Tackling the causes of stress

Staff morale has topped the list of NHS foundation trust finance directors’ concerns, for the King’s Fund fifth quarterly monitoring report in a row. With financial pressures at unmanageable levels, increasing demands and great uncertainty for staff, how should NHS leaders respond? Here is a summary of a blog from Michael West, Head of Thought Leadership and Donna Willis, Programme Director, Collective Leadership.

One way of improving stress levels is to implement health and wellbeing strategies to help staff take more responsibility for their health. But, to some extent, this is treating the symptoms, not cause – preparing staff to be more resilient in order to send them back into the trenches. And there is a danger that leaders could use a health and wellbeing strategy as a sticking plaster, instead of addressing the underlying and pervasive structural and cultural causes of low staff morale.

We know that stress is a result of a toxic cocktail of high work demands coupled with low levels of control and support. We must address all three elements.

First is the need to reduce work demands. A recent study showed that long shifts are associated with poor patient care and higher levels of errors and it is key to address the culture of long working hours that often characterises NHS organisations.

Second, control. NHS staff are more highly motivated, skilled and experienced than staff in virtually any other industry. Command and control cultures in such a context are unnecessary; the number of levels of hierarchy in NHS organisations is far too high; and we must give frontline staff the autonomy and control to provide care (within safe boundaries) in the way they know is most effective. In effect, we must create shared leadership in teams and cultures of collective leadership.

Third, staff must have support to do their jobs effectively. This includes developing effective team- and inter-teamworking in health care because effective teamworking (where teams have clear objectives, work closely together and meet regularly to review their performance) is associated with better-quality care, staff wellbeing and innovation in improving patient care.

The role of leaders is to create the conditions that enable staff to do what it is they chose to commit their working lives to – offering high-quality, continually improving and compassionate care. And there needs to be the necessary resources, staff and time for the work to be conducted effectively.

Leaders must model compassion in their dealings with staff: paying attention, appraising the situation, having an empathic response and taking intelligent action to support them. Our surveys of culture in the NHS suggest that leaders are not always seen as being compassionate towards staff. Indeed, a shocking 24 per cent of NHS staff report being bullied by colleagues and managers compared with around 16 per cent in some of the worst-offending industries outside health care. A service focused on delivering high-quality compassionate care must not be damaging to those who deliver that care in the process.



Michael West, Head of Thought Leadership and Donna Willis, Programme Director, Collective Leadership.


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