Why this matters now
It might seem self-evident that NHS managers need to look after themselves so that they can offer sustained support to their teams. Yet, in our service, we do have a high proportion of leaders and managers with a tendency towards self-sacrificing; and this can be compounded in a crisis situation, with some pushing themselves beyond their natural limits.
If you recognise some of your own behaviour in this description, this brief guide is for you. There may be much here that you know and do already – but there may also be one or two helpful tips which you haven’t tried.
It’s OK for leaders and managers to be vulnerable
Right now there are plenty of reasons for feeling we don’t have all the answers – problems with the supply of PPE, unprecedented mortality rates (with disproportionate impact on BME staff), daunting workloads and continuing uncertainty; and for many of us this comes on top of self-isolation, worry about our families and additional strain of caring responsibilities. It wouldn’t be human not to show signs of stress and fatigue in this context.
So, we need to be kind to ourselves, and we also need to be good at listening to signals that perhaps it’s time to slow down and re-charge. Often these are physical – “the body keeps the score”.
Do you recognise any of these?
If so, you may also recognise that they can be related to cognitive effects such as impairing the quality of decision-making and communication.
- Shallow breathing
- Muscle tension
- Aches and pains
- Difficulty concentrating
- Difficulty sleeping
- Fatiguing faster than usual
Options for quick respite
When we do recognise the need to step away from the fray and re-charge, there are many quick and accessible techniques which can help. There are three very simple examples in the later steps in this guide:
- Grounding – a simple technique to help you slow down, dispel anxiety and confusion by connecting to the present moment
- Breathing – a three-minute breathing technique to help you step back or get unstuck during complex or draining work
- Relaxation response – a longer exercise (10-20 minutes) proven to help turn off the fight-or-flight response and bring the body back to pre-stress levels.
Another technique which may not always be quick, but is highly reliable for sharpening decision-making and reducing stress is “externalising” – essentially taking the chaos in your mind, expressing and organising it – in speech (with a trusted peer), or using our 10 minute pause space; in written form (lists or journals); or in visual form (e.g. with a mindmap). Externalising is how we make sense of complexity. It can be highly cathartic when that complexity carries added stress.
More extensive support
Click on the link for information on more in-depth wellbeing support services available to you. These include Helpline support, Occupation Health assistance with stress and trauma responses and psychological support for individuals and groups.
Checking our biases
Under pressure, for very good reasons, most of us tend to employ what Kahneman and Tversky  called System 1 thinking – fast, instinctive and emotional decision-making. This can leave us prey to biases which distort perception and judgement. Among these are:
- Hero bias – setting unreasonable expectations for ourselves, and feeling guilty or incompetent when we don’t meet them
- Loss aversion – constantly framing situations in terms of loss (e.g. mortality rates) rather than gains or successes (e.g. survival or patient discharge rates)
- Control illusion – the tendency to overestimate one’s ability to influence events.
As a counter to these and related biases, it can help to have a few trusted reality check questions up your sleeve, such as:
- What assumptions am I making here?
- What can I control in this situation?
- What assets do I bring (e.g. from my past experience and current abilities)?
- What do I know works?
- What is important right now?
In a moment of downtime, you may find it helpful to reflect on whether you have scope to adjust the balance in your life. Are there one or two tweaks which might help you feel more relaxed, mentally sharper or more fulfilled?
The simple framework below might help with this. It is similar to the well-known “Life Wheel.” To use it, look through all the segments in the wheel – each one represents an aspect of life alongside work which can offer relaxation and reward. Which of these are important to you? And of these, which are you already nurturing; and which are you neglecting?
You may have identified some areas with potential to help you de-stress, and build resilience. If so, it will be important to prioritise them. Make a commitment. Schedule time in your calendar. It is only through conscious and persistent practice that we develop new habits.
You may also find it useful to check review the detailed guidance on mental wellbeing at this link: https://www.nhs.uk/conditions/stress-anxiety-depression/improve-mental-wellbeing/
 Kahneman and Tversky”, D Kahneman (2011), Thinking, Fast and Slow, Farrar, Straus and Giroux