Enabling Complaint Handler Wellbeing

This article is a write-up of a session on ‘Enabling Complaint Handler Wellbeing’ which I delivered (twice) at the Scottish Public Services Ombudsman (SPSO) Conference ‘Supporting Good Complaints Handling in a Changing World ’ on 16 November 2023. The content is broadly drawn from notes made in preparation for this session along (and from what I remember saying at the time) with some additions [in square brackets] for context and clarification. And I definitely had more to say on the day than the time available to say it in (it was ever thus).

Introduction

My aim in this session is to share some thoughts from my own experiences and learnings to do with complaint handler wellbeing. I know that there is knowledge and guidance available about the interactions that staff experience as challenging in relation to the people who make complaints about their organisation. And in relation to this, I will tell you about some of my own research (with others) and would reference the SPSO’s own Engagement Policy , published in 2021, which sets out their approach to managing engagement and supporting staff.

However my learning and experience over the years has increasingly been that staff also experience challenges and harms relating to the complaint handling approaches of their own organisation. There seems to be little written about this in relation to public services - and it is these complaint handling challenges and harms that I want to focus on mainly in this session today. To manage your expectations, I will say now that I definitely don’t have all the answers and that I will be posing questions for you to consider – both for you as an individual, but also in relation to your organisation.

And a conclusion I reached when preparing what to say today is that you can’t assess complaint handler wellbeing without having some sort of standard or definition to assess it against. So I will end this presentation by sharing my thoughts on what a definition of complaint handler wellbeing could look like.

About Wellbeing

I want to start by considering what wellbeing is. In general terms, I understand that wellbeing is about feeling good and functioning well. This includes having your needs met. I am sure that you will be familiar with Maslow’s hierarchy of needs – which is a motivational theory in psychology comprising a tiered model of human needs. Broadly in Maslow’s model, of which there are many versions (you can find one here ), there are deficiency needs which are to do with basic survival and include physiological needs and safety needs. And there are growth needs which are more psychological and are associated with realizing an individual’s full potential and needing to ‘self-actualize’.

Over recent years it seems that more notice is being taken about wellbeing in a work context, with the increasing realisation that organisational performance has a direct link with employees being healthy and happy at work. The Chartered Institute of Personnel and Development (CIPD) has resources on wellbeing at work and says that promoting wellbeing involves creating an environment which allows staff to flourish and achieve their full potential for the benefit of themselves and their organisation.

I understand wellbeing to include experiencing joy and meaning in your work. By meaning I am referring to having sense of the importance in what you do and of accomplishment in your daily work. By joy I am referring to the feeling of success and fulfilment that results from work that is meaningful. And I am sure that your own organisation will have some form of Wellbeing policy, strategy or framework – though this is likely to apply to all staff in the organisation – whereas here I want to focus on the wellbeing of complaint handlers.

Being Complained About

I have long had an interest in the impact of complaints on the people who work in organisations – and the harms that can result from this. When at Queen Margaret University, colleagues and I became aware that relatively little attention had been paid to the way in which complaints are experienced by those complained about. Existing research in this area was predominantly confined to the health sector – and this showed that complaints could have a significant impact on the health, wellbeing and work practice of medical staff.

So along with others from the Universities of Glasgow and the West of Scotland, we decided to explore whether being complained about similarly affected those working in areas of public service other than health. The SPSO expressed an interest in and support for this research. And we surveyed staff in Scottish councils (specifically local authority planning departments) and housing associations, as we knew that they had relatively high levels of complaints to the SPSO and, therefore, represented areas where complaints were likely to be an important issue for staff. We followed our survey with in-depth interviews, with the focus being on health and wellbeing, attitude to service users and work practice.

Our resulting report ‘How do complaints affect those complained about? ’ was published in December 2017. And our findings included that most respondents who had been subject to a complaint said it had affected their work practice (71%) and their wellbeing (67%). Most said they had been affected “to some extent”, although a significant minority reported they had been affected “a great deal”. 61% of respondents considered that being complained about had affected their attitudes and/ or feelings towards the users of their services and 57% worried about receiving other complaints in the future.

Harms identified from our research

[Although not part of the presentation at the Conference, I have included a couple of quotes below from the Being Complained About research as I think they illustrate our findings well:

“I was quite shocked, and a bit hurt by it, to be honest, because I? feel like, when I did my job, you know, I'd kind of gone above and beyond... And then I just felt a bit angry about the whole situation because it got quite personal... and then, you know, questioning my professional ability, and my, yeah, capability of doing my job, I felt it was a bit, you know, uncalled for.”

