Episode Three: Being an Upstander: Combating Racism in the NHS A Conversation with Patricia Miller
Shownotes
Join us for an eye-opening discussion with Patricia Miller MBE, CEO of Dorset's NHS Integrated Care Board.
Patricia brings over three decades of experience in the NHS and offers an in-depth look into her path to becoming one of the few Black women CEOs in the NHS. She candidly discusses the hurdles she's encountered along her leadership journey, the implementation of unconscious bias training, and the innovative initiatives she has spearheaded to foster inclusivity within the NHS.
This conversation with Patricia Miller is more than just a story of personal achievement; it's a deep dive into the systemic challenges and triumphs in creating a more inclusive and equitable workplace. Barbara explores with Patricia the practical steps and strategies that can be employed to confront and dismantle racism in an institution.
You can find Patricia Miller here.
You can find Barbara Banda here.
The Model Black by Barbara Banda
Music by Maiwa Banda.
Transcription
[00:00:00] Barbara Banda: Hello, I'm Barbara Bander. And this is The Model Black, [00:00:10] a podcast about equity at work. This podcast series aims to create a space where we can have open and positive conversations [00:00:20] around race and difference in the world of work. My ultimate goal is to create more inclusive and equitable workplaces, recognizing [00:00:30] As we do, that achieving equity at work is very much a journey and not a destination.
[00:00:35] Barbara Banda: During this podcast series, we're going to have conversations with experts from [00:00:40] across the globe exploring what we can all do to make our workplaces more equitable. My guest today is Patricia Miller. [00:00:50] Patricia has got over 30 years of experience working in the National Health Service and is the Chief Executive Officer of Dorset's NHS [00:01:00] Integrated Care Board.
[00:01:02] Barbara Banda: This care board is responsible for overseeing the complex health services and health improvement programs [00:01:10] for local communities, and that's for around a million people. In 2013, Patricia was named as one of the 25 [00:01:20] rising Stars of the NHS, and in 2019, she was named as one of the top 50 CEOs. And in that year [00:01:30] was also named as one of the top 50 black figures who will exercise the most power in the NHS and [00:01:40] health policy in 2020.
[00:01:43] Barbara Banda: In 2019, Patricia was awarded an OBE for services to the National [00:01:50] Health Service. So a really warm welcome to you, Patricia. Thank you very much for joining me today.
[00:01:56] Patricia Miller: It's a privilege. Thank you for inviting me. Patricia,
[00:01:59] Barbara Banda: do you know, [00:02:00] even before meeting you, I had heard so much about the cutting edge work that you've been doing within the whole area of equity, diversity and inclusion [00:02:10] within the National Health Service over the years.
[00:02:12] Barbara Banda: One of the things I'm really interested to hear about today are your successes or challenges or even some of the [00:02:20] frustrations that you've had in that space. But ahead of getting into all of that, I'm also intrigued to hear your story. How did you become [00:02:30] to be a black CEO of a UK NHS trust?
[00:02:35] Patricia Miller: First of all, I have to remind myself all the time that I'm the exception, not the rule.
[00:02:39] Patricia Miller: [00:02:40] So when I became a chief exec in the NHS in 2014, there were only less than half a dozen of us out of 230 [00:02:50] organisations, provider organisations. And even in the role that I'm in now, there are 42 integrated care systems across the NHS in England, [00:03:00] and I'm the only BME chief executive. So That tells a story about the progress that the NHS is not making.
[00:03:07] Patricia Miller: And even when I look at the mix of the [00:03:10] 42, there are very few women. The majority are white men of a certain age. So we've still got a lot of work to do in that space around equality [00:03:20] and inclusion. It wasn't a great choice to be in the NHS, if I'm honest. I wanted to be a teacher when I was at school. I was very good at languages.
[00:03:27] Patricia Miller: When I did my A levels, I went to the [00:03:30] Caribbean where my father and my grand grandmother were from in Barbados. When I was 18, I went for a two week holiday and that ended up being a two year. [00:03:40] I'd like I said to my parents a working holiday. I'm not sure I did much work, but I did a lot of holidaying.
[00:03:45] Patricia Miller: And when I came back, my mom, who was a nurse. My paternal [00:03:50] grandmother, both my aunts on that side of the family were nurses and my mum had got me a job in the local hospital and that's where it all started really. I realised very quickly [00:04:00] having had a very strong Christian upbringing that was grounded in values of honesty and fairness but a really important value for us was [00:04:10] giving back and I found that was a way to be able to do that.
[00:04:14] Patricia Miller: And so I progressed quite quickly. By the time I was 28, [00:04:20] I was one of the youngest directors of IM& T in the health service. IM& T? Information management and technology, so what we call digital space now. [00:04:30] But I knew I wanted to be in a role that was more patient community facing. And so I took a career break at 30, another moment where my parents thought I'd [00:04:40] completely lost my mind, and I came back into the service as a middle manager, an operational manager, a service manager, where I would have lots more contact [00:04:50] with not just members of staff and the clinical staff, but also with communities and the patients were there to look after.
[00:04:57] Patricia Miller: And then from that point, because I had a lot of [00:05:00] managerial experience previously, again, I moved along quite quickly. I became a executive director in my early forties and then [00:05:10] three years into that role, And my chief exec decided she was leaving, which was quite unexpected. I never once considered applying for that job.
[00:05:19] Patricia Miller: I've never [00:05:20] had a career path in my mind that I wanted to be a chief executive. I just knew every time I'd reach the ceiling of influence and decision making that I would have for [00:05:30] communities, I wanted to move on to a job where I had a bigger sphere of influence. And I didn't apply for the job. And on the very last day that it was advertised, the closing day.
[00:05:39] Patricia Miller: I remember the [00:05:40] chairman coming to see me and saying, you've not applied for the job. And I said, no, I haven't. And he said, please, can you? And I said, give me one reason why I should. And he said, because I'm sick of clinicians knocking on [00:05:50] my door, asking me to twist your arm to apply. And at that moment I thought actually clinicians are.
