What are the long-term risks of chaos?

Warning triangle

The immediate impact of the current chaos is fairly obvious. It means best practice is often no longer realistic. Even good practice is challenging. In fact, doctors are often functioning in the world of novel practice, having to create new solutions to new challenges. Unfortunately, this plays into the hands of the mavericks and feeds the problematic subcultures identified by the GMC pre-pandemic. The divas take centre stage. Conflict leads to factions forming. Those who are liked or revered are often excused or even enabled in their shortcomings. And it’s not difficult to find groups who are embattled or becoming increasingly insular.

Falling short of standards and results expected by yourself and others is stressful. This increases the risks of individual errors, burnout and system failures. In turn, they feed absence rates and people leaving the healthcare professions, resulting in an ever growing vicious circle. Leadership typically becomes more directive, more top-down, meaning the smaller voices go increasingly unheard. And that’s just the short term impacts.

But what about the long term risks?

A recent podcast by the KingsFund discussed the risk of doctors losing sense of what good care looks like. It’s a common human reaction that when we fall short or keep being disappointed, we start to expect less. The longer this goes on, the more it becomes the norm. So, we could be on a path toward accepting lower standards and shortcuts.

We form a new habit when we repeat a behaviour often enough that it becomes our default response to a situation. As time goes goes on and we continue to repeat the pattern further, our habits becomes more and more deeply entrenched. They even take a firm hold when they conflict with our desires and values. This process is accelerated when we are surrounded by others who are experiencing the same situation and reacting in the same way. Although we may be aware of this for a while, we can easily slip into “unconscious incompetence”. Habitual behaviours are triggered by an endless array of cues – some obvious and some not. When they take root, they can persist long after the original driver for the behaviour is gone.

Now consider the doctors who have taken on their new roles during the pandemic. Many of them will never have had the opportunity to experience high standards and best practice in the first place. How will they know what good practice looks like?

From emergency to recovery

It’s going to be tough for everyone to move forward from the repetitive strains resulting from this latest pandemic wave. So, good leadership will be essential to get through the coming months. It can be argued that it will be even more important for getting through the pandemic’s aftermath and for achieving stability. All healthcare professionals will have a role to play in this and can’t start preparing early enough.

The pressure and creativity of the emergency phase will inevitably be followed by confusion and regression. We can’t take for granted that we will easily recover to regain and improve on previous standards. The journey from novel practice, through emerging practice, then good practice, re-defining and re-establishing best practice will take deliberate effort. The leadership styles correctly employed in the emergency may become yet another bad habit. But people behave differently in different contexts. So, versatility in approach will be essential. Good planning and organisational skills will also be required, as will good teamwork.

What steps are you taking to be ready to participate in the journey out of the chaos?

Stephen McGuire – Managing Director