Values based recruitment: What works, for whom, why and in what way?
The NHS employs 1.2m staff, with almost one million employed in direct patient care activities (639,891) professionally qualified clinical staff, supported by 355,572 support staff) (Health and Social Care Information Centre, 2014). These staff largely determine how patients experience healthcare. Recent reports have highlighted deficiencies in healthcare services delivery and organisation (Francis, 2013; Keogh, 2013) and the need for cultural change to ensure these staff promote quality of care and patient safety (Department of Health, 2012; Berwick, 2013; Cavendish, 2013).
The promotion and adoption of a Values Based Recruitment (VBR) approach which aims to attract and select health care students, trainees or employees 'on the basis that their individual values and behaviours align with the values of the NHS Constitution' (Health Education England, 2013) is one high profile policy response. VBR is one element in a broader Values Based Employment model (Health Education England, 2013) in which recruitment strategies are supported by systems and environments that promote effective individual and team working, to ensure the delivery of high quality services and care. Early scoping work suggests the majority of Higher Education Institutions (HEIs) are using some form of VBR for NHS funded training courses (Health Education England, 2013) and that NHS organisations vary in their implementation of VBR for different staff groups - (http://hee.nhs.uk/2013/08/15/collaboration-deliveredsuccessful-values-based-recruitment-events/ for examples of between and within-site differences).
Despite nuanced differences, defining characteristics of VBR include: explicitly weighting values (such as compassion) over and above applicant' training and experience; a formal and structured approach to identifying and matching applicants' values to those of the NHS Constitution (DH, 2013); 'stages' in managing values in recruitment through pre-application expectation management ('what sort of people do we want?'); explicitly referencing values at screening and interview; and values-reinforcing activity once in employment and as part of continuing professional development.
VBR assumes that recruiting for values and behaviours, and then maintaining and encouraging these, will improve the quality of healthcare provision. Whilst intuitively appealing, there is no evidence to support this assumption. The evidence that exists is unsystematic and largely anecdotal (Connolly, 2013; Strachan-Hall, 2013). There have been no evaluations of the impact of VBR on aspects of care such as 'compassion' or variables such as staff retention rates or indicators of organisational health (such as staff sickness and absence rates). Moreover, the costs (from both the organisational and the macro NHS perspectives) of implementing VBR are unknown. Consequently, deciding if VBR constitutes a worthwhile return on investment is impossible at present. There is a need to broaden understanding of organisational processes and cultures which sustain (or erode) health care professional values and behaviours (Maben et al., 2007; Mannion, 2014).
A perceived gap between NHS workers' values and the NHS constitution has led to the proliferation of models of values based recruitment (VBR). Despite high level principles (e.g. recruiting applicants, 'on the basis that their individual values and behaviours align with the values of the NHS Constitution'), considerable flexibility in NHS operationalisation exists. The empirical picture of NHS impact is limited and questions around VBR persist:
- What models of VBR are emerging and how do they differ?
- How does VBR impact on important variables that drive NHS quality: compassion, 'organisational health', patient safety?
- What are the costs (and consequences) associated with implementing VBR?
- How transferable are successful models of VBR?
- Understand and conceptualise VBR in healthcare education and service delivery to unpack what works, forwhom and why; and
- Identify the ‘active’ components of models of VBR, create a typology of VBR models, and propose successful models of VBR.
April 2015 - March 2017
HSMC Lead: Russell Mannion
PI: Karen Spilsbury, University of Leeds
Other researchers involved: Carl Thompson, University of Leeds; Karen Bloor, University of York; Yvonne Birks, University of York.
This will be a realistic evaluation (Pawson and Tilley, 1997) with mixed methods data collection and analysis. A three-stage, theory-driven, evaluative, approach, will unpack the relationships between context (C), mechanisms (M) and outcomes (O) and answer 'what works, for whom, how, and in what circumstances'. Organisational cultures (Scott et al., 2003) and multi-level structure, process and context (Bate, 1999) will provide the theoretical framework.
Stage 1 will generate a 'working' theory of VBR by:
- Analysing national and local policy documents to derive an 'official' theory of VBR;
- Undertake a rapid synthesis of the wider VBR research literature;
- Interview developers and implementers of VBR (e.g. DoH; HEE and NHS employers) to explore intended advantages and disadvantages, contextual influences, mechanisms and processes by which outcomes are intended to be achieved, and how VBR differs from previous recruitment models; and
- Use a 'virtual pane' (education and clinical service providers, commissioners, patient and public representatives, regulators and professional bodies) to increase engagement, successful dissemination and NHS utility.
Stage 2 will test this theory using four, purposively selected, case studies to study VBR 'in context'. Relationships between espoused strategy and emergent strategy will provide the focus (Lipsky, 1980; Ferlie, 2001) for
- Comparison of case site documents against stage 1’s conjectured theory;
- Time series scrutiny of 'organisational health and performanc' measures (e.g. recruitment and retention rates);
- 'Cost consequence analysis' (Kaufman, Watkins and Simms, 1997) of VBR;
- Qualitative interviews and focus groups with local and national stakeholders to explore the perceived Qualitative data will be thematically analysed using the 'Framework' approach (Ritchie and Lewis, 2003) and 'CMOs' will be tested and refined sequentially within, and finally across, cases.
Stage 3 will present a cross-case analysis of costs and consequences present theory and evidence based models of successful VBR.
DH Policy Research Programme