[00:05:56] Patricia Miller: not usually wedded to the [00:06:00] executive. I was obviously doing something right. And so I put in a last minute application and I got it.
[00:06:06] Barbara Banda: Wow. So quite a journey, Patricia. Again, I want to [00:06:10] hear some more about some of the changes that you've implemented. But again, I want to take you back a little bit to your time in the Caribbean.
[00:06:19] Barbara Banda: Tell [00:06:20] me a bit more about what impact that time had on you, on your identity, what you thought about yourself. Perhaps just take me there for
[00:06:28] Patricia Miller: a little bit. I think [00:06:30] probably it had the biggest impact on me of anything that has happened in my life, if I'm honest. Just before that in the summer, my mother's final relatives had passed away.
[00:06:39] Patricia Miller: And [00:06:40] so she'd chosen to use her inheritance to take my dad home, because he'd not been home for 17 years since I was two. And we [00:06:50] stayed for three weeks. And that's what really made me think, actually, once I've finished my exams, I want to come back. And it was the first time, I [00:07:00] think, as an adult, I'd been in a place where I felt comfortable.
[00:07:04] Patricia Miller: I've been brought up in this country and I still don't quite feel as if I belonged. And I didn't have [00:07:10] that feeling in Barbados. And actually we, I take the children back every two years now and they absolutely love it. The minute that the plane switches down and we [00:07:20] get off and the warmth and the smell of cane, and it's a completely different environment that we're not under pressure.
[00:07:27] Patricia Miller: We don't have to worry about. anybody saying [00:07:30] anything to us or behaving in a way that is not appropriate. I remember taking my stepson when he was 17 and he said it was the first time he'd [00:07:40] ever been anywhere where the police were here to help and he didn't have to be afraid of them. So it's a totally different environment.
[00:07:47] Patricia Miller: There's a reason why people in the Caribbean don't [00:07:50] have a shorter life expectancy as they do in Europe, because it's the place where they feel comfortable, where they don't have to get up every morning thinking about what response they're going to get to the color of [00:08:00] their skin or their ethnicity because they're in a place where they are of the majority and it's home.
[00:08:05] Barbara Banda: Yeah, and I was particularly interested in that because, I'm thinking [00:08:10] about, the impact that had on your self confidence when you came back to the UK. And I wonder to what extent that made you feel bigger, more positive [00:08:20] when you came back. Perhaps that inspired you and maybe that's had quite an influence on you becoming a Chief Exec.
[00:08:28] Patricia Miller: I think going back there [00:08:30] recharges my batteries. If I go back to Barbados, especially when I've been through a really difficult period here, that will It will give me a sense of purpose again for when I [00:08:40] come back. And it does make a huge difference. It made me see myself differently. It made me realise that actually all the things that I'd been taught [00:08:50] by my father and my grandfather about the fact that you can be anything you want to be.
[00:08:57] Patricia Miller: Do not let anyone else define you, [00:09:00] define yourself. that was all reinforced by going back as a young adult and starting to think about that context and what it meant to me as an individual.
[00:09:09] Barbara Banda: Yeah, so [00:09:10] quite a deep effect on your life then. And then you came back, and as you said, you rose through the ranks relatively quickly.
[00:09:18] Barbara Banda: So [00:09:20] clearly extremely talented. So what was it like for you on that first day, Patricia, when you sat there as the as a Black [00:09:30] woman in that seat? Tell me about it.
[00:09:32] Patricia Miller: It was a mixture of being terrified, feeling proud, also [00:09:40] feeling a huge amount of pressure because that puts me even more in the spotlight and that means my mistakes will be amplified much more than any of [00:09:50] my white colleagues.
[00:09:52] Patricia Miller: There was very quickly a sense of right, what can I do to help other people get into this? space, recognizing that, we [00:10:00] all come forward on the shoulders of others. And also being clear, I wanted to do something about race equality, but also needing to [00:10:10] not take that as the first priority, because then people think actually that's the only reason you've been appointed, because you want to drive that agenda, not because you are a skilled [00:10:20] individual who can manage the whole organization.
[00:10:22] Patricia Miller: And so having to think through quite quickly, the timing of when I might start that work in the organisation and how [00:10:30] I might start to bring the board online with what needed to happen and
[00:10:35] Barbara Banda: why. Yes, so that's quite an interesting dilemma, isn't it?[00:10:40] As a Black person, you're promoted into that role, and yet you're having to be really cautious, trying not to fit into a particular box or a particular stereotype [00:10:50] that says, I'm only here to promote other Black people, which may not have been the case had you not been Black.
[00:10:56] Barbara Banda: Yeah, that's another dilemma, possibly, another stress that [00:11:00] you might have been carrying
[00:11:01] Patricia Miller: as well. It is very much so that we talk about this all the time in leadership communities around, what's racism all about? [00:11:10] And for me, it's about seeing white as being superior and how can we change that?
[00:11:15] Patricia Miller: And there's a fine balance between as a [00:11:20] person of colour wanting to offer. expert advice on how that can be changed but not leading some of that change because that change needs [00:11:30] to come from white colleagues and how do white colleagues get the right balance in leading some of that change but not in a way so they're seen as a white saviour and it is really [00:11:40] complex getting the right balance so that people see the work.
[00:11:43] Patricia Miller: for its true value. No matter who brings that forward, it's a fine balance of getting it right and not [00:11:50] upsetting different parts of society or the organization. So
[00:11:54] Barbara Banda: that's a balance that you've been trying to work with presumably then throughout all the work that you've done, [00:12:00] all the kind of race work, let's call it, that you've been involved in.
[00:12:04] Barbara Banda: So you started to do that work because you're a black woman put in that position. So [00:12:10] how did you get
[00:12:10] Patricia Miller: started? I took part in different bits of national work when I was an executive, before I was a chief executive. And then when I became a chief [00:12:20] executive, I realised very quickly that there is, there's a level of influence and freedom that comes with that [00:12:30] role.
