Lanarkshire NHS - pilot round - good practice in attraction and assessment - 2013

Key learning outcomes

• Appointment rounds can be used to engage more effectively with the communities that the board serves. To be most effective at this, the body’s own brand and resources should be utilised alongside those of the Scottish Government 
• Boards and the Scottish Government should consider well in advance what vacancies are due to arise so that their ongoing community engagement activities can be adapted appropriately when competitions are on the horizon
• Assessments can be conducted in groups whereby people participate in simulated board meetings. Trained assessors who can report their findings to the selection panel should be used for such exercises 
• You can appoint people who don’t have more traditional governance skills when those are already well represented on the board. This allows you to appoint people with perspectives and backgrounds that would otherwise be lacking. This isn’t about creating two tier boards. Everyone has a valuable and different contribution to make   
• For this approach to be successful you have to make significant changes to the more traditional methods used for application and assessment.

As this pilot round used a range of innovative techniques, this case study is quite comprehensive and includes some additional, more detailed, lessons. For those that might wish to try the approaches taken. 

Background

Alex Neil MSP, the Cabinet Secretary for Health and Wellbeing, commissioned this as a pilot appointment round to find two new board members. 

The Cabinet Secretary had indicated that he was very keen for the round to use a more pro-active approach to publicising the opportunities to serve as board members and for a more accessible, engaging and attractive appointment process to be tried. In particular, the Cabinet Secretary wanted the exercise to be used as an opportunity for the board to engage effectively with the communities that it serves and for the round to generate a more diverse field of applicants than can sometimes be the case when standard approaches are tried. 

The broad proposals for the pilot were agreed with the Commissioner and he assigned a Public Appointments Adviser (PAA) to play a full and active part in the pilot as a selection panel member and to assist by providing advice and expertise throughout. 

A number of the methods tried during the pilot exercise were relatively new and innovative and were considered successful.  

Planning

The Cabinet Secretary had given some broad direction on the type of people that he wanted to appoint. The selection panel, including the chair of the board, expended time and effort to establish a shared understanding of the board’s requirements from the outset. Two planning meetings were held to ensure that there was clarity on what ‘merit’ might look like for this particular round and how this might link to the particular resource and governance requirements of the board at that point in time. 

The panel agreed on five criteria for selection:

1. Ability to understand how diverse groups of people (for example disabled people, ethnic minority people or other under-represented groups) are affected by the things a Health Board does
2. Ability to communicate effectively
3. Ability to analyse and review complex issues
4. Ability to challenge constructively
5. Ability to weigh-up conflicting opinions and reach your own decisions

The panel was clear that it was not enough simply to attract new and different types of applicant. They had to design the whole appointments process to be accessible to such applicants. Planning considerations included:

• how best to define the essential criteria for the role and what variations between the two positions being filled meant for the person specification(s) being used
• the diverse ways that applicants who had not previously engaged with the traditional public appointments process might potentially demonstrate their match for the selection criteria 
• the methods that the panel might use to consistently and fairly assess a more diverse range of applicants against particular criteria for selection
• the importance of ruling people in rather than out by ensuring in particular that the first stage of assessment didn’t prove to be a barrier to people who weren’t adept at filling out forms in a prescribed format
• the importance of integrating this appointment round into the wider public engagement and communications work of the board so that it reached beyond those people who might traditionally already be interested in applying for public appointments
• the importance of using the board’s own resources (in HR, communications, equalities and public engagement particularly) to make it both deliverable and directly relevant to NHS Lanarkshire’s local issues and audiences.

Attraction

No paid for advertising was used for the round as it was felt that this was more likely to reach people who already had an interest in public appointments.  Instead, the board undertook significant face to face publicity work and active engagement with communities across Lanarkshire, running five public engagement sessions during daytimes and evenings that specifically targeted a range of under-represented groups. This approach integrated the board’s broader public engagement strategy with the specific information about these vacancies. Potential applicants were personally encouraged to get involved. The comprehensive communications plan also included:

    • letters from the Chair to a wide range of local and national organisations
    • press releases
    • local newsletters
    • posters and flyers displayed in local NHS premises and sent directly to targeted local organisations
    • NHS Lanarkshire display screens
    • public information sessions and 
    • social media. 

The chair of the board also spoke personally to a significant number of people who accepted the invitation to contact her directly to discuss the opportunities. This approach achieved significant targeted outreach although it was highly resource intensive. 

The positions were also publicised in the standard way on the Scottish Government and board’s own websites and Twitter account.  Wider notification of the opportunity was also provided to the normal range of professional bodies.  

Assessment

It was decided that applicants would have to demonstrate an understanding of how diverse groups of people are affected by the things that a Health Board does at every stage given the importance placed on this by the Cabinet Secretary and body chair.  

The panel agreed to use a three stage appointments process which was designed to:

• maximise the numbers of people from non-traditional/under-represented backgrounds that would be interested in and able to apply
• rule people in, wherever possible, at the initial assessment stage
• pilot alternative methods of early assessment through group exercises that would be more accessible and better suited to assessing people from non-traditional backgrounds
• build up a clear composite picture of applicants from an assessment journey that enabled them to demonstrate their match for the role in different ways and contexts.

