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Leaders must look after themselves first …

For an already stressed workforce the changes made to adapt to the pandemic has meant that not only have staff had to adapt to rapid change in their work routine, but leaders have been confronted with herculean challenges to keep the show on the road. Now we are trying to get back to normal and catch up on the backlog of work those in leadership roles are becoming stressed and overwhelmed by the work pressures.

This pressure has to be seen within the context of an already difficult operating environment before COVID-19 and where symptoms of burnout are evident in many practices and amongst managerial and clinical staff. Therefore, when I read the helpful article by Helen Northall Next Steps for Leaders (Insight August 2020), her advice that “the leader needs to look after themselves first” really resonated with me.

What do we mean though when we talk about leaders looking after themselves? Helen Northall gives us some very practical advice in how to take forward the challenges of developing PCNs at a time of heightened uncertainty and disruption. We are well aware of other advice about eating well, ensuring we get enough sleep, exercise, and the importance of family and friends. In our recent work with the Healthcare People Management Association – HR in the NHS, and our research into the evidence of psychological distress in healthcare professional’s after pandemics (HSJ article), we found that having trusted professional relationships, strong values, particularly altruism or sense of service, more experience and expertise were protective against developing psychological distress (characterised by symptoms of depression, anxiety, insomnia and post-traumatic stress).

We know that stress is both a psychological and physical reaction to what we are experiencing in our lives – at work, at home, in our relationships, etc. Short periods of stress can be beneficial. If we have a sense of control we can cope with work pressures, unfamiliar or uncertain situations and events. It is when we lose that sense of control that pressure or tension becomes strain which in turn leads to stress and if not resolved can produce distress.

The Stress Continuum

How can we increase our ability to manage work pressure and increase our ability to cope with stress?

There is a lot of advice to help us become more resilient. One resource I like is the NHS England’s 10 High Impact Actions. Topic sheet 6.2 on Personal Resilience. This highlights the importance of strong and trusting relationships, creating a positive work environment, and taking practical steps to look after your own health and wellbeing, such as eating well, having good sleep hygiene and exercising. It also provides good advice in how to support colleagues who have reached the point of burnout.

Neuroimaging research has shown that stress, particularly chronic stress, leads to physical changes in the brain and that can cause physical and mental ill health. Studies have shown that areas of the brain critical for learning and memory (hippocampus), motivation and mental agility (prefrontal cortex) are vulnerable to chronic or repeated stress. Stress also produces high levels of hormones like cortisol which have been associated with mood disorders and the shrinking of the hippocampus.

Developing psychological flexibility has been shown to positively help those working in the NHS to improve their psychological wellbeing. It is defined as a person’s “personal tendency to focus on their current situation, and based on the opportunities afforded by that situation, take appropriate action towards achieving their goals and values” (Bond, Lloyd, & Guenole, 2013, p. 332). It is the Psychological flexibility is a skill and can be developed through training and practice. The training combines elements of mindfulness and CBT to develop an increased awareness of self, ability to work with unhelpful thoughts, emotions and feelings and to focus on what is important to you.

The evidence is there to show that this type of training works. In a Northumbian trust the ACT skills resilience programme resulted in HCP’s symptoms of psychological distress were significantly reduced and their psychological functioning was better than average. This improvement was not just temporary but persisted for months after the training. Neuroimaging support these findings. Regular mindfulness practice has been shown to increase volume and function of the hippocampus and it also produces positive functional changes in other parts of the brain associated with emotions, mental agility and motivation.

Psychological flexibility is becoming recognised as a key competency for leaders and a skill that helps them to look after themselves.

Valerie Amies is a PCC associate. Valerie runs Stress and the resilient GP MBTI workshops for PCC. For more information please contact