Raising concerns at work can feel daunting and sometimes truly scary.

Are you going to be labeled as difficult or as a whistleblower and will it

come back to bite you at a later date?

The anxiety about potential repercussions are enough to raise

your stress levels, let alone the thing that's actually going on.

Obviously, if you have grave concerns about something going on at work,

you need to report it, but what about those hundreds of things which

aren't ideal, which could be done better, or just feel a bit off?

Does speaking up about these things raise or lower your stress levels?

And whilst it may benefit the system, does it actually do you more harm than good?

Attempting to address everything officially just might not be possible.

And so this week, psychologist, lecturer and researcher Olga Lainidi joins me to

talk about what she's learned from her research about speaking up in healthcare

and how healthcare practitioners can do it in a way which makes us

feel better and not more anxious.

And if you are in a leadership role, Olga also have some great

advice to help when someone needs to chat something through with you.

If you're in a high stress, high stakes, still blank medicine, and you're feeling

stressed or overwhelmed, burning out or getting out are not your only options.

I'm Dr. Rachel Morris, and welcome to You Are Not a Frog.

I am Olga Lainidi.

I'm a psychologist by training and I'm currently a researcher at the

postgraduate level at the University of Leeds in the school of psychology.

My interests are in burnout, voice and silence in UK healthcare workers, uh, but

also broadly in their wellbeing and how we relate to our jobs on a daily basis.

Great to have you on the podcast, Olga.

I'm really interested in the research that you're doing at the moment.

I know you got in touch with us 'cause you thought people need to hear about

this and you have been looking into speaking up when you see issues at

work and you've got an interesting take on that in your research.

Why do you think your research is really, really important for

doctors to hear about right now?

Thanks Rachel, and thank you for having me here.

I think it's a great opportunity to talk about different things than what we

usually read about speaking up and voice.

Now, I don't want to imply that what we read out there is wrong, but as with

everything in, in research and especially in in the social sciences, a lot is up

for interpretation and there is a lot of things that we can research in different

ways and end up finding different results.

So what I am focused on is the experiences of speaking up and employee

silence in UK healthcare workers.

And just really briefly to, to, to explain a few definitions.

We, we often talk in terms of voice and silence in my, in my field.

So employee voice would be any form of genuine expression of thoughts,

feelings, evaluations, about things at work, two persons capable of

change in that work environment.

And then at the sort of lexical opposite would be employee silence.

And that's where we have the withholding of those genuine expressions, uh, from

persons capable of change or redress.

So practically speaking, if I feel that in my unit we need to change the way we

do something, if I hold that back from my manager who has the power to change that I

would be engaging in, in employee silence.

And then if I go and I communicate this suggestion to my manager, who is the

person capable of changing this case, then I'd be engaging in employee voice.

And around the start of my PhD, I had the opportunity to interview healthcare

workers in the UK from very different positions, porters, uh, healthcare

assistants, managers, senior, consultants.

And I, I got to see a very different picture of silence

and voice than what until then.

A lot of the literature and a lot of the sort of, um, promotional materials, if

I can say that were, were suggesting.

So that simple, speak up more and you'll have less burnout and, and patient safety

will be better was not really working.

And what was happening instead was that in environments where people failed

speaking up was welcome and where suggestions and, and concerns were being

heard and acted on, people were feeling happier, people had less burnout, people

were feeling valued and acknowledged, and that potentially would have some

effect on patient safety or the overall functioning of the unit or the team

or, or the organization or the trust, rather than kind of suggesting that,

you know, if you, if you say everything that's on your mind all the time,

we're gonna have less problems, it's, it's not, it's not really like that.

This is really fascinating.

Where did that initial, understanding come from?

Because intuitively, you know, speaking up is stressful and

I think will cause burnout.

And I've coached people who have spoken up and that act of speaking

up has added to their stress massively not detracted from it.

And so are there other reasons why people just equated

speaking up with less burnout?

It doesn't make sense to me.

I think what you're raising, Rachel, is a very important point.

it, it, it goes to, to something I, I, I'm not an expert in, I

don't work in how people translate evidence into application, but I

suppose where my understanding lies is in how we can misunderstand or

misconstrue evidence in order to develop interventions and policies.

So, Amy Edmondson with her work on psychological safety raised a very

important issue that, you know, psychological resources where people

feel they can fail, they can take risks, they can take time to learn, and mistakes

and opportunities to learn, created a very, uh, interesting shift in how

we started thinking about workplaces.

We always knew that those things were important, but I think this was very

impactful work that got very quickly adopted and, and obviously abundance of

research linking psychological safety to positive psychological outcomes.

But that kind of research only tells us the associations.

That kind of research only tells us people who feel psychologically

safe at work are less likely to report higher levels of burnout.

That type of research does not tell us what we need to

do, what needs to be changed.

We need, we need different type of research to do those things.

So the evidence is there that indeed those who feel more psychologically safe

have benefits and they believe that they work in more safe environments in terms

of patient safety and quality of care.

The evidence is not there that psychological safety always

leads to better objective patient safety outcomes, for example.

We don't have that evidence.

So any documentation that says we improve patient safety outcomes by increasing

psychological safety, no, we improve people's beliefs about patient safety.

Yeah, thank you for clarifying that.

That's really interesting.

'cause the other thing I'm just thinking is that again, it seems that there

would be a link between sort of long term reducing burnout and speaking up.

