Developing leadership by managing unconscious behaviour

NHS leaders need to understand more than they currently do about unconscious processes. Twentieth century psychology familiarised us with the idea that, beneath the surface of the rational mind, unconscious processes drive a good deal of human behaviour.

Yet, it is almost as if they were a taboo in development programmes. But this misses a golden development opportunity. When leaders are helped to understand and manage unconscious processes they start to forge more productive relationships and collaborative leadership across the NHS.

The best known of the unconscious defence mechanisms is denial, which keeps anxiety at bay by excluding certain thoughts and feelings from consciousness.

Closely related is projection, by which I ascribe to someone else feelings that are actually mine. For example, a senior manager was too anxious about his competence to face up to it. Unconsciously he split off his feelings of incompetence and projected them on to his team.

The power of unconscious processes is that they work like a self-fulfilling prophecy. The team became incompetent. He then complained the team were useless, dependent and that he had to do everything. As he learned to acknowledge his own anxiety he trusted his team more and their competence returned.

It is particularly dangerous to ignore these unconscious defences during times of transition and downsizing. The disruptions to teams and human relationships in an already stressed environment trigger even higher levels of uncertainty. They affect those involved by creating a difficult work atmosphere with high levels of sickness, absenteeism and subtle sabotage. Left unattended, they precipitate the opposites of engagement, collaboration, partnership working, integration and increased staff motivation.

While this neglect prevails, talk of distributed leadership will remain aspirational rhetoric rather than reality. Leaders simply have to gain some understanding of how unconscious processes play out in organisations. There are some good ways to make more sense of them in the service of developing more effective leaders.

At the King’s Fund, the top manager and leadership for senior managers programmes are designed to help leaders gain insights into the world of the unconscious and how it touches on organisational life. Up to 36 participants take responsibility for their own and each other’s learning in a temporary learning community. This enables an effective balance of challenge and support from peers. We find it can massively increase confidence and transform leadership behaviours.

The programmes emphasise a whole systems approach to leadership, which entails very strong facilitative and communications skills and acute self-awareness. Experiential activities and group work allow participants to explore team dynamics, including unconscious processes. They find themselves having disclosure moments – showing them what they didn’t know they didn’t know.

For example, participants discover the power of increased awareness of feelings to help them think. They discover how to employ their imagination and creativity. They spot the limitations of analysis and logic to provide solutions. They learn to see with new eyes.

Behind the mask

Courses like this achieve their aims primarily through the depth of the work in groups. These sessions have no agenda and no chair. The purpose is to learn from what happens as it happens in the here and now. When I start to notice feelings of frustration, anger, pleasure and so on, and connect with what triggered them, it’s like taking a compass reading on what’s going on inside me. I become acutely aware of my own and others’ responses.

I start to discern what masks I put on and what manipulative games I play. I start to know what it’s like to “be on the receiving end of me”. I discover how flawed my assumptions often are and how prejudiced my judgements. Slowly, I start to see through my defences and catch a glimpse of how my unconscious impulses are driving me.

A modest increase in awareness and emotional intelligence can result in exponential improvement in synergy back at the workplace. This improves team performance within and across organisations. These are precisely the skills required to make the quality, innovation, productivity and prevention programme a reality. In an evaluation of the 2010 top manager programme, one participant stated: “The whole programme was one big lightbulb moment to me. It gave me a new lease of life. It reinvigorated me with confidence and motivation to maximise my career potential for the NHS.”

Cost savings can be quite direct. One participant cites a reduction of “almost £2m”, where increased confidence and facilitation skills enabled collaboration to achieve consensus about ward closures. Savings also come via increased ability to challenge, delegate and build relationships enabling better engagement, negotiation and more win-wins. For example, an inter-organisational pathway redesign project that “turned the whole model of care upside down”, enabling patients to be involved in their care plans and assessed more quickly, saved “£1m last year and £1.2m this year”.

Unconscious processes are mostly neglected in leadership development, but the pay-off for rising to the challenge can be better patient outcomes and direct cost savings.