[00:12:30] Patricia Miller: I started to think about how I could use that influence in a broader setting, both regionally and nationally. And then, there was an occasion at the [00:12:40] board where we were reviewing our workforce race equality performance. And every year, it always seemed as if we were doing reasonably well when we compared ourselves to the national benchmark.[00:12:50]
[00:12:50] Patricia Miller: But, The conversation I tried to lead at the board is that whether it appears on the surface from the statistics that we're doing okay, if one person says [00:13:00] that they have had a poor experience in the organization or their career prospects have been negatively affected by the color of their skin, that's one person too [00:13:10] many.
[00:13:11] Patricia Miller: And two, statistics only a part of the story. If I, as the most senior person in the organization, was [00:13:20] experiencing microaggressions regularly, then that said to me that other people in the organization were probably having an even worse experience. [00:13:30] And the board's original response was, Yeah, but according to the benchmark, we're not doing too badly.
[00:13:37] Patricia Miller: And I said, so what you're telling me then is your [00:13:40] view is that people like me in the organization don't matter. And I think that made them think about the messages. that the inaction was sending out. [00:13:50] And so we agreed that we would start a process of discovery where we would do two things. We'd [00:14:00] establish a set of listening events only for BME staff where I would be there and the HR director would be there and the purpose of those events would be to listen [00:14:10] to what their experiences were like of working at the organization.
[00:14:15] Patricia Miller: And then we also decided we'd do a culture audit where we [00:14:20] asked all of the staff to engage in a process of answering three questions and there were Do I belong? Do I feel safe? And do I feel heard? [00:14:30] And there were a whole lot of ways where they could respond, either through one to one interviews, anonymously through surveys, through group sessions, or they could write to any member of the [00:14:40] executive team and then we'd put all that information together.
[00:14:43] Patricia Miller: And that information pulled out a number of themes that yes, we had [00:14:50] some issues with race that were quite clear. We also had issues with the broader characteristics about the way that our [00:15:00] LGBT staff were handled, or were managed, or were engaged with by the rest of the organisation. And we had issues with people [00:15:10] and not, I wouldn't say discriminating against those that were disabled, but not really understanding what disability meant in the workplace and [00:15:20] what reasonable adjustments should be made to enable people to stay at work and be as productive as possible.
[00:15:28] Patricia Miller: So we had a whole range of issues [00:15:30] that we had to deal with, but race was one of the bigger ones that was quite deep seated in some parts of the organisation and the Care Quality Commission. [00:15:40] When they came to do their quality inspection, kept telling us that we were a friendly organisation. And the message I gave back to the staff was, it's more friendly for some than others.[00:15:50]
[00:15:50] Barbara Banda: You've done this, or rather you've decided to do the listening exercise. Patricia, what did you have to say to people ahead of that to make them feel that it was safe, [00:16:00] that made them feel that they could be honest, and that actually something would be done about it? Because lots of ex organizations.
[00:16:07] Barbara Banda: They do this listening exercise and [00:16:10] people say, yeah, you've heard me now. So I guess what I'm really interested in is how you prepared them and then, [00:16:20] how it was that you made the bridge between what you heard and what you did then.
[00:16:25] Patricia Miller: We prepared them by shaking the culture up a little bit. So if you look [00:16:30] at Edgar Shine's theory on culture change, he talks about destabilizing the existing culture so that people are more receptive to the [00:16:40] change that might be coming.
[00:16:41] Patricia Miller: So how we prepared everyone was having some conversations at our leaders briefs, our network meetings, [00:16:50] at our all staff briefings that said This is what the Care Quality Commission says about us, but this is what we think is actually happening in the organisation. And that made people [00:17:00] feel slightly uncomfortable because they wanted to believe they were working in a really friendly organisation, and for the most part it was, but under certain circumstances.
[00:17:09] Patricia Miller: So it made [00:17:10] them really think about how they reflected on behaviours. And the other thing that I think I'd, I had built a reputation as an [00:17:20] executive that I did what I said I would do. I realised that was why I had a reasonably good relationship with the clinicians because I always did what I said I would do.[00:17:30]
[00:17:30] Patricia Miller: And so when I said to the staff, whatever we find out, that needs to be fixed, we will tackle it. There was an element of trust [00:17:40] built in there already that if I said I'm going to do it, I'm going to do it, no matter how difficult it is. And also the promise to people that if they didn't want to [00:17:50] be identified in terms of their feedback, then that was fine because nobody would be identified because we would play the themes back anonymously.
[00:17:58] Patricia Miller: So nobody would be able to say, oh [00:18:00] Joe Bloggs said that about my department and because that's always the fear about the staff survey. If you're only one of one or two of a whole group of scientists in a [00:18:10] department, then if you respond, that's BME, if you respond in a certain way to the survey and then the survey is broken down by ethnicity, you will be identified.
[00:18:18] Patricia Miller: And so saying to the staff. [00:18:20] This is really important that we need to hear what you think because we can't change anything unless we know what needs to be changed. But also we absolutely [00:18:30] guarantee your anonymity because the feedback will come on that basis.
[00:18:34] Barbara Banda: Yeah, so you started to talk about the response that you got and then the themes that came out [00:18:40] of that then.
[00:18:40] Barbara Banda: So perhaps you can just expand on that a bit more for us. Give us a sense of what it was you found out that you were dealing with.
[00:18:47] Patricia Miller: So there were things that you would expect to be honest [00:18:50] language being used that was racist or homophobic or offensive to people who were disabled. We had [00:19:00] individuals who felt they were being held to a higher level of performance because of their ethnic background.
