From helpless to helpful - let's get proactive about great care.

However! The theory of helplessness being learned turns out to be a furphy. One of the original researchers in this area, Martin Seligman, has taken another look and concluded that learned helplessness is ‘the default mammalian reaction to prolonged bad events.’ So, staff who have been bullied,  managed by strict command and control managers, or constantly discouraged from excelling or contributing their ideas, over a prolonged period, may suffer ‘passivity and heightened anxiety’ because it seems it is the human condition to retreat in the face of these situations, for the purpose of self-preservation. So not so much learned, but automatic.

Feel a bit helpless now to do anything about helplessness?  Fortunately there is some good news as well.  The later research also gave some substantial clues on how to re-wire helplessness.  Apparently, hope is the kryptonite! Some people are naturally hopeful and optimistic and so avoid falling into helplessness, even when they experience situations where others succumb and give up.

But we don’t have to depend entirely on people’s internal optimism to overcome mediocrity. We can make a decision to actively cultivate hope in people to short-circuit helplessness.  Managers have the power to show that there can be a better way, or day, and that staff are valued contributors to making this happen.

These are salient lessons in the context of leading quality, and fit nicely with other related research that tells us that job satisfaction is reliant on staff feeling their role allows them to experience purpose, meaning, mastery and autonomy and acknowledgment.  Apparently the drive to create meaningful connections by helping others is also a key motivator, which should give us a significant advantage in healthcare, but clearly, we’re not yet using it to its full potential. It seems that helping staff to build these drivers into their roles will repay leaders in spades: less helplessness, more proactivity,  better care.

But take a look at these role characteristics.  Each of them presents a challenge to the hierarchical and command and control human services environment.  I’m reminded of the many conversations I’ve heard in health services over the years when it comes to supporting staff to provide good care. Purpose: shouldn’t they know what their purpose is and get about it?  Meaning: they get paid, don’t they? Mastery: no, we don’t want them to use their improve their skills or use experience and judgement – something might go wrong. And who do they think they are, anyway?  Autonomy: they can’t just do what they like! I’m the boss! Acknowledgment: they’re professionals, why do they need a reward?

These conversations demonstrate a stubbornly persistent old school view of how organisations should work. But if this were the ideal organisational model for providing care, we wouldn’t have the problems we do. Command and control creates a whole lot of unmotivated staff and learned helplessness, blocking the initiative and proactivity required to create great care every day.  So the very changes that will support great care are those that are the most threatening to the current management mindset and processes.  Where managers feel confident enough to provide these conditions for their staff to thrive, so does care. Where they’re not, it doesn’t.

With research consistently demonstrating the efficacy of supporting staff to thrive, not just survive, perhaps it’s time for this to become a key tenet of improving care safety and quality.  Supporting these changes will require quality leaders to shift their own mindset and skills, and those of the managers around them.   Not an easy task!  But it’s an essential step in our pursuit of great care.  So much effort goes into developing new protocols, standards, systems and training, but not so much into the people who must work with them.  In the end, staff belief in their contribution to creating greatness may be a missing link to improvement success.

Isn’t it worth putting a little effort into developing this as well?