I guess in my head I'm thinking, well, you know, it's stressful to speak

up but if once you've done it and you've spoken up to somebody who can

change things and then things change in the long term 'cause you've spoken

up, um, patients are, you know, kept safer, which reduces our stress.

You know, things, the workplace changes, which reduces our stress.

So long term, the effects of speaking up may be a reduction in burnout, but

short term it's very uncomfortable.

But then part of me thinking, well also long term.

Maybe you speak to the wrong person, or you do speak to the right person

and then nothing changes, then that increases your stress as well.

So it's a, it's a total minefield, this, isn't it?

You know, in the, in the ways that you do it, you can only do

what you do and how it's received.

That's not under your control.

And we can't change other people.

And again, that's, that's really stressful.

So what have you found in, in your research?

Yeah, so I think you're raising a really important point about

the long term and the short term.

But we are finding that the constant act of engaging in withholding what you

wanna say, so the daily employee silence.

And, and that's, that's quite interesting 'cause it, it, it includes a lot of

different instances and experiences.

It could be related to, um, I think this week's, um, work schedule

and shifts are unfair, but I didn't say anything to my manager.

I saw, um, a more senior colleague making a medication error, but I didn't

say anything 'cause I was afraid.

Um, you can imagine loads of, loads of different experiences.

So that daily engagement in withholding those genuine expressions,

those, those thoughts, those evaluations is very consistently

linked to higher daily burnout.

However, so far it seems that the engaging into daily voice acts

does not have that positive effect and burnout that we thought.

So what you said in that short term, there's no relief.

It's not like if today I speak up three times, I'm gonna go home feeling better.

And at the moment, again, it's preliminary evidence, not the full

data set, but at the moment it seems like it could actually be adding

to that daily strain, so you might actually go home feeling a bit worse.

Now the other interesting thing from that study, because it's it's a diary

study and it's still ongoing, um, is that we also get, um, something new.

We get to see what are those daily things that people withhold

or that people voice about.

And if you, if you kind of start looking at, at those entries, the

things that people withhold are quite different than the things they are

feeling comfortable speaking up about.

So small suggestions to improve something, that the person feels

are not gonna be perceived as very threatening or are not questioning the

professionalism of their colleague, they're more likely to be voiced.

Whereas the things that we hold back are more likely to be related to, you

know, patient safety issues or, or staffing issues or work related issues.

So there is also that sense in which very quickly we know what we are

allowed to speak up about and what not.

That is fascinating.

So what you are saying is that when it was maybe something about professional

behavior or there's like an error, people felt more able to speak up

'cause I'm interpreting it now because it was something they could see.

It was about somebody else.

It was concrete, they could, they could say, this is somebody else.

They've done that and they felt more able to speak

Then it's, it's, it's the other way around.

It's the other way around.

So it's when, when it's something that does not involve accusing another person

of being unprofessional or it's not going to jeopardize your relationships,

or it's not gonna stigmatize you as a troublemaker, that's where you're more

likely to hold it back, until a massive crisis point is reached where you know,

more and more mistakes happen and more and more people are endangered, and, and

then we, we, we hear about, you know, whistleblowers or, people start feeling

they need to do something about it.

Whereas things that are less threatening, which is like, you know, oh, we're using,

uh, green gloves, but I think green gloves, they, they're not the best.

Maybe the blue are better.

Yes.

This is a very simple example, but I'm just trying to, to to show that it's,

it's a very resource consuming strategic daily process until potentially we

develop a set of rules where we know, okay, that's a no-no, don't touch that.

And it's interesting that you can also get that from, from speaking to more

senior, healthcare workers as well.

People with, you know, managerial roles, people with leadership roles

where their reality is, is very, very clearly reflecting that, that

we have big, serious political, financial problems to deal with.

We don't have enough beds for patients.

We don't have enough resources for this.

You know, we are on a very tight rope here, so we don't have

time to deal with everything.

We don't, we, we, we can't.

So all those things are not really captured very well when we, when

we read about, about speaking up, and the oversimplification speak up

and everything is gonna be better.

Unfortunately, like psychological safety has been turned into a magic solution.

But the actual ways this can work, we don't really know that.

And that's really, really important to keep in mind.

'cause I know a lot of people struggle and, and they feel that, you know, they

don't matter or they're, they're, they don't know who to speak to and they

don't know how to speak to, to anyone.

But the reality is nobody's really trained.

Nobody's really taught.

I remember interviewing a junior doctor, um, and, and the person saying to me,

I, I, I wouldn't know where to go.

In, in, in, in, in medical school and in training and, and induction.

And when I came here, nobody told me what I should do if I want to raise something.

So there's, there's sort of a hidden curriculum there,

a hidden agenda, isn't it?

If we want people to speak up, shouldn't they all know what the exact pathways are?

So that that adds even more to the stress of speaking up.

I wanna say something, but.

I wouldn't know where to go.

I wouldn't know where to start.

I don't know what the procedure is, is everything I say going to be recorded

and, and used in a court case against me?

We, we know of cases where people lost their jobs and, and, and lost,

uh, court cases to, to the NHS because they, they spoke up and what

they had to say could not be proven.

So there's, there's this sense that whatever I say can be used against me.

So unless I'm very sure about where I'm gonna go, who I'm gonna speak to, and

that the people who I'm gonna ask to help me are actually going to have my back,

isn't it a bit too much to ask and not prepare people properly for that as well?