“There can be a culture in organisations where if a complaint is made then it’s presumed that the complainant is right and that there are grounds for the complaint and I think there should really be… guidance to say that no blame should be apportioned until actually a case is found against somebody, but I think the... I’ve worked unfortunately with a few directors who apportion blame first and ask questions later.”]

Our research findings included that being complained about had a negative impact when complaints were experienced as personal attacks and/or attacks on professionalism and where there was a lack of clarity about the consequences relating to being complained about. The harms commonly reported by respondents included emotional trauma and loss of self-confidence. There were strong emotional reactions to being complained about - shock, anger, shame, guilt, feeling sick. And being complained about knocking confidence, challenging both professional and personal self-worth.

There were also harms relating to the prevailing organisational culture, which can be thought about as the personality of an organisation – the shared beliefs, values and behaviours which shape how people work together and interact with each other. Issues here related to there being a ‘customer is always right’ approach, with the primary aim being to satisfy the customer, rather than impartially investigating the issues in the complaint or trying to understand the issue from a staff member point of view.

When harms occurred there was also a perceived lack of balance, a lack of information, poor communication and experiences of not feeling heard. Poor communication and a lack of information extended in some cases to not being told what the outcome of the complaint was or, where the outcome was divulged, not being given a clear explanation about why a complaint was upheld. And a conclusion to be drawn from our research is that the operation of the complaint process was particularly important in terms of whether staff were likely to feel that a complaint had affected them negatively.

Being Complained About Guidelines

We wanted our research to have practical as well as academic application, so Chris Gill and I went on to develop Good Practice Guidelines in consultation with practitioners. The resulting 'Being Complained About – Good Practice Principles and Guidelines ' are a free resource which can be adapted into existing complaint handling procedures.?Essentially the Guidelines are about having a more balanced approach to complaint handling, including providing appropriate support to staff who are complained about, involving them in the complaints process and including them in communication.

The Being Complained About Guidelines have a ‘just culture’ approach (drawn from an earlier version of the NHS England ‘Just Culture Guide ’) which seeks to understand why failings occur, recognises that things going wrong can be the product of many factors and which focuses on changing systems and processes when they do. A just culture also ensures that people feel confident that they will be treated fairly if there are concerns, doesn’t seek to blame but is accountable, balancing fairness, transparency and learning and taking responsibility for actions. It also holds people appropriately to account where there is gross negligence or deliberately harmful acts.

I have continued to be interested in the harms related to being complained about – and more recently to the impacts on those who work with complaints. It will come as no surprise to those who do this work to hear that complaint handlers themselves are often complained about, so I would suggest the related harms identified in our research (and maybe more) are also experienced by complaint handlers.

And through my work as a mediator (in particular, to do with workplace disputes) and related to my work with health and social care, I have become increasingly aware of the impact and harms which can result from the way in which workplace policies and processes are implemented. I think there is much learning from internal workplace concerns and disputes that has relevance to complaint handler wellbeing.

A Changing World

But before I say more about this, the title of this SPSO conference is ‘Supporting complaints handling in a changing world’ – and I think it is worth acknowledging some recent changes. The impact of the Covid-19 pandemic has been significant, not least in the resulting acute and chronic traumas. There has also been a significant change in how people work with an increase in home and hybrid working arrangements. I have noticed that there is increasing specialisation at work with the resulting fragmentation of jobs (and increasing issues relating to communication).

Austerity and pressures on public finances mean that organisations are trying to do more with less, with an increasing focus on efficiency and outputs and getting things done. This includes increased automation, such as the use of standard letters and notifications. Another change is that many services are now online. And my observation here is that this can work for many when all is well, but is not so great when a person wants to complain and wants to speak to a human about this.

There is also the increasing use of digital technology and of Artificial Intelligence (AI) generated solutions. I think that AI has its uses. My understanding is that it works by replicating and simulating based on past learnings, which means that it is less able to deal with novel situations. And a concern I have about the increasing reliance on AI is that with this reliance we lose our ability to think about what we are doing.

And I suggest that there is now much greater awareness of the impact of trauma, about neurodiversity and about intersectionality, with more understanding about how people experience life through multiple co-existing identities and that we all experience the world in different ways.

