Paradigm lost? Reflections on the effectiveness of NHS approaches to improving employment relations

The National Health Service in England has largely relied on a human resources trilogy of policies, procedures and training to improve organisational culture. Evidence from four interventions using this paradigm-disciplinary action, bullying, whistleblowing and recruitment and career progression-confirms research findings that this approach, in isolation, was never likely to be effective. An alternative methodology is proposed, elements of which are beginning to be adopted, which is more likely to be effective.