So there is a contradiction there between encouraging voice, but actually

giving people the means, the knowledge, the opportunity, and the capability

to be able to do that without, without suffering all the stress.

And that's a big conflict, isn't it?

When you're seeing something that's affecting patients or affecting your

colleagues and it feels wrong and you know you ought to speak up, but speaking

up is so threatening personally because yeah, you'll get labeled a troublemaker.

You might damage that relationship with your, with your boss, and

that is really, really important.

Or, uh, I've, I've noticed doctors really hate feeling like they're being difficult,

you know, even just raising a workload issue might mean they're being difficult

or a snowflake or anything like that.

But then you've got this moral imperative to protect things and to improve things.

And that's a lot of, a lot of cognitive dissonance.

And you are right.

We are constantly told to speak up, but we're not told how to do it.

And then when we see that there are consequences for speaking up, like

you said, people being ostracized by their colleagues or counter

accusations going, or court cases, it's, it's incredibly difficult.

So you're damned if you do, damned if you don't in a lot of ways.

What's the solution?

You know, what have you found actually works?

That's a really great question, Rachel.

But I think in over simplified way, we could separate solutions

into two sort of big categories.

The, the solutions that are about me taking care of myself and the solutions

that are out of my hands and that we are hoping to see in the future that are going

to reduce the burden on the individual.

So what we can do is, is take better care of ourselves.

We can give ourselves the opportunity to talk about things we hold back on a

daily basis, even if it's just to feel better at the end of the day, even if

it's just to be heard, even if it's just to, to make sense of what happened.

This could be with a trusted colleague.

This could be with a friend, uh, with a family member, a spouse.

This could be with, uh, a therapist if, if this is something that,

that, that people want to do.

This could be even just writing.

There's loads of evidence on, on how emotional writing helps a lot

cope and, and, and manage with, you know, difficult emotions.

So I could be journaling, I could be writing, I could be talking.

Because we need to hear somebody telling us that, you know, you did

the best you could with what you had.

And if you keep chasing up those things on a daily basis, you want, you won't be

able to do the other parts of your job.

And, and, and the patients need you and, and, and the world needs you.

So the, the self-care part is not, the solution to burnout, is not the solution

to silence, is not the solution to wellbeing that comes from a workplace,

but it is something we need to do.

We need that self-compassion.

We have loads of evidence that self-compassion helps.

And understanding that you're doing the best you can is a very big part of it.

It won't cure your burnout because your burnout is not coming from you.

It is coming from an overburdened system.

It's coming from, from a place of work.

It's a bit like to use your, your, your metaphor with, with

the frog in the boiling water.

You know, it's, we often say, take some time of work and look after yourself,

but, you know, we take you out of the boiling water, we let you cool down, and

then we just, we just put you back there.

So you're, and, and you're supposed to have found a way

to, to not get burned anymore.

That's, that's, that's, that's not how it works.

So the self-care part.

Is to, to start giving ourselves better understanding and start

giving ourselves self-compassion.

This will help with the daily stress.

This will will help starting to see ourselves that our value and

who we are and what we can do is not determined by the constrain of

an overburdened work environment.

And the other side of the solutions is sadly, very, very slow and, and

requires a lot of multidisciplinary collaborations, requires a lot of change.

Uh, requires something that we can do very little about, requires

potentially political changes.

And, and that's, that's a very, very difficult thing to do.

Even managers can be more understanding, can be more supportive.

Maybe Yes, we need better training for our managers.

We, we need to help people.

'cause, 'cause you know, there's the other thing, you're a clinician.

You're, you're not trained to be a manager.

You're not trained to be, uh, in that role.

So that's quite unfair as well.

You have to support a lot of people who are going through a lot of things

without having those resources yourself.

So it's like being, um, it's like being a psychotherapist who's not

been trained to be a psychotherapy.

You don't, you don't have the resources to protect yourself.

So in, in terms of those daily emotional, experiences and, and

the daily relationships, yes, we help people communicate better.

We can help managers support better their teams, but also themselves.

We're all part of the system, aren't we?

That, that, that's the problem.

And I a hundred percent agree with you about the, the training, the managers.

'Cause actually, if you were a clinical leader, you've got a team, um, but the

team come with, come to you and somebody starts sort of whinging or telling about

things that could be changed or whatever, if you were just trained not to take

that defensive stand, to just be able to listen, and even if there's nothing you

can do about it, to be empathetic and say, you know, I understand where you're coming

from thank you for sharing and, and.

Not have the relationship threatened, not have the other person feeling that

they've been difficult by raising it, and you know, obviously we are not in

charge of what other people feel, but we can do things to, to reassure people.

So that's, that's really important.

Um, so there is so much the system needs to do to change

and you are absolutely right.

The, the frog in the boiling water.

If you go off with burnout and then you go back into exactly the same situation

without changing anything, then you are just gonna get burnout on repeat.

What I'm particularly interested in is this the first half of what

you were saying, because this podcast is about how we can change

ourselves in order to be able to turn down the heat in, in that pan.

And when you first got in touch with me, Olga, I was really

interested in this thing about.

Speaking up yourself to somebody else.

Um, not with a view to having to change the system, but with a view to getting it

out of your own system and helping with, with self-compassion because, yeah, that's

just another stick we can beat ourselves with, isn't it that I haven't spoken up.

I'm, I'm part of the system.