My view is that all these changes have resulted in an increasing mismatch between what our complaint handling systems were designed to do and the current working life reality for many complaint handlers. And I also question the increasing emphasis on function, efficiency and outputs, as I think that crucial aspects of complaint handling are about doing no further harm, repairing any harm done and maintaining and restoring relationships.

So I think it is important to acknowledge the impact that the changing world has had on the work of complaint handlers in public services, both on the skills and abilities that are now needed to do the job and on whether organisational approaches to complaint handling now match the current reality.

Complaint Handler – What’s the job?

Before going on to consider the impact of organisational approaches and practices, I think it is worth pausing reflect on the job of a complaint handler working today in public services. I am always fascinated to learn how people end up in this job, as I don’t think that the ambition of many at school is to work with complaints. And while I recognise there will be different complaint handler roles at different levels in different organisations, I think the job can be boiled down to ‘handling external concerns and dissatisfactions about your colleagues and your organisation’.

A significant characteristic of public services complaint handling is that there are often ongoing relationships with the people who use or receive these services of an organisation, as well as with colleagues. So a complaint handler works with both internal and external relationships, which often involves managing the intersection between two different ‘worlds’.

A few years ago now I came across the work of the social theorist Jürgen Habermas, whose system theory is that we live our lives in two distinct spheres: there is the everyday world in which we interact socially with family and friends (which Habermas refers to as the Lifeworld) and there is the professional/ administrative sphere in which we interact with institutional authority (which Habermas calls the System). I found this such a useful concept in relation to complaint handling and in appreciating that a complaint handler needs to have an understanding of both the ‘Lifeworld’ of the complainant and the ‘System’ world of their own organisation.

[Related to this, there is an excellent 2021 article ‘Why do systems for responding to concerns and complaints so often fail patients, families and healthcare staff ’ by Martin et al. which uses Jürgen Habermas’s systems theory to analyse and identify structural features that militate against processes and outcomes that satisfy complainants. Habermas’s theory is well explained in this article. Basically, and with relevance to complaint handling, our Lifeworld is based on shared understandings and meanings and so our day-to-day actions here are mainly communicative. However, the aim of the System is to achieve its own aims and to serve the interests of institutions and organisations, so actions here are mainly instrumental. Do read the original, but if interested, I have summarised this article on LinkedIn (see here )].

My experience has also been that complaint handlers need to be able to work with ambiguity and with issues which can be fragmented and complex (because people’s lives are complex). There is often a struggle for control about how a complaint will be dealt with and the job often involves telling people what they may not want to hear. It also involves trying to improve what an organisation does and how it goes about doing what it does. I have seen how complaint handlers are increasingly urged to empathise and to look at the human aspect of a complaint. And while I am positive about this approach, I think there are implications for complaint handlers being equipped to do this.

Complaint Handler - Skills and Abilities Needed?

So I think it is important to recognise the breadth of skills and abilities which are needed to work as a complaint handler in an increasingly complex and fragmented world. When preparing for this session I started to list what I think are the current skills and abilities needed, and these are the ones which immediately came to mind: Listener, Curious, Influencer, Noticing, Patient, Emotionally Intelligent, Logical, Thinker, Explainer, Adaptable, Time Traveller, Can tolerate Uncertainty, Boundary Spanner, Compassionate, Reliable, Kind and Versatile.

These are listed in no particular order, but I do believe that listening is the foundational skill and that complaint handlers need to be curious about what happened, why and the resulting consequences. In my view, being a ‘boundary spanner’ is also essential to the work [many years ago now I came across the work of Peter Williams in relation to organisational boundary spanning – in which he describes boundary spanners as having “lives of tension and ambiguity with multiple accountabilities” - and think his article ‘The Competent Boundary Spanner ’ is still well worth a read as it focuses on the skills, competencies and behaviours of boundary spanners.] ?I would also highlight ‘time traveller’ – this being the ability to put yourself back into past situations and circumstances. And the ability to tolerate uncertainty as matters unfold (or don’t). Also to have compassion – a sensitivity to suffering in self and others with a commitment to try and alleviate and prevent it.

So I believe that complaint handlers need to have a unique set of skills and abilities as the work is about being both tender-hearted and tough-minded. And in thinking back to what has changed in recently in the world, my thoughts are that the skills and abilities that complaint handlers need to do their job well have also changed – and I am not convinced that all organisations recognise this – or acknowledge the increasing importance of emotional health to wellbeing.

