Cultural issues related to allegations of bullying and harassment in NHS Highland: independent review report

7. Initial thoughts

Understanding

7.1. I accept that a report like this cannot meet everyone's expectations. Indeed, it should not try to do so. Some people have been so affected by events that they seek retribution or revenge. Others see no need for change. In all respects, we need to understand why that is and, in the review, I have been mindful of the need to try to understand at a deep level what happens when some individuals and groups experience trauma of some sort, especially when for some it seems to be embedded, to a degree at least, institutionally. As I have indicated earlier, there is both restorative and preventative work to be done.

7.2. Nicholas Janni writes:

"We understand the essential nature of trauma to be energy that could not be and has not been processed and therefore stays stuck as frozen layers within our personal and collective structures. By learning to work directly with these layers, we create together a journey of restoration, allowing large amounts of core life energy, intelligence and relational capacity to be released."^[10]

Process

7.3. Unpacking these words is a part of the process. It is unlikely that the value of this report can be measured by people's immediate reactions. There are some "quick wins" to be sought. However, a lot of thought will be required over a long period of time to produce meaningful longer-term benefits. As I mention above, there is no magic instant fix, or a binary right/wrong solution. The real value may lie in enabling thoughtful people - and a new leadership - to take responsibility for matters going forward in ways that they understand and can deliver.

Relationships

7.4. There may be no greater leadership challenge in 2019 than to help people under pressure to feel valued and for everyone to appreciate the benefits which come from rebuilding strong relationships, bringing out the best in each other and enabling everyone to be more effective in every way.

7.5. That probably means letting go, enabling people to thrive and for people to be given responsibility. In an infinitely complex world, not everything can be controlled or micro-managed from the top.

7.6. This is a journey. It will be better to focus on how to travel than on a hoped-for end point. The goal may simply need to be endeavouring to work more effectively together in tough times – and creating the environment for that to occur. If so, relationships will be a vital part of this. Ultimately it is usually all about people and relationships: why have they broken down and what can be done to restore them? Indeed, as I observe later, prioritising good relationships at all levels is likely to make the biggest difference. People will need to walk with - and care for - others, including those with whom they have fallen out in the past or by whom they feel undervalued.

7.7. People must feel valued in NHSH and that will only occur if it is done from all perspectives: from the leadership in NHS Scotland to those involved with the day to day intersection with the patients. This will need a lot of patience and tolerance. The future cannot be viewed as a series of one-off transactions but must be seen as a pattern of new behaviours and approaches, providing growth and healing as an antidote to the pain and loss which so many have experienced. This will take time.

Change

7.8. Change is not easy. Growth cannot occur without pain. Healing can be a hard thing to achieve. Letting go of grievances and grudges may not be appropriate in all cases but it is likely to be necessary in many. Giving up that which has defined us or in which we have placed so much hope or expectation is a tough thing to do. We may fear many things, including loss of face and relevance, with a sense of emptiness and even hopelessness. To be open to our own shortcomings, as well as those we perceive in others, takes courage, especially if we have been or feel wounded.

7.9. A change of heart, as well as mind, will be the biggest challenge and yet that seems the only way to achieve release and a new way forward. This must be demonstrated by leadership from the top. Humility, authenticity, vulnerability, openness, courage, responsibility, accountability, self-discipline – these are all essential components and are likely to be important touchstones in the future.

7.10. A number of these, and other attributes, are apparently recognised as leadership qualities in the NHS Highland Senior Manager and Executive cohort annual appraisal. It is time for the words to be demonstrated in practice. I note that a top-selling book at the time of writing is The Language of Kindness^[11], written by a nurse, Christie Watson. Kindness is what is needed in NHSH.

Learning

7.11. If real learning can be taken from what has happened, and if kindness and compassion can be restored in NHSH, there is a great opportunity to build a new kind of organisation, a beacon of hope in the NHS, in which good relationships, collaboration, fairness and a welcome for courageous conversations and constructive challenge, together with mutual respect and dignity for all, are experienced throughout. I explore this further later in the report.

7.12. As I mention above, I acknowledge that not everyone will recognise all of the findings or accept all of the proposals in this report. I am also aware that both the Board and management have begun to take steps to try to address some of these matters already, albeit it is probably necessary for them to have a much fuller understanding of the depth and breadth of the concerns in order to do so really well. Whatever is done should be undertaken in a way which brings, and by those who can bring, credibility, confidence, compassion and competence to the tasks.

7.13. I pick up on these themes towards the end of this report in the final chapters. In the next chapter, I set out some general observations about human nature. Some readers may prefer to pass over this but I include it and commend it as part of the context for what follows.

7.14. It seems important to understand the emotional, psychological and neuro-scientific aspects of what has happened – and to find compassionate ways to address the issues. As the University of Edinburgh Global Compassion Initiative reminds us: "Developments in neuroscience and psychology are providing evidence-based insight into the importance of values and character building to health and well-being in an increasingly secular age. Compassion is a defining human ethic."^[12]