I've seen this thing happen and because I haven't spoken up, I am as bad as the

people committing the crime type thing.

But you know, we know it's all shades of gray.

And just to be clear, what I'm not saying is that we let you know dreadful

things go on without speaking up.

I'm not saying that at all, but what we're talking about is all those

little things we see all the time, the little things that we would like

to change, but it's like you can't change everything all the time.

And you said to me that your research has shown that even just debriefing

with a family member at the end of the day about the things that you haven't

been able to speak up about, the things that you've been silent at work about,

but even that can be really beneficial for you and your, your wellbeing.

What, what's your, what examples do you have from your research

about that sort of thing?

Yeah, so we know, we know that mainly from, from qualitative evidence, um,

from from qualitative interviews and speaking to people when, when you try

to understand in that, in that very pressurized system, okay, so what, what

do you do to help yourself feel better?

What, what is the thing that you sort of, how, how are you not drowning, basically?

How have you managed to go on for 20 or 25 years and, and, and you're not drowning?

And it often comes back to self-compassion and readjusting

those expectations from yourself.

And, and the realization that you are just one person who can only

change so little at every time.

And I, I know it sounds quite oversimplified, but it is, it is a habit.

And, and, and the habit is the best mechanism we have at the moment to

help change how people feel and to help people take better care of themselves.

So it might not feel great the first time you do it.

It might in fact feel a bit weird and it might make you feel even more

angry to, to start talking about it.

You come from work, you've had a very difficult day.

You saw 10 things that they, they weren't, uh, scandal worthy, but they,

they, that you feel that they, that they shouldn't be happening, right?

And, and, and healthcare workers are, are people with, with what we

call very high pathological altruism.

They are people who will show up to work with high fever and awfully

tired and unwell because they feel they need to keep going and they feel

they need to keep helping people.

So inevitably when you see harm going, even if it's the smallest

thing, it's, it's, it's, it's gonna make you feel awful.

It kind of makes sense.

But we need that reality check.

We need that realization that even in, in the best of work environments, with

all the support, something will go.

Wrong.

Something we won't be able to fix, something will happen.

It is part of, of the nature of, of, of the job.

It is part of, of healthcare.

There's so much happening.

So that dark side of, of, you know, being somebody who cares a lot means that we

might overemphasize how much we can really do and we start being unfair to ourselves.

So this is where a little habit formation will, in the long term, start

helping us see things differently.

And, you know, we, we've got evidence from, from therapy as well that

the first times we try to do things differently, they don't often make sense.

They might make us feel a bit worse, they might make us feel a bit

more angry, but in the long term.

I start to come home and I developed the habit of decompressing.

I developed that habit of talking to, to my friend, talking to, to my partner,

talking to, to, to, to somebody.

I feel comfortable and I trust.

So when I come home, I can have that conversation.

I can say, right there were 10 things today happened and I really did my best.

I know they're not life-threatening.

I really wish I could do more,

but that's, that's all I can really do.

And this just for, for the first few weeks, we might have to do it

a little bit forced and eventually it will start feeling better.

Not that, as you said, we let things sleep and, and we don't care anymore.

But this is a reality check.

Like with, with everything in, in our life, we, we can't fix everything.

We can't change everything.

We need to choose our battles.

And the second thing I can do is I can start thinking, is there anything

small I can change in the way I work that can make me feel better?

So, for example, if I keep coming back and constantly, my main thought is I've

got so much to speak up about, but I don't know where to go, right, maybe the first

step is to find out where I should go.

Because it's not your fault.

You don't know.

You should know from, from your, your training, from, from, from the

system, from the people around you.

But since you've discovered that, the first step would be to start

finding out, okay, where should I go?

What, what are my options?

Because it's, it's really unfair, isn't it, to try and force yourself

to do something without having that, that knowledge of, of, of

where to start from, where to go.

So it could be to, to reach out to somebody who, you know, has,

you know, spoken up before.

Um, look into what's available in terms of NHS support, something

like the Speak Up Guardians.

Or even, yeah, reach out to, to, to, to people who do and write about it.

Who, who, who, who are researchers or academics or universities.

The UK is, is great in that there's, there's so much academic effort going

on in, in supporting healthcare workers and, and often we find that we know

more than, than potentially, you know, more junior healthcare workers.

And that's quite unfair that, you know, somebody who's researching it, who's

not leaving it, knows more about what to do than the person who's in there.

That's, that's quite unfair.

So there's also this sense in which, you know, 'cause then that allows

us to, to make a bit better plan and say, okay, if I see this, then

I could go and talk to that person.

If that happens, then I could do that.

So I start finding small things that I could start doing differently

and see what helps me feel better.

And that to me is all about autonomy, isn't it?

And control.

So when you feel you've got some control, even if it's just right, okay, well

the one thing I can do is to find out next time where to go, what to do.

That's, that's giving back control.

And if I was to come home and, and talk to someone, so I'm just thinking, well,

if I come home and talk every night, like to my husband saying, right, these

are 10 things that happen at work today, i'm not sure he's gonna know what to

do or say to make things better, 'cause often he just wants to run in to fix

it for me rather than just listen.

So if I was a person being talked to about these things, if I was a partner or a

friend, what sort of things should I do?

What sort of questions could I ask that person?

Or is it literally a question of just listening and, and repeating

that whole mantra of you are just human, you've done your best, you've

done what, you done what you could.

Are there any particular questions that would be useful there?

