Acronyms

What’s in an Acronym?

Have you noticed how in the NHS our talk is peppered with acronyms? I would imagine it’s the same in all other industries. Being an NHS veteran, understanding the meaning of what is said is never a problem. I understand most of the acronyms and those that I don’t I can easily work out from the context of the conversation. We talk about the CQC, PHE, HEE, NHSI etc. There are acronyms for every area we work in SCBU, ITU, HDU, CCU, A&E, and in the community, HV, DN, CPT, SpAds. There are acronyms for diagnostics, CAT scan, MRI, BP ECG. In the NHS there are hundreds if not thousands of acronyms and depending on the area you are working in you get to know what they mean when people use them, it’s kind of an ‘in club code’. The NHS confederation even has an NHS acronym buster on their  website in case you are too embarrassed to ask what AQuA means or what is a CQUIN, you can look it up on Google.

A couple of weeks ago a very senior leader asked me if I’d read an article in the Times by Matthew Parris a white journalist entitled ‘BME is racist and misleading. Let’s drop it’ I had to admit that I hadn’t read it; he kindly gave me a copy and asked me to read it and tell him what I thought.  In short, the journalist took issue with the acronym BME because he found it, in his words, lazy. That’s a charge that can be made to all other acronyms but this particular one caught the journalists’ attention. He said that he hated the term. For the first time, it actually made me really think about the acronym BME and whether as a black woman I found it offensive.

On Friday 22^nd May 2015, a similar article appeared in the guardian entitled ‘Is it time to ditch the term ‘black, Asian and minority ethnic’ (BAME)? this article  was referring to a speech given by ex-chairman of the Commission for Race Equality (CRE) Trevor Philips stating that phrases such as black and minority ethnic (BME) and black, Asian and minority ethnic (Bame) have become outdated, existing purely “to tidy away the messy jumble of real human beings who share only one characteristic – that they don’t have white skin”. He said the acronyms could be divisive, and actually served to mask the disadvantages suffered by specific ethnic and cultural groups. The article then asked four people of colour (POC) what they thought about the acronym and they all said they didn’t like it.

This made me think about whether I was out of step with modern thinking on the acronym BME and maybe should start using something else to describe people that are not white British.

Working on the Workforce Race Equality Standard (WRES) we use the term BME a lot and I wonder if we should if it’s not considered PC these days or worse than that, if people find it offensive. If we agree that all acronyms are an easy or as Mathew Parrish put it, lazy way to say something that would otherwise be longwinded and sometimes difficult to describe, then perhaps we shouldn’t use acronyms at all. Perplexed and bothered that there have been two articles in reputable newspapers deriding the acronym, I did a mini survey of friends and family, interestingly no one was particularly bent out of shape by the term, however some people did question the minority ethnic part of the acronym and wondered what exactly did it mean, did it mean white other, it wasn’t clear if it meant all POC or people that were not white British. In the WRES technical guidance the section on collecting the WRES data states that, “The definitions of “Black and Minority Ethnic” and “White” have followed the national reporting requirements of Ethnic Category in the NHS Data Model and Dictionary, and are as used in Health and Social Care Information Centre data”.

“White” staff includes White British, Irish and Any Other White “Black and Minority Ethnic” staff category includes all other staff.

In writing this article it became clear to me that we use the acronym because it is easier than saying, black people and then breaking that down to African Caribbean people, African people, African American people and so on or and of course Asian people, from India, Pakistan or Goa etc. The term ‘BME’ only has the function of describing a set of people based on one shared aspect. In this context we are simply grouping together those who are subject to certain forms of discrimination because they are not ‘white’. Its usage is not akin to expressing the belief that all BME people are exactly the same. No singular term could possibly account for every aspect of everybody’s experience and culture. Nor is it always necessary to account for every individual’s differences when addressing the issue of their unequal and unfair treatment. In this instance discrimination is the problem, not the people being discriminated against.

A colleague that read the blog in draft actually touched on an important and relevant point, he said, ‘I get quite annoyed when critics attack such terminology for being ‘reductive’. It’s the laziest form of criticism, and if we were to cede to its logic we wouldn’t be able to talk or think about certain forms of racism at all’. – Johann Piper

 

I believe that as the article by Matthew Parris says each group is different, with different needs, aspirations, culture etc. I agree that the needs of each group should be considered and services should be designed and developed to meet the needs of individuals from each group, however, with the work we are doing on the WRES I believe the acronym is valid. Matthew Parrish and Trevor Philips aside, it doesn’t appear to offend too many people, most people understand what it means and in the absence of anything else to describe groups of people that are not white British, it works.

I have to own that I have not given this issue very much thought, having now done so, I believe its permissible for people in the NHS, DH, CQC, CCG, PHE, NHSI and all the other parts of the service to use the term BME.

 

 

Discipline – The scariest word for NHS staff.

Discipline – The scariest word for NHS staff.

 

When the official looking brown envelop landed on the hall mat with a thud, my heart would sink in my chest and I would feel physically sick. The outside of the envelop had the words private and confidential printed in red on it and my full name and address written in Arial size 12 font, very formal, very officious. In the left hand corner, a stamp of the name of the organisation I was working in, no ambiguity about the seriousness of the letter and its contents would be. This was the first in a series of letters I was to receive from the HR department as the organisation geared up to discipline me. In my thirty plus years in the NHS it was without question the most depressing, frightening and dreadful experience.

 

The definition of discipline in the Oxford English Dictionary is;

 

The practice of training people to obey rules or a code of behaviour, using punishment to correct disobedience:

 

 

The word discipline itself conjures up a feeling of dread that involves domination, power and distress. It strikes fear into people’s hearts.

