Grounded optimism and NHS organisational change leadership

Optimism – from the Latin term optimum, meaning ‘best’ – gets a positive press in academic literature and management textbooks.

Its reported upsides include better sleep, lower cholesterol and higher life satisfaction. It’s also associated with an ability to thrive at work, make decisions, improve productivity and make organisational change happen.

An alternative perspective on optimism comes from one study that showed that students who described positive fantasies about their career prospects were found, two years later, to have applied for fewer jobs, received fewer job offers and secured a lower salary compared with less optimistic graduates.

The researchers involved suggest this shows that a pessimistic appraisal of life challenges may actually help stimulate action, energy and focus.

Problems with positive thinking

The problem with positive thinking within the workplace is when it becomes ‘Prozac leadership‘. This happens when leaders convince themselves that everything is wonderful within their organisation and will only get better.

Having identified the pathway to the sunlit uplands of a golden organisational future, such leaders dismiss staff concerns about the risk of stormy weather ahead as ‘resistance to change’.

In this way, grandiose fantasies of corporate excellence can develop that don’t bear any actual relation to what’s happening in the real world. Problems become swept under the carpet. People don’t feel able to raise concerns. Leaders lose touch with reality and their own staff.

Taken to its extreme, excess positivity and unrealistic optimism can lead to a situation like Mid Staffs where leaders become blind to problems, deaf to concerns and unable to conceive of the need for improvement. In a setting like the NHS, this can literally place patients’ lives at risk.

Creating right culture is painstaking

Creating the right culture is painstaking, continuous work. In that sense, it’s apt that the term derives from the Latin term ‘cultura’ for cultivating crops by tilling the ground. Really paying attention to what patients, families, carers and staff say means you can’t afford to look away when this feedback contains difficult truths.

I’ve spent the last three years studying change leadership, staff engagement and communication in the NHS.

Looking at the literature and interviewing 20 NHS chief executive officers informs my idea of ‘grounded optimism’ as an antidote to Prozac leadership.

This concept comprises four elements:

• a leadership worldview where hope for the future is balanced with realism
• a leadership change mode that recognises the emotional impact of organisational upheaval (which can include feelings of grief and loss)
• leadership engagement with staff that is rooted in the value of dialogue, debate and disagreement, in a way that helps safely surface potential problems and new ideas
• leadership communication that is experienced by staff as both positive and plausible, because it is anchored and informed by their experience.

Balancing positivity with realism

Balancing positivity with carefully titrated doses of realism (and even the odd drop of pessimism) can help NHS leaders develop a vision that is both optimistic and credible.

By recognising things are tough, and that the route to improvement is fraught with difficulty, I’d argue it’s possible to hold hope for the future in a way that people are more likely to buy into.

After all, wishful thinking isn’t enough when it comes to making the changes needed in the NHS to improve patient experience.

Dan Charlton is Chief Communications Officer at Sussex Partnership NHS Foundation Trust