Yeah, that's, that's a brilliant question, Rachel.

I think that, um.

Just, you know, drawing a little bit on my, on my training

in, in, in therapy as well.

Um, the power of of, of just listening is, is massive, isn't it?

And, and we know that sometimes allowing somebody to say out loud something

they've been thinking has, has a big transformative effect as well.

So yes, primarily the person who's been talked to, we need to listen.

We, we, we, we are not asked to fix anything because if the person who

works in that organization can't, somebody who is outside definitely

can't do anything about it.

However, we, we, we are in the, in, in the position to ask people

what they need to feel better.

Cause often, you know, in, in the, the, the reality of of work life

is we often don't know what people around us go through at work.

Not everybody talks about it and we often, we, we often think we

realize, especially if, you know, it's somebody who works in healthcare.

We often think, we realize how difficult it is.

But let's be honest, unless we are there, we have no clue.

And that includes me.

We spend most of my time talking to healthcare workers.

I've got no clue how it is to be in your shoes.

So all I can do is, is listen and ask what would you think would help you?

And similarly goes to, you know, all the friends or, or family members or partners.

We, we want to listen.

We can ask all the questions we want to, to, to, to help

us understand what happened.

That, that valuable sort of feedback on, you know, sounds like you're already doing

everything you can and, and that's okay.

'cause there's also shame with it, isn't it?

If you go home and, and you say, you know, I could have done more for this

patient, but I didn't have the dime or the resources or this or that, this, this,

this comes with, with a lot of shame.

And even feeling that the people around you, they understand that you've

already, you know, exceeded yourself, that, that has, that has a huge relief.

And then it's really about, you know, what, what would

help you feel better right now?

What would help you feel better when you come home?

What would help you feel better?

I mean, it's just helping people figure out what would help them feel better.

This is, this is a much bigger conversation about, you know, work-life

balance and how we bring work at home.

And it's, it's, it's a whole different thing.

But for those who have that opportunity and that luxury, I think it's really

important that the ones who are on the side of listening, we don't wanna

urge them to do more, we don't wanna help them figure out ways to become

better at their job 'cause they're already as, as, as good as it gets.

We have to help them take better care of themselves, listen and, and, and

take away that shame that comes with taking responsibility for a failing

that is not yours for, for a failing that is, that is part of the system.

I love that.

With, with that whole self-compassion thing, I often, you know, do try

put my hand on my heart and say to myself, you've done your best

in really difficult circumstances.

And actually anybody would've responded like you did.

Look what you're coping with.

You know, and I guess that applies just as much to the fact that you

didn't speak up when you thought, you know, about the million different

things you could have spoken up about.

And Olga, if, if there isn't somebody there every day for you after work

and with the best one in the world, even if there is you, it's, you know,

I can't imagine them, you know, five, six days a week having half an hour

conversation with you about this.

I love the idea of journaling.

what journal prompts would you use?

It really, I think, I think with journaling we need to find what

works best for each one of us.

Um, some people love a bit more structure, in, in, in their journal.

Some people like, you know, to, so there's, there's lots of, you

know, journals out there as well, like gratitude journals or, you

know, loads of, loads of ideas.

So it's about finding what we like.

If we, if, if we like the structured style, then starting from, you know,

today what were the things that happened that made me upset, right?

How did they make me feel?

Was there anything I could do differently?

And then something about, you know, self-compassion and, and, and accepting

that I did everything I could.

So maybe I could have done something qualitatively differently but not

have done more, even if it's just, you know, questioning that assumption.

I didn't need to do more.

I could have done this differently.

So again, it goes back to the implementation intentions.

If, if, if I find myself in this situation again, then I should try to do this.

And this might change 'cause I might try to do something new

and it, it won't work again.

And I might have to try something else.

But this is if I, if I want to have a little bit more

structure so I could write yeah.

About what happened, how did this make me feel, what I did, and, and

if I find myself in this situation again, what, what do I wanna do?

I couldn't be keeping to do the same thing.

I can also do expressive emotional writing.

I can also just start writing about my day again.

It doesn't have to be every day.

It's only when I feel I, I really want to do it.

So I could sit down, just start writing about how did this day make me feel?

What did make me think about?

There is, there is a lot of sense making to be made through

those negative experiences.

And if we just try to suppress them.

They're only going to build up under that same narrative of I'm not good

enough, I'm not effective enough.

I'm, you know, I, I suck basically and I should be doing better.

So this kind of free expressive writing, this, this kind of journaling

allows us to take control of that narrative that, you know, we are

shaping every day about, about work.

And through that, again, we get moments of clarity, you know, through that.

Again, you could think, oh, maybe I could have, you know, maybe next time

I should talk to that person 'cause they've been involved in this as well.

Maybe they have an idea.

And of course, there's also the whole, you know, creative writing.

So you can, you could take that to a whole different level and

you can start writing a story.

You can, you can use storytelling, you can, you can approach these as,

as somebody else's story, somebody who's gone to work and had to deal

with this, and you can, you can start thinking what else they could have done.

You can create a different ending.

Very often you can rewrite the scenario.

So there's many different ways that we can write and, and, and journal,

depending on what suits us best, depending on what, what helps us the most.

But it helps control and, and, and think about the narrative rather

than just, you know, put it back in that box that says I failed again.

And, and that then becomes huge.

And then that becomes my label, and then I get angry, and then I just, you know,

I either either become very, very happy or I decide to leave because I've, I've,

I've decided I can't, I can't do better.

