The traumatised organisation

The traumatised organisation – Kate Jury, Managing Partner

Increasingly, trauma is being recognised in the NHS not only at the patient level, but within staff at services level, and increasingly at an organisational level (arguably, we could start to see traumatised ‘systems’ too).

An organisation can become traumatised as the result of a single event, or persistent stressors which ‘overwhelm its ability to cope, leading to dysfunctional patterns of behaviour and broken connections’.  There are classic hallmarks of a traumatised organisation, such as dysfunctional relationships, fear and high staff turnover. But all the classic signs of individual trauma can be prevalent too, such as hypervigilance, defensiveness, and disassociation.

Organisational trauma can cause extreme over-reactivity in the forms of staff turnover, burnout, performance at any cost, or under-activity such as inertia or paralysis in decision-making (we don’t want to get it wrong), very low staff turnover – people terrified of not getting another job or taking any action at all, sustained underperformance and the inability to move the dial on any metric.

The common causes of organisational trauma

The reasons that organisations can become traumatised are plenty, but the most common we would cite are:

• The cost of caring – Firstly, and at a fundamental level, if this is an organisation which is dealing daily with ‘high-expressed emotion’ (see also whistleblowing below). This can be as a result of the emotional cost of caring and is prevalent in mental health inpatient and CAHMS inpatient services. If staff are not supported to process their own trauma this can have a cumulative effect.
• Shame – A ‘scandal’ that may be in the media and is causing staff across the whole organisation to feel shame and/or distress. All resources are being diverted to fixing the crisis and the organisation is operating in an unusual and highly reactive environment.
• Trauma – Board members or staff who have been singled out as individuals internally, in the media or on social media which can lead to fear and distress. The impact of smear campaigns upon individuals and teams cannot be underestimated. This can lead to abnormal decision making that is designed to assuage the issue which can also lead to unintended consequences.
• Coping – Poor culture over time, particularly where there is a lot of leadership churn. This can lead to managers and staff adopting a ‘coping’ stance where they turn inwards for resilience rather than upwards in the chain of command. This can also put services on the pathway to becoming closed cultures.
• The panic button – Whistleblowing and external concern raising with frequent Freedom to Speak Up (FTSU) cases, or grievances being raised. This is indicative of an organisation that is running ‘hot’ in terms of its emotional load which are not being addressed via internal governance processes.

How do we address organisational trauma?

With organisational trauma, there is a cumulative effect. Like a pressure cooker, unless there is a steady release valve and controlled distribution of stressors, then an organisation can become normalised to the maladaptive response.

To break the cycle, organisations need fair and consistent leadership. Strong leaders at the helm can ensure that staff feel ‘seen’ and that their experience is valid. They ensure there is proper psychological support and regular de-briefs when incidents or complaints occur.

Additionally, when an organisation is ‘scandal hit’, being clear on strategy, remedy and progress for all staff is vital to restore pride, belief, and determination in the future. Senior leaders have more power here than they might assume, and fair and consistent leadership can break the mould to address organisation trauma early and head-on.

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