The recent report from People Opportunities into the culture of the Care Quality Commission (CQC) makes for depressing reading with 92% of those interviewed saying they had experienced bullying. The report describes people being ridiculed in team meetings because the pace of their work was allegedly too slow, being too terrified to complain because no one had faith in the grievance procedures and some managers owning up to the fact that they had been guilty of bullying behaviour themselves.
Of course they were – bullying arises directly out of organisation culture and usually starts at the top. The ‘one bad apple’ excuse, espoused for instance by the US military after Abu Ghraib, is a fiction. When invited to behave in a way that will harm others, two classic 20th c experiments show how readily we will abandon personal moral values and do what we are told. Many of Stanley Milgram’s naïve subjects administered what they believed (wrongly) were fatal electric shocks to others, and Philip Zimbardo’s nicely brought up students swiftly became abusive ‘guards’ in his Stanford Prison experiments. In both cases this was because ‘someone in authority’ said it was OK.
Most bullies believe themselves to be people who are only doing their duty. They are responding to bosses unable to manage the anxiety created by demands from their bosses. The only unusual thing about the CQC is that its culture has been exposed as a result of its failure to raise concerns about poor performance in hospitals like Stafford. This is ironic when you read the People Opportunities report where obsession with performance was the overt reason for the bullying. So this was an organization whose only purpose is to manage performance yet could not do it effectively either externally or internally.
Is bullying more prevalent in the NHS than elsewhere? Comparable statistics are hard to find, but it seems unlikely. However, the political status of the NHS does make for unique difficulties. Ministers, desperate to show that they can be trusted with the NHS, fear press attacks; senior civil servants fear ministerial censure; trust chief executives fear rebukes. The more senior you are, the more you may believe you need tangible statistical proof, hence the importance of targets – and the unbridled pressure that may follow.
Many managers don’t understand why pressurising doesn’t work. The taken-for-granted principles of organisation life are based on fatally flawed assumptions so familiar that we have stopped noticing them. But eighty years of research has shown not only that they have never worked but that they never could. So senior people don’t exclusively know best. Fear leads to compliance but not commitment. Financial incentives do not increase work satisfaction. Performance appraisals do not improve performance, in fact in about one third of cases it worsens. Threats of punishment merely mean we get better at evasion. Goals set by others are not motivating.
Yet the idea that cascading command-control is the way to get results survives intact in most organisations, including the NHS, despite nods to ‘empowerment’ and ‘involvement’. When people miss their targets the belief is not that the principles are wrong but that they need to be applied with yet more ‘firmness’ – the kind that can easily degenerate into bullying.
The People Opportunities report rightly concentrates on recommendations about changing the culture at the CQC – for instance introducing training in coaching and other approaches to having ‘difficult’ conversations that would combine high challenge with high support. But no-one ever changes an organization’s culture by trying to change the culture or ever does it quickly. It flows slowly and cautiously from changes at the top with leaders who are brave enough and skilled enough to model the right behaviour themselves and who are in it for the long term. As the report acknowledges, having a ‘coaching culture’ is more than just running a few training courses and hoping for the best. It involves every single aspect of how the organization conducts itself including all that invisible stuff about what people believe will be rewarded and punished.
It also means that for the CQC, its senior leaders must know how to manage ministers, the press and the recipients of CQC’s inspections: a tall order indeed. Will they do it? We can only wish them the very best of luck.