The NHS is a sand dune; an ever shifting, dynamic political environment that every young medic must learn to navigate. Each culture and sub-culture within the NHS is unique. Some function and some do not. As juniors, we are transient members of these teams, moving in and out often with a sense of detachment. Poorly functioning teams are a 4 month inconvenience, well-functioning teams are a 4 month sabbatical and because of this we don’t necessarily invest ourselves in understanding the dynamics that makes one team function and one implode. But does it matter? And should it matter to us as junior staff? 

In short, well, yes to both. Studies have shown a link between poor psychological working environments and employee sickness rates (1). Sickness absence rates are higher in the NHS than the rest of the economy (2). The cost to the NHS for sickness absence is estimated to be around an astounding £1.1bn in 2017 (3) . Imagine what we could do with such funds year on year. A breakdown of causes of sickness rates shows that mental health issues formed the bulk of the causes. This is demonstrated in The King’s Fund graph at this link: https://www.kingsfund.org.uk/blog/2019/10/nhs-sickness-absence 

This is not suggest that all of these absences can be attributed to work related stress but the data is certainly interesting. In addition, The King’s Fund reports that in certain populations, these incidences are increasing (5). 

Staff absences and high turnovers may lead to increased working demands on remaining staff, therefore increasing the workload on those employees, further perpetuating the cycle. Whilst we cannot attribute working environment to being the sole cause of the above and certainly long shift patterns, personal issues and the emotional demands of the work must factor, we must consider that it plays its role in contributing.

There have also been noted links between staff engagement at work and absence (6). Poor engagement is linked to higher absence and this is where knowing how to a be a good leader is imperative. If you’re a medic, one day you will be managing a team and more than likely, line managing junior doctors. Understanding this link and knowing how to motivate and engage your staff is likely to have a real impact on the working dynamics of your team.

Suddenly, the quality of our working environments becomes painfully relevant to both the functioning of the NHS, its long-term financial viability and our wellbeing as staff members. Individual teams must be assessed and altered if they are not functional and supportive. This should be a priority for everyone.

No doubt we would all agree that critical assessment of dysfunctional teams is a necessary step but on whose shoulders should that responsibility fall? Surely not on ours as junior staff? We are merely visitors in someone else’s house during the course of each of our clinical rotations. We are not well positioned in senior roles or even as established team members.

Of course, no one would have expected Captain Tom Moore to have raised 20 million pounds for the NHS (7). He was not positioned to do so and yet with determination he has done. Likewise, Dr Kate Granger was not seemingly well positioned to change the face of the NHS with her “Hello my name is” campaign and yet she did. Change is blind to occupation and hierarchy and leaders can be anyone, they are not necessarily those with the most senior roles. 

In our role as transient staff, we often have the fresh eyes to notice poor staffing or outmoded systems, where others may be jaded or accustomed. I would argue that we are uniquely placed to make change. And yet, with little formal training in leadership, how well equipped are we to understand what are complicated dynamics and infrastructures? What tools do we have to make change, even if we are inspired to do so? 

I would urge all medical schools to include more formalised teaching on leadership in the curriculum, crucial as it is to our progression as senior clinicians and to making significant and effective changes to the NHS. In the meantime, individuals wanting to improve their leadership skills (and CV) may want to considering en-rolling on either the Edward Jenner or Mary Seacole leadership programmes to refine fledgling leadership skills. (I have done the Mary Seacole programme and recommend it.) 

As a final note, it is important to mention that leadership is a skill, rather than a role. Like all skills it will take time to refine. We shouldn’t be waiting until we are consultants to consider our abilities as leaders. This is something we can start today, whether pre-med or registrar, at great benefit to our teams, our co workers and the NHS as a whole. 

Written by Dr Lauren-Jane Bowyer (FY2)

Follow Dr Bower on insta @thesurgicaldoctor and youtube @thesurgicaldoctor 

Bibliography 

https://www.kingsfund.org.uk/blog/2019/10/nhs-sickness-absence (Accessed 18/04/2020) 

https://digital.nhs.uk/data-and-information/publications/statistical/nhs-sickness-absence-rates  (Accessed 18/04/2020)

 https://www.bbc.co.uk/news/uk-england-beds-bucks-herts-52269398 (Accessed 18/04/2020)

 https://en.wikipedia.org/wiki/Kate_Granger (Accessed 18/04/2020)

https://www.businessleader.co.uk/nhs-absenteeism-the-crisis-months-are-here/58259/ (Accessed 18/04/2020)

Vahtera J, Kivimäki M, Pentti J, et al

Effect of change in the psychosocial work environment on sickness absence: a seven year follow up of initially healthy employees

Journal of Epidemiology & Community Health 2000;54:484-493.

[1] https://jech.bmj.com/content/54/7/484

[2] https://www.kingsfund.org.uk/blog/2019/10/nhs-sickness-absence

[3] NHS digital

[4] https://www.kingsfund.org.uk/blog/2019/10/nhs-sickness-absence

[5] https://www.kingsfund.org.uk/blog/2019/10/nhs-sickness-absence

[6] https://www.businessleader.co.uk/nhs-absenteeism-the-crisis-months-are-here/58259/

[7] At the time of writing