At Eastern AHSN we pride ourselves on being a critical friend within the NHS, finding best practice and situations where learnings can be shared across the health and care system even when we may not have had a role in the project. Of course, the benefit of hindsight can make it easier to identify sticking points which were missed in the scoping stages, preparedness exercises and planning, even before factoring in the uncharted waters of a pandemic with the scale and duration of COVID-19.
A common issue I have seen when looking back on projects is around the rigidity in persevering with a plan, in spite of opposition and facts to challenge the realistic prospects of achieving this plan. These reflections extend beyond pandemic planning and can relate to any project or business aspiration. Drawing on my clinical psychology training, I have considered the roles of the two biggest factors I see in organisations or teams being unable or unwilling to change their plan when it isn’t working.
This is a type of cognitive bias that causes us to rely too heavily on the first piece of information we are given. Then when we are setting plans it is more normal to interpret any newer information from this reference point (the anchor) instead of seeing the new data objectively and independent of other information that we made our first judgment on. It is only natural that this can distort judgment and decision making.
For example, someone shopping for a new car might see one for sale for £12,000, which will be the anchor upon which other cars are judged. If the next car they see is only £8,000, they might view it as cheap, regardless of the actual value of the car (which is why some restaurants have a very expensive wine on the menu which they don’t expect to sell much of – it’s there to make the other prices seem more reasonable). In healthcare, those conducting family assessments are trained to avoid being too heavily swayed by their first impressions of the house and overt parental behaviours to avoid anchoring bias when making assessments about children’s wellbeing and safety.
We have an inherent tendency due to this biased way our brains work that then prevent us from updating our plans or predictions as much as we perhaps should, even when presented with new information or views. Our brains have to make leaps and simplify decision making due to the sheer amount of information they receive – not least when facing complex problems or high stress decision-making as has been seen in the pandemic.
“The pessimist complains about the wind; the optimist expects it to change; the realist adjusts the sails” – William Arthur Ward
In leaders we generally admire them communicating a firm aspiration or vision. It’s not ideal to see them waiver between options or give up at the first sign of resistance. Perseverance, defined as “continued effort to do or achieve something despite difficulties, failure, or opposition” is generally seen as a positive attribute in leadership. But when does perseverance turn into perseveration – the unhelpful continuation of something, usually to an exceptional degree or beyond a desired point?
Given these powerful processes (which are going to be strongest and most rigid when people are in pressured situations), I have begun to think about how to encourage leaders to think and plan flexibly at times of significant pressure:
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I oversee the delivery of Eastern AHSN’s national programmes from NHS England and the NHS Accelerated Access Collaborative. My portfolio includes oversight of local projects supporting the NHS recovery from the pandemic and localised challenges for health and care partners. I work closely with NIHR East of England Applied Research Collaborations (ARC) and I’m the NIHR Mental Health Implementation Network team (MHIN) co-lead for implementation of evidence-based solutions at a national level.
I have held numerous strategic NHS roles since qualifying as a clinical psychologist. I was the regional lead for the national dementia strategy before taking up a patient safety and safeguarding leadership role at NHS England. Through being part of large-scale change programmes as well as after action reviews I have seen patterns of decision-making and the commitment to a vision when perhaps counter information becomes available as a programme of work develops.
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