[00:19:06] Patricia Miller: We had individuals who were hiding [00:19:10] their sexuality because they didn't want colleagues to know because they were pretty clear what response they would get. We had BME junior [00:19:20] doctors who consultants at times used completely different names for them because they just couldn't be bothered to remember their name or even be bothered to learn how to pronounce it.
[00:19:29] Patricia Miller: It was all [00:19:30] those kind of behaviours that you really will expect in society that just were mirrored in the organisation that we knew we had to get on top of. If one, we were going to [00:19:40] create a safe environment, but two, we were also going to create an environment where everybody could reach their full potential regardless of their background.
[00:19:48] Barbara Banda: So essentially, you're up against [00:19:50] a kind of shift in culture. That was essentially what needed to happen if people from Black, minority, ethnic background were to have a different experience. And you [00:20:00] were dealing with an organization, with the National Health Service that has some pretty entrenched practices.
[00:20:06] Barbara Banda: So again, how did you go about saying [00:20:10] yeah, we've heard these themes and now we're going to make this a safer place for you. We're going to make it a more comfortable place for you.
[00:20:17] Patricia Miller: We took the board through a development [00:20:20] program that lasted around about 12 months. So we were clear as a board that if we were going to make some changes that we had to lead them [00:20:30] and that this was not about giving the board a half day seminar in ED& I and then expecting them to be experts.
[00:20:37] Patricia Miller: So we developed a program for them [00:20:40] with the third party organization. They had to come together regularly for two days at a time of development, and they were asked not to go home in the evening to stay [00:20:50] over in the facility. And the reason why they were asked to do that is because it's really easy to connect with this subject on an intellectual level, and we needed them to connect with it on an emotional [00:21:00] level.
[00:21:00] Patricia Miller: So what we didn't want was board members being in the room, connecting with the intellectual, then going home. having the evening with their families, disengaging and then coming back the day after. [00:21:10] And actually what happened from that, which is what we wanted, was that the conversations carried on into the evening because people got immersed in the subject that we needed them to understand it on [00:21:20] a deeper level, to then know what they had to do to make a difference.
[00:21:24] Patricia Miller: So they were asked to do lots of things as part of the program. They were taught about the difference between racism, prejudice and [00:21:30] discrimination. They were taught about the background of racism, where it came from. They would talk about it. They were taught about slavery and the impact it's had since abolition.
[00:21:39] Patricia Miller: They were [00:21:40] asked to plot their own life journeys and identify individuals and moments that had influenced their worldview. So they could see how that [00:21:50] worldview was no contrary to what the world was actually like. And that the, I think the deepest thing they were asked to do to learn was they were each asked to go and [00:22:00] identify.
[00:22:00] Patricia Miller: four BME members of staff and they were to interview them but they were given some really strict instructions that they were to ask them to talk about what it was like to [00:22:10] live in the UK and also what it was like to be an employee of the organisation and they'd not to interrupt, they'd not to try and influence, they just had to listen [00:22:20] and for lots of our board members who were white and middle class actually that was a really difficult exercise because they were exposed [00:22:30] to lived experience that had never been theirs and that they honestly thought didn't exist anymore in this country.
[00:22:35] Patricia Miller: So they were shocked, they were upset. I remember [00:22:40] one colleague saying to me that she had worked in public health all of her life and she just realized that she'd only scratched the surface on inequality. [00:22:50] So it was a deep learning curve for them. And then as part of that work, We then said, what's our ambition then for the organisation?
[00:22:59] Patricia Miller: What is [00:23:00] the type of culture we really want to create? And then we involved a lot of staff in that conversation. And from that came an ED& I strategy.
[00:23:09] Barbara Banda: [00:23:10] Yeah. And what you say there. about the senior team going through this kind of deep learning process in the first instance. Again, I'm sure this will probably strike a [00:23:20] chord with some of the people who are listening, because there's often a sense that you can go in, you can have an initiative and somehow that sorts it.
[00:23:29] Barbara Banda: But what [00:23:30] I'm hearing from you is that you were investing a lot of time and energy into this. And there was a real sense that you were almost slow to start and fast to [00:23:40] finish in this process and that you were taking people on a journey. So now you've got the top team and you've got them being the change [00:23:50] you want to see, or at least they have an understanding of the change that they want to see.
[00:23:55] Barbara Banda: and now you're coming up with a strategy. So what did you want to become [00:24:00] and how are you going to measure
[00:24:01] Patricia Miller: it? I think we recognised from the work we were doing two really important things that, that culture change only happens one conversation at a time. [00:24:10] There isn't any golden bullet that you can pull out and all of a sudden this great initiative makes it happen.
[00:24:17] Patricia Miller: It changes through conversations [00:24:20] and that. Something that one of my colleagues at the ICB now says all the time, which is ICB, I'm sorry, Integrated Care Board. Lovely. [00:24:30] That, real change happens in real work. So taking people to a classroom, teaching them a lot of theory about inclusion, then plunking them back in the workplace doesn't actually deliver.[00:24:40]
[00:24:40] Patricia Miller: So we wanted to create an organization where our staff felt psychologically safe, that they felt listened to, that they [00:24:50] felt valued, and where they were going to be able to reach their full potential no matter what, because their difference would be celebrated. And we then developed [00:25:00] a strategy that was put into three different strands that would enable us to deliver on that.
[00:25:06] Patricia Miller: So the first one was leadership development and that [00:25:10] focused on all of our managers from our senior managers right through to consultants and senior [00:25:20] nurses and executives. And that program was six modules. And it focused on three areas, which were seeing the world differently, [00:25:30] responding to that difference, and then leading differently.
[00:25:35] Patricia Miller: For each of the modules, they were expected to be released for a [00:25:40] whole day. It didn't have to be at a time, it could be two half days. One half day was the actual working in the workshop with our facilitator, [00:25:50] and the other half day was before the workshop where they were sent lots of information to read, articles, or they were asked to watch short videos, [00:26:00] and then the beginning of the workshop would be.
