History’s lesson on the toxic power of fear

Over recent weeks, so many of us have been gripped by watching the fantastic television series based on real life events, Chernobyl.

The tragic and inevitable unfolding of the completely avoidable events in reactor number four on 25 April 1986 makes compelling viewing. The subsequent management of the nuclear core meltdown disaster recovery led not only to thousands of deaths but directly to the dismantling of the Soviet Union.

The culture of fear in the control room at the time the early morning test was taking place in the power station was clearly the main driver behind the explosion.

A lack of questioning of the test procedure, confusion over which written instructions to follow (those with a line through them or those unmarked on the flowchart) and a fear of failure and subsequent recrimination if the test was not completed on time led to one of the biggest global disasters and the end of the regime for a world superpower.

The irony was that the risks people wanted to avoid were exacerbated, not mitigated, through a culture of fear

The team in the Reactor Four control room were not a team. Nobody wanted to be blamed if the test was abandoned and the most junior engineer was made to carry the can. Everyone was ruled by fear, by group think and rational, logical questioning was dismissed outright and ridiculed. Fear paralysed their ability to think straight. The irony was that the risks people wanted to avoid were exacerbated, not mitigated, through a culture of fear.

As a newcomer to the NHS from the world of local government, I find it fascinating and eye-opening to see differing cultures that permeate organisations and in system partnerships.

Fierce but calm focus

In Bolton Foundation Trust and Bolton as a place we have a very different culture from the normal leadership culture. Doctor Jackie Bene, Bolton FT chief executive, is a truly inspiring organisational and system leader. Her quiet, Intelligent, humble, person-focused questioning leadership style has permeated the organisation from top to bottom.

She is a trusted leader in the Bolton system who leads on integrated neighbourhood working across the whole partnership including police, social care, housing and voluntary sector.

Similarly nursing director Trish Armstrong Child has the same fierce but calm focus on quality, not achieved through blame and fear, but by building a questioning culture where people feel safe and supported to speak out, where differing views are not only acceptable but actively sought and promoted. This honesty and humility is at the beating heart of the organisation and its values and is the reason the trust was rated Outstanding for Leadership by the Care Quality Commission in April.

It’s so brilliant to come into an organisation with teams of executives and non-executives who have built this positive, accountable and creatively challenging culture in reality, every day on wards, in community centres, in people’s homes, in real life.

The ‘super stranded’

We see on the twitter accounts of some NHS and council system leaders their promotion of trendy relational models based on kindness, humanity and trust but we know in reality this doesn’t exist in their own organisations.

Top down, competitive, fear and blame driven sovereign cultures exist and positively thrive in many teams unchallenged. The modelling of these behaviours in real life not just on social media is harder to do in reality in a world of “never events”, “near misses” “stranded patients and super stranded patients” and the four hour target.

Fear in all organisations is as toxic as nuclear fallout and creates the conditions for bad decision making that harms patients and communities. Getting locked into the old familiar blame triangle of persecutor, victim or rescuer rather than coach is something that happens so easily but we have a really exciting model here built on humility.

Donna Hall CBE is chair, Bolton Foundation Trust and the New Local Government Network.