According to research by NHS Employers, 20% of NHS staff report that they have been bullied by other staff. 30% indicated that they had some element of psychological distress. Managers and supervisors were perceived to be the most common source (51%).
What drives, seemingly normal people, who work in a compassionate profession and are probably lovely outside of work, to behave in a bullying manner in the workplace? My guess is that it is based in fear.
"Fear is toxic; it creates an unconscious psychological response in our amygdala or ‘reptile brain’ which is fight; flight; freeze. This is helpful when a sabre-toothed tiger is bearing down on you but has no place in today’s healthcare environment"
Fear of missing the target; fear of the ramifications of spending too much money; fear of losing job/ reputation/career that you’ve spend decades building; fear of rocking the boat or speaking up. What fuels these fears?
Fear is toxic; it creates an unconscious psychological response in our amygdala or ‘reptile brain’ which is fight; flight; freeze. This is helpful when a sabre-toothed tiger is bearing down on you but has no place in today’s healthcare environment except in extreme circumstances. We are starting to see some of the unintended consequences; such as a recent CQC report awarding a “requires improvement” rating citing “learned helplessness” as one of the cultural indicators created by the senior leadership team.
So, how can we support our leaders to move away from fear, and start to create the right conditions for staff to be able to operate at their full potential?
Collaboration is the key. Today’s healthcare environment is too complex to rely upon the leadership approaches that worked for complicated problems. Complicated problems can be solved through processes and linear solutions. Complex problems are worsened if this thinking is applied as there are too many factors and variables, and therefore a more emergent approach is necessary.
The fear many leaders will have to face is that their ‘tried and tested’ methodologies that worked for yesterday’s problems no longer work, and they have no more tools in their toolkit to rely upon. This can often be the root of fear that drives the ‘tell’ culture and often leaders struggle to understand why these methods – previously so successful – don’t work in today’s technology driven, disrupted environment. They interpret the lack of results as due to the way the staff are implementing their instructions rather than it being the wrong approach and so give further, more detailed instructions. Thus creating a vicious circle of decline.
The simple truth is we need a new toolkit and manual for ‘letting go’. Bringing together clinicians and giving them the tools and techniques to enable them to improve how they deliver care and trusting them to come up with the answers, is the first stage to truly transforming the culture in the NHS.
We need leaders that can lead from behind, rather than in front; pose questions rather than offer solution as they recognise problems require emergent solutions; and truly collaborate with the workforce and inspire them with purpose and commitment.
These are the leaders that will create the right conditions to replace the fear currently being felt in the NHS workplace with love and compassion, both for staff and patients. Sarah Morgan is Director of Organisational Development at Guy’s and St Thomas’ NHS Foundation Trust.