[00:26:03] Patricia Miller: Let's have a conversation about what you took from those reading, from those readings or videos. What did it [00:26:10] say to you? How is it now influenced the way you think about your role in society? And then the rest of the module was breaking out into smaller groups to say, Okay, so now [00:26:20] we've got this theory, let's talk about how you're going to use it.
[00:26:24] Patricia Miller: in your leadership journey as you go back to the day job? What does it mean for how you operate as a leader? [00:26:30] What does it mean for how you engage your team? What does it mean for how you see them as human beings? So
[00:26:36] Barbara Banda: tell me, how were they held to account once they came [00:26:40] back? So they've gone through this leadership development.
[00:26:44] Barbara Banda: Who checks on them? Who checks those behaviors? That who checks that they're actually having [00:26:50] different conversations to the ones that they were having beforehand?
[00:26:53] Patricia Miller: So we did a number of things. We surveyed the direct reports, their team before the program, and then we [00:27:00] surveyed them again a little while after the program, see what changed in terms of their ability to be inclusive leaders.
[00:27:07] Patricia Miller: We also developed a corporate [00:27:10] dashboard. that went to the board at every board meeting that had some hard measures around people, but it also had some softer cultural [00:27:20] measures. We developed an internal survey mechanism for the organization that we would target different departments using that survey.[00:27:30]
[00:27:30] Patricia Miller: And then we also use the staff survey because you can add a small number of questions of your own to the national survey that you want locally in your organisation. [00:27:40] And then we adopted a process of comply or explain within our divisions and services where we set them some targets around different areas of ED& I, [00:27:50] on the understanding that Every few weeks when each of the divisional teams met with the executives, we would ask them how they were doing.
[00:27:59] Patricia Miller: We'd look at their [00:28:00] performance, but we wouldn't look at it with a hard performance set. We'd look at it through the lens of, okay, if you're not meeting those standards, let's talk about [00:28:10] what you've already tried. what approaches you've tried, and then how can we offer some additional support to get you to the place where you need to be.
[00:28:18] Patricia Miller: There was the odd member of [00:28:20] staff who didn't want to engage at all and they were working in the wrong organisation.
[00:28:25] Barbara Banda: So she was taking this very seriously. And, I [00:28:30] think, or at least I'm hoping that people listening to this podcast are really getting a sense of the time investment, the energy investment that you need to make if [00:28:40] you really want to make a shift.
[00:28:42] Barbara Banda: You're setting up systems, processes to measure it as well. You've done this, you've done all [00:28:50] this work, you've listened, you've done the leadership development stream. Tell me a bit more about the other elements that you also included in this. [00:29:00] Because again, I'm imagining the people who are listening to this will think, we need a bit more of that in our organization or, we're learning a lot from listening to this.
[00:29:09] Patricia Miller: For the lower [00:29:10] level team leaders, we developed a slightly different program. It was still focused on inclusion, but it was less intellectually challenging. So that was [00:29:20] called Dignity and Respect at Work and we coupled that with something called Management Matters. So we had a set of modules that taught people the hard skills of [00:29:30] management but also some of the softer skills around how you encourage positive human relationships between people in teams.
[00:29:37] Patricia Miller: And then we took [00:29:40] our key people policies, so there were recruitment, talent management, and succession planning. and our disciplinary policy. We pulled people from [00:29:50] our networks together with people from our people teams and we got them to work over a series of four months on rewriting those [00:30:00] policies through an inclusive lens.
[00:30:02] Patricia Miller: And when we looked at the disciplinary policy, because we were so clear that what we wanted to do was create adjusts and learning [00:30:10] culture, one where people were trusted, not monitored all the time to catch the five percent out who will fall in sick when they're not really sick or do something naughty at [00:30:20] work.
[00:30:20] Patricia Miller: We wanted to have an environment of trust because those things will come to the surface anyway. We asked the people team to interview 100 people who'd been through the [00:30:30] disciplinary policy recently because If the people team is going to be the conscience of the organization, it has to be on this journey as well.
[00:30:39] Patricia Miller: It's quite, [00:30:40] because quite often the policies. that discriminate are written and signed off by the people teams and implemented by the people teams. So it's important they were part of the [00:30:50] process.
[00:30:50] Barbara Banda: And so how did you keep them on board? Sorry to interrupt you there but how did you, because that can be really important, particularly for people who are not [00:31:00] of the majority, who are looking on there and they're seeing people.
[00:31:05] Barbara Banda: or policies that are being used in their minds [00:31:10] against them by a group of people who should be supporting them. So how did you make that work?
[00:31:14] Patricia Miller: We brought them in right from the beginning because it was important that [00:31:20] they were sitting alongside and part of this work. And when they did the exercise on the disciplinary policy, it, I think it all, [00:31:30] it brought it home to them very strongly that they were really distressed by the whole exercise because it made them realize that when you put someone through a policy [00:31:40] intervention, That actually it causes a lot of emotional and psychological distress to them.
[00:31:45] Patricia Miller: And that distress can happen for their whole lives in terms of the psychological [00:31:50] contract between them and their employer. And so they started to see the world through a different lens. And I remember One very senior person in HR saying to me [00:32:00] one day that you've opened my eyes and now I see it everywhere and I can't unsee it and she meant racism.
[00:32:07] Patricia Miller: So we rewrote those policies and then the final bit we [00:32:10] did was we developed an accountability framework and that was how were we going to hold each other to account at the board? How were we going to hold each other to account [00:32:20] across the organization? And that's where we developed this process of comply or explain.
[00:32:26] Patricia Miller: and the dashboard reporting so we were clear what the [00:32:30] expectations were of everyone and also that trying to be really clear when individuals don't behave in a way that you want them to when [00:32:40] that is done because education is needed. as opposed to when that is done because people just don't agree with creating an inclusive environment and how do we [00:32:50] respond to that.
