MedicalCoachingCulture

In most organisations disengaged workers are viewed with disdain by leadership. They are seen as being a blight on the workplace, flawed troublemakers, and somehow morally reprehensible. Disengagement is felt to be due to an inherent problem with the individual concerned.

However, the disengaged worker can be viewed in an entirely different way – a way that allows understanding of these people and the challenges they have faced and which may lead to improved outcomes for the workers and the leadership.

An alternative view of disengagement

A high rate of disengagement in workplace survey tools is feared by organisational leaders, as it is a public indication of poor organisational ‘buy-in’. The immediate reaction is a desire to silence these voices. But the disengaged workers may be those who once entered the organisation with the highest hopes and the most optimism for what they, and the organisation, could achieve. They may be the people who most fervently believed in the words of the organisation’s mission statement.

Those who have the greatest emotion invested can be the ones who are most vulnerable. These people are sensitive to thwarted goals and hopes. They can be the ones who get damaged the quickest. The trauma may include moral injury or burnout.

In this way, disengagement can be a defence mechanism. Rather than being let down once more it’s easier to become closed off and cynical. Instead of showing enthusiasm for a new organisational structure or management plan, one’s instinctive reaction may be seen to be obstructive and negative.

But these workers may be the proverbial canaries in the coal mine. These individuals may be the ones more easily affected by a poor working environment. Their disengagement may point to a workplace that has suboptimal conditions or culture, that will eventually affect others.

So, instead of reviling these people is it possible to somehow appreciate what they may be telling us? To drill down on their frustrations and listen to what has lead to the disengagement. Important insights may arise that give organisational benefit. Ironically, willingness to listen may begin the process of repair and engagement.

Leadership and Disengagement

We all recognise that leadership is difficult and a subordinate who is a pebble in your shoe can quickly become a major annoyance. In a busy world it may be easier to disregard, or even terminate, a worker who has continual gripes or doesn’t show a level of enthusiasm that is seen as being appropriate.

A different way to view these people may be to consider that their personal hopes, or dreams for how the organisation would develop, have not been realised, and that they have suffered heartache over this. Bringing an attitude like this may allow compassion and understanding. There could also be significant challenges in this person’s life outside work. Sometimes we have to walk in another’s shoes.

In some situations the disengaged worker may be too far along the road to be able to reimagine committing to the organisation’s purpose, and it may be more appropriate to part ways. However, this should not be a hasty decision for these workers are often vastly experienced and carry a wealth of organisational knowledge.

Whatever the final outcome, leaders must listen to disgruntled workers. Even in a critical commentary there will be some rare gems of unfiltered truth – which unfortunately are often discarded as the feedback is uncomfortable to hear. Again, true leadership is hard and it requires courage. Those brave enough to listen, and willing to consider inconvenient viewpoints, may be able to create change that ultimately benefits all within the organisation. Dialogue with disaffected workers may represent an opportunity, even a gift, for a struggling organisation.

Can disengagement be reversed?

If disengagement sometimes constitutes a defence mechanism to protect the worker from having their hopes dashed once more, then engagement may equate to faith and belief.

Belief that the work is important and that the leaders always have the best interests of workers as part of decision making. Faith that the organisational directions are noble. A belief that the words of the mission statement are an ethos that drives all actions, rather than just ink on paper. Disengagement might be the point when faith is completely eroded.

Can disengagement be reversed and can faith be restored? I don’t know if it’s always possible, but I do know that it starts with qualities such as listening, compassion, humility, and integrity.

It seems that every aspect of life as we know it is currently changing.

Of course, rapidly evolving climate change with altered conditions, more-frequent natural disasters, and flow-on economic consequences and climate refugees, will increasingly effect all of our lives.

