Tracie Jolliff, head of inclusion and systems leadership, explains why working through discomfort in pursuit of insight and understanding can achieve great progress when striving for race equality.
The NHS has had ambitions around inclusion for a long time, but despite legislative progress such as the amended Race Relations Act in 2000 and the Equality Act in 2010, for many of us (who have been around for longer than we care to mention), we’re not in the place we envisaged we’d be in 2017. The Snowy White Peaks report in 2014 reinforced this view. Black, Asian and minority ethnic (BAME) staff continue to be disproportionately disciplined and report greater levels of harassment, and when we look up, we can see how under-represented BAME talent is at a senior level.
I believe that the continuation of these trends is partly because historically we’ve not looked deeply enough into the nature of the problem we’re trying to fix in order to gain an understanding of it. Because of this, we have attempted to address something that for the large part is unconsciously motivated, complex and challenging, with tools that have been far too simplistic to bring about the changes required.
The NHS is a microcosm of society; there will be a minority of people that have attitudes which don’t chime with promoting equality and the NHS constitution. The majority however, have the desire to learn how to create cultures that are truly inclusive, with humanity, dignity and respect at their core. But thanks in part to numerous past failures in progressing equality and inclusion on many levels, a desire to learn is now often accompanied by simultaneous high levels of anxiety, and fear of getting things wrong. Practice and progress in this area have therefore become stilted.
For the last few years, unconscious bias has come to the fore as a popular means of addressing the problems around equality, diversity and inclusion. This approach highlights the fact that all of us make assumptions around difference and sameness, and these assumptions consequently drive actions and behaviours, some of which create the conditions in which discrimination and harassment take place.
As unconscious bias training has rolled out, the critique of this approach as a universal cure is also mounting, as are questions about its efficacy. Many people still harbour the belief that to raise the issues about difference (disability, race, LGBT+ and gender equality for instance) is the cause of all the problems. The implication being that if we just don’t talk about it, the problems will go away by themselves. This is faulty logic.
There’s no substitute for human enquiry
Process-driven tools like equality impact assessments have a role to play in addressing the issues relating to under-representation, equality and inclusion. The NHS Workforce Race Equality Standard (WRES) has been a significant instrument in highlighting problems within trusts. It has introduced a framework through which to have meaningful conversations, leading to focused action towards inclusion. Such tools however are not a substitute for purposeful human enquiry that rigorously considers the multiple dimensions of an issue such as race, and asks some critical questions about how effective change towards greater levels of equality can be achieved.
Human beings are relational by nature; it’s the relationships between us that create the cultures we work in. How people feel is an essential component of understanding inclusion and creating change, but we can’t count feelings. The quality of relationships also determines whether or not people feel valued, but we can’t measure the worth of these using counting methods either. Knowing how we can achieve cultures where people feel valued is paramount, which means we need to engage more sophisticated means of enquiry to complement and introduce a depth of understanding to the data. These include:
- The nature and content of the conversations we have: The nature and content of the conversations we have can have a significant impact on culture. How these conversations are experienced and given meaning by people really does matter
- Emotional intelligence: Where feelings matter, high levels of emotional intelligence also matter. Approaches which pretend that difference doesn’t exist will fail to pick upon the importance of how every-day language, attitudes and behaviours may have a negative impact
- Acknowledging difference: Many people are very busy trying to appear fair by maintaining the pretense that they don’t see colour, disability or gender etc. (where race is concerned this approach is called colour blindness). In pretending that difference doesn’t exist, we also fail to recognise, engage with and understand the valuable lived experiences of that difference that people can offer; a vital component in aiding enhanced understanding of complex issues. We also miss the opportunity to work and learn from those that experience exclusion, using their valuable insights to change and transform our cultures and services for the benefit of all
Stepping into a space where we can be truly honest about race can feel very uncomfortable because we’re not used to doing it, but the benefits are huge. Considering where things currently are on race equality, for example, would suggest that pretending our differences don’t exist hasn’t got us very far.
What the Academy is doing
The Academy is pioneering new approaches to inclusive leadership that involve the heart as well as the head, supporting complex ways of understanding the issues relating to equality, diversity and inclusion in health. On our leadership development programmes, we support learning by creating a safe space where people have these uncomfortable conversations. This requires really skilled facilitation, which features particularly strongly on our senior programmes; Nye Bevan, Director and Aspiring chief executive.
The Ready Now programme supports BAME colleagues at band 8a and above to realise their potential with a view to securing a more senior role or a place on the board.
A difficult nut to crack
As mentioned before, some of these issues generate discomfort. If we give people the time and confidence to really say how they’re feeling, they’d tell us things like ‘I feel uncomfortable because I don’t want people to feel left out’ or ‘I feel like emphasising differences in the room is wrong’. But the fact is that some differences were there and clearly noticeable before any ‘emphasis’ was given to them!
These uncomfortable conversations are where an enormous amount of progress is made. If we don’t create safe spaces for people to talk about how they feel – to get it out in the open – we’ll never engage with the work in a way that will change people’s perceptions, thinking and world views to really change the culture around race.
This type of work is unpicking years of operating in a completely different way. For example people generally don’t discuss the importance of strong feelings in the workplace; they’re encouraged to think about processes instead; counting, data, targets… This can lead to catastrophic failures such as the demise of compassionate care in the Francis Report. We need to raise standards in ways which support humanity to re-enter the room with compassion and inclusion.
There’s a growing body of knowledge that tells us race is a difficult nut to crack; its complexity is compounded by things such as class, disability, sexual orientation. We can grow the skills to understand and work with this complexity, as we cannot adequately understand race, without considering power, class, politics and privilege in the same way that we can’t scrutinise disability without considering all of the above, empowerment, access and so on.
Strategies to address the problems associated with discrimination and inequality must be based on a sound understanding of what the problem is and how it manifests itself on many levels across the system. Being nice to each other whilst eating a samosa once a year (a real example from one team about how they address racial discrimination) isn’t going to scratch the surface.
The more senior people become, the more the system tends to assume they’re expected to know intuitively how to eliminate discrimination. This is completely wrong – it often means that senior people don’t ask for help or advice when they need it. They have usually not been adequately quipped through development interventions with the capabilities to effectively address discrimination. Historically leadership development programmes have superficially addressed inclusion, if at all. That’s why raising issues of discrimination tends to represent a high risk to those who are most negatively affected by it. Creating inclusive cultures should be the responsibility of all leaders who should be held accountable in multiple ways for making sure this happens.
What you can do
If you’re reading this, I’d urge you to consider how you develop your people so that increasing and sustainable levels of inclusion result. Some questions you might want to think about are:
- Where and how does inclusion show up in your organisation?
- Are you taking the bold, courageous step to ask questions about the quality of your facilitation in leadership development spaces?
- What is the depth and quality of learning towards inclusion that takes place within your organisation on a daily basis?
- Does your organisation challenge colour blind approaches or approaches which say that everyone’s the same?
- Are you brave enough to consider what cultural transformation really looks like and how power needs to be addressed in order to achieve it?
- How does male privilege and white privilege show up in the teams that you are part of?
Are you asking these questions in your own networks?
The NHS Leadership Academy is happy to share its approach to inclusion for organisations who want to adopt best practice. For more information, contact Jane Hundley.