[00:32:51] Patricia Miller: And I think I was really clear with all the staff in saying that anyone who doesn't want to engage in this work because they don't feel it's necessary, [00:33:00] then you're not working in the right organisation. because you're not aligned to the organization's values. And I would much rather that you chose to move on, [00:33:10] so that we don't have to do it to you.
[00:33:13] Barbara Banda: So quite firm, really, around upholding standards and sticking to what really mattered here. And you know what I'm [00:33:20] hearing in all of this, Patricia, in, in what you're describing here, I'm hearing a lot of you in this because inevitably it's you that's guiding it, it's [00:33:30] you that's leading it, you're the CEO.
[00:33:32] Barbara Banda: So how much of this was dependent on your presence being there and to what extent were you able to set up systems [00:33:40] and processes, ways of being different in interactions? Ways that, that could be sustained beyond you, so people could be different, [00:33:50] even perhaps when you were no longer involved in the process.
[00:33:54] Patricia Miller: I think at the beginning it did feel like it was my journey and I remember [00:34:00] when we were doing the board development work that the person that supported us with this work was also black and he was used [00:34:10] to facilitating all white boards in that space and because I was in the room we had to have a conversation quite early about how we would do the work but not [00:34:20] trigger each other because there were moments like When we talked, for example, when we had a workshop with Robin [00:34:30] D'Angelo about white fragility and I got very distressed by that, because even I hadn't thought very deeply about why certain people want [00:34:40] to shut down a conversation about racism before you've even started it.
[00:34:43] Patricia Miller: And so we had to think really carefully about how we were going to get through these modules and he wasn't going to [00:34:50] get upset because I got upset and then his response to the group might be different. I think that the fact that we, even when we started [00:35:00] the leadership development program for the senior staff, that all the executives joined a different cohort, that said to the organization, this is not just about me, [00:35:10] this is about the executive knowing that this is the right thing to do.
[00:35:14] Patricia Miller: And actually someone else is the leader, the chief exec at that organization now. And. [00:35:20] The first time that he walked around the organization to meet the staff, one of the things he said to me afterwards is, you've left a really good legacy. [00:35:30] And I thought, okay, I feel good about that now because that means that some of that work, which is still, the leadership development work is knowing the essential [00:35:40] skills.
[00:35:40] Patricia Miller: training bucket. So you reach a certain point, you have to do it, but that's still carried on because people recognize it's the right thing to do.
[00:35:48] Barbara Banda: You've left a terrific legacy [00:35:50] there. And as you've said, it really does have a life beyond you. And I think that's quite important as well.
[00:35:57] Barbara Banda: So as you look back, [00:36:00] Over all of this, over all this deep work that you've done, all this deep work that you were doing in the organization. What would you say are the key things that you've learned [00:36:10] as you look back? What are maybe, the top two or three things that you've learned from this entire experience?
[00:36:16] Patricia Miller: There's probably three or four important things I've learned. [00:36:20] One, there's a massive difference in the response that you get from people if you talk about pro equity as opposed to anti racism. Because,[00:36:30] this idea that if we support one group that we're taking that away from another group. It helps people understand that [00:36:40] equity benefits everyone and that in that space of equity versus equality, it's okay to invest more [00:36:50] in some groups than others to enable everybody to reach the same standard.
[00:36:54] Patricia Miller: I think the other things I've learned is that if you don't know how someone wants to identify, don't just [00:37:00] make assumptions, ask them. Nobody's going to be offended by you asking them. What they are going to be offended by is you making assumptions or giving them a name that they haven't really got because you [00:37:10] won't, you don't want to ask how to pronounce their name or, making assumptions about their ethnic background and prescribing something for them medically that's not appropriate because you just [00:37:20] don't want to ask them.
[00:37:21] Patricia Miller: Ask them. Nobody's going to be offended by that. I think the other thing I've learned is being an upstander matters, not a [00:37:30] bystander. I don't really like the word ally, because it makes me feel like a victim. But, if you see something that's wrong, be that person that is an [00:37:40] upstander and says that.
[00:37:41] Patricia Miller: And that's really scary. And sometimes you won't be able to, because you're not brave enough. And that's okay as well. because people respond to fear in different ways, [00:37:50] but if you can, be that person that steps out before that person of colour has to challenge what's said and say it for them, because that makes [00:38:00] everyone's life easier.
[00:38:01] Patricia Miller: You don't want to be the black person in the room, the only black person in the room, that's always the one that challenges everyone's language or assumptions. [00:38:10] So if you're a white colleague, yeah, be an upstander. Say when things are wrong. And then I suppose the other thing I've learned is that I said earlier on, [00:38:20] real change happens in real work.
[00:38:23] Patricia Miller: Don't teach people the theory of racism without getting them to think through how [00:38:30] they might be different in the workplace with the knowledge that they've got because otherwise nothing changes. People have a lot of knowledge in their head but nothing [00:38:40] changes and create an environment where it's okay for them to get it wrong every now and again because people will get it wrong and that's okay as long as they're [00:38:50] receptive to the feedback that they've got it wrong and then we try to be different going forward.
[00:38:55] Patricia Miller: So
[00:38:55] Barbara Banda: again, some really great learnings there, and I think those learnings are [00:39:00] going to be beneficial to anyone, regardless of where they are on their journey within their organization. And those are some really [00:39:10] key things that you've learned, as you've said, around equity, about how people identify themselves, about being an upstander.
[00:39:17] Barbara Banda: Those things really [00:39:20] resonate with me, that upstander piece. You've learned a lot, Patrician. Tough question here, or maybe not so tough, we'll see. If you look back, what would you [00:39:30] have done differently if you were to go back now? Because clearly, you've said you've left a real legacy.
[00:39:36] Barbara Banda: So looking back, what would you say, maybe I could have done that [00:39:40] differently, or perhaps I could have done that better, if you do have those
[00:39:43] Patricia Miller: moments? I would have started it sooner because When we'd done the listening exercise and the culture [00:39:50] audit, we then decided that we would take one step further and during Inclusion Week, which happened to be in the month of Black [00:40:00] History, that we would have this display along the corridors of 100 members of staff all from different ethnic backgrounds with a hashtag on the bottom that [00:40:10] said basically we all work for the same organization.
