How Patient Safety Lessons Are Transforming Employee Investigations
Just as the world of patient safety benefited from lessons learned outside of healthcare, patient safety is influencing an area of business that touches millions of workers around the world: human resources.
Anne (not her real name) was a healthcare professional who had given decades of dedicated service to the NHS. Starting in nursing at the age of 18, she eventually became a midwife and head of a midwifery ward.
According to Andrew Cooper, Head of Programmes for Employee Wellbeing in Aneurin Bevan University Health Board in NHS Wales in the UK, Anne was passionate about her profession. “It was more than just a job for her,” Cooper recalled in a recent interview.
Then Anne’s career took an unexpected turn. An administrative error regarding the revalidation of her professional license turned her life upside down.
Anne found herself in the middle of both a formal disciplinary process brought by her employer and a parallel investigation by her professional body. The dual inquiries dragged on for many months, leaving Anne unsure she would ever be allowed to return to the work that she viewed as her calling.
In the end, neither process uncovered any wrongdoing. “The professional body said that there was no case to answer,” said Cooper. “The HR team said she should never have been taken through the process in the first place.”
By then, however, it was too late. Anne had planned to give many more years to the NHS, but the heavy-handed and prolonged experience left her distraught. She decided not to return to midwifery.
Cooper says this kind of outcome is far too common in human resources (HR) employee investigations. “We end up losing good people because our process is often cumbersome and lacking in humanity,” he acknowledged.
Employee relations investigations are a necessary part of managing the workplace, but using a “one-size-fits-all” or inflexible approach can inflict deep and unnecessary harm on both the employee facing scrutiny and HR professionals and managers responsible for the process. According to Cooper, once a formal investigation starts, a process begins that often quickly becomes legalistic in its approach, reduces the opportunity for relational solutions, and makes the restoration of an employee to an organization more difficult. “We too often lose sight of how to look out for the person through the process,” explained Cooper.
Cooper and his NHS Wales colleagues are on a mission to change this. Under Investigation: Transforming Disciplinary Practice in the Workplace, the book he and co-editor Adrian Neal have just published, asserts the need to rethink and reform how disciplinary investigations are commissioned and undertaken. Their research indicates that prioritizing employee wellbeing while simultaneously following a clear and equitable process can reduce potential harm and create healthier work environments for all.
Learning from Patient Safety
For Cooper, the key to change has been reframing the problem as “preventing avoidable employee harm.” He drew inspiration from the patient safety movement that recognized that medical errors are rarely the fault of a negligent individual, but rather failures of complex systems. Cooper and his colleagues recognized that defaulting to a formal process for everyday issues – such as an innocent, incorrect expense claim – was akin to automatically attributing malice to a clinician for a medication error and contacting the police instead of conducting a root cause analysis.
Reforming HR investigations has the potential for massive impact. The Advisory, Conciliation and Arbitration Service in the UK estimated that approximately 1.7 million formal disciplinary cases are enacted and 428,000 workers are dismissed every year in the UK across all sectors.
In addition to the negative impact on individuals, poor application of HR policies can harm organizational culture, operational effectiveness, and the delivery of services. “They can also lead to an increase in sick days, potential legal costs, and negatively affect recruitment and retention,” stated Cooper. “All this can be financially draining for an organization.”
The Power of Storytelling
With his background in communications, it is no accident that Cooper’s approach to transforming workplace disciplinary practice has been rooted in storytelling, arguably the most fundamental tool for creating cultural transformation. It is another lesson learned directly from the patient safety movement. “We’ve used two things,” Cooper said. “We’ve used data, and we’ve used story.”
To demonstrate the full impact of formal employee relations processes, Cooper and his colleagues present quantitative data with personal employee narratives. Employee stories demonstrate the powerful and often overlooked human impact of these investigations.
As Cooper explained, “It is only by listening that you start to understand just how traumatic the process is,” specifically citing how employees under investigation often describe feeling isolated, stigmatized, and abandoned. He noted these feelings are often exacerbated when individuals take to heart their employer’s directive not to discuss an investigation, causing them to avoid sharing their experience with those who would otherwise be their sources of support.
Crucially, Cooper and his team have also learned that HR and line managers often believe they have no choice but to follow an established, formal inquiry. This understanding has led to a collaborative approach to looking for solutions to a key question: Is it possible to create a disciplinary policy process that meets the legal requirements and deliver it with compassion? This approach has led to an important partnership between HR and Employee Wellbeing teams, bringing together what Cooper called “the process side” and “the care side.”
What Next?
The work has begun to address systemic equity issues in employee investigations. Organizations are finding, for example, that disciplinary processes are disproportionately applied to certain populations. Cooper noted that one organization acknowledged that Black males have a significantly higher chance of being taken through a disciplinary process. This has led to proactively asking questions about potential bias and using case review panels instead of giving one individual sole responsibility for key decision-making.
While these efforts started in healthcare, it has also been resonating with HR teams in other sectors, including local government, academia, and manufacturing. Cooper also hopes colleagues in other countries, including the United States, will hear their call to action to use data and stories, curiosity and humility, and cross-team collaboration to ensure that supporting an employee’s wellbeing is an essential component of a successful, ethical, and sustainable disciplinary system.
To learn more:
Under Investigation: Transforming Disciplinary Practice in the Workplace, edited by Andrew Cooper and Adrian Neal, is published by Bristol University Press. It can be ordered here and wherever books are sold.
BMJ Leader — “When work harms: How better understanding of avoidable employee harm can improve employee safety, patient safety and healthcare quality”