How much do you think over responsibility plays into this?

Oh, I should have spoken up here, here, here, here, and here.

Do you think healthcare professionals do feel incredibly responsible

for speaking up about stuff they have absolutely no control about?

Or, or, or that they should have done something when actually they

definitely couldn't have done something?

Does that play into this too?

Yeah, I think, I think if we start thinking about, you know, who are the

people most likely to work in healthcare?

Who are the people most likely to become nurses or, or, or doctors, and

we start thinking about education and high school and all the time we, we find

that these are the most conscientious people are usually choosing a career

that sadly has become a system that takes advantage of that conscientiousness.

So in many ways it's the perfect material.

Isn't it?

We know that these will be people who will keep trying their best and will

take as much responsibility as you can.

Forbid.

It's like unimaginable that you know, you, you take responsibility

for people's lives every day.

Like I often joke with, you know, my, my husband or with my, with my

family that I don't have a real job.

I, I, I write things, I talk to people and I write things.

These are real jobs.

'Cause you have to go every day.

You're a surgeon or you're a nurse.

You do things that you're, you're taking responsibility for my life.

So that alone is, is massive, right?

I mean, I appreciate, you know, they enjoy, this is their dream

and this is what they wanna do.

But by definition it's, it's a job of over responsibility.

It's a job where the slightest, like, if I sneeze while I'm

teaching, nothing's gonna happen.

But the surgeon can't just sneeze while they're doing an operation.

Like it's, it's a whole, it's a whole different thing.

So it's, it's a job of, of over a profession, of over

responsibility from the start of it.

And then add on top of that a training system that constantly reminds you that

you have to be on top of your game all the time and you have to be amazing all

the time and there's no margin for error.

And if you get something wrong, it's your fault.

And then on top of that, you enter a work environment with usually no proper

reduction, no proper adjustment period.

And again, all the decisions for your future are made based on how on top

of your game you are all the time.

So, are you gonna sleep to feel better?

Or are you gonna keep reading and find that solution to that

problem that nobody can solve?

Are you gonna try to see more patients because, you know,

that's, that's, that's what the projection you're dealing with is.

So at no point in, in on that trajectory, we see, self-compassion,

self-care, you know, support, understanding, human nature.

It, it, it never comes up.

So you have people who are naturally prone to being overly responsible being

trained in a system that the rewards and values over-performance, you know,

and, and presenteeism and, and, and constantly being on the top of the game

into a system that basically depends on you doing 200% of, of your job.

Because otherwise you feel it's going to collapse.

So it's reinforcing all that, isn't it?

And then, and then on top of that, if you see anything wrong, it's also your

responsibility to report to fix it.

That's unfair.

Gosh.

I mean, when you put it like that, no wonder everyone's burning

out and that's such an eloquent description of genuinely what

But I think, I think, you know, I don't, I don't work in healthcare,

so I'm not trying to say it's an awful place to work in.

That's really, really important.

What all I'm trying to say is what, what we hear, that the emotional experience,

you know, the emotional trajectory is that brings people to either feeling

I've, I've had enough, I'm gonna leave, or I've had enough, I don't care anymore,

and I'm gonna do the medium expected or leads to, you know, all those scandals

and those are problems that we need.

This is not because they don't care or, or they're bad people.

It's because the emotional demands are just piling up over and over

in what makes it look like a very, a very negative place to be.

I love what you are doing is thinking actually you can't speak

up about everything, because it's just, it's literally not possible.

It's like you can't, I think you can't ever get to the end of your to-do list.

In healthcare, it's literally not possible.

It's very difficult to meet every single patient demand

and need that, that's going on.

Therefore, you have to pick your battles.

Obviously the, the stuff that's really important that you know

that, that, that's causing severe patient harm or, or staff harm.

Those issues do need raising, but there'll be, like you said, eight, 10 a day that

you notice that you could speak up about.

But you, even if there is something you can do, you can't do everything.

You are human.

You've got a finite capacity.

So I love what you are talking about with actually, how do

you then, um, mitigate that?

How do you then not get massive moral injury from not being able to

be omnipresent and do everything?

And just talking or journaling is a, is a pretty simple solution

that, that most of us can do.

And the other thing I was wondering, where's the role of the

peer groups and talking to your, your colleagues in all of this?

That's, that's quite interesting, Rachel.

So we, we, we wrote a paper about a year or two years ago where we

were just thinking about, informal communication in, in the workplace.

So that includes talking to your peers, having those chats that includes

go C, but anything you can imagine.

And, and again, there, the, the evidence is, is quite mixed.

So.

if you are a lucky one that can find a group of peers where you share values

and, and you have that psychological safety, to be open about things,

then that's great, it could help.

Mentoring with senior, you know, colleagues who have been

through similar situations.

Yes, that's great.

But at the same time, because of the way the healthcare, you know, professions can

be structured and especially in the early years, it's quite competitive, isn't it?

Um, not everyone is lucky enough to find that kind of peer

group, that definitely helps.

So sometimes we can end up having, you know, negative effects if,

if there is not the right kind of support from, from our peers.

So that's really important to keep in mind.

Just trying to develop as many, you know, peer groups you can, it's,

it's not really always going to work.

So there's, there's cases where feeling too relaxed and, and,

and too sort of, you know, safe with, with your peers can actually

start having the opposite effects.