[00:40:12] Patricia Miller: And one evening, A member of staff, and we never found out who it was, but we knew it was a member of staff, defaced four of those [00:40:20] photographs, two that were staff that were LGBT and two that were people of colour, one being me and another colleague. So they damaged the pictures? They [00:40:30] crossed our faces out with a black marker.
[00:40:33] Patricia Miller: And that took me a few weeks to move past that, because it, because when someone [00:40:40] does something like that, it basically gets to the heart of you, how it's, as a human being, it's crossing out your existence. And, but actually when I reflected on it [00:40:50] over a month, it made me more determined to make the change that we needed to.[00:41:00]
[00:41:00] Patricia Miller: And then there was a moment of reflection then for me, which was. We should have started this process earlier because the fact that we're getting this kind of [00:41:10] backlash says that we really needed to do it. And it wasn't just from the staff, it was also from the community. We got to a point where [00:41:20] all of my correspondence and emails had to be filtered before they came to me because I had letters.
[00:41:27] Patricia Miller: emails from people outside the [00:41:30] organization that were just blatantly racist and didn't understand why we were doing any of this work. And someone who, there was an article in the Daily Mail about [00:41:40] an event I'd been at speaking and someone from the other side of the country sent me some vile correspondence and eventually was charged and found guilty of [00:41:50] distributing malicious material.
[00:41:52] Patricia Miller: So yeah, it was a really challenging time, but it just made me realize actually this, we can eat, we can either all crawl under the [00:42:00] carpet now, or we can just keep going because this is really important and it's really necessary.
[00:42:06] Barbara Banda: I guess what I'm hearing is, there was an element or perhaps even more than an element[00:42:10] of personal risk for you in this whole thing, both from being the CEO, will it fail?
[00:42:15] Barbara Banda: Will it not fail? And also, on a very personal level of. [00:42:20] receiving abuse. So how did you deal with
[00:42:23] Patricia Miller: that? Oh god, my husband was, yeah, coming home and being able to have a supportive [00:42:30] family that could talk to about that was, I don't think I could have kept going without that. Also, I've got a network of [00:42:40] Not just BME colleagues, but white colleagues as well, who are on this journey and who I can talk to about any of this stuff.
[00:42:48] Patricia Miller: And that really made a [00:42:50] difference as well. Because, yeah, when somebody writes to you from the other side of the country, you start thinking, Blimmin heck, am I safe anywhere? But yeah, having those people who were [00:43:00] grounded that I could really turn to for support was really important during those, especially those few weeks of the event at work and then [00:43:10] lots and lots of correspondence arriving.
[00:43:12] Patricia Miller: And I, what I kept holding on to was that the NHS in the health and care system in Dorset employs [00:43:20] over 32, 000 people. If we can change the attitudes of more so those 32, 000 people, then they will change the attitudes of their [00:43:30] friends, of their family. So we have an opportunity in the NHS to create a social movement around social justice if we just take it seriously.
[00:43:39] Patricia Miller: Yeah. [00:43:40] And yeah, I just. I decided no matter what happened, I wasn't going to walk away from it. And it's
[00:43:45] Barbara Banda: interesting, again, what you're saying here, because, you're changing attitudes, you're [00:43:50] changing perceptions, you're changing the culture of an organisation, on one hand endorse it, and yet, I know there are going to be people listening to this, and [00:44:00] they'll be saying, yeah, but what about Snowy White Peaks?
[00:44:03] Barbara Banda: We're not really seeing the differences that we want to see in the NHS. You've done great work, [00:44:10] and, we all have a sense that there's so much more work that needs to be done. So what would be your message to those people?
[00:44:17] Patricia Miller: Yeah, we've had snowy white peaks [00:44:20] and I
[00:44:20] Barbara Banda: think that And that's a report that talked about the lack of representation of certain minority groups within leadership within the
[00:44:28] Patricia Miller: NHS.
[00:44:29] Patricia Miller: We've [00:44:30] made a good amount of progress in terms of non executive directors in the NHS, but we're not making anything like the same progress in executive directors, [00:44:40] so we've got to get on top of that. And some of that is because we're not creating the pipeline of people. to put into those [00:44:50] roles and some of that will be about attitudes and, I talk all the time nationally about the fact that we think that nurses that come and doctors that come from overseas, [00:45:00] from places that were previously part of the empire, that their training programs are suboptimal to ours, so we need to test them over and over again when they arrive here, it's just a nonsense.[00:45:10]
[00:45:10] Patricia Miller: So we've got to deal with some of that and we've also got to make the NHS an attractive place for people to work. They're, at the moment we've got high [00:45:20] levels of bullying and harassment for ethnic minority staff and people feel pressured and overworked. So we've got to tackle some of those harder [00:45:30] things in order to make it a more attractive place to work, recruit to what we've got to recruit to, but also create that safe caring environment for [00:45:40] our staff in every organization at every level, not just some.
[00:45:44] Patricia Miller: But I also think that There's something about when you've got interventions that work and I think part of the reason why [00:45:50] the NHS is still where it is because people repeatedly implement lots of interventions that have no evidence base underneath them whatsoever that they're going to make a [00:46:00] difference.
[00:46:00] Patricia Miller: So there is something about. We tried for a long time, tested different interventions until we found the golden nugget of something that actually worked, because we [00:46:10] engaged the staff in that process and said, does this work for you? Does this work? Tell us what you thought before. Tell us what, how you think afterwards.