 

My misdemeanour at the time was to do a piece of work for a GP in the area I was working on, in my private time I hasten to add. I remember at time, thinking my world was going to end, I wasn’t aware at the time that it was not right to do the work and that it was seen as a conflict of interest. How difficult would it have been to tell me what the rules were and make me promise not to do it again, Job done. No, the organisation decided that I needed to be disciplined, trained to obey the rules and code of behaviour by putting me through the process of a disciplinary hearing.

The feelings of shame, embarrassment, humiliation and fear nearly crushed me. I was depressed and distressed and without the support of my family and good friends, I don’t know what I’d have done. It felt like the organisation that I loved had fallen completely out of love with me, none of my good past work or my desire to put things right mattered, I was left on my own to prove my innocence. Colleagues I believed knew and supported me no longer wanted anything to do with me, phone calls went unanswered and I was to all intents and purposes persona non gratis. Guilty as charged and though the situation was supposed to be private, everyone knew what was going on and I became the topic of conversation around the water cooler. I was fortunate enough to have the support of a wonderful union representative called Sue Carr, she was supportive and kind, I know now that not everyone has that, some people do not even belong to a union and are left completely on their own to go through this horrible experience.

 

That experience has led me to believe that the draconian act of disciplining someone within the work environment should never be entered into lightly, never executed without in depth discussion and agreement that there is no other way forward. Being part of disciplinary proceedings breaks people and in some instances kills people. A couple of weeks ago, I read about a nurse that set fire to himself, http://bit.ly/1psqFqd committing suicide as a consequence of being involved in disciplinary proceedings. The number of people that are treated for depression as a consequence of being subject to these procedures is staggering and unsurprisingly if you are from a black and ethnic background you are much more likely to be subjected to this experience than if you are from a white background. The work by Professor Udy Archibong http://bit.ly/1U3wfdU and colleagues highlighted disproportionate number of people from BME backgrounds being subjected to these procedures.

 

It was as a consequence of Dr Archibongs report and the number of BME people that are disciplined in the NHS that the Workforce Race Equality Standard (WRES) http://bit.ly/1Srzegl metric 3 looks at the number of formal disciplinary procedures that are initiated against BME staff as opposed to white staff.

We have been collecting and analysing the data submitted for the WRES, comparing the experiences of black staff and white staff in the NHS, sadly I have not been surprised to see the difference in experience of white staff as opposed to black staff in the NHS, black staff have a much worse experience across many of the WRES indicators. In some organisations you are four or five even seven times more likely to be disciplined if you are from a BME background than if you are white.

 

I have never forgotten my experience, nearly 20 years ago when potentially I was going to become a statistic and how it made me feel, I recalled these feeling in brilliant Technicolor recently when three members of staff contacted me with their own stories. What particularly struck me about all three, apart from the fact that all three were BME men and in roles at bands 6 and 7 were the reasons for the disciplinary processes being initiated. The reasons seemed to me, and I realise that I was only hearing one side of the story, weak.

 

At a recent talk I gave to a predominantly white audience, the middle managers were courageous enough to be honest and explained to me why they would initiate disciplinary procedures more quickly when it was a BME member of staff. They said it  because they feared that the BME person would take out a grievance against them if they spoke to them informally about any issue. They feared that the ‘race card’ would be played. They admitted that with their white colleagues they would tell them off and leave it at that but with black staff they would seek advice from HR and begin the formal processes sooner. I remember attending a seminar 2013 when the fabulous Yves R. F. Guillaume, Aston Business School, Aston University and Jeremy F. Dawson

Management School and School of Health and Related Research, University of Sheffield talked about ” Making diversity work at work” they talked about the work carried out in the US by Luksyte, A., et al. (2013). “Held to a different standard: Racial differences in the impact of lateness on advancement opportunity.” Journal of Occupational and Organizational Psychology 86(2): 142-165.

In the paper, the authors found that managers treated staff differently depending on race and recommended the following.

 

– Both employees and managers should be made aware that lateness behaviours are viewed differently for Black, White and Hispanic employees with the penalising effect applying only to Black employees.

 

–Managers should avoid differential evaluation of the same lateness behaviour of their racially diverse employees when evaluating performance and making subsequent promotion decisions.

 

–Managers should be trained to focus on behaviours, not the race of employees, when making important personnel decisions.

 

Since working as one of the Directors for the WRES and being fortunate enough to get an overview of race equality across the provider organisations in the NHS, I have become increasingly aware and concerned by the arbitrary and unscientific way these procedures  are initiated. Frankly it’s the luck of the draw whether you are managed by someone that is willing to have a conversation with you about what hey believe are undesirable behaviours or whether you get the formal brown letter on the mat!

 

I believe a policy that impacts on individuals as much as the disciplinary processes do, should never be initiated likely and on the say so of just one person. There should be a system in place to question the validity of going down a road that is very difficult to turn back from. A road that causes, distress, depression and sometimes death. My personal view and my experience as a manager in the NHS for over 20 years of my working life is that disciplining someone should be an absolute last resort, not the first and that the manager initiating the procedure should fully understand the implications for the individual(s) involved.

 

In my case, I left the organisation, I resigned rather than put myself through that process, I recognised that my mental health was not robust enough at that time to cope with the process. Luckily, I had a husband that was working and could afford to walk away. Many people do not have that option. I understand that after I had left, the HR department found that, ‘ there was no case to answer’ I was fortunate enough to get a new job and pick up the pieces of my shattered career and confidence.

We talk about valuing staff a lot in the NHS, we talk about engagement and inclusion, yet we still use this, in my view, draconian and out dated method of dealing with people. I would urge managers of all levels to carefully consider and think about the impact of ‘disciplining’ someone on the individual, on the organisation and on the NHS as a whole.