Assessing Yourself - Ten Questions

So I am going to suggest that complaint handlers take some time after this event to assess yourself in relation to the work you are currently being asked to do by your organisation. And to help with this I am going to pose ten questions. If the answer to a question is negative, then I would ask you to consider what you need or what you need to do differently. The questions are:

1. Do you listen well and are you aware of what your emotions are telling you?
2. Are you fully present at work and in the right job?
3. Do you have the knowledge, skills and training you need to do the job?
4. Do you have the supervision and support you need and at the time you need it?
5. Are you treated with dignity and respect by those you encounter at work?
6. Are you recognised and thanked for what you do?
7. Does your work have purpose and can you see the impact of what you are doing?
8. Do you have influence at work?
9. Do you have time to reflect and to restore relationships – with others and with your organisation?
10. Are you aware of how you are experienced by other people at work and do you know whether you are harming others in the way that you work?

The aim of these ten questions is to provoke insights about yourself and the approach of your organisation to the work you do. A question which may be tough to consider is whether you are in the right job? I remember reading somewhere about the positive psychology researcher Martin Seligman saying that the right job is one that aligns with our signature strengths, by which he means the elements of our personality that make us feel authentic and engaged.

And another tough question is to think about whether you may be harming others in the way that you go about doing your complaint handler work. And while I am sure that many complaint handlers will receive supervision and support at work, is this related directly to your complaint handling practice and is it available at the times when you need it most?

[Some of these questions relate to self-awareness – about understanding yourself. For example, I think that listening includes whether you can hear your own inner voice and emotional awareness includes understanding what your body is trying to tell you. This self-knowledge also includes understanding the impact you might have on others – and my firm belief is that you can’t work well with complaints unless you are ‘comfortable with conflict’. I have written a bit about this (see 'Being Comfortable with Conflict Revisited ') and have also written about understanding your own response to conflict in two more recent articles (see Understand Your Own Response to Conflict Part 1 and Part 2 )].

The impact of systems and practices

But I think there are limits to what you can do as an individual complaint handler to maintain and enhance your wellbeing. And as I said at the start of this presentation, my learning over the years has increasingly been that staff also experience harms relating to the complaint handling approaches of their organisation. I think this quote from a book by Tulloch and Schulman (2020) well illustrates this: “While hope and healing lie in relationships, too often our human systems are cool, distant and transactional. …? Systems like that are hard on those who seek help, and hard on those who deliver it.”

I have found little research relating to the harms associated with the impacts of systems and practices which relate to ‘external’ complaint handling? - by which I mean complaints about an organisation. But as mentioned earlier, I think there is much to learn from how internal ‘complaints’ systems and practices operate – such as those relating to employee grievances, disciplinaries and adverse events.

Recent incidents in health, mainly in England, have increased awareness about how corporate decisions and behaviour can negatively affect the health and wellbeing of healthcare professionals. For example, this quote is from ‘The impact of poorly applied human resources policies on individuals and organisations ’ (Neal et al. 2023), an article in the British Journal of Healthcare Management: “Failure to recognise and prevent employee harm caused by poor organisational practice can lead to a range of negative outcomes for both the organisation and its staff”.

A number of articles, including the one by Neal et al (2023), have explored the harms that human resources procedures can cause to individuals, organisational culture and effectiveness. Findings include that poorly delivered human resources policies can have a significant detrimental impact on those being investigated. And a conclusion drawn is the need for organisations to be more aware of and take greater responsibility for the health and wellbeing of all those involved in employee investigations. It is noted that these articles essentially had no concerns with the employer’s policies in themselves, but found that their flawed implementation had significantly impacted on employee wellbeing.

Avoidable Employee Harm

Another article ‘When work harms: how better understanding of avoidable employee harm can improve employee safety, patient safety and healthcare quality ’, this time in the British Medical Journal, advocates a better understanding of avoidable employee harm. Jones et al (2023) say in this article that: “Where harm to employees is not defined and typologised, it will be incredibly challenging to avoid similar harms occurring in the future” and they also say that “A critical first step in improving awareness and prevention of avoidable harm to patients was to identify and define key terminology. We recommend a parallel approach which starts with defining the term Avoidable Employee Harm (AEH).”

So in applying this to staff, their AEH definition is: “Where harm occurs to employees because of an identifiable and modifiable workplace cause, the future recurrence of which is avoidable by reasonable adaptation, subsequent adherence to and thoughtful implementation of a workplace process or policy.”

