Resilience – and why it should not be essential

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In his latest blog, Chris Lake, head of professional development at the Academy, discusses how resilience has become a sought after quality in NHS leadership and questions whether this should be the case.

I’ve been running a research project recently. It’s pretty raw stuff, so those of you who favour the scientific validity of a randomised double-blind control trial can look away for a moment. Think more along the lines of a straw poll. I’ve been asking NHS colleagues, participants on NHS Leadership Academy programmes and NHS staff I bump into around the country the same question: ‘What are the top three human characteristics you think are most important to work in today’s NHS?’ Want to know what the most quoted characteristic is? Compassion? Empathy? No. It’s resilience.

Resilience is the quality that allows people to flex and adapt to the inevitable winds of life, to be knocked down and to come back rather than letting lumps and bumps overcome them and drain their resolve.

It’s an often requested topic when we ask people what workshops or resources they might find useful as part of a wider programme of leadership learning.  It comes up when heads of organisation development review staff surveys and ask themselves what they need to offer their employees to support them in the face of results that show stress is up, morale is down, sickness rates are worrying and people are considering leaving the NHS in greater numbers than ever before.

I’ve been asked to speak on the topic of resilience – and how to develop it – at the upcoming HSJ Emerging Leaders Summit in November. It was requested as a topic by the (bright eyed, full of hope, future-focused) emerging leaders themselves. Of course, we need to do something for our staff. People are experiencing stress and pressure, and it’s our responsibility as organisational leaders to do something effective in response. But is a short training event or online resource the right thing to do? I’d say no. Such interventions are known to make very little difference. More though, surely our organisational response should be more about dealing with the source of the pressure rather than teaching our staff strategies to survive it?

The rather bleak analogy I’ve been using recently is this: if you find yourself being hit repeatedly with a stick, do you want the source of your pain to offer you some padded clothing so they can carry on or maybe even hit you harder? Or, do you want them to stop beating you? I’m not denigrating resilience as a good thing to have, but the fact that our system requires it in such high volumes is a bit of an indictment of the culture. Wouldn’t it be better to lead organisations where resilience was desirable rather than essential?

At least once a year I shadow an NHS colleague who works at the frontline, to experience first-hand the culture and climate of at least their corner of our NHS. I used to call it a ‘back to the floor’ experience until a 25-years-in-the-NHS-nurse (my sister actually) sent me a sweet-but-pithy text saying, ‘Brother, you can’t go back to somewhere you never started from!’ She’s right – my early career was in retail and I’ve spent the last 20 years as a leadership and organisation developer. I’ve always learned loads on these outings as I follow the daily experience of someone working at the sharp end of NHS services. That said, three colleagues (including that sister of mine) challenged me again: ‘Stop glory hunting and spend a day with someone in the core of the NHS!’  (I think they were referring to a previous not-back-to-the-floor nightshift I did dressed in orange in fast response cars with the London Helicopter Emergency Medical Service team). In line with my developing thoughts around resilience, I took their challenge and looked for someone in a suitably demanding role.

So, last Monday I arrived at Charing Cross Hospital and met Merlyn Marsden – site director at Imperial College Healthcare NHS Trust. I’d already swapped some emails with Merlyn – she told me to wear comfortable shoes! Merlyn has a massive job. She and her team are responsible for the allocation to wards of all patients who come into the Trust’s five hospitals as either emergencies or planned admissions, and for the smooth and logical flow of these patients through the hospitals, anticipating problems and responding with a mix of care and urgency. Also in Merlyn’s portfolio is hospital security and patient safety, estates, liaison with the London Ambulance Service regarding emergency intake capacity, and so much more. She leads a team of around 40 people, not from a remote office, but from operations rooms at the heart of two large and complex hospitals, and most often from the wards, stairwells and corridors of one of the largest NHS Trusts in the country.