So we see that it affects people's sense of efficacy, it actually makes

people less, feel less competent and deficient, 'cause you, you start going

down that route where you spend most of your day complaining about your job

and that starts make you feel worse.

So there's an interesting, an interesting balance to be, to be had there.

I think.

I think to the extent to which our peers can give us empathy.

Because they are going through similar things.

We can talk about solutions, we can talk about ideas and, and

dealing with stuff, we can have some genuine, almost like support groups.

This, this is, this is really great.

But we need to remember as, as social animals as we are, emotional

states are very contagious.

Burnout is contagious.

So you can, you can get burnt out very quickly by simply starting to work

in a place where everyone's burnout.

So if we, if we spend a lot of time with people who are really deflated

emotionally, we also risk shifting the way we feel about ourselves

and our jobs, uh, even further.

So I think it's, it's about finding those peers that make us feel safe to

express how we feel about our jobs, but who are also helping us feel energized

and helping us, you know, feel better.

So maybe we don't need to talk about it all the time.

Maybe we need to go, I dunno, for, to have some, some, uh,

sport thing we do together.

We can all go play tennis and, you know, hit those balls and, and feel better.

So it's, it's finding those activities, finding those things we can do.

Maybe not talk about work at all with our peers and just being with

people who know what we're going through is, is, is going to help.

So it's, it's quite an interesting one, uh, with peer support as well.

And the other issue we have in healthcare of course also is that

people are not always open to talking about what they're going through.

Self-medication with alcohol or drugs or mental health problems.

People don't talk about those to their colleagues.

People don't talk about to their peers 'cause they're afraid that, I don't

know, in, in, in a moment of, of, of, of weakness or an error, this is

gonna be used sort of against them.

So there's this other issue of, you know, how, how honest can I

be with my colleagues, how much I can say, how open I can be?

And that's where I think often talking to people outside or, or entering

anonymous peer groups might actually be a bit, a bit helpful until we are,

we are at the point where we're more ready to accept healthcare workers

as, you know, human beings with needs and weaknesses and, and, and in need

of support and help, like depression, anxiety are, are, are really, really high.

But I don't know how many colleagues talk about that.

It's huge.

It is really huge.

So what you're saying about the peer groups, they can be helpful I guess,

because you have a little bit more empathy 'cause you know the situation people are

in, but, and I've experienced this, some peer groups can get a bit competitive.

I remember going to a GP group and actually I came away feeling much worse

'cause I'd share something and then I get told what to do and I was like, oh, I

hadn't done that, oh, made me feel worse.

So, or or we try and fix it all because we sort of, in the same sort of situation,

we know exactly what that person should do, even if they're in a different one.

So they could be helpful and, and unhelpful.

Exactly.

It's, it's, takes a bit of time to find out what we need, and it might be that

what we need changes over time as well.

So first, you know, we need this peer group and then we

need, we need something else.

So we have to be open and, and sort of attuned to what we need and how we feel,

and accept that not every advice or every interaction should be adopted or should

be helpful or, you know, people are telling you what they did, how they coped.

And you can also think, you know, okay, do I like the way this

person is, is, is behaving, is, is their coping actually working?

Like we have the right to, to sort of question advice?

That's why I do love coaching and, and therapy as well.

'Cause a, a good coach, a good therapist, is asking you what

you think, you're feeling.

They are being very empathetic towards you and with unconditional

positive regard, but they're not trying to fix or give solutions.

You're coming up with a solutions.

So I think if you can find a good coach or a good therapist, that's great.

And there are certainly a lot of free coaching that's available

and therapy available to NHS, um, employees and doctors and, and,

and other people in healthcare, even if you don't work in the NHS.

But they're often just underutilized.

Totally underutilized.

And I know that it often a time issue or people even don't know it about it.

But honestly, coaching has been one of the things that's changed my

life, um, and has been brilliant.

Yeah.

It's also that that little bit of, of stigma, you know, that I, if, if I go

to a therapist or a coach, it means I'm at the meeting, I need help, and

if I need help, I'm admitting I failed.

And so there's all that, you know, need to regain control of the

narrative that needing support or needing help is not failure.

It's a sign that I need to go to the next level basically.

I mean, it's mad, isn't it?

I have a tennis coach to make me better at tennis.

Why wouldn't we get a coach to make us better at our jobs?

A lot of our listeners, uh, they're in the role of people who are seeing

loads of things that they feel they need to speak up about, but they can't.

There's silence.

But also they are clinical leaders and they are in roles where people might

be coming to them and speaking up.

And they're being spoken up to as a person who can potentially change things, but a

lot of the time they can't change things.

And so you've got that sort of double whammy.

Well, someone has trusted me, they've spoken up to me, and you might be

feeling upset because you might feel you've failed because that

person's not happy about something.

They might be speaking up to you about your behavior, or they might

be speaking up to you about something in the system that they think

something should be done or you should change it and you absolutely can't.

Have you got any, any tips for if you are that person in the middle?

Yeah.

Again, uh, it's a disclaimer.

My advice comes from my academic and research background.

I've not been a clinical leader.

I don't know how it feels to be in, in that situation.

I dunno what's right or wrong, but there's, there's, there's a few

things we can do to buy yourself time.

Also the same.

Also, things apply if you're a clinical manager and there's loads of people

that you have to, to, to support, you have to accept you can't help everyone.

