NHS0035

 

 

Written evidence submitted by Dr Ali Budjanovcanin

King's College London

 

As a Senior Lecturer in Work Psychology and Public Sector Management[1], I work within two academic departments situated within the Business School at King’s College London. These departments focus on researching workforce issues more generally, but also within public services, including the NHS (the Human Resource Management and Employment Relations Group and the Public Services Management and Organization Group[2] respectively).

 

I am submitting this evidence because the research I have been conducting over the last decade on individuals’ experiences of their careers, provides insights into mechanisms that underlie their intentions to leave organisations, both inside and outwith the NHS. It could therefore provide some clear implications for both short-term and longer-term action to alleviate the workforce pressure in the NHS.

 

Summary

 

  1. Introduction

Labour market shortages and low productivity are important threats to the UK’s economic standing. This is particularly evident in the NHS, where an exodus of workers is leading to chronic backlogs and potentially reducing the quality of patient care. Key to mitigating these threats are employees that thrive in their work and that are committed to their occupations. However, many workers are instead suffering from occupational regret – a wish that they had never chosen the career path that they have - leading to either disaffected and unproductive employees that feel stuck in their occupation and/or unhelpful movement out of professions, risking potential labour shortages. Even before the great resignation, the statistics about the number of people unhappy with their career situation or wishing for career change were notable[6]. This briefing note summarises recent research exploring occupational regret, that points to important policy implications to avoid its damaging effects for the NHS.

 

  1. Why does the evidence suggest good occupational fit is important?

Our research based on a survey of 559 NHS cardiac physiologists in Great Britain shows that employees who have a poor fit with their work, as manifested in occupational regret, will experience lower career satisfaction but also be less committed to their work and have intentions to quit their profession[7]. Another study we conducted into employees across a range of occupations – professional and non-professional employees – involved interviews with 51 individuals who self-identified as having occupational regret. The findings from this research demonstrate that in addition to work-related consequences, such as withdrawal from work (e.g., absenteeism, tardiness), that occupational regret has detrimental implications for individuals’ mental health, because of rumination and corrosive coping strategies[8]. Even when employees don’t withdraw their effort and productivity when feeling a poor fit or lack of meaningful engagement with their work, our research suggests there are indirect impacts on organisations due to individuals having to engage in emotional labour when dealing with colleagues and clients/ customers, because of having to regulate negative feelings; the consequence is burnout[9], which has implications for productivity and employee health.

 

A wish to exit an occupation is a clear consequence of regret across all our studies, however, the negative effects for organisations are pronounced in professional occupations. The investment in a professional career (temporal, financial and emotional), and therefore the perceived sunk costs that tie individuals into their occupation choice, mean that although they wish to exit the occupation, many do not actually do so. This means that even though some will self-select out of their role or even occupation, a high number of discontented employees remain. This was demonstrated by research we conducted among UK pharmacists (both NHS and non-NHS). In a study commissioned by the then Department of Health[10], we worked with the professional body for pharmacy[11] to examine the likelihood of a nationwide pharmacist shortage. Our survey, amongst circa two thousand British pharmacists[12], identified an important supply-side risk, namely that around 50% of individuals regretted their career choice. These individuals, some of whom we interviewed in a 39-person follow-up study[13], found themselves in the ‘wrong’ profession due to various causes, as outlined in the next section. The risks stemmed not only from the potential for regretful employees leaving the profession and thus, workforce shortages, but also the possible withdrawal of discretionary effort of and several unpaid hours worked every week by the regretful professionals who chose to remain in the workforce.

 

  1. What are some of the causes?

A working paper[14], from the afore-mentioned interview-based study across multiple occupations, as well as the research on cardiac physiologists, suggest that there are various causes of occupational regret that all stem from poor fit between an individual’s desires for their career and what it provides. These include:

 

 

Relevant to the NHS workforce, the research also identifies triggers of underlying occupational regret, which are more about the working environment in which a regretful individual works and can bring the feelings of regret, and is consequences, to the fore. These include:

 

 

  1. How might occupational regret currently being experienced in the NHS be mitigated?

Tackling the causes of regret and therefore the aspects of the backlog caused by its consequences (withdrawal of effort and increased quitting across healthcare professions), can be considered in terms of both short- and long-term strategies.

