Organisational anxiety and what leaders are (or aren’t) doing about it

Working with others in any context can be stressful. For many, though, anxiety is likely to increase when there’s a lot at stake – for example, if people are working in a health care setting where other human beings may live or die. There are lots of ways that leaders in health and care organisations can try to manage organisational anxiety. To explore this in more depth, The King’s Fund is looking for people to join a year-long learning group to help us find out what taking a holistic view of organisational anxiety actually involves. 

Working in health and care can give rise to a range of emotions. While caring for people who are suffering or dying can be immensely rewarding, people may also experience more difficult feelings, such as grief, fear, anger or shame, as they care for people going through the sometimes life-changing impact of illness. Add to this the current challenges of ongoing resource constraints, increasing workload, long-term staff shortages, the impact of Covid-19, and challenges regarding pay and conditions and it’s little wonder that care worker health is in decline. The scene is set for anxiety in the forms of workplace stress,  exhaustion, moral injury and burnout. 

How well people are able to cope in this context varies. Some can manage their anxiety well – they are able to maintain perspective and moderate their distress. Others, though, may turn to strategies such as denial, withdrawal or substance misuse that provide short-term relief but which don’t actually help longer term. This can be problematic: for the individuals themselves, because these short-term strategies can adversely impact their wellbeing, but also for their employers and society more widely – increased errors, absenteeism and turnover all reduce the potential to provide high-quality care, and the resulting wider impacts may be significant. 

There is clearly a necessity then for leaders to be interested in containing anxiety in organisations. But how do the people leading organisations or working on employee wellbeing understand anxiety in the workplace? What kinds of interventions are they making, and are these interventions focused at an individual or organisational level? What can we learn from how people are going about trying to think more holistically about anxiety in organisations, and the challenges that can involve? 

Our question 

In the 1960s, Isabel Menzies Lyth developed a theory about what happens to anxiety in organisations, based on a study of student nurses at a London teaching hospital. Using psychoanalytic ideas, she suggested that groups facing anxiety can find sophisticated ways to avoid it, but – like the short-term individual strategies described earlier – these approaches don’t help in the long run with things such as morale or retention. Menzies Lyth called these sophisticated avoidance techniques ‘social defences’ – examples included nursing staff relying on checklists in place of making decisions; avoiding personal responsibility and blaming others; or depersonalising both staff and patients.  

These ideas have continued to be developed over the last sixty years and still resonate today in the nursing profession. We think they are likely to affect many other health and care workers, too. So we looked at what people are currently saying about how to deal with organisational anxiety. Our review suggested that interventions tend to be directed more towards supporting individuals – for example, offering counselling, cognitive behavioural therapy, yoga, meditation, employee assistance or health promotion. These kinds of interventions are important; however, reflecting on her own work just before she died, Menzies Lyth was concerned that people hadn’t really engaged with her core argument about organisational interventions being as – if not more – important in trying to create healthy and effective workplaces.  

Such interventions include: 

• providing adequate resources (people, funding, and a suitable physical environment) to enable work and to help staff feel valued. (Obviously, this is very challenging in the current climate.) 

• systematically providing spaces for people to process the impact of their work (eg, Balint groups, Schwartz Rounds, team meetings/forums, supervision or consultation). While these may be more common for clinical professionals in relation to their clinical practice, our work with both clinicians and managers suggests that many people working in health and care may benefit from these environments to process the impact of managing in significant uncertainty. 

• leadership and management approaches that are thoughtful about containing anxiety – for example, by promoting the tolerance of uncertainty, ambiguity and risk; enhancing people’s sense of hope and optimism; being clear about purpose, objectives, professional authority and role expectations; enabling participation in decision making; appropriate workload management and protecting time for development. 

Recent reports on the wellbeing of doctors, nurses and midwives have highlighted the need for these types of interventions, which are also encouraged in guidance on managing workplace stress (for example, NHS Employers 2022, HEE and NWSDU 2019). At The King’s Fund, we’re curious about what a holistic approach to managing anxiety in organisations means in practice, and what might stop this from happening.  

Our project

We want to bring together a representative group of 8–10 people who are responsible for workplace wellbeing in health and care organisations to explore these issues, learn from each other, and experiment with what is possible.¹ Practically, we’re looking for people from different types of organisations who can commit to meeting virtually for three hours at a time on four occasions over a period of 10–12 months, and can participate in producing some outputs in various formats from the work. We are especially interested in how addressing the differential impact of interventions is due to diversity among staff members of different background, profession or experience. So ideally the group will reflect some of this diversity.  

Depending on the responses we receive, we may create a wider reference group to test ideas or findings with during the process.