First-class coach

Q: I work as a manager in the NHS. I feel passionate about its value but I'm losing heart. Each month brings new ill-conceived initiatives, new targets and more administrative pressure, taking us away from caring for patients. We have big cuts in resources, so we don't have the people, the equipment or the money to do a good job. How can I keep myself and my team committed?

by Miranda Kennett
Last Updated: 31 Aug 2010

A: It's a supreme irony that all the people involved in the health service - government ministers, civil servants, hospital administrators, doctors, nurses, medical technicians - are united in the goal of trying to improve it, and yet the net effect of their combined (but not concerted) efforts seems only to make the situation worse.

Being squeezed between the conflicting pressures of the target-setters and those who have to implement their plans is a phenomenon afflicting many senior managers now, especially in the public sector. My clients in the education world feel very much as you do: stuck in the middle, trying to meet demands from above that do not sit well with what they see as their core developmental role. No wonder many, like you, are exhausted and disillusioned.

Naturally, your sympathies lie with your team: perhaps you spend time discussing the iniquities of the system with them. Siding with your team and demonising your bosses may seem comforting, but it casts you in victim mode, powerless to change the situation. This mindset makes you a less effective manager and adds to your stress.

However, taking up arms can also have an adverse effect on your performance. You're trying to protect your people, but if you always respond with confrontation, your boss will tend to resist, block or ignore your messages. You may come across as an argumentative person who is best ignored, and this will prevent you doing the best job for the people you're trying to shield.

Try instead to find points of agreement with your manager and build the relationship so that he or she will be receptive to the areas where your professional view diverges from the line coming from above. Evaluate the potential effect together. Explain the implications of new policies and ask for help in lessening the impact of negative introductions and easing implementation of the changes that stretch resources.

If the more senior managers in your health trust seem unsupportive, provide your boss with the data that will help him or her make your case for you with others higher up the food chain.

To protect the effectiveness, health and happiness of your team, take care of your own needs first. As team leader, your emotions are infectious: you may not express anxieties verbally, but you communicate them to those around you. If you greet each new initiative with despondency, you provide a role model for despair.

Take steps to reduce your own stress, so you're more in control of the messages you send out, and more helpful to your staff in handling their own stress. There are two aspects to stress reduction: managing your workload, and protecting your mental and physical wellbeing. Allow yourself to worry only about the things you can personally change, and then take action on them. Review all the tasks and sources of dissatisfaction and decide which priorities to resolve. Start planning how and when they can be tackled, and by whom. Don't load yourself up with tasks that should be done by someone else: spare your energies for the things that only you can do.

Your physical health will have considerable impact on your mental health and your effectiveness as a manager. Try to get fresh air and exercise. A 20-minute walk round the block will help clear your head and give you a little perspective on things. Invite a trusted colleague to join you and allow each other five minutes for offloading problems and 10 minutes for finding solutions. Given that you work in the health service, you know the negative effects of caffeine and alcohol on stress management.

When you're feeling more positive, enlist your team's support in tackling a difficult situation together. Share any progress you make and get them to focus on the things they can do that will have a positive effect, rather than dwelling on the problems. By reminding them that the work they do is really important, you'll be remotivating them and reducing their own stress.

Miranda Kennett is an independent coach. If you have an issue you'd like her to cover, e-mail: miranda@firstclasscoach.co.uk

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