[00:00:00] Imagine this, you're in a meeting, could be a divisional meeting in a hospital, maybe an ICB meeting, and somebody puts up a slide with a target. Maybe it's waiting lists, maybe it's access or quality metrics, and this manager says something like, We need to reduce the waiting time significantly over the next few months, and everybody nods.

[00:00:21] Nobody says anything. And you are sitting there thinking, well, we don't have any more staff. We don't have any more clinic rooms. We don't have any more hours in the day. How exactly is this supposed to happen? and yet as the meeting ends, something very familiar happens. You walk out of the room feeling like this is now your problem to solve.

[00:00:40] Nobody actually directly said that, but your brain has already translated the expectation into responsibility, and it's your responsibility. So in this Quick Dip short series, we've been exploring how responsibility lands on us without us even noticing. In episode one, we [00:01:00] talked about the silence gap.

[00:01:01] When nobody volunteers for something, the most conscientious person, the most senior person who thinks they ought to, they step forward. In episode two, we talked about that helping reflex when somebody asks you directly, and so saying no doesn't even feel like an option. But there is a third way that responsibility lands, sometimes it lands because the system expects it or society expects it, or sometimes because we expect it to and we believe that it lands with us and it should be us carrying it.

[00:01:34] Particularly in healthcare and other high stress, high stakes work where stuff really matters and consequences are real, there is a powerful assumption that that's running in the background.

[00:01:46] And it's this, if something appears as a target, if it appears in the system, if it's in a job plan, then it must be our responsibility to deliver it.

[00:01:55] Even if we don't have control over staffing or resources or [00:02:00] demand or the behavior of other people, or the number of hours in the day, and when these expectations exist, either expectations by other people, the system, or by ourselves, the responsibility often lands automatically.

[00:02:14] don't just end up carrying responsibility because we volunteered. We don't just carry it because someone's directly asked. Sometimes it just lands with us because the system assumes it.

[00:02:25] I often do work with trainers. Educational supervisors, appraisers, and there was one particular session I was doing with a bunch of GP trainers and I asked 'em at the beginning of the session, what do you feel responsible for? And my goodness, they felt responsible for so much, not just the quality of the training that their trainees.

[00:02:45] We're receiving, they felt responsible for if the trainee was happy or not with the practice, with how the trainee was actually practicing, if they were safe or not. They felt responsible for if the trainee was gonna pass their exams or not,

[00:02:59] Their [00:03:00] wellbeing. Honestly, they felt responsible for everything so much so that when their training had just failed to hand in their portfolio, one trainer canceled their annual leave so that they could mark it when it was late,

[00:03:11] and no one had specifically told this group of trainers, you are personally responsible for all of this. But their brains have just translated all the expectation around being a trainer into full responsibility for everything in their trainer's lives, feeling that if they have an issue, if they have a problem, it's now mine to solve.

[00:03:31] And this is the invisible transfer of responsibility it lands with you, even if nobody explicitly handed it to you or may have partly handed it to you. But you've ended up taking all of it, because there is something else that often happens.

[00:03:45] Now, sometimes the expectation is real.

[00:03:47] People do expect you to be able to produce trainees who parcel their exams, even if you're not in control of very much of that.

[00:03:54] But sometimes the expectation isn't even real. It's not in your job [00:04:00] description. Nobody's explicitly asked for it, but somewhere along the way, you've decided it must be your responsibility anyway. So often we carry things simply because we think we should, and we believe that other people expect it, and we don't wanna let anybody down.

[00:04:15] So responsibility does land, not because somebody gave it to us. Because we picked it up automatically. Nobody would've said to that trainer, you are responsible for

[00:04:26] that trainee's portfolio whenever they hand it in.

[00:04:30] of course, nobody would've asked them to cancel their annual leave.

[00:04:33] That is just unreasonable, but they expected it of themselves.

[00:04:37] And doctors and senior healthcare professionals often carry responsibility for things like patient outcomes. Even when complications are unavoidable, we know this. They carry responsibility for how their team is feeling. Whether people are stressed, burnt out, or unhappy at work, whether colleagues go off sick, where the staff decide to stay in the job or decide to leave.

[00:04:59] They feel [00:05:00] responsible for how the receptionist speaks to patients, whether the service runs smoothly on days when they're not even there,

[00:05:05] whether the access and the waiting list improved and whether the system works. Now, of course, we care deeply about all of these things, and of course there are some things we can do to influence these things, but caring about something and doing our best and having full control over it. That is not the same thing, and this is where this burden creeps in because we start carrying responsibility for things that we can influence a little bit, but we ultimately cannot control. And that is extremely frustrating and it's extremely stressful and it causes an awful lot of anxiety.

[00:05:38] Why do we do this? Well, we do it because from a very young age, we've been groomed to take responsibility for everything. From the very beginning, we are told the buck stops with you. Patient safety depends on you, and if something goes wrong, you will be accountable. And so your brain develops this, this rule, this assumption.

[00:05:55] If something exists in this system in which I work in, I must be responsible [00:06:00] for it, even when we have no control over it.

[00:06:03] And this is where things become really, really hard because many, many of the expectations that are placed on us are just structurally impossible. Waiting list must fall with no increased funding. Access must increase with diminished levels of staff. Quality must improve when everyone is burning out.

[00:06:21] Wellbeing must improve When all staff study budget and training is being canceled all at the same time with the same resources or with less resources, so we find ourselves carrying something we can't actually control. And when the impossible doesn't happen, surprise, surprise, we feel like we failed.

[00:06:39] That causes us to feel shame, guilt, and we feel like we're just not good enough. and there's a bit of a deeper human pattern underneath this. And that's this. We often feel morally responsible for things that are structurally or systematically impossible.