 

For the short term, the plan for recovery in the NHS should include addressing the triggers of occupational regret – the changes to the work environment that bring occupational regret to the fore. Where viable, i.e., where changes will not cause disruption to service delivery, this could include job crafting, that allows employees to redesign aspects of their role to emphasise working on their strengths and/or aspects of work that are meaningful to them. Job crafting has been associated with fewer withdrawal behaviours, and greater motivation because it provides greater meaning to an individual’s work. Job crafting can come in the form of task crafting, relationship crafting and/or cognitive crafting. These interventions achieve improvements in how employees feel about their work via exercising greater control over tasks, determining the way tasks are perceived, or being able to decide which social contexts and relationships to encounter at work[15].

 

For the long-term attempts to address the NHS backlog, addressing the underlying cause of occupational regret, which will be important for tackling workforce satisfaction and retention challenges, can be achieved by ensuring the recruitment of people who are well fitted to the type of work, and who will be less likely to feel regret even if encountering work environment triggers. This requires greater attention to the processes that inform individuals’ career choices, including career guidance and self-understanding at late adolescence and early adulthood.

 

  1. Implications for the Public Accounts Committee’s inquiry into NHS backlogs

Below are outlined the implications of the findings for the committee’s inquiry into the NHS backlogs and for recovery plans:

 

  1. Given the economic implications of occupational regret, government policy would benefit from expanding the definition of quality of work to include occupational fit. Where there is a good fit between a person and their career pathway, this has implications for performance and productivity at work, especially in the presence of regret triggers – such as those currently being witnessed in the NHS.
  2. The committee’s efforts to address the triggers that are exacerbating occupational regret and causing healthcare workers to exit their role or even occupation can be addressed in the form of job redesign to ensure that even where certain conditions may be less amenable to change (e.g., pay) that the intrinsic meaning of work is increased.
  3. The identified aspect of job quality (i.e. a well-fitting career) can inform policy designed to shape the offer of the Department of Education’s National Career Service, the quality of which has recently been criticised[16]. Occupational fit needs to be central to a national career service that is going to be fit for purpose and can ensure that individuals entering the NHS professions going forward are both a good fit for the work and are having their expectations about the career choice met.
  4. The goal of reducing occupational regret can potentially inform Government decisions about the prioritisation of schemes that provide a realistic occupation preview, including (professional and blue-collar) apprenticeships. The promotion of such initiatives, that already form part of the Government’s Industrial Strategy, may be beneficial to increasing productivity in the UK workforce.

 

November 2022


[1] https://www.kcl.ac.uk/people/alexandra-budjanovcanin

[2] https://www.kcl.ac.uk/research/psmo and https://www.kcl.ac.uk/research/hrm-er

[3] https://commonslibrary.parliament.uk/research-briefings/cbp-9561/

[4] https://www.cipd.co.uk/news-views/viewpoint/job-quality#gref

[5] Simms, M. (2022). Trade Unions and Job Quality.

[6] https://www.lsbf.org.uk/blog/opinion-features/lsbf-survey-finds-nearly-50-of-uk-workers-want-to-change-careers#

[7] Budjanovcanin, A., Rodrigues, R., & Guest, D. (2019). A career with a heart: exploring occupational regret. Journal of Managerial Psychology.

[8] Budjanovcanin, A., & Woodrow, C. (2022). Regretting your occupation constructively: A qualitative study of career choice and occupational regret. Journal of Vocational Behavior.

[9] Budjanovcanin, A and Woodrow, C (2021) Regret’s consequences: The performance of Regretful Workers; Conference paper delivered at Academy of Management Conference, 2021.

[10] Guest D, Budjanovcanin A, Oakley P. (2008) Planning the Pharmacy Workforce: will pharmacists stay in pharmacy. The Pharmaceutical Journal 2008, 281: 672-675.

[11] Royal Pharmaceutical Society

[12] International Pharmaceutical Federation (FIP) (2009) FIP Global Pharmacy Workforce Report

[13] Budjanovcanin, A., & Guest, D. E. (2021). Understanding the unobserved influences on the careers of ethnic minority women: implications for human resource management. The International Journal of Human Resource Management, 1-26.

[14] Budjanovcanin, A (2022) Why we regret our choice of occupation and what can be done about it. Working Paper.

[15] Berg, J. M., Dutton, J. E., & Wrzesniewski, A. (2013). Job crafting and meaningful work.

[16] Careers Guidance in School, Colleges and Universities (England). Series: House of Commons Library briefing paper; no. 07236.