First stage - paper-based

All applicants were asked to refer to the person specification and to respond to the following in their written application: 

NHS Lanarkshire must deliver its services in a way which is as accessible and inclusive as possible to the diverse population of Lanarkshire.  Please explain in 500-700 words what skills, knowledge and experience you could bring to support NHS Lanarkshire to do this better.

As additional guidance and to be as explicit as possible, applicants were further prompted as follows:

When providing your answer to the question, please ensure you cover what has been specifically asked by:

• Highlighting what skills, knowledge and experience you could bring to support NHS Lanarkshire to deliver its services in a way which is as accessible and inclusive as possible to the diverse population of Lanarkshire.

You should aim to demonstrate in your answer how your skills, knowledge and experience match the following criterion from the Person Specification:

• Ability to understand how diverse groups of people (for example disabled people, ethnic minority people or other under-represented group) are affected by the things a Health Board does

It was also made explicit from the outset that one of the new board members would need to take on a significant ‘chairing role’ immediately. If applicants wished to be considered for this they should also outline their relevant experience for this aspect of the post in their initial application.

Second Stage - Group exercises

The group exercises were observed sessions of around 1.45 – 2 hours. It effectively created a simulated board setting which was clearly designed to test how people might fulfil the role in the event that they were successful. Each group had 10-12 people and went through a structured process of analysing and discussing a sample board presentation on health inequalities. The discussions were based on papers for pre-reading that they had received one week prior to the sessions. Participants were asked to explore what they believed the priorities to be around health inequalities for NHS Lanarkshire. Each participant also completed an individual pro-forma on the day covering similar question areas. The panel assessed the pro-forma responses alongside the reports about individual performances in the groups.

Those invited to attend were given the following written brief in advance:

“The Group Exercise has been designed to create a situation similar to that you would experience as a member attending board meetings.  You have been provided with some background material to provide you with some context on what will be discussed on the day.  Please review this as though you were a non-executive board member of NHS Lanarkshire.  When you attend the Group Exercise, you will receive a presentation from an executive member of the team.  You will then be provided with the opportunity to raise any questions and discuss any issues or concerns you may have, with a view to being able to reach and demonstrate your own conclusions.

Participants were also advised in advance, and reminded on the day, that they would be individually assessed for their match to the person specification by trained observers. This role was fulfilled by five members of NHS Lanarkshire HR team. 

Reasonable adjustments were made to meet the particular needs of applicants with special requirements. The PAA and observers provided the panel with evidence-based and objective information on individual performance based on the nature and content of their interventions and on the impact that these had on the group dynamic (as per the 5 essential criteria listed above).

Third stage – Interview

This was a relatively straightforward competency-based interview format used to assess the essential skills. It allowed the panel to follow up on specific areas from the substantial information that it had from candidates’ performance at the group exercise stage. 

Candidates were also asked to prepare in advance a response of no more than five minutes to the following question:

“In your view, what is the biggest challenge for NHS Lanarkshire in meeting the health needs of under-represented groups and what particular skills would you bring to help the Board address this?”

Some additional, more detailed, lessons

Stage one

Although the initial paper-based assessment stage was specifically designed to be very ‘accessible for a wide range of people, the quality of responses was very variable. Some applicants had no apparent sense of what a board position entails, some did not have a clear understanding of ‘diversity’, some focused on single issues of importance to them and others submitted a more ‘traditional’ competence-based response without really answering the question asked. This could point to a need for more education or awareness-raising for potential applicants either more generally or specifically during the period in which community engagement is going on. The panel nevertheless agreed that a wider and more diverse group of applicants than usual had been successful at this stage.

Stage two

• An element of ‘streaming’ was introduced for the group exercises to reflect the panel’s judgement (from written applications) as to the applicants’ previous levels of experience. This was designed to ensure the groups were not unbalanced and that less experienced participants were not disadvantaged by being in groups with people who were perhaps more accustomed to such scenarios. This generally worked well and the three groups each performed as expected with balanced participation.
• From the panel’s perspective and that of the PAA and observers, the information gleaned from the exercise was rich and provided insight into the candidates additional to that which would have been gained from the traditional interview format.
• The group exercise approach was however resource intensive and relied upon considerable time input from NHS Lanarkshire HR professionals. 
• The particular skills needed for the group facilitator, a role in this instance taken by the PAA, also had to be secured.
• More applicants from more diverse backgrounds reached the final stage of assessment than would likely have been the case using a standard application form and interview.

Stage 3

• There is always a balance to be struck between people’s potential and people’s track records and proven abilities. Panels have to be clear from the outset about what is most important for the board when the appointments are being planned so that the process is open and transparent and potential applicants know whether they will be a good fit for the position. 
• Panels should consider weighting criteria if the appointing minister wishes to prioritise skills, knowledge or other attributes that are not currently represented on the board over other criteria that are already well represented. More advice on achieving this in a fair, open and transparent manner is available from Ian Bruce (see below under More Information). 

Conclusion

Fifty-seven applications were received. The applications included people from a far wider and more diverse range of backgrounds than might be considered usual, many of whom had attended the awareness events and/or taken the time to speak to the Chair in advance. 

Neither of the successful candidates had previously held a public appointment and one had never applied for one before.

When candidates were considered across all aspects of the assessment process, the panel noted that the candidates showing greatest merit against the five essential criteria at the end were still those who could perhaps be considered to have had more traditional trajectories towards a public appointment.