[00:06:56] And when that impossible thing doesn't [00:07:00] happen, we experience that as personal failure, like we are not good enough. That's incredibly heavy to carry.

[00:07:06] and this pattern is what I call control responsibility, mismatch, specifically control, responsibility, mismatch type one. This is where we feel very responsible for stuff that is outside our control. Now we may care deeply about it, but we literally cannot do anything about it yet many of us still carry that responsibility emotionally.

[00:07:29] We carry the emotional load because it feels wrong just to leave it, just to accept it, just to let them, and we think, well, I can't ignore this 'cause it's so important. But sometimes. The bitter truth is, and the reality is that there is nothing we can do about it.

[00:07:47] And this feeds into what I call the responsibility delusion. That belief that if something matters or because somebody else expects it of us, or even if it's in a contract that's been imposed upon us, [00:08:00] we should somehow be able to make it happen even when it is totally outside of our control. I am gonna repeat that.

[00:08:08] We think that just because someone else expects it or it's in a contract, perhaps we should be able to make it happen even when it's outside our control. That is denying reality. It is actually impossible. No matter how hard you try, no matter how stressed you get about it, no matter how much you carry that load emotionally, you can't change it.

[00:08:30] And of course, that's the basis of the serenity prayer, isn't it? Grant me the serenity to accept the things I can't change, the courage to change the things I can. And the wisdom to know the difference. and I looked up the definition of serenity in that context and in the context of that prayer, apparently serenity means unclouded.

[00:08:47] So unclouded acceptance means acknowledging that even though we care deeply about this thing. There is nothing we can do about it. It means that we have looked at it from all angles, and yes, we've taken those things [00:09:00] that we can do to influence it that are in our control and we've done something about it, but the rest we have to accept

[00:09:06] But many of us don't. We become automatic carriers of this responsibility. When it lands, we pick it up, not because we agree to it, but because we feel we should. But there is a very simple truth. You can't argue with reality. There are only so many hours in the day. So many staff, so many patients that can be seen safely so many resources in the system.

[00:09:26] There is no magic money tree. No amount of caring can change that,

[00:09:30] so if you just accept every single responsibility that lands on you, whether or not you're in control of it. Whether or not there's anything you can do about it, just because the system expects it, someone else expects it, maybe you expect it of yourself, you'll carry it. You'll try and fix things.

[00:09:46] You'll work harder, you'll stay later, you'll push yourself further. You'll slowly become overwhelmed because you can't do it. Or you could change things up a bit and instead of asking, well, what am I expected to deliver here and working harder and [00:10:00] harder, you start asking. What do I actually control around here?

[00:10:04] Because responsibility really only belongs where you have control.

[00:10:10] and there is some interesting research around burnout in professionals in high stress jobs. And the professionals with the, with the highest levels of burnout in high stress jobs are those who have low control in their jobs. The people that are taking on the emotional load and worrying about everything but can't do anything about it.

[00:10:28] And interestingly, those in jobs where they have high control, they have lower levels of burnout. So what do we do about jobs where we do have low levels of control? Well, one of the things will be to start looking at where you do have control and the stuff that you don't have control over. Learn how to care deeply about it without carrying it,

[00:10:47] because you might care enormously, but if you don't control the outcome, it cannot be your default responsibility.

[00:10:55] And sometimes when I talk to people about this idea, they say to me, well, I know, but I just have [00:11:00] to. And of course that feeling is really, really real. There may be parts of the situation that you can influence. You can talk to people, you can support your trainees and make the environment safe. You can give people a good experience when you work with them.

[00:11:14] But you can't protect people from everything that might happen to them. You can't control their decisions, what's happening in their lives, outside work. You can't control every mistake or spend time. You can achieve a lot through willpower, but you can't create more hours in the day or days in a week or weeks in the year.

[00:11:31] You can't control other people's behavior. And one thing you might think you can control is your own capacity, but even that runs out. You cannot keep pushing beyond your own capacity forever, because that's when burnout happens. And sometimes the most honest question is not, should I be responsible for this?

[00:11:50] It's, well, what's actually in my power here and do I have the capacity for it? Recognizing that limit. It's not failure, it's [00:12:00] reality.

[00:12:00] So across these three bits, we've been exploring the different ways that responsibility lands and the different ways that we just become automatic carriers of this default responsibility. So sometimes it lands in silence. Nobody volunteers, the busiest person. The most responsible person, the most conscientious person steps forward and it lands on them.

[00:12:19] Sometimes somebody directly asks you, it lands through a request, and saying no doesn't feel like an option. And sometimes the responsibility lands because the system expects it or because we assume it does, even when we have absolutely no control over it. And so if we are not careful, we fall into the responsibility trap. This is where caring, capable professionals slowly become automatic carriers of responsibility. Not because we chose it, but because it landed before we even had a chance to question whether it was actually ours to carry. And the real challenge I think we have particularly as leaders, is learning how to care [00:13:00] deeply without carrying everything, how to support people, without doing it all, without rescuing them, and how to take the right responsibility to become a conscious carrier of responsibility that is in your capacity, rather than carrying the default responsibility for everything that slowly leads to overwhelm.

[00:13:22] So if this series has really resonated with you, you might wanna have a look at The Shapes Academy. This is a membership for senior leaders and healthcare professionals, where we share more tools and ideas to help leaders protect their own time, embrace their capacity, manage their energy, and also support their teams to do the same.

[00:13:42] The real work is about taking the appropriate responsibility. Accepting and leaving the stuff that we can't change, but also having the courage to do the things that we can and create healthier ways of working without burning out in the process. So if you are interested in that, have a look in the show notes, [00:14:00] check it out.

[00:14:00] We'd love to see you in there because caring deeply about the work does not mean carrying the impossible.