My view is that this AEH definition could equally well apply to the ‘external’ complaint handling harms which result from organisational approaches to complaint handling.? And my overriding learning over the years has been that how organisations deal internally with conflict (such as grievances) are a significant indicator of how well they are likely to deal with external complaints. My experience has also been that wellbeing programmes and strategies will have little positive effect if an organisation does not work well with internal conflict.

Your Organisational Approach – Five Questions

My working theory – which I am sharing with you today - is that complaint handler wellbeing depends both on how well you are equipped to do the job and on the approach of your organisation to the work you do. In relation to approach, I have five questions for you to consider posing to and about your organisation:

1. How would you describe your organisational culture relating to internal and external conflict?
2. Does your organisation live its stated values relating to how complaints are viewed and experienced?
3. Does your organisational approach to complaint handling match the current reality?
4. What does your organisation measure, report and value in relation to complaints?
5. Do you know who is harmed by complaint handling within your organisation and the extent of this harm?

An issue for complaint handlers and their organisations to consider is whether your complaint handling approaches match and meet the presenting realities in changing world I spoke about earlier. And if not, what could be designed into your process to moderate any resulting harms and to enhance the work of a complaint handler?

The Tyranny of Measures and Targets

You will see that one of these five questions posed [above] relates to complaint measurement – and I can’t let this opportunity go by without sharing my dislike about how some organisations use performance measurement – which I have been known to describe as the tyranny of measures and targets. I have written about this on a number of occasions – such as in a 2017 Linkedin article with the title ‘Hitting the target, but missing the point ' in which I wrote that: “My main concern is that performance measurement is not a neutral activity or an impartial assessment of performance. And I have seen it result in too many inappropriate and dysfunctional behaviours and unintended consequences over the years.”

[I also wrote in this article that “It is usual to measure performance against a target. And in setting targets there is an assumption that this will act as a spur to improvement. Too often, I think, it results in a spur to meet the target”. And I have also written in a more recent article ‘Views and Learning about Patient Experience ’?that: “my experience has been that measures reported to Boards can mainly relate to acute hospital activity (time and wait) - and this can be regarded as the primary measure of 'success'. Less consideration seems to be given to measures relating to effectiveness, equity and being patient centred and there is more of a focus on quantitative rather than qualitative measures”.]

So I think it can be telling to consider what your organisation is measuring and what measures you are judged on, as in my experience this often reflects what is valued by an organisation.

Preventing Avoidable Employee Harm?

Moving on, here are some thoughts on what your organisation could do to help to prevent complaint handling implementation harms to complaint handlers – and in doing so - both maintain and enhance complaint handler wellbeing.

• Deal positively and well with internal conflicts – psychological safety and seeking resolution
• Adopt a restorative just culture approach to complaints (as in the Being Complained About Guidelines)
• Focus on complaint handling impact and outcomes
• Design in complaint handling approaches and ways of working which don’t result in harm
• Review and update the skillset, support and training necessary for complaint handler wellbeing

Complaint Procedures in General

I also have views to share on complaint handling procedures in general. These views have evolved over the years [and are both reflected and well-articulated in 2021 article by Martin et al (referenced earlier) on why complaint systems so often fail patients, families and healthcare staff]. My experience has been that complaint policies and procedures tend to work well with concerns that are relatively straightforward and easily categorised, but that they are less well suited to concerns that are complex, multifaceted or cross cutting (i.e. complaints that can’t easily be defined or don’t fit into a complaint definition ‘box’).

I also consider that the basis for many complaints policies and procedures is the application of legalistic processes and rational thinking, such as what happened/what should have happened (as in what do the ‘rules’ say). And that in this, complaints procedures are effective in what they are designed to do. But where they are less successful is in dealing with the messy reality of the ‘Lifeworld’ which, according to Habermas, is dominated by a communicative rather than the functional reality of the System world. [Martin et al (2021) helpfully articulate “how the operation of complaints and concerns bureaucracies is underpinned by a logic or, in Habermasian terms, rationality that is oriented towards certain preordained (and arguably desirable) objectives, but which is ill-equipped to handle the full range of issues, concerns and hoped-for outcomes brought by stakeholders”.]

My thoughts are that many complaint handler challenges – and consequential harms – come from trying to fit concerns and issues resulting from often complex lives and situation into a complaint definition and process. I am not saying ‘do away’ with complaint procedures, but my view is that harms to complaint handler wellbeing can result from the specified limits of what complaint handlers are allowed and enabled to do. And that much could be achieved if complaints procedures were not seen as being stand-alone, but were designed to be well-integrated with other organisational procedures and systems.

