‘It’s Not OK’ campaign – sustaining culture change

As chief executive of Derbyshire Healthcare NHS Foundation Trust, I recently participated in our trust’s anti-discrimination It’s Not OK campaign. My face, along with other staff members, featured on posters as part of a multi-faceted campaign, aimed at eliminating discrimination against its staff. By working closely with staff groups, we hoped to bring about a sustained cultural change, backed up by changes in policies that make it clear discrimination and abuse will not be tolerated.

We started working on the campaign pre-COVID-19 after becoming concerned about the number of macro and microaggressions staff were experiencing, especially around race. The health inequalities exposed by the pandemic and the George Floyd killing in the US – and the birth of the Black Lives Matter movement - gave added impetus, but the campaign has been constantly finessed to ensure it feels real to people.

When we were developing the campaign, we mulled over using shadows or blurred images but colleagues in our networks were clear and adamant that we should use real faces as it was a much more openly powerful message. It was on that basis that colleagues volunteered to take part. The result has been a powerful anti-discriminatory message, which it is hoped will change attitudes and behaviours among colleagues and people using our services.

Engaging with staff networks

This campaign covers all forms of discrimination and is part of a very clear message from our board of being anti-discriminatory

The trust is aiming at lasting change rather than a ‘tick box’ exercise. Key to this has been extensive involvement of our staff networks, which cover everything from race/ethnicity, our LGBT+ to spirituality. This campaign covers all forms of discrimination and is part of a very clear message from our board of being anti-discriminatory. We do also have initiatives that focus on race alone as the evidence says that tackling race will have a positive impact on other groups with different protected characteristics. Ethnicity is also the biggest driver of health inequalities and is often a very visible characteristic, leading to overt discrimination.

Long-term impact

Our ‘It’s Not OK’ campaign is not just about posters in places where both staff and patients will see them, it is about changing policies as well

I was determined the campaign would have a long-term impact. One of the things that I worry about is that the equality, diversity and inclusion space in the NHS is rather crowded and full of ‘thou shalts’ landing on chief executives’ doorsteps. That can drive a tick-box mentality that almost misses out the essential need for culture change and long-term sustainability. There is nothing wrong with tactical solutions, but if you want to be sustainable, you have to bring people with you and be willing to talk about the way.

Our It’s Not OK campaign is not just about posters in places where both staff and patients will see them, it is about changing policies as well. One of those was around recording when staff received abuse from patients whose illness had impacted on their awareness; another is ensuring that when alleged discrimination is reported through HR processes, it is dealt with in a timely manner.

We are also working with the police to ensure that abuse which amounts to hate crime is reported as such. Staff may have been a little bit surprised when we started talking about hate crime, but that is the law.

This is not a quick fix, and we may not see immediate results. Indeed, by creating the conditions where staff talk about discrimination, I expect to see an increase in reported cases initially as people feel enabled to come forward. This will reduce, but it will take some time for cultural change to impact on this.

It is sustained culture change which is important – not any short-term change in the figures. The culture is set by the board and senior leaders – we want a culture of openness, of not ticking boxes but of being actively anti-discriminatory.

And inevitably what the trust is doing is only going to be one factor affecting discrimination – there is a wider societal influence. I’ve been heartened to see the support given to England footballers racially abused for missing penalties in the Euros final, but would like to see such support extended to NHS staff who are also abused and threatened?

Lessons

• It is important to ask why you are doing this rather than starting with what you want to do.
• Campaigns like this need to be co-created with staff rather than imposed from above. Engaging and involving staff who experience discrimination, or are likely to experience it, is vital.
• Organisations need to respond to the issues and situations in each organisation in order to make the campaign meaningful and authentic, rather than adopting a generic approach.
• A slogan which summarises the aim of the campaign can be helpful.

Ifti Majid is chief executive of Derbyshire Healthcare NHS Foundation Trust and also co-chair of the NHS Confederation’s BME Leadership Network. Follow Ifti and the BME Leadership Network on Twitter @Ifti_Majid @NHSC_BMELeaders