“If people can’t demonstrate the right values and behaviours, they should not get jobs in our NHS. It is as simple as that.” Health Education England chief executive Ian Cumming’s words, spoken last year, make clear the “values challenge” facing every person intent on working in the NHS today. Following the reviews by Francis, Berwick and Keogh, and their seminal reports of 2013, an HEE mandate is now in place that makes it clear that there is no place for poor culture, poor behaviour, lack of care or a lack of compassion in today’s NHS.
HEE plans to have a framework and resources to support this mandate in place by October 2014, and pledges to see values-based recruitment (VBR) become embedded in all levels of the NHS — from pre-entry training to post-selection professional development.
According to HEE, VBR is an approach to recruitment that attracts and selects students, trainees or employees on the basis that their individual values and behaviours align with the values of the NHS Constitution.
This is to ensure that the right workforce is recruited to the NHS: not only people with the right skills in the right numbers, but also people with the right values to support effective delivery of excellent patient care and experience. VBR can be delivered in a number of ways, such as pre-screening assessments, using certain interview questions (see Panel 1), role play and written responses to scenarios and assessment centres.
Panel 1: Values based interview questions
– Describe a situation in which you used persuasion to successfully convince someone to see things your way
– Describe a time when you were faced with a stressful situation that demonstrated your coping skills
– Give a specific example of a time when you used good judgment and logic to solve a problem
– Describe a time when you had to go above and beyond the call of duty
– Describe a time when you had to prioritise tasks
– How do you deal with conflict?
How valuable is VBR?
The London deanery believes that behavioural competence testing can complement technical or work-based assessments by helping the employer to “distinguish between occasional and systemic difficulty on the part of the trainee”. For example, a scenario involving a clinical interaction that requires patient consent calls upon trainees to demonstrate their communication skills as well as their clinical understanding. The deanery notes that a shortfall in the latter may indicate a small weakness in the applicant’s knowledge base, whereas a failing in the former may identify an underlying behavioural characteristic.
However, according to the Chartered Institute of Personnel and Development — a member organisation for human resources professionals — critics believe that behavioural competency testing in this way cannot keep up with rapidly changing environments because it focuses on the past, and warn that staff may become “clones” of each other if everyone is expected to behave in the same way.
Panel 2: Values based recruitment and leadership
The Royal Pharmaceutical Society is reviewing its Leadership Competency Framework, previously published in 2011. The review, which should be complete by the end of 2014, will provide pharmacy professionals at all experience levels, and in all sectors and regions of Britain, with the tools to deliver the care and compassion required of leaders in pharmacy. As well as aligning with the aims of the RPS Faculty, the new RPS LCF will also support the aims of the new Healthcare Leadership Model, which will be formally launched in April 2014.
The new Healthcare Leadership Model sets out four levels of proficiency (essential, proficient, strong and exemplary) as applied to nine dimensions of leadership behaviour. These include:
– Inspiring shared purpose
– Leading with care
– Engaging a team
According to Alan Nobbs, the Leadership Academy senior programme lead in programme delivery and frameworks, the model has an application at all levels of the NHS and at all stages of employment, from recruitment to post-selection training and development. He says: “It speaks from the bottom to the top and from the left to right of an organisation, and it has as much validity for an orderly as it does for a senior medical director with 30 years’ experience.”
The Healthcare Leadership Model replaces the previous Leadership Framework and is being developed by the Leadership Academy as a tool for recruitment and training in the NHS.
Led by NHS England chief executive Sir David Nicholson, the academy board includes NHS and private sector representatives, and its work is said to “bring together into one body, for the first time, all the national activity supporting leadership development in health and NHS funded services”.
For more information on the Healthcare Leadership Model, visit the Leadership Academy at: www.leadershipacademy.nhs.uk/discover/leadershipmodel.
How should VBR be used?
Behavioural competency testing has been used widely in recruitment and learning and development for many years and it is the view of the CIPD that competency assessment must be managed carefully.
It recommends that any organisation that uses competency testing should have robust, validated reasons for carrying out an assessment and that any questions and processes used should accurately reflect the needs of the role — ie, target skills, experience and behaviours — and the organisation. This could include the organisation’s medium- and long-term needs for talent, its workforce diversity and wider ethos and values.
In addition, it recommends that a competency assessment has to be fair (measurable and able to be standardised across organisational and geographical boundaries). Employees also need to understand how their behaviour can contribute to personal and organisational success. Finally, the organisation must put in place culture, resourcing and management structures (employment conditions) that support employees to reach target competencies. This may highlight the need for additional training over and above that already on offer.
What NHS recruiters say about VBR
Aamer Safder, principal pharmacist lead for education and development at Guy’s and St Thomas’ NHS Foundation Trust, says: “We’ve been using values testing for years… . In fact, in the preregistration interview we don’t ask any clinical or knowledge-based questions at all — we are only interested in a candidate’s behaviour.”
Mr Safdar goes on to explain that when recruiting for band 6 pharmacists, 60 per cent of the interview still involves behavourial testing, but clinical knowledge and specialist skills are increasingly tested for higher bands.
“In our interviews, we have a list of set questions and model answers that vary according to the band level being filled,” explains Mr Safdar. “For example, a preregistration trainee might describe being faced by an angry patient for the first time as their response to the question, ‘Describe a time when you were faced with a stressful situation’. However, when recruiting for a higher band, we would expect to hear references to workload pressure, meeting deadlines, etc,” he says.
“A challenge for interviewers is to be fair; experienced interviewers will help reduce subjectivity, and we moderate the scoring applied to given answers. It is also important for the interviewer to fully understand his own organisation’s competence framework, ie, the must-have skills and values for that organisation, and the job specification in question. A recruiter must be able to justify why a question fits in with all those objectives. If he can’t justify a question, it shouldn’t be asked.”
South West Yorkshire Partnership NHS Foundation Trust advertises itself as an organisation where “services are run and staff are trained with all of us in mind”, explains the Trust’s acting chief pharmacist Sarah Hudson.
She says that VBR is becoming increasingly important at her trust and a pilot is under way to evaluate a more practical assessment of values than the one currently in use. In the assessment, which will be led by the trust’s human resources department, candidates will be set task-based assessments, where their values and behavioural competencies will be examined through practical activities. If successful, this assessment approach will be applied to all professions working at the trust, including pharmacy.
Recently, the trust recruited for a band 7 pharmacist and, like many other trusts, it is experiencing stronger demand for vacancies that arise. The trust sees values-based testing as an effective additional screening tool and, according to Ms Hudson, its failure rate in terms of delivering personnel with the expected behaviours is low. However, Ms Hudson admits: “It can be quite hard to be objective about scoring the answers we receive, which is why we are considering an assessment centre type model.”
Andrew Ingham, undergraduate programme director at Aston University, says: “The aim of values testing is to get people to talk openly and honestly, and we use such techniques to enable candidates to demonstrate their ability to make clear opinion statements.
“We use questions based around the core competencies for pharmacists and we are looking for candidates to make statements or outline a chosen approach to a situation. We assess candidates on their commitment to the answer, the justification they can provide and their use of factual information to support the answer.”
Dr Ingham explains that, to ensure fairness, interviewers are trained accordingly and always interview in pairs, so that behaviour can be assessed during the interview. Dr Ingham believes that values testing can provide a good assessment of character and, although it cannot necessarily guarantee the production of “a good pharmacist” at the end of the course, he believes it is effective at picking out “oddities” or characteristics that typically remain undocumented in a candidate’s personal statement, for example, distinct personality traits and tendencies to argue, bend rules or lie.