioritising patient care overall not just care provided in their part of the pathway.

Perhaps surprisingly, such approaches reduce discrimination and exclusion despite not being focused specifically on equal opportunities issues and the more concrete manifestations of discrimination (such as lack of promotion, selection and rewards) we tend to think of in our efforts to reduce discrimination.

We have to create dialogues that identify discrimination as a shared problem

The approaches described here can augment the human resources practices that are vital for reducing discrimination and encouraging climates of inclusion. These include coaching and mentoring of underrepresented groups; mobility policies and the use of quotas to influence promotion decisions; ensuring job security for minority groups including, for example, additional approvals for terminating employees from protected classes.

But such interventions are not enough. We have to change the climates of our organisations in ways that will make a more profound difference.

Above all, we have to discuss these issues openly rather than producing fear, defensiveness, embarrassment and resentment. We have to create dialogues that identify discrimination as a shared problem that all must work together to overcome.

If the NHS is to be a beacon of compassion and inclusion in our society, we must begin now to make a difference through working together to lead the change.

Michael West is head of thought leadership at the King’s Fund. Making the Difference is available here