This particular Monday morning, the Trust was coming off a challenging weekend – full to capacity across all wards and a full Accident and Emergency department working beyond capacity. I’d found the right place to experience where resilience was needed!  First up was a multi-site virtual meeting where Merlyn and her team scoped the detail of bed availability (none), likely discharges (too few) and potential discharges (only a few more). Next we were off around the hospital where Merlyn skilfully facilitated a series of face-to-face meetings between matrons. ‘Who’s got capacity?’ ‘Who needs help?’ ‘Who can offer some (scarce) resource?’

As the day progressed my admiration for Merlyn blossomed from good to great. She works right at the nexus of pressure in an NHS system that’s working beyond capacity and beyond resources, and squeezed by climbing inbound demand with falling resources in social care to support outbound patient discharge. All her efforts were focused on helping the hospitals do two things: work at maximum efficiency, and work with care and compassion. Throughout the day these two objectives often appeared to jar – yet Merlyn managed the tension with aplomb. I was touched by the way that she walked (quickly and purposefully) between wards, she’d stop and help anyone that looked like they needed it, pick up bits of litter, stop and give directions, redirect people heading for the (out of action) escalator towards the stairs, and redirect patients using crutches away from the stairs and to the lifts. She was always ‘on’, flipping from emails on her smartphone, to calls, to patients, to ward managers, to her bed managers, to nurses, to doctors…even to the BBC film crew walking the corridors making a documentary about the pressures and processes in the NHS.

Merlyn was the absolute model of resilience.  Take a look at the picture of us both at the end of her 10-hour shift – she’s wearing the same engaging smile that greeted me at the start. Both Imperial hospitals I visited were great – filled with staff focused on delivering the best care they could. But they, like Merlyn, were working uphill into a headwind: the pressure endemic at the sharp end of a healthcare service suffering from 10 years of flat-line funding (down to 7.4% of Gross Domestic Product in comparison to say France or Germany at around 11%), demand increasing by 4% a year, ever-higher patient expectations, a social care system starved of funding, and a management culture of demand and command rather than compassion and care.

As I walked home that night I was left with the overriding thought that, I was immensely impressed at Merlyn’s resilience and talent and so thankful for all colleagues across the NHS who, day-in day-out, bounce back and deliver such great care. I’d rather they didn’t have to. I’d rather we had properly funded, brilliantly led organisations characterised by care and compassion that were really fit to house the human spirit.

14 thoughts on “Resilience – and why it should not be essential

    1. Thanks for the comment Trine. The message of the blog is one I’d love more people to hear. We are asking too much of our dedicated staff. Don’t give people padding – drop the stick!

  1. Thank you and Spot on. In all sectors it seems the pressure is on to do more with less with no let up. I deliver Personal Resilience training to senior police leaders. This includes how to help those around you and how to influence up and challenge. Ironically it seems that at the very top of the decision chain there is a drive to be more efficient and save money yet all the evidence shows it’s costing more due to sickness & poor performance impacts. Keep up the great work in the NHS.

    1. Hi Joanne. Thanks for the comments – and the ‘Keep up the good work in the NHS’ support too – we’ll do our best. I agree – the pressure is on and building across the public sector – leading more often than it should to employee dis-engagement and stress, even bullying and harassment, and sometimes causing committed and caring people to vote with their feet – a potentially harmful spiral. The public sector needs investment to support committed leaders to improve the climates and cultures of their organisations and nurture workplaces fit to house the human spirit.

    2. ‘Keep up the great work in the NHS’ you say. Yes, we will. 1.4 million people working in service of health and welling is important. Hopefully we’ll get to a place where resilience is just a good thing to have and not an essential.

  2. Really interesting article on resilience which I notice seems to be the buzz word of the moment. It does seem to be “get out jail free” card for any employer who wants to overload staff with more and more work then make out its their fault that they are not resilient enough. I notice that my sons school are now also promoting resilience workshops possibly to prepare them for a workforce where if they complain about anything will be made to feel that its their issue for not being made of sterner stuff.

