The impact of Covid-19 on working relationships

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Recovery plans are gearing up to deal with the legacy of an emergency response that put many services on hold to prevent Covid-19 from overwhelming the health and care system. Efforts are focusing on unmet need – deferred treatment, late presentations and the long-term physical and mental health effects of the crisis – alongside a determination to retain and embed some of the innovations resulting from new ways of working. But, while some individuals and teams are flying, with energy to capitalise on the opportunities, there are other, harder to acknowledge, aspects of unmet need emerging.

Some system leaders have shared a growing unease about the relational and cultural consequences of the focus on Covid-19, describing this as being hard to talk about without seeming churlish or challenging, especially during a national crisis that needs everyone to pull together. There is a risk that some of the more difficult relational aspects of the crisis period are unresolved and may potentially lead to future relational breakdown. Here are some of the things we’ve been hearing about.

Damage to collaborative working and team relationships as a consequence of the shift to command-and-control leadership

Covid-19 has changed the balance of power in many teams, organisations and systems. For some leaders this has brought the exhilaration of power and control – opportunities to get things done quickly without having to consult or collaborate. Others are left feeling frustrated, undermined, voiceless and side-lined. And while, initially, people were willing to set aside frustrations to support the emergency measures, that willingness is now waning.

'Covid-19 has changed the balance of power in many teams... [with some people] left feeling frustrated, undermined, voiceless and side-lined.'

Bruised relationships and damage to collaborative processes have brought tensions to the surface in a heightened and often emotional way. People describe being overly sensitive, scratchy or irritable, with cracks in effectiveness beginning to appear. Some are worried about whether the damage is recoverable; whether the emotional backdrop to Covid-19 means a return to old tensions; and whether the value of collaborative leadership, which is often disputed by those who favour a more directive approach, can now be openly dismissed.

A sense of rejection and worthlessness felt by some individuals and specialisms about being redeployed, furloughed or held at home until Covid-19 recedes 

For many of these people, the experience of their ‘place in the system’ during Covid-19 has evoked unexpectedly difficult feelings of exclusion, not being valued, or being lost. For some, this has been a powerfully felt loss of purpose and role. Some examples shared with us include clinicians without patients; managers redeployed to old roles or given time-filling tasks; experienced leaders left out of decision-making while other colleagues are now authorised to lead instead of them.

'Many capable people describe the frustration of just waiting… waiting to be called, to be allowed to be useful again'

Many capable people describe the frustration of just waiting… waiting to be called, to be allowed to be useful again. The risk of depression and demotivation in those who feel side-lined is significant in terms of future relationships and working cultures. Some people are describing feelings of embarrassment and even shame, making the experience of work during Covid-19 very difficult to talk about.

 

The loss of voice experienced by some groups

As data emerges about the differential experience of some groups during Covid-19, the question of how to speak about the reality of lived experience, especially for those who have less formal power, has come up time and again in our conversations with system leaders. Anecdotally, some equality leads and middle managers have found themselves unable to speak about difficult issues, describing how they are often heard as challenging rather than helpful in raising questions. This matters because the power to privilege some perspectives and realities over others can reinforce existing inequalities and deepen systemic disadvantage.

'The anticipation of post-Covid-19 inquiries has raised fears about who will be blamed for the impact of Covid-19... for some it has created an environment of fear, hesitancy to speak and disempowerment.'

Recently, another hard-to-talk-about fear – scapegoating – has begun to emerge. Some integration and social care leads have described a struggle to be heard and a loss of influence as the requirements for public health assurance vie with social care accountabilities . The anticipation of post-Covid-19 inquiries has raised fears about who will be blamed for the impact of Covid-19, not least the impact on black, Asian and minority ethnic communities and the deaths in care homes.

In the future, this may affect morale and confidence to act in a crisis situation where no one has certainty about decision-making. But more worryingly, for some it has created an environment of fear, hesitancy to speak and disempowerment. For some staff, staying safe during Covid-19 has meant keeping quiet about issues that should be raised collectively, trying to stay out of the firing line as the gaze of blame gets stronger in our society, as well as in our health and social care system.

These relational and cultural unmet needs are harder to quantify than reduced A&E attendance but the seeds of relationship damage for many are already planted and growing. These need to be addressed in the recovery narrative, perhaps with a sense of urgency that allows us to capitalise on the opportunity for a more inclusive ‘new normal’. If we brush these under the carpet now, we risk having a resentful and demotivated workforce as the system begins work to recover, as well as an exhausted one.

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Comments

Andrew Haworth

Position
specialty doctor,
Organisation
NHS
Comment date
22 May 2020

If we can reacquaint ourselves with the principles set out in Dale Carnegies "how to win friends and influence people", it should not be too hard to heal the wounds. Indeed, there is no reason, that I can see, for why these principles should not be valid during any crisis. It is, by any measure, the bible on how to foster good relationships, in any setting.

Brendan Dunphy

Position
CEO,
Comment date
26 May 2020

Was the collaborative culture displaced by command-and-control truly effective? I doubt it. Maybe there is now the opportunity to begin to create a third way, one that is based on knowledge and data and not opinions, outcomes not inputs and capabilities rather than personality and position?

Susan Murray

Position
Programme manager,
Organisation
NHSE
Comment date
24 June 2020

I totally identify with this paper. Thank you for articulating some very real scenarios, very cathartic reading. I have felt side lined, under utilised and loss of direction in my working role as a result of COVID-19 - whilst watching other interesting behaviours - senior managers taking on all the work and not delegating and other senior managers demonstrating a loss of control and ability to lead through a crisis. Its not been easy!

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