By Sue Walsh & Sharon Warden
© S.Walsh & S. Warden 2013
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Values, peoples and structures
Digesting current NHS organisational
processes/dynamics: in the service of your own
learning needs; and to enhance your supervision
of others
Taking you through a set of ideas, concepts that
we have found useful in our own practice
(healthcare culture, pulls to perversion and
resilience)
Set up your learning groups-get into a pair, when
ready make a four (what suits you? Familiarity or
stranger group?)
© S.Walsh & S. Warden 2013
Sharon: Healthcare culture, understanding
the dynamics of “the perfect storm”
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The analogy of the perfect storm
Failure to thrive healthcare cultures & the
pull to perversion
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An organisational Case example
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‘Therapeutic alliance’ as model for resilience
© S.Walsh & S. Warden 2013
Current NHS conditions ripe for the
‘perfect storm’?
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Industrialisation of healthcare
Commodity relationship - consumer /
Provider couple
Financial cuts and survival angst
Increasing demands of population changes
(eg: age, obesity rise in chronic conditions)
© S.Walsh & S. Warden 2013
‣ A small group struggling to
survive in a large
organisation struggling to
survive in a climate of
severe cuts
‣ Embattled Perception of
the small “unwanted”
group
© S.Walsh & S. Warden 2013
‣ Staff feel devalued, demoralised, frustrated & afraid
(survival anxiety – fight, flight, freeze)
‣ Suspicious of “hidden organisational agenda”
‣ Risk of “repetition compulsion” self defeating
replaying old wounds (split between Psychology /
Psychotherapy)
© S.Walsh & S. Warden 2013
Do the ideas make sense?
Have you experience of these
processes?
Through your own supervision
& of others?
© S.Walsh & S. Warden 2013
© S.Walsh & S. Warden 2013
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Leads to an attack on the capacity to
relate (“kin”) reduced reflective
function due overwhelming survival
anxieties.
© S.Walsh & S. Warden 2013
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Overwhelming “survival anxieties” / fear
Disconnection - not seeing the ‘whole picture’
Forgetting – ‘slips’
Shut down - “turning a blind eye”
Magical thinking – “obsessions”
Punitive / moralistic concerns or judgements
© S.Walsh & S. Warden 2013
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What is happening when things go
wrong?
What frameworks/ ideas can we hold in
mind to help us digest “the perfect
storm”
Recent examples of failures – Mid
Staffs & Winterbourne & Norfolk
© S.Walsh & S. Warden 2013
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Individual pleasure at expense of general
good
Knowing & not knowing (turning a blind eye)
Instrumental relations are dominant – others
seen as ‘things/objects’ opens possibility of
abuse
Engagement of others in system
Once engaged others are corrupted because
they become accomplices
Can you apply these concepts to
your work environment if so in
what ways?
‣ Containing anxieties: the “safe harbour”
function
‣ Integrating splits
‣ Staff can become “irradiated by distress” of work
© S.Walsh & S. Warden 2013
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Atmosphere
Culture
Attuned links
Space to reflect
Emotionally intelligent anticipation of
failure
Culture of curiosity – “duty of candour”
© S.Walsh & S. Warden 2013
Therapeutic
Alliance
Evidence based
Promotes change
Predicts outcome
Fosters resilience
© S.Walsh & S. Warden 2013
Sue: Resilience and supervision
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“It is written that when you do not have hope you
look for it in the face of your friend” Gazan man
quoted by Gordon (2009)
The word ‘solitude’ expresses the glory of being
alone, whereas the word ‘loneliness’ expresses
the pain of feeling alone. (Tillich, 1959 as quoted
by Cacioppo et al 2010)
© S.Walsh & S. Warden 2013
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To consider the literature on resilience
To reflect on individual, organisational and
social resilience
To connect this literature up with our
supervisory practice both in terms of what we
give others and what supervision we have for
ourselves
© S.Walsh & S. Warden 2013
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“resilience has been defined as successful
adaptation or absence of pathological
outcome following exposure to stressful or
potentially traumatic life events or life
circumstances” Seery et al 2010
maintaining a healthy outcome in the context
of adversity and the capacity to rebound after
a negative experience
Most people experience adversity in their life
yet most of us rebound
© S.Walsh & S. Warden 2013
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Is it about recovering from adversity (baseline
functioning) or is it about deriving a greater
capacity for future resilience?
A positive toughening effect when exposure is
limited with time to recover. This toughness
leaves individuals more emotionally stable,
better able to cope. Once toughness develops
can permeate to other domains
Moderate adversity predicts better mental
health than either high levels or no adversity
© S.Walsh & S. Warden 2013
◦ A clear acceptance of reality
◦ A clear value system- that life is
meaningful
◦ An ability to improvise
◦ (taken from Coutu 2002 Harvard Business
Review)
© S.Walsh & S. Warden 2013
◦ Facing down reality
◦ The search for meaning (not necessarily
ethically minded - Barclays, cohesive
identity of the group)
◦ Ritualised Ingenuity- ‘bricolage’
© S.Walsh & S. Warden 2013
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e.g. Caioppo, Reis and Zautra 2011
Individual achievements vs collective
action
“social resilience is the capacity to foster,
engage in and sustain positive
relationships and to endure and recover
from life stressors and social isolation”
© S.Walsh & S. Warden 2013
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Adversity into strengthening social
engagements, developing new
relationships, collective action,
emphasizes an individual’s capacity to
work with others and therefore to
enhance the groups capacity to do so
‘Social’ –building more adaptive social
ecologies for people/organisations,
groups
© S.Walsh & S. Warden 2013
Are there additional issues for the caring
profession?
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Holding Fast (2005) Kahn
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Not too close or too far away
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A paradoxical stance needs to be maintained
of being open to others and detached from
those we help
© S.Walsh & S. Warden 2013
How do you create the
conditions for resilient
supervision? (personally and
professionally)
© S.Walsh & S. Warden 2013
‣ In caregiving environments members
generate with one another the experience
of being contained and provided for…
◦ Primary task as integrating mechanism
◦ Integrity of roles and authority
◦ Structural interdependence
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Yet these things are very difficult to do well
in the context of current fragmentation
© S.Walsh & S. Warden 2013
Pick a case/issue with you as supervisee
or as supervisor (that you don’t think is
going well).
Using the previous 3 exercises, what
factors may help you to understand
what changes need to be made to your
supervision?
In line with social resilience prepare
your feedback for wider group
© S.Walsh & S. Warden 2013
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Facing a reality
◦ Not being alone- making connections
◦ Being prepared to prioritise yourself and your
learning (including being prepared to pay for
supervision)
◦ Anxiety about revealing your work and having
‘your mistakes’ seen
© S.Walsh & S. Warden 2013
© S.Walsh & S. Warden 2013