Just how tough are NHS managers? Alex Davda and Guy Lubitsh look at the ways NHS staff show resilience in adversity compared with the private sector
Developing resilience has become a vital skill for health leaders, as it allows them to continue to challenge a changing system during critical periods
If ever there has been a period when one professional sector has been put through a test of resilience, the current restructure of the NHS has been exactly that. The personal and organisational stresses have impacted upon careers, livelihoods and relationships and the operational working of many departments.
‘Managers who were, or still are, clinicians are used to making tough and rapid decisions as part of their working life’
Alongside this, there are numerous projects and initiatives which, with such a conglomerate as the NHS, require resilience to overcome the hurdles of persuasion to put them into practice.
So how resilient are managers in the NHS?
With this background in mind, Ashridge Business School undertook research to compare the resilience of leaders in the NHS with those in the private sector. It reveals that NHS leaders differed from their counterparts in their willingness to make pragmatic and “on the spot” decisions.
The concept of resilience
Developing resilience has become a vital skill for health leaders, as it allows them to continue to challenge a changing system during critical periods. The concept of resilience at work has been described from various different perspectives.
Cooper, Flint-Taylor and Pearn (2013) take into account these variations when defining resilience as: “Being able to bounce back from setbacks and to keep going in the face of tough demands and difficult circumstances, including the enduring strength that builds from coping well with challenging or stressful events.”
Ashridge’s recent work with the NHS has revealed cases of resilience that combined an ability to keep going with taking the time to renew and recover and an increased strength and perspective as a result of the challenging experience.
The research compared 156 leaders from NHS London, working in a variety of healthcare settings (acute, mental health and primary care) with the same number from the private sector. Both groups completed the Ashridge resilience questionnaire as part of the “resilience focus” within their respective learning and development programmes.
Different strategies to relax
The research found that NHS participants were more able to balance alternative options, try out different strategies to relax and give attention to different parts of their lives, than their private sector counterparts.
It may appear that with the imminent challenges being faced, that NHS leaders would find it difficult to make informed decisions and instead only focus on the task at hand.
‘NHS participants were more able to balance alternative options, try out different strategies to relax and give attention to different parts of their lives’
Instead, they proved to be smart decision-makers and during their development programmes provided examples of when they need to “think on their feet” and respond to changes in circumstances. It appears that health leaders are used to juggling conflicting demands and making uncomfortable choices, especially during periods of ambiguity.
For example, even in the face of public sector cuts, many remain extremely creative about how to best use the resources that are still available to them.
Dr Caroline Allum, associate director of quality and medical appraisal at the Whittington Hospital in north London, commented on the findings from a clinician’s perspective: “Managers who were, or still are, clinicians are used to making tough and rapid decisions as part of their working life.”
She said that managers in the NHS are used to the fluidity of the environment and therefore more comfortable making choices in line with this fluidity. She explained that “during the Ashridge programme participants often had to respond to unexpected challenges. Everyone seemed to step up to the mark and feel comfortable innovating and making decisions, probably because people in the group are used to operating in a changing and challenging system”.
This ability to make pragmatic and tough decisions is also apparent in a case of resilience (see box) within a ground level service led reorganisation such as that handled by Linda Saxe at Derbyshire Community Health Services Trust.
Case study: building strength across the organisation
A real situation requiring resilient qualities faced workforce health and wellbeing project manager Linda Saxe in rolling out Derbyshire Community Health Services Trust’s workforce health and wellbeing programme. In the end her resilience and determination led to staff changing their lifestyles, improved patient services and outcomes as well as a more satisfied workforce.
A framework, called “Making Every Contact Count”, was introduced to inspire staff and their family and friends to improve their own health and in turn, that of the trust’s population.
It involved getting everyone in and around the trust to engage in conversation and support, that would help others to change their lifestyles. Nothing complicated is involved, merely to offer simple, brief lifestyle information of the existing services or support that is available.
Wellbeing among all staff is critical in the face of the current demands in the NHS to meet financial and productivity targets. It took resilience on the part of Linda and her team, to ensure health and wellbeing maintained a high profile and hit every part of the organisation.
The project works because of the relationships that have been developed with all parts of the organisation. During organisational change Linda lost some of her contacts and became unconnected with some key support networks. It took resilience to say “it’s not right” and “it is not working”.
As a result changes were made and her team became part of the People and Organisational Effectiveness Division, allowing them to reconnect with the organisation. “It took confidence to do this,” she says. “Even if you do not feel confident inside, you need to be seen as confident and passionate about what you’re doing.”
What helped Linda to stay on track was that she found an abundance of like-minded people in the organisation and that she spoke to many doing similar work. Her team of three worked closely together to train 3,000 staff in delivering what the framework said, “making every contact count”.
Linda adds: “Talking with my team is the kind of reflective practice you need to maintain your confidence and resilience to keep going. It was hard at the beginning, but everyone bought in to the values: team support for each other and care about each other. And this helped to create strength right across the organisation.”
Instant results don’t often happen and it requires the strategy and patience to push back on the immediate need for return on investment in the interests of longer term outcomes. With persistence, dedication and resilience, Linda and her team found that results do come.
Lower levels of confidence
Conversely, the research highlighted that private sector managers displayed a higher confidence in their capabilities than those from the NHS. However, in line with the magnitude of the current reforms, political and media pressure and the challenge of delivering significant performance improvements, it is not surprising that confidence within the NHS is not currently at its peak.
Tim Jaggard, deputy finance director of University College London Hospitals Foundation Trust, explained that confidence may be lower at this time because the political changes currently taking place are making people feel less in control of their working environment.
‘NHS leaders are able to adapt and continue to make difficult decisions, even when faced with a high level of personal uncertainty’
Anne-Marie Archard, head of the London Leading for Health Partnership, shared insights in relation to the context for the development programme.
She said: “We recognised that when commissioning this programme there would be participants on it who were faced with significant change in their working environment, including possible redundancy. While this was reflected in the lower individual levels of confidence demonstrated by the research, by investing in development we were able to provide time and space for participants to share their concerns and find ways of becoming resilient. This comes through in the way NHS leaders are able to adapt and continue to make difficult decisions, even when faced with a high level of personal uncertainty.”
Separate from the research, a number of senior leaders in the NHS revealed how they found it useful to step out of their comfort zone on to the frontline in order to increase or top up their resilience.
This could involve simple activities such as, giving directions to visitors or spending time with families and patients after an operation. In other instances they might visit wards, talking to patients or help members of staff who need support and positive feedback.
These experiences then give them the strength to appreciate more fully the challenges their staff encounter on a daily basis and to witness the care and empathy offered to patients.
Learning or conditioning?
Our work with healthcare professionals across London has brought a rich understanding of the significance of the change they are experiencing and how this affects every aspect of what leaders do.
The pragmatism of these leaders could be something they have learnt to do, through their experience in public health over the years. Alternatively, this “can do attitude” may be a positive that has emerged as a result of their recent change experience.
As the NHS continues to evolve, it is vital that managers are allowed to develop and maintain their pragmatism for the benefits of patients and staff.
Alex Davda is a business psychologist and Dr Guy Lubitsh is an organisational psychologist at Ashridge Business School