Increasingly stressful work environments are taking their toll on NHS managers, but chances exist to adapt and change, writes Judith Krichefski

In the NHS, mental toughness is extremely relevant - especially for teams because it impacts on group dynamics. There are lots of things people can do to improve their own mental toughness - some easy ones are things like time management, monitoring “self-talk” and not trying to control the uncontrollable.

According to the Association of Qualitative Research: “Mental Toughness is the quality which determines, in some part, how people deal with challenge, stressors and pressure, irrespective of prevailing circumstances”.

It has been proven that people who are mentally tough will deal well with challenges while others crumble.

Examples of mental toughness include:

  • the ability to get up from life’s knocks and bounce back again stronger;
  • the ability to cope, adapt and thrive during change and adversity;
  • having the courage to face fears and overcome them;
  • having the strength of mind to persevere against setbacks;
  • having a resolute spirit and an indomitable attitude.

There is a strong link between mental toughness and issues like stress management, peak performance development and behaviour, and many leadership attributes.

In stressful situations there is undeniable evidence that shows a link between the degree of mental toughness in an individual and the quantity of work achieved, the quality of work and the wellbeing of individuals.

A number of trusts are already benefiting from targeting their recruitment towards mentally tough directors and senior managers, while others are building mental toughness into their management development programme.

How does the Mental Toughness programme work?

First, the online Mental Toughness diagnostic is completed. This gives an overall measure of mental toughness, including in four key areas:

  • Control To what extent do we feel we can shape what is happening?
  • Challenge How we respond to challenge and change
  • Commitment The ability to deliver even when the going gets tough
  • Confidence Self belief and interpersonal confidence to deal with setbacks.

Four individual, key area reports are generated. These can be applied to a range of uses including recruitment or selection assessments, coaching and staff development programmes, detailed feedback to the participating individual, the interviewer or the senior manager.

Results for mental toughness continue to be “life changing” as well as key to helping organisations transform, develop and improve.

Teams have:

  • the ability to recruit and retain staff that can handle challenge, pressure and change;
  • increased innovation and creativity;
  • better health and wellbeing;
  • improved morale and working environment;
  • improved results.

Individuals have:

  • belief in their ability to succeed;
  • focus on the task, despite distractions;
  • a retained confidence and focus despite being frustrated;
  • the ability to push through until goals are achieved;
  • the ability to bounce back quickly when things go wrong.


Managers at a primary care trust were struggling to meet targets and were experiencing symptoms including chronic fatigue and panic attacks. The Mental Toughness diagnostic identified specific areas for development.

Over 12 per cent of the managers assessed had an overall mental toughness of Sten 4 and below, suggesting a culture where they might avoid commitment, goals and targets. According to AQR, Stens 1-3 typically represent “low” scores - people who would be expected to show evidence of “mental sensitivity.”

Over 17 per cent of the managers had a challenge score of Sten 4 and below, indicating they were hesitant toward change and new challenges.

Of the total, just 28 per cent of managers had high commitment scores, suggesting a small proportion of managers were driving the goals and targets.

Following three months of mental toughness training, the stress symptoms had gone and productivity and effectiveness had increased by 30 per cent.