    1. Hi Amanda. Thanks for the comment. My point exactly – let’s build organisations that deserve the commitment and effort of the people that work there through compassionate and inclusive, as well as stretching and demanding, leadership. Personal resilience is a brilliant thing – let’s not make it the default requirement though and outsource our responsibilities as organisations and leaders to provide decent places to work.

  3. Interesting read Chris. Stress and burnout is still so poorly understood, its impact on staff, patients, clients, teams and organisations is immense in terms of presenteism, lost days at work, compassionate care experiences and compassion satisfaction to name a few. Resilience training can support but often needs to backed up with other tools and techniques. There is no quick fix and one size does not fit all in terms of keeping staff well at work.
    Leadership is essential in terms of maintaining or building resilience in individuals and teams. It great to see Merlyn role modelling great leadership and indeed resilience, but there are some poor examples too which has a great impact on staff and teams.
    Having trained many in Restorative Resilience Supervision i see staff in the NHS with high levels of stress and burnout who relish having a little more understanding regarding their own and indeed their teams stress, burnout and resilience. After a degree of training: 121 and group supervision supports processing of work events and enables staff to develop and sustain their own coping strategies and then transfer skills to others through further training and supervision. As a clinician I feel honoured to work with staff to enable them to cope, support others and indeed excel in their role within health and social care environments. Stress is a normal part of life and work, but it’s how we respond and learn from it that builds resilience and keeps us well.

  4. Hi Chris.
    Good read and glad you highlight the core need for healthier organisations rather than health and performance being only an issue of individual responsibility.
    Your point about one day sessions on resilience being misguided is also spot on – so far as these sessions think anyone can become resilient as a result of any process let alone a one day instant fix. Too often the notion of ‘be more resilient’ becomes just another bat to beat ourselves and each other with. When we might feel overwhelmed, thwarted and frustrated, running on empty, not up to the task – or any of the many phrases our little gremlins use, we can now add an extra domain of self-loathing – why can’t I be more resilient??!!!?!
    As someone who has commissioned a programme this year called Resourceful and Resilient Change Makers I know there is a way to work with resilience that is evidence based, positive, self-affirming and practical.
    Your blog raises similar questions at organisational and system level too – maybe this is a good idea for a one day workshop!
    Andrea Overton

  5. I am a newly qualified nurse, I am pleased to hear that someone has a word for copying with the work pressure within the NHS, resilience is the way forward with the ever increasing work and pressure at all levels with all staff from the admin, to the domestic, medical and nursing and I guess our patients feel it too as they often comment on how hard our job is working in the wards as they watch the day roll from their bedside as inpatients. With resilience we can all soldier on knowing we are making a difference to people’s lives.

  6. Generated some good debate. Resilience – bouncebackability – at individual, organisational and community levels….very empowering – trust you do organise that workshop recommended above.

  7. Loved this blog, Chris. And just what we are talking with NHS management trainees about right now – there are emotional costs to this work to which the NHS does not pay enough/any attention. Let’s look after our current and future leaders to avoid them becoming lost leaders.

  8. When such stress is caused by broken processes and lack of funds, trying to `fix the people` does not attack the heart of the problem.

  9. Well I work in resilience. I have recently discovered that in the UK people do not really understand the concept. I don’t think you really do. I studied in Latin America and SPain and we have a completely different approach. IN fact much more holistic and spiritual if I dare say that.

    I am busy now writing some courses to get rid of the people who are not understanding the concept.

    Resilience is not a buzzword like the dreaded mindfulness movement, it is something that has come out of years of research with children, social exclusion and migration. It is something that it is used in these fields because it is the only thing that works. It is something present in all cutures, it is about positive tranformation, story telling, identity and many other things. It is not about stress management and expecting people to keep bouncing back.

    One thing that is very important in resilience work is sense of humour and in most UK model this has already disappeared in organisations. Learning in the latin world they would talk sometimes about the anglo saxon approach, focussing way too much on the individual. In resilience we don’t talk about the self, only the self in relation to everything else.

    Resilience is not about toughing it out and it is definitely about the psycho social issues and not the ME ME ME world of mental health that we are presently living in.