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Leadership challenges

Rebecca Myers and Aroon Lal Mid and South Essex Foundation Trust 10 February 2022

Rebecca Myers and Aroon Lal write about the emotional and psychological challenges senior health leaders are facing, and how the Schwartz Community can help to support them.


As facilitators for Schwartz Rounds in our Trust for over 6 years, we wondered whether senior leaders were able to put aside feelings of duty of care towards their staff and contribute to the Rounds in the same way as other members of the audience. Could their leadership position affect their experience and reduce the benefit they derived from attending? Were they able to resist ‘problem solving’ or be too overwhelmed by a sense of responsibility? Indeed, was it a disincentive to attending the Rounds completely?

In 2020, we undertook some research to try to understand how senior leaders in healthcare engaged with Schwartz Rounds and what participation evoked in them. Through interviews with 25 senior leaders across a range of organisations, we found that whilst leaders valued Schwartz Rounds within their organisation, particularly the benefits to their staff, their own experience of participation was complex and at times it was difficult to benefit personally from the sessions.

Senior leaders recognised that taking part in Schwartz Rounds was valuable for various reasons. For some, it was because it gave them an opportunity to hear first-hand about the experiences and feelings of members of staff and hence better understand their situation. Others felt that by attending, they were making a public statement that staff wellbeing was important to them.

However, many senior leaders we spoke to told us that the personal emotional and psychological benefit of attending Rounds was not necessarily the same for them as for other participants. They found sharing emotions, even in the protected environment of the Round, to be challenging as they feared it might undermine their credibility as leaders by being perceived as weak and vulnerable, and cause some level of distress to staff.

We were keen to share our learning and gain further insights with the wider Schwartz community, and presented the findings to facilitators and steering group members throughout 2021. The overriding response was one of surprise and concern at the difficulties our senior colleagues felt in being able to share their own emotional and ethical challenges in the Rounds The feedback they had received from Round evaluations was that attendees appreciated the honesty their executive colleagues showed during Rounds, and had gained greater understanding and empathy for them and the role they had.

What have we learned?

Two years on, and in the midst of the increased pressures on senior leaders brought about by the pandemic, we want to share some of what we have learned through our ongoing work.

Following our research, we identified a need to learn more about how to better support senior leaders. To this end we ran workshops, and focused Rounds, with groups of leaders across the Integrated Care System structure, where we heard about their experiences of dealing with the responsibility of leadership in health and social care organisations. Being with peers, they opened up more, sharing the realities of their experiences and the impact on them.

As the Point of Care Foundation focuses on expanding access to reflective practice to support the wellbeing of people across the health and care system through #reflect2repair, we hope these observations will help to raise awareness of the particular set of challenges senior leaders face. 

Heightened pressures

Today, senior leaders are facing many challenges. The ongoing Covid crisis has evolved from the immediate issue of how to protecting staff whilst meeting the needs of the sheer numbers of patients and communities accessing the health service, to the longer-term problem of catching up on the backlog of care, which has fallen so far behind. Another big challenge, linked to the first, is workforce, with recruitment and retention both creating acute and chronic difficulties. Keeping services going, through and after Covid, has been a constant worry for many for the last two years.

Against all this, leaders feel pressure to stay positive, to reassure staff and the wider public. Without time or space to reflect, and with no respite, this cocktail of circumstances has placed emotional and psychological strain on individuals.

These circumstances make it essential that leaders, whilst working to ensure that staff have access to reflective practices, are also able to participate. Furthermore, we know from other Round attendees the powerful impact that hearing from senior colleagues can have. Whilst signaling that it is okay to feel as they do – because even those in senior positions can feel the same way – it can also increase understanding and empathy for the challenges senior colleagues face. This can have ripple effects for organisational unity and effective internal communication.

Support structures

For their own wellbeing, leaders do have other sources of support. The evidence we have seen is that many senior leaders rely on personal networks of family and friends, and on their peers, with whom it is easier to be more open. Hearing from other senior leaders facing similar challenges in different organisations has proved valuable, reminding people that the challenges they face are not always unique. Some have also emphasised the value of having good relationships with their immediate teams, who can share the load, and the importance of good administrative support to facilitate their day-to-day work.

Whilst these support mechanisms are vital, they do not have the institutional or systemic impact that participation in wider group reflective practice offers. The challenge for the Schwartz community is therefore to find ways to help senior leaders to engage more fully with Rounds.

It is important that Schwartz facilitators and steering group members listen to senior leaders’ reservations, recognise the particular challenges they face, and build trust. It also important for staff to see rounds as a support mechanism for those in leadership roles and to display curiosity and compassion towards them as well as their peer groups.

In times of crisis, we often look to our leaders. Sometimes we expect too much of them. Leaders are not superheroes – they are human too, subject to the same emotional challenges as everybody. Through the Schwartz community working to ensure that Schwartz Rounds are fully accessible to this group – and senior leaders taking some risks – there is real potential for greater understanding and improved wellbeing for everyone working in health and social care. By ensuring the space to reflect and repair, we can make organisations and systems of health and social care more humane for us all.