Engaging with an organisation as a whole to surface the underlying causes of conflict and underperformance and lay the foundation for systemic change.

In the context of several budget cuts, failed performance targets and a new service-wide restructure, the board of an NHS trust approached Tavistock Consulting after receiving an influx of grievance cases for bullying and harassment.

Claims of ‘micromanagement’, dismissive and undermining behaviour and being ‘picked on’ were rife, and multiple members of staff were refusing to work the same shifts.

We approached this from a whole systems perspective and began by seeking the views from individuals and groups at all levels of the organization, drawing this range of perspectives to create a diagnosis of the existing culture. This highlighted that senior managers were feeling bullied by the board and forced into pushing through ‘impossible cuts’. Any doubts or concerns were silenced. New line managers were similarly experiencing the board as highly directive, with no opportunity for challenge or dialogue.

We worked with the board to think about the culture in the hospital in the context of the grievances, and how we might work with the organisation to bring about a culture shift. Unsurprisingly, our work revealed a board that was also struggling, and under enormous pressure to ‘pull rabbits out of hats’. The organisation was feeling the strain at all levels of the system.

We took a two-step approach, focusing on conflict between individuals as well as working with the board and senior clinicians on tackling the culture’s negative aspects and instituting a programme of staff engagement.

  • The board adopted a new, phased approach to change and revised some earlier decisions about staffing cuts were revised.
  • Board and senior management felt more in control of the change process and more able to actively involve staff at an earlier stage.
  • There was a reduction in grievances filed at the hospital.
  • There was an improvement in the next staff survey, with staff reporting that they felt more listened to by management.