In a recent Insights post we explored whereJeremy Hunt may have gone wrongin his efforts to force a 7 Day NHS with greater availability of doctors at the weekend. In this post we will look at this issue from the experience of doctors, relate this to the work of Elizabeth Kubler-Ross and then consider the implications for your daily practise.
You may well be familiar with the work of Elizabeth Kübler-Ross, an American psychiatrist and an expert in near death studies who wrote the seminal work On Death and Dying. In this book she defined the five stages of grief that have shaped the thinking surrounding how people deal with unpleasant and unwanted developments in their lives for many years. The five stages of denial, anger, bargaining, depression and acceptance are illustrated at the top of this page.
The basic principle of this cycle has been widely adopted and adapted in many fields to describe the human reaction to imposed change. Many writers have interpreted the five stages with different labels into numerous versions of the ‘change curve’. At Oxford Medical Training we utilise these models in a number of our courses – during ourmedical leadership and management courses as well as in our communication skills courses for doctors. The basic principle is that it is necessary to progress through each stage in order to reach a genuine state of acceptance.
We can easily relate this to the reactions of doctors in the face of the demands for a 7 Day NHS, increasing the number of doctors in work at the weekends.
Denial – The first reactions were that this is unrealistic – it cannot and will never come to reality. Focus was upon gaps in the argument with the validity of the data used to support the drive questioned.
Anger – Anger can be expressed in many forms, from emotional outbursts to militant behaviour. In this case we have witnessed the #ImInWorkJeremy campaign on twitter from doctors who argue that they are providing a service and feeling unappreciated. There have also been petitions supported by hundreds of thousands of signatories with stinging open letters from organisations and high profile collectives.
Bargaining – In time, assuming that the government does not back down, there will be a desire to move forward in some way and resolve issues. It is likely that the desire to be constructive and find solutions will lead the representative bodies of doctors to engage in discussion and make counter proposals to find alternatives.
Depression – Should the demands for change continue we can expect a realisation of inevitability to grow. It is likely that many doctors will experience feelings of despondency, reducing their communication as they reflect internally, trying to come to terms with the implications of the new situation.
Acceptance – The end stage of the process – again assuming that change materialises – is that doctors will start to look for new ways to adapt their work, social and family arrangements to find a new balance.
Being mindful of this model and maintaining honest, self-awareness of where you are on the curve can shift perception from being a victim to being in control.
Much of the wider UK culture has already shifted to 7 day weeks – shopping, services, leisure and entertainment – with the majority of us enjoying these arrangements to a greater or lesser degree. As a result, we all have friends and family members who have experienced similar changes to their working arrangements to those which are being proposed.
A lot can be learned from finding out about the implications to their lifestyles – how have they adapted; what have they gained and where have they had to make compromises. This can help you to move through the curve. Of course it is still important to engage fully in the debate about the changes with those who have influence to ensure that the best outcome for all interested parties is achieved.
The demand for weekend working and the 7 Day NHS is just one example of change that will be impacting on your day to day working practise. Forces of change are constantly at play, though they may not always be so fundamental. Some of these changes will be imposed – driven by your senior colleagues, other departments or regulators. Others may actually be driven by you.
When we are the drivers of change we will typically feel positively energised and can be confused or frustrated by the reactions of others to our initiatives. In these cases we will be experiencing the cycle from the other side and recognising this has many benefits.
Awareness of the cycle of grief can both shift us from feeling like a victim to being in control and can also help us appreciate the reactions of others, resulting in more effective leadership for change.