Organisational anxiety: what does taking a relational approach mean in practice?
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The publication of the 10 Year Health Plan is a significant moment. It outlines how the government sees the NHS evolving in the coming years – shifting care away from hospitals, emphasising prevention, and using technology more effectively.
Although this new direction is welcome, the plan has been introduced into a distressed system. Despite offering hope for a better future, the reality of day-to-day work remains challenging for many. Workloads are too high, and ongoing financial constraints may necessitate further staff cuts. The reorganisation of national and regional teams adds to the uncertainty, all while leaders grapple with problems that have felt intractable for decades.
Against this backdrop, our project exploring how leaders are thinking systemically about organisational anxiety seems more relevant than ever. The psychoanalyst Isabel Menzies Lyth coined the term ‘social defences’ in the 1960s to describe the dysfunctional group behaviour that can arise from under-acknowledging the anxiety inherent in caring work. The current context likely exacerbates anxiety related to job insecurity, competition for scarce roles, loneliness, fear, moral injury, and the distress of providing less than desired care, alongside cautious hope.
In our previous blog, we suggested that engaging with colleagues about organisational anxiety benefits from a relational approach. In this blog, two members of our action research group describe what doing this has meant in practice as they navigate the current challenges.
Stephen Veevers and Dr Amelia Randle on organisational anxiety
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Stephen Veevers
Chief Executive Officer, HFT -
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Dr Amelia Randle
General practitioner, Glastonbury Health Centre; clinical adviser for urgent care NHSE South West; clinical director SWAG Cancer Alliance
Transcripts of Steven and Amelia
These recordings share individuals’ experiences and also represent the collective work of our group. They highlight the importance, and potential, of a relational approach as a foundation for leadership practice. They illustrate how leaders in health and social care can engage meaningfully with how anxiety manifests in day-to-day work in order to better support their colleagues. This involves being present, fully participating in conversations, actively listening, and exploring what is happening.
Leaders who take this approach will benefit from what we call ‘doing their own work’. Being present means allowing yourself to be affected by the experiences you hear your colleagues sharing when it would be easier to defensively close yourself off. ‘Doing your own work’ might involve talking to other leaders or colleagues, journalling, recording voice memos, or finding other ways to acknowledge and process your thoughts and emotions.
The 10 Year Health Plan sets out a future where people can stay well and receive excellent care when they need it. However, excellence needs to be defined in broader terms than just optimising operational processes: as one member of the group said, maybe the excellence we should be striving for is for everyone to become more self-aware, less defended and therefore more able to deal with the world as we find it rather than as we want it to be. We believe leaders who engage in this work will be better equipped to support their colleagues and teams and help them thrive, despite the challenging conditions ahead.
As always, we are keen to hear your reflections on working relationally. Please share your experiences in the comments below.
Find out more at our Annual Conference
Attend the interactive and experiential session on organisational anxiety at The King’s Fund annual conference on 5–6 November, at which Kiran Chauhan and Naja Felter will explore how health and care leaders could try to manage anxiety in organisations more holistically.
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