Hello

Well here we go again, more leadership failings in the NHS. 

This from the BBC: “Dr Lewis Morrison said bullying and harassment in the service is still widespread, and had a serious impact on doctors”.

Dr Morrison is the BMA Scotland Chairman.

Let that sink in for a moment. The Chair of the British Medical Association in Scotland is stating that bullying and harassment in the NHS was still widespread, and that it was having a serious impact on doctors. I’m pretty certain that he will not have made that claim lightly. The exact nature and scope of this bullying has not been made public at this time, but for this to be a central theme of the BMA’s Christmas message in Scotland is very telling.

How can this still be going on? It appears that the drive towards unrealistic targets with less than optimum resources may be one key factor. However, if that’s the case, why are more people not speaking up? Well there are no doubt many reasons for that, but one essential ingredient I’d wager, will be fear, fear of losing promotion prospects in the future. Who wants to work with a troublemaker? Of course an individual who speaks up is not a troublemaker at all, they are to be applauded, and where and when appropriate, promoted; so that they in turn can encourage others to create a more open performance (rather than blame) culture.

Here’s another interesting snippet.

“An independent review is being held into NHS Highland after senior clinicians raised concerns over a “long-standing bullying culture” they alleged was damaging patient care.”

Senior Clinicians! That’s important. Perhaps they had to be Senior Clinicians i.e. holding a Senior (enough) position, and there had to be more than one of them, to be believed/take the risk!

Intriguingly, and worryingly, here is the Health Board’s Medical Director’s response.  

“The health board’s medical director Dr Rod Harvey has said he does ‘not recognise’ the claims.”

Perhaps the Board are ‘covering up’ that of which they are only too actually aware. Or perhaps the Senior Clinicians are exaggerating the problem, mistaking a high pressure and robust no-nonsense environment for bullying. 

Firstly, let’s look at the claims of the Senior Clinicians. It is significant that there were apparently four of them. That minimises the risk of this simply being delusional thinking. Perhaps there has been some form of ‘group hysteria’. This would seem unlikely, as Senior Clinicians tend to be quite independently minded (it comes with the territory). Not only are they independently minded, they will have, by the very nature of their careers, endured some quite severe pressures and working environments, which implies that if they are ringing the alarm bells, things really are way off-kilter. 

Secondly, let’s consider the response of Dr Rod Harvey and presume that him not recognising these claims has nothing to do with a ‘coverup’ and is entirely accurate, which on the face of it, there is no reason to doubt. How then can these two perceptual universes co-exist? The Board on one hand not recognising such a culture, and on the other hand, four Senior Clinicians being vocally and publicly adamant that it does. 

I would posit (with the caveat that this is pure conjecture, as I have no ‘inside knowledge’) that the Board may be isolated and that the ‘signals’ reaching them may be an extremely low resolution version of reality. I have seen this happen before in different organisations, including the NHS. Some individuals who should be demonstrating those leadership traits of transparency and integrity become overpowered by their darker side. They can resort to short-term thinking, ‘let’s just survive this meeting’ and shirk from their responsibility to tell the truth. 

The problem with that approach is this – if they don’t, who will? Who will say that things aren’t sustainable, that there aren’t enough resources to meet these particular demands? It appears that we may have the answer to that question, four Senior Clinicians, but where is everyone else? 

Remember these issues are not just being reported from one Health Board, this is Scotland (and I suspect UK) wide. Something is badly awry. And the ‘leaders’ who report directly to the Health Boards, and the individuals who report to those leaders, and indeed to Boards themselves need to take a good long hard look in the mirror. What are you actually there to do? Short answer, make things better. Undertake to do so. Lead by walking about. Call things out when you see them. It’s not good enough to do no harm, it’s imperative to actually do good. 

In conclusion, I note that Dr Morrison, who is to applauded for speaking out, states that, “greater efforts were needed to ensure doctors can speak about bullying without fearing for their careers…BMA Scotland will carry out work in 2019 to understand doctors’ experience of bullying and harassment, examine causes and put forward solutions.”

That work cannot begin soon enough.

Seasons greetings 

Mike