That's like the reality, and especially in such a strained environment with

those resources and all the pressure that clinical leaders have to deal with, to

keep up numbers to, to, to, I know, keep governments happy or, or boards happy.

So there's the same self-compassion and self-understanding applies.

So when these happens, we don't want our first thought to be,

gosh, I need to solve these two.

No, I need to buy myself some time and see if this is something I

can actually do something about.

So don't, don't rush into giving a response to anyone.

Somebody comes with a suggestion, a concern, a problem, even if it sounds

something that needed to be sorted yesterday, and it's really, really

serious don't make any promises.

You cannot keep.

Don't say, oh, we're gonna sort that.

Oh, I know what I'm gonna do.

The need to show that we have a solution and an answer.

We don't want that.

That's adding to your pressure, creating unrealistic expectations from your team.

And then you're tied yourself into notes to solve problems that

you know you maybe didn't even know existed in the first place.

So buy yourself some time and give a realistic expectation to the person coming

to you can say something like, you know, I'll look into this, let's book some time

to discuss it in the next couple of days.

Just help them feel heard, but don't commit yourself to something that you

haven't had enough time to understand yet.

And by that already, you will have bought yourself some time to really

think about, is this something I can actually do something about?

If this is something I can do something about and it's not gonna

take me a lot of time and it's not gonna take me a lot of effort, then

okay, I could address it quite soon.

Now, if this is something I definitely can't do anything about, I need to find

a way to communicate that to my team.

I need to find a way to save the person that, you know, I hear you.

I agree.

This is a massive problem.

But this is a red tape.

This is, this is a policy, this is a rule.

There's very little I can do about it.

Maybe there's something you can redirect people to.

You can tell them, you know, I'm not the right person to talk about it.

You should go there.

So that need to solve everything is what gets us often in, in, in a

very difficult situation, and we end up making promises we cannot keep.

So take the time to think, is this something I can do something about?

Okay.

If yes.

When do I think it's realistic for me to look at it?

Make that arrangement that is realistic, that doesn't create of expectations.

And if it's something you definitely can't do anything about, do not

try and, and, and convince yourself or, or, or, or everybody else that

you have to find a way around it.

At some point, you know, the, the system needs to take responsibility.

So if this is something you need to raise with somebody else,

raise it with somebody else.

Um, somebody told me once that, um, one of the big problems in the NHS was that

taking time to think is not something people, you know, talk a lot about.

And at the same time though, their experience at a very senior, um, uh,

surgeon and with loads of clinical and training and managerial experience

as well, and in their experience, that was the most magical thing

was the finding the time to think.

But, but he was saying that we, we don't value that.

So let's try to create those little, you know, opportunities of taking a few times

to think about, about is this something I can help you with and what's the

best time to, to sort of talk about it.

If you feel like you're running around putting out fires,

it's, it's not sustainable.

Olga, if you were that person, or if you were talking to that person

who's documented eight instances of, of silence when they thought they

should speak up, what would your top three tips for them be right now?

I dunno.

I think the first one would be to lie down and take a big breath and for,

I dunno, a few minutes, just really try to ground yourself in the here

and now, and push those thoughts away.

With, with, with all, you know, your, your, your strength and

power, take a break from that.

'cause I know it goes on in, in, in your head all the time.

So it's a bit like, you know, we, we do loads of, uh, positive

imagery in, in psychotherapy or muscle relaxation techniques.

So the first thing would be you can't think clearly about something unless

you stop thinking about it for a while.

So, first of all, lie down, clear your head.

The second thing is from those eight things, was, was there anything, any of

them that really, really, emotionally stayed with you during the day?

And if yes, just please talk about it, tell me about it.

Let's, you know, let's try to make sense out of it.

And then the third one would be, you know, eight times is a lot.

Is there anybody you need to be talking about it in your, in

your team, in your organization?

'cause that sounds like a lot.

And are all those a things part of your job description?

Are all those a things part of your responsibility?

So it'd be, yeah, just first of all, take a break and relax.

Let's, let's clear heads.

Now let's look back.

Were all those a things equally important to you?

Or was there something in there that's actually, you know,

emotionally hurt you more and is there something we can do about it?

So maybe they're not a things tomorrow.

and, and the less that would be a it.

Great, Olga.

This has just been so fascinating.

Um, if someone wants to find out more about your research and get in

touch with you, how can they do that?

Yes, thank you.

So I am, uh, based in the School of Psychology at the University of Leeds.

So if you Google my name, um, Olga Lainidi and University of Leeds, you're probably

gonna be redirected to my profile.

Um, you can also find me on LinkedIn, Olga Lainidi.

And yeah, I'd be happy to answer questions, share any further insights.

I'd love people to take part in my research.

It's still ongoing, the diary study.

We are close to, to finishing it, but we need about 30 more

participants to, to have, um, to complete the sample that we need.

So if, if anybody would like to take part in the diary study, as

I said, it's quite innovative.

It's, it's not happened before in that format.

The feedback from people who've participated already has been

really, really positive on, on how helpful it is to actually realize

what, what you're going under.

And you'll be helping inform, um, a different type of research looking

into how it feels daily to be you rather than assuming that we know

what, what works best for you.

Brilliant.

And we'd love you to come back, or once your study is finished and you've

got some more findings, come and come and talk to us about it again.

So thank you so much for being on the podcast.

It's been totally fascinating.

Thank you for inviting me.

Thank you, Rachel.

Thanks for listening.

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