Organisational anxiety – can we even talk about it?

In the 1960s, the psychoanalyst Isabel Menzies Lyth used the term ‘social defences’ to describe how groups can find sophisticated but ultimately unhelpful ways to manage the anxiety inherent in care work. Nearly 60 years later, the health and care sector has changed a lot and services are under huge operational pressure. This amplifies anxiety further and the resulting workplace stress, moral injury and burnout create the potential for a downward spiral, both for staff experience and outcomes for people using services.

Menzies Lyth suggested that individual-based responses, while helpful, are insufficient when it comes to significantly improving people’s experiences at work because they don’t address the group-based (or social) defences. Instead, she recommended more holistic approaches, including the provision of adequate physical, financial and people resources, enabling people to have space to process the impact of their work, and leadership and management approaches that are thoughtful about containing anxiety (ie, making it easier to surface, manage and mitigate the effects of the difficult feelings that are to be expected in care work). Yet individually focused interventions – for example, counselling, cognitive behavioural therapy or yoga – remain the mainstay of current organisational responses to workplace wellbeing. So in May 2024, we launched a project to find out how health and care leaders could try to manage anxiety in organisations more holistically.

We asked for expressions of interest in joining a group to experiment with what this might mean in practice. We received more than 100 responses and selected members from different sectors (acute, community, mental and primary health care, social care, public health, VCSE, and regional and national bodies) who had responsibility for workplace wellbeing in some form and the ability to direct resources and/or influence their systems. After two meetings, the group’s central questions have come to be:

In inherently stressful environments and geopolitical contexts…

• how are we building understanding of organisational anxiety, its sources and effects on staff wellbeing, the quality of patient care, and organisational sustainability across health and care?

• how are we developing our systems, structures and leadership practices to contain anxiety?

In this blog, we share some insights from group members’ reflections during the first period of research.

Our first learning: encountering resistance

For many, the first hurdle was getting colleagues to engage in even thinking about organisational anxiety. While several group members were intrigued and attracted to the term ‘organisational anxiety’ (rather than the more common ‘workplace wellbeing’), their colleagues’ responses were mixed. Group members tried a range of approaches to start conversations with colleagues about the subject and to ask questions, for example via email, meetings, discussion forums and informal chats.

Success was varied. Those already familiar with psychodynamic or systems theory seemed more open. Those who could see the relevance of organisational anxiety to current work challenges talked about it providing a helpful way to step outside the challenges of the day-to-day situation, and for thinking about what might help. More often, though, group members experienced resistance from colleagues, including no response at all, not being able to make time for conversations that went beyond short-term fixes, or insisting on focusing on individual-level interventions.

Of course, current pressures mean leaders are extremely busy, and the stakes are perhaps higher than ever. But if Menzies Lyth was right, then leaders aren’t helping themselves by avoiding the systemic sources of anxiety. Adequate resourcing may not be possible in the current financial and operational climate, but group members found some of the people they were trying to engage resisted acknowledging their own contributions to, or responsibility for, how effectively organisational anxiety was being managed.

The group speculated on the reasons for this resistance. Suggestions included:

• the system and context in which leaders are working rewards transactional and impersonal assumptions about how work gets done. Some leaders may never have considered how their own behaviours could be contributing to the very problems they were trying to solve. Acknowledging this could potentially cause feelings of shame, hopelessness or inadequacy that they’d prefer to avoid.

• the language of organisational anxiety, and talking about emotions at work, is itself anxiety provoking, and people don’t always feel equipped to sit with or speak about their own uncomfortable feelings, or to manage the disruption or conflict that might emerge if others do.

• although longer term or systemic thinking may be helpful, in the busyness of working life, where many leaders already feel a lack of control as well as regulatory and media scrutiny, it would be another thing on an already too long list, and perhaps another thing to fail at, so, it can be easier not to think about it.

There are likely to be many other possible reasons, which together perpetuate a cycle of overwhelm, transactional/survivalist mindsets, inability to think, and continued overwhelm.

Our second learning: what helped?  

Fortunately, other aspects of our group members’ experiments did seem to help others to engage in their work on this project. A key insight was that just as leaders need to be able to process and manage their own anxiety so that they can support others, so too does anyone engaging people in conversations about anxiety. This meant our group members having a tolerance for being open, for sitting with and naming their feelings, owning their positional authority, and using it, where appropriate, to challenge institutional norms and habits of thinking.

A second insight was that taking a relational approach and making time to do the topic justice also seemed to lead to more productive conversations for our group members. Working with these kinds of ideas can surface disturbing aspects of experience that people might prefer to avoid. So it makes sense that providing a safe enough space for people to explore these can be another important condition for working with organisational anxiety.

The busyness of organisational life and defensiveness might mean that these kinds of conversation never make the top of leaders’ to-do lists. However, making time, and fostering relationships in which it is possible to be collectively more open, thoughtful, generous and daring seems important in service of improving people’s working lives.