Psychological safety, culture and vampires: A blog by Maria Paviour

Summary

While it’s vital to acknowledge the pivotal role staff wellbeing plays in fostering high performance, as supported by extensive research, how do we translate this knowledge into conducive work environments and cultures?

From an evidence-based perspective, two factors require consideration:

• each individual's position on the mental health continuum
• neuroscience-based analysis of organisational and team culture.

This blog from Maria Paviour, an occupational psychologist, explores the significance of these factors and the importance of empowering and engaging all healthcare staff in positive wellbeing, leveraging skills and resources beyond conventional methods to ensure not only staff safety but ultimately patient safety.

Content

The mental health continuum – River of Life

Mental health is dynamic, fluctuating between states. While mindfulness and meditation are beneficial, they are often insufficient during demanding work situations. We need our minds and bodies to respond swiftly without becoming overly reactive.

The River of Life metaphor illustrates how individuals navigate the mental health continuum.[1][2] At peak mental health, challenges are surmountable, akin to crossing a bridge. Supportive measures can help individuals return to this state when feeling overwhelmed. However, without adequate support, individuals may drift downstream, struggling to stay afloat. In severe cases, they may become emotionally withdrawn. Timely human support is crucial at these stages to prevent further decline.

The culture and climate

Individual wellbeing profoundly influences organisational culture and performance, which can subsequently impact on patient safety. A team with over 75% wellbeing thrives, fostering a culture of learning and growth. Conversely, lower wellbeing levels may lead to survivalist or ethically compromised cultures.[3]

From 30 years of studying workplace wellbeing, I have identified two key components of a healthy and productive workplace:

1. Commitment – The degree to which staff are engaged on an emotional level with the organisation, not just in the work, but in the mission, values and community at a deeply personal and psychological level.

2. Resilience – The degree to which the organisational environment impacts staff personal resilience daily. This measures how individual strengths are either undermined or supported and uplifted by the organisation.

Using these measures, I have identified four different culture types within organisations:

1. The Phoenix culture – This culture has a robust level of staff wellbeing and is demonstrably psychologically safe. People feel they can act in ways that make them vulnerable, knowing they will be accepted and not judged. The group functions as a unit, driven by mission, values and purposeful work.

2. The Angel culture – This culture has high levels of wellbeing and team acceptance but little drive. Relationships are prized over organisational or customer focus, leading to low productivity.

3. The Vampire culture – Where wellbeing levels drop, the culture becomes survivalist. Behaviours focus on personal safety rather than organisational or others' safety, leading to unethical practices and an inability, in terms of cognitive processes, to effectively co-operate [4]. Staff in this culture are unlikely to admit mistakes or call out unethical practices.[5] Blame, shame, bullying and injustice characterise this culture. It is resistant to change and at high risk of legal issues if not addressed; for example, employment law transgressions, fraud, cyber crime and theft (all of which I have witnessed in these cultures).[6]

4. The Zombie culture – In this culture, people experience cognitive shutdown, hypo-arousal, hopelessness and a sense of inadequacy. This removes their ability to ‘act with free will’ and instead revert to survivalist reactions and limited cognitive capability – they can literally stop seeing anything outside a narrow range[7]. In these cultures it is common to have high levels of absenteeism and sickness absence as well as presenteeism (being at work in body, but not fully engaged of mind). This can be the result of physical or mental health issues and has a dramatic impact on productivity.[8] Decision-making, problem-solving and creative thinking are significantly impaired.[9] People may be too damaged to find other jobs, leading to a high degree of immobilisation due to fear or threat.

How can we address the issue?

One problem in wellbeing is the lack of robust data, leading to knee-jerk responses without clear impact measurement. The final proof often lies in absence numbers and financials, which are lag measures difficult to link directly to interventions.

Measuring presenteeism is also challenging, making it hard to forecast organisational risk and target resources effectively. Presenteeism results from environmental factors lowering individual resilience, causing capable individuals to become depleted in toxic cultures.[10]

The PPMA report in 2020, covering over 4,000 public sector employees, identified high levels of presenteeism.[11] This rose significantly during Covid-19, and current data from both public and private sectors reflect this trend.

Without evidence of current mental health states in the NHS, a culture of denial is developing among senior leadership, leaving employees, HR and wellbeing leaders in limbo. The risks from poor mental health at work do not disappear if ignored; they escalate, and this has been experienced in the NHS, whereby, even if not ‘ignored’ as such, the pressures of day to day management and tight budgets have made it difficult or impossible to build in effective mental health measures. This has created a cyclical problem for leaders, no matter how engaged they are conceptually. Consequently, empowering and supporting employees within the NHS, especially non-clinical, is advisable providing this is within a psychologically framework – in other words, the role of the advocate is respected and promoted and that we use Black Box Thinking,[12] all errors being an opportunity to honestly learn and change as opposed to blame and shame. This is the core of the Phoenix culture. This needs to come from the top.

Steps to a high-performing healthy culture

There are simple and cost-effective ways to solve poor mental health issues, alongside good leadership, living wages, sensible hours and decent conditions. Herzberg’s ‘hygiene factors’ must be addressed first. While working on these, measure and identify where wellbeing is compromised and support individuals preventatively.

Priority one: Middle-out – Building self-empowered communities at work

Preventative action is key to maintaining workforce wellbeing. Building wellbeing communities empowers individuals to stay healthy and engaged. Skilling employees to provide peer to peer mental health support through programmes such as 'Wellbeing 1st Responders' can play a vital role in identifying at-risk individuals and providing support, saving organisations significant resources. Empowering them with software to measure and monitor wellbeing in their small cohorts enables powerful wellbeing projects with high impact.

Top-down: An integrated wellbeing strategy and integrated HR and wellbeing data

To create a Phoenix culture, assess the current state of all staff and develop a robust strategic plan. Connecting wellbeing data to HR systems allows quick identification and support for individuals before issues become crises and can help align governance and policies.[13]

Priority two: Bottom-up – Nurturing your Forest Garden

Nurturing thriving communities requires a bottom-up approach. Using the Forest Garden model, organisations can cultivate a culture of self-empowered wellbeing. Wellbeing first responders initiate the process, but engaging staff in their small cohorts creates self-supporting communities[3] and a sense of ownership and emotional engagement at work.[14] This approach naturally results from a supportive leadership programme and an empowered base of wellbeing 1st responders in the workplace.

We use the term Wellbeing 1st Responder to describe trained non-professional wellbeing advocates who play a crucial role in our research. Other forms of community-building wellbeing support can provide similar powerful results if they are given a skills base in community building and a mechanism for measuring impact and focusing support.

Conclusion

Building a high-performing, healthy culture requires a multi-faceted approach, addressing both the immediate and long-term needs of staff and the organisation. By focusing on commitment, resilience and creating supportive cultures, organisations can foster environments where employees thrive and organisational goals are met.