[00:46:17] Patricia Miller: Actually, we didn't make a change and we dropped it. We [00:46:20] modified it as we're going along. And I've taken the opportunity to. take up the role of SRO in our southwest region. SRO. Senior responsible officer. Thank you. [00:46:30] In our southwest region for equality and inclusion and we've developed an ED& R strategy for the region and the same [00:46:40] leadership development program we implemented at the hospital we're now going to roll out across the region.
[00:46:45] Patricia Miller: And that's taken a lot of individual conversations. It [00:46:50] also took a year of development with the chief exec community, just like we did at the board at DCH to help them understand why this is necessary and why they [00:47:00] need to lead it. And so you can make change if you really want to and you're determined, but it takes time and it takes conversations [00:47:10] and there's no quick fix in this.
[00:47:13] Patricia Miller: And if you want results in three months, you're not going to get them. If you want what we saw, the first results [00:47:20] after two years, because people started to work in a different way, you've got to be prepared to stick with it for the long
[00:47:26] Barbara Banda: haul. And I think that's a wonderful message [00:47:30] again, to share with people who are listening to this, and and I know that we've said it already, this isn't a quick.
[00:47:36] Barbara Banda: fix. This requires some determination, and we're also getting [00:47:40] towards the end of this podcast now. And there are a couple of questions that I'm still desperate to ask you. And one of them is a kind of practical, physical question around you. You've made [00:47:50] these great changes and, you've talked about the fact that somebody else has picked up the baton.
[00:47:56] Barbara Banda: So if I was going to walk into your organization [00:48:00] now, into that organization now, what would I? feel that I would know that something's happened here that what would I feel that I could [00:48:10] be sure that someone has put some energy into making a change that helps people who might in some way be outside the majority in the [00:48:20] organization that might make them feel
[00:48:22] Patricia Miller: more comfortable.
[00:48:23] Patricia Miller: I personally, I would hope that you would walk in and you'd immediately feel that you're in a safe environment and [00:48:30] that people that are there to look after you will see you as an individual human being, not a homogenous [00:48:40] group or a stereotype, they'll see you as an individual and they'll want to provide you with the care that you as an individual [00:48:50] need in a way that matters to you.
[00:48:52] Patricia Miller: And I would, I really hope that's what you would experience.
[00:48:55] Barbara Banda: Yeah. Yeah. And that's great. So that, that, that's, again, part of your legacy, [00:49:00] the legacy that you've left there. And, if I'm looking at this fantastic woman who is Patricia Miller, who has achieved all these achievements [00:49:10] tell me, Patricia, what's next?
[00:49:11] Barbara Banda: What's your next big aspiration?
[00:49:14] Patricia Miller: I would like to get to the end of the work programme in the South West region. So I know we've really made a [00:49:20] difference because We really want the Southwest to be the best place to work and live. And so we've got work to do, and [00:49:30] recognizing that this work is the right foundation, the precursor to tackling wider health inequalities and how we do that, so that we are [00:49:40] equipped to have the right conversations with our communities so that we do start to see social justice in practice.
[00:49:48] Patricia Miller: And then [00:49:50] four years I'll be 60, so who knows.
[00:49:52] Barbara Banda: You don't need to give away too much information, but that's absolutely fine. And what I like about what you said, yes, you've done a lot of work, you've done a [00:50:00] lot of work around race, but this isn't just about race. This is a broader social justice movement.
[00:50:05] Barbara Banda: This is very much about making the world a better place for everyone. Yeah, that's [00:50:10] essentially what I've heard. Is there anything that you haven't said? Anything that you would like anyone who's doing some work in this area, anything that you would still like them to hear? [00:50:20] Is there anything that you've learned that is perhaps still unsaid here?
[00:50:23] Patricia Miller: The only thing I would add is that when you look at the way that western [00:50:30] cultures operate, and you look at the way that cultures from Africa, Asia, how they operate, the UK is very much a society based on [00:50:40] individualism. And yes, we all pulled together through the pandemic, we did a great job, but by and large, it's based on individualism.
[00:50:48] Patricia Miller: When we look at cultures in [00:50:50] Africa and Asia, they're based on collectivism, and that's an entirely different concept. So when we talk about wanting to move [00:51:00] society forward so it's more cohesive, where, some of the things that our community's told us when we asked them, what do you want us to put in the strategy, And they talked about [00:51:10] wanting to have a purpose to their day, wanting to feel a sense of belonging in the community they lived, wanting us to help them strengthen community networks, because [00:51:20] that gets them through when they're unwell, as opposed to accessing public service.
[00:51:25] Patricia Miller: There is a lot that we can learn from ethnic minority communities [00:51:30] about what that model looks like. And If we're really going to make integrated care systems work, it's all about partnership and a [00:51:40] collective approach to good health, to everyone having the opportunity to live their best lives. And so when we're [00:51:50] talking about multiculturalism and what it means, We always think that everyone else has got something to learn from the West, but actually in the [00:52:00] times that we're in, we've got so much to learn from them around how community really galvanizes itself to build on its own [00:52:10] assets and be part of the direction of its own future.
[00:52:13] Patricia Miller: And so I, yeah, I would really want people to really think about that more deeply because it can be the [00:52:20] catalyst to lots of positive
[00:52:21] Barbara Banda: change. Thank you so much, Patricia Miller. This has been a fascinating conversation. I'm so highly [00:52:30] impressed again by the fantastic work that you've done and the legacy, the kind of living legacy, if there is such a thing that you've left.
[00:52:36] Barbara Banda: So thank you very much again. for being part of this [00:52:40] podcast.
[00:52:40] Patricia Miller: Thank you. Thank you, Barbara.
[00:52:44] Barbara Banda: Thank you so much for listening to The Model Black. These conversations mean so [00:52:50] much to me, and they're so important in helping change to happen. If you've enjoyed what you've listened to, please rate, review, follow, subscribe, and share. [00:53:00] This helps other people find the show, and it means you won't miss a thing.
[00:53:05]Barbara Banda: If you'd like to find out more information about my book, The Model Black, you can find [00:53:10] more information. in the podcast description.