So I think that complaint handling approaches need to have more of a relational focus, with seamless links to addressing the full range of issues, concerns and hoped for outcomes, including those which are not considered to be complaints. [What I was trying to say here is that from the point of view of the complainant, there is a ‘holistic’ organisational approach to dealing with their concerns, rather than being told that a concern did not fit into a particular procedure.] This has implications, I know, for the role of a complaint handler, not least to do with work relating to boundary spanning.

Assessing your Organisational Approach – Ten Questions

In starting to draw this session to a close, I am going to pose ten questions to consider when assessing your organisational approach to complaint handling – which hopefully will address some of the challenges and harms touched on in this session. For each question I would ask that you consider whether your complaint handling approach:

1. Has a relationship-based approach which is not adversarial and which recognises and responds to people as individuals?
2. Appreciates that everybody is doing their best with what they've been brought up with, what they've been given and what they have learned
3. Takes care of everyone, with the default approach being that when in doubt, choose to be human
4. Views a complaint as being about the organisation including when individual staff members are named
5. Pays attention to things that matter as there is a need to know what happened, but there is also the need to attend to the impact and any resulting consequences
6. Accepts what has been experienced as being that person’s experience? and recognise that what happened cannot always be established to the satisfaction of all concerned
7. Reflects the importance of how language is used and that words can dehumanise people
8. Removes barriers to addressing concerns which relate to other processes or have no process to deal with them, acknowledging what can be ‘solved’ and what cannot be ‘fixed’
9. Understands that staff need to know that they are trusted to do what is needed in particular situations and circumstances
10. Appreciates that emotions can be heightened but does not expect staff to continue to engage in contact which is having a negative impact on them

And again, if an answer to any of these questions does not reflect your current complaint handling approach, then I would ask you to consider what your organisation may need to do differently?

Complaint Handler Wellbeing - A proposed definition

So when thinking about what maintaining and enhancing complaint handler wellbeing might involve – my view is that this is well summed up in this quote from an article by Sikka et al (2015) relating to joy and meaning at work:?

“The precondition for restoring joy and meaning is to ensure that the workforce has physical and psychological freedom from harm, neglect and disrespect …. An organisation focused on enabling joy and meaning in work .. needs to embody shared core values of mutual respect and civility, transparency and truth telling and the safety of the workforce. It recognises the work and accomplishments of the workforce regularly and with high visibility.”

And I suggested at the start of this session that you can’t assess complaint handler wellbeing without having some sort of standard or definition to assess it against. So to end this session – here are my thoughts on what a definition of complaint handler wellbeing could look like - and I offer it for you to consider when assessing complaint handler wellbeing in your own organisation:

“Feeling competent and confident in your complaint handling work, in the knowledge that your work is meaningful, that you are well equipped, supported and appreciated in what you do, and that your organisation expects you to work in a way that does not result in harm to you or to others.”

References

Jones, A., Neal, A., Bailey, S. and Cooper, A., 2023. When work harms: how better understanding of avoidable employee harm can improve employee safety, patient safety and healthcare quality. BMJ leader, pp.leader-2023. [online]. [viewed 30 November 2023]. Available from: https://bmjleader.bmj.com/content/early/2023/09/10/leader-2023-000849

Martin, G.P., Chew, S. and Dixon-Woods, M., 2021. Why do systems for responding to concerns and complaints so often fail patients, families and healthcare staff? A qualitative study. Social Science & Medicine, 287, p.114375 . [online]. [viewed 30 November 2023]. Available from: https://www.sciencedirect.com/science/article/pii/S0277953621007073 ?

Neal, A., Cooper, A., Waites, B., Bell, N., Race, A. and Collinson, M., 2023. The impact of poorly applied human resources policies on individuals and organisations. British Journal of Healthcare Management, 29(5), pp.112-121. [online]. [viewed 30 November 2023]. Available from: https://www.magonlinelibrary.com/doi/pdf/10.12968/bjhc.2022.0130

?Sikka, R., Morath, J.M. and Leape, L., 2015. The quadruple aim: care, health, cost and meaning in work. BMJ quality & safety, 24(10), pp.608-610.

Tulloch, G. and Schulman, S., 2020. The trampoline effect: Redesigning our social safety nets. Reach Press.

Williams, P., 2002. The competent boundary spanner. Public administration, 80(1), pp.103-124. [online]. [viewed 30 November 2023]. Available from: https://onlinelibrary.wiley.com/doi/10.1111/1467-9299.00296