Pause, reflect, think, make-meaning
Why creating time to reflect is an essential practice for NHS leaders, particularly at this pivotal moment of significant structural change
The recent abolishment of NHS England and the radical restructuring of healthcare leadership represents one of the most significant shifts we’ve seen in decades. As DHSC reconfigures its relationship with local systems and ICSs evolve in their role, leaders across the healthcare landscape are navigating not just structural changes, but a fundamental reshaping of how care is conceptualised, delivered, and governed.
The hope with any transformation is that things will be get better as a result; that productivity will increase, staff morale will go up, and that all of this will be reflected in improved patient care, reduced waiting lists and better population health. The danger is that it could cause major psychological and emotional disturbance amongst the workforce, leading to a reduction in productivity, loss of good staff, internal fighting and toxic dynamics. As such it is essential that these changes are implemented well which means really taking on board the emotional impact of change and working this through as part of the change process. As I put it at our recent 30th anniversary conference:
As the NHS continues its journey of transformation, understanding how change is experienced – not just how it is designed – becomes essential. Systems psychodynamic approaches give voice to the subjective realities of organisational life, illuminating how changes ripple through complex human systems. Only when we truly recognise rather than deny the impact of change on human beings and implement change with this understanding in mind, can we bring about successful and sustainable change in organisations.
What often goes unrecognised in these transitions is the profound emotional labour required of those in leadership positions. You’re tasked with implementing change while simultaneously processing it yourselves. You are required to hold onto hope in the face of uncertainty. You’re expected to emotionally contain others while those structures and people that keep you on a steady footing are being dismantled and at best rearranged. You are trying to help others process loss whilst managing your own losses.
These challenges are not merely technical problems awaiting technical solutions. They are adaptive challenges that touch on the deepest aspects of organisational and professional identity. They evoke powerful emotions – anxiety, uncertainty, feelings associated with loss, sadness, anger, and of course hope – these emotions impact and shape behaviour and decision-making at every level of the system.
From a systems-psychodynamic perspective on organisations and leadership, these boundary changes between central oversight and local delivery are reshaping both authority relations and emotional and psychological containment. When containers change shape, what was once held securely can feel precariously balanced, triggering defensive responses – from idealisation of the past to difficult team dynamics, staff fighting, fleeing, losing the capacity to think for themselves, scapegoating and becoming less productive.
At Tavistock Consulting we’ve observed that the most effective healthcare leaders during transitions are those who develop what psychoanalyst Wilfred Bion called “negative capability”; the capacity to stay present with uncertainty without prematurely grasping for resolution. Our work focuses on creating reflective spaces where the emotional experience of change can be metabolised rather than defended against, helping teams:
- Distinguish between technical problems and adaptive challenges
- Recognise unconscious group dynamics that may sabotage implementation
- Create transitional objects and structures that provide psychological safety
- Build capacity for holding complexity without rushing to premature solutions
If you’re an NHSE, DHSC or ICS leader navigating these profound system changes, we invite you to consider how creating protected time for reflective spaces – executive coaching, group work, team development workshops, etc – might support you and your teams during this pivotal moment. Sometimes, the most productive action is to pause and make meaning together before moving forward.
We would welcome a conversation about how our approach to change and transformation might support your leadership teams in finding creative responses to the complex reality you face.