Freeing up anxious managers to act intelligently

I’m in touch with frontline staff in different NHS Trusts through my work. The story is the same from each of them: understandable fear for themselves and their patients, amplified by the lack of PPE and ignorant or helpless bureaucratic responses when they complain about this. The virus is now prevalent on many wards, not just those devoted to Covid-19. Patients who come in for other reasons such as strokes are not being tested for the virus unless they have obvious symptoms. The risk of cross infection is being made worse by the rationing of protective gear. Nurses are apparently not necessarily changing gloves and masks between patients. Single-use visors are being used many times with jokes about the make-up still there from the last staff member to use them. 

These staff have been led to believe that the PPE is now there – allegedly, there are rooms packed high – but they are being discouraged from using it, the rumour being that the hospital wants to keep back stocks of PPE for the ‘peak’ period. 

If what I hear from these frontline staff is true, how can it possibly be happening? The Government has promised it’s making every effort to manufacture and obtain more PPE. National leaders – admittedly slow to act and slow to understand the issues – look baffled that there is still a problem in hospitals, whilst acknowledging that there are real shortages in care homes. NHS England’s downgrading of WHO guidelines has now been acknowledged, partly rectified and clarified. Broadcasters mention huge numbers and show battalions of loaded-up lorries on the move. After all, we are not talking about complex ventilators here: presumably this equipment is relatively easy to manufacture at speed. 

If there is a policy of holding back supplies, will it be coming from director level? Or could it be that an anxious middle-manager somewhere fears he or she will be blamed if the hospital runs out of stock in the future? Or perhaps trying to exert some kind of (unhelpful in this case) authority when they feel helpless? Anxiety hits us all in different ways with some of us retreating into old patterns of thinking and unable to adjust to new information. If there was a food shortage for a defined period, it would make sense to ration it and make it last – indeed, many of us are thinking like this about flour and toilet rolls in our homes at the present time. But PPE is different and everything should be done to minimise the spread of infection now or the problem will be greater in the future. 

These are anxious times and overwhelming anxiety has a detrimental effect on thinking.  It is inevitable that some anxious people are not going to be able to think clearly in a crisis and will continue to doggedly follow rules and guidelines learnt during ‘austerity’ but inappropriate to the present context. How terribly sad if this gets in the way of our collective response to this crisis. 

Unfortunately, the bureaucratising of professional life over the last twenty years has meant NHS staff are too used to following rules and guidelines and less good at thinking for themselves and practicing with appropriate autonomy. Our leaders need to recognise this reality and not take anything for granted. They need to be mindful of how their message is being heard, aware that it may be distorted by some who don’t properly grasp what is important. They need to wise-up to this and work to engage with staff, particularly frontline managers, to help free them up to act intelligently, creatively and supportively.  In a time of crisis, it is more important than ever that NHS leaders open up channels of communication with the frontline; and find ways to do this directly, not just relying on layers of management in between. Frontline staff, in turn, need to make sure they make every reasonable effort to get the important messages through, and not resign themselves to a paralysing, sometimes punitive system and culture that is not up to the present task.


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