However, many other elements of our lives and society are also shifting. These include:

• an increasing wealth disparity, lack of fairness, and segmented society
• increased political polarisation – perhaps most-obviously seen in the US with the ‘red/blue’ divide
• Far right extremist political parties, movements, and attitudes in many countries
• Lack of trust in leaders – political and business
• Low birth rates and aging populations in developed countries

Many of these changes seem to have come on quite quickly. But most actually occur slowly, almost invisibly, for some time until they are recognised. Similarly, in many countries of the Western world, systems that have lasted for generations seem to be stretched and failing. This includes Healthcare. Some of the manifestations of our failing health system (due to unrecognised long term change) are the erosion of general practice, unprecedented demand on Emergency Departments, reduced healthcare worker wellbeing and skyrocketing burnout levels.

These indicators of a struggling system have not arisen overnight and are not solely due to the Covid pandemic. Instead, they have come about silently, almost imperceptibly, over many years until they ‘suddenly’ become a pressing issue. Perhaps this is inevitable. All things, including social systems, decay over time – particularly when overlooked, taken for granted, or neglected. And all systems, including the mode of healthcare, eventually become obsolete and are replaced by other systems.

But before one system can be replaced by another stable system there will be a period of turmoil that includes instability and uncertainty. As humans, we dislike feeling unsettled and we resist change. We prefer the familiar than the unknown. Change comes with fear and anxiety. Routine patterns are comfortable and require less cognitive effort.

However, in many systems including healthcare, this period of turmoil can be appreciated rather than resisted. This is the time that delivers potential for needed change, even rebirth, and can be used to great effect. When we accept the inevitable degradation of our systems, and instead recognise the opportunity for improvement, we can let go of fear and resistance to change. Rather than trying to maintain things exactly as they are, we can approach the new dynamic with curiosity and optimism about creating better systems and better ways.

Health organisations, teams, and the overarching bodies that have an ability to guide societal healthcare delivery systems, are all important to this process. All have a role to play. Acknowledging current challenges and deficiencies will be crucial to allow acceptance and recognition of opportunity. Those who can develop hope and enthusiasm about the future will direct change in more positive ways than those who are motivated through fear or an inability to imagine a new paradigm.

Guiding positive change can regenerate healthcare and enable better integration of all facets of our system. Positive change can further create a collaborative environment that optimises desired results while also prioritising communication, inclusion, and facilitation of the wellbeing of staff and workers.

In many ways (and to paraphrase ex-Prime Minister of Australia, Paul Keating), perhaps this is the turmoil that healthcare needed to have.

The importance of leadership feedback cannot be overestimated.

Kindness, balance, support, and wisdom are essential qualities that a

team needs from its leaders; without them, a group will not excel. The

leader must recognise and appreciate what each team member brings to

the group, and ideally this is spoken about and disseminated publicly.

‘Praise in public, challenge in private’ is a useful phrase to keep in mind.

However, of equal importance in generating a highly cohesive group is

enabling the team members to appreciate each other.

At the end of 2021, as the Covid-19 lockdowns and restrictions were

easing in Australia, it became clear that our obstetric department team

could meet in person as a group for our usual December celebration.

These dinner meetings were always eagerly anticipated, however, this

year, I hadn’t had time, or indeed inclination, to arrange any

presentations. In fact, the very thought of arranging another meeting left

me with an overwhelming sense of exhaustion. I asked the group whether

we should go ahead with the event, secretly hoping that they would

decline. However, there was great enthusiasm to meet and have dinner

and the usual fun night, so I booked our regular venue.

When the date rapidly arrived, with growing trepidation, I had come up

with only one activity. This would be an activity that was unfamiliar to

most of us, including myself. My sense was that it would either be a

roaring success or a complete disaster. After the usual end of year

comments, I stood in front of the group of around 50 doctors and senior

midwives holding a container full of individually wrapped chocolates.

“In this bucket, I have three Lindt Chocolate Balls for each person” I

began, “The first is for yourself. This is to recognise all the hard work that

each of us has done, and the resilience that we have shown after a tough

couple of years. So, the first chocolate for each person is to honour

themselves” – I paused and then continued, “The other chocolates are to

give to two other members of our team. These are for special efforts that

you have noticed, to express thanks, to acknowledge hard work, or to

publicly appreciate someone who has gone above the usual excellent

standards to do something amazing. The only proviso is that we each

come to the front and present our chocolates, telling everyone what the

recipient has done that is special.”

I presented my own two gift chocolates, one to a junior doctor who had

been struggling with the pressures of work but had lifted her effort. With

persistence and dedication, she had become a reliable and valued

member of the team. The other I presented to an extraordinary senior

midwife who was a wonderful leader. She combined efficiency and

compassion to both staff and patients in an admirable mix. I stepped

back.

There were some moments of quiet. I sensed a reticence to be the first

to participate in the process. Finally, just as the silence was becoming

uncomfortable, a doctor rose and came to the front. Taking chocolates

from the bucket, she presented thanks and chocolate to two others in the

group. Soon after, the enthusiasm for the activity became infectious.

Some wanted to present a second round of chocolates. Eventually, every

member of the team had risen, one by one, and thanked, recognised,

appreciated, and honoured, others in our team.

There were affirmations given that night which were heart-warming.

There were comments and anecdotes that I had not heard before, and

perspectives I hadn’t considered. In the end, all of us seemed to be aware

of how fortunate we were to belong to the group. We felt joint pride,

mutual respect, and gratitude. With the team’s ability to be brave and

open on that night, many bonds were strengthened.

From Hurting to Healing – Delivering Love to Medicine and Healthcare. Hambone Publishers, 2023.

Recently I moved suburbs. Where I used to live everyone seemed to carry plastic bags when walking their dog. All owners picked up their dog’s droppings. There was very little dog shit on the nature strip or footpath.

I assumed that my new location, a more affluent place with big houses and expensive cars, would have even better standards with owners cleaning up after their animals. To my surprise this was not the case. In the rich suburb, there was much more dog shit laying around for others to step in.

Lesson 1: More impressive surroundings does not guarantee good behaviour or better culture.

Walking Lily, my dog, each day in the ‘leafier’suburb, I now noticed owners who would openly ignore the shit their dog left in public places. Some would pretend not to notice their dog taking a dump, while others reluctantly would pick up the pooh, but then hide the full bag under a tree or leave it on top of someone else’s fence as though it was another person’s responsibility to put in the bin.

I became upset with these behaviours, but over time I also started to hesitate when Lily took a pooh. If no-one else picked up after their dog – why should I? Why should I carry a steaming bag of excrement around with me?

When Lily paused, arched her back, and started to strain, I began to surreptitiously look around, to see if anyone had noticed my dog doing her business.

Lesson 2: In poor cultures, new members may initially become disillusioned with suboptimal practices, but will eventually adopt similar behaviours which become unconscious and unquestioned.

In the first suburb there was a communal park where dogs could be off the leash. At this park were a number of outlets that dispensed dog-pooh bags, provided by the local Council. These bags were accessed and used by all. In addition there were bins handy to deposit the full bags in.

Lesson 3: To generate optimal behaviour the overarching organisation must make the desired action easy. When the desired behaviour is convenient, simple, and frequently seen, it becomes the norm. The underlying assumption held by the group is that all do the right thing.

During the Covid lockdown, services were reduced and the free bags at the park were less often replenished. However, despite this, the good practices continued. Local residents began carrying their own bags from home and still picked up after their dogs. The amount of dog excrement lying around did not increase.

Lesson 4: When good culture is well established it will overcome times of difficulty. Good behaviour will continue.

Today, in the newer suburb, I still carry bags with me and I pick up every time. Often I have to uncomfortably carry the filled bag for some time before finding a bin. Why do I do this? Why carry an uncomfortably warm bag of pooh around when no-one seems to value this?

I guess it’s because even when no-one else cares whether or not I have done the right thing – I still know. The influence that I have in this practice of neighbourhood cleanliness is over my own actions, rather than other people’s.

Lesson 5: Good cultural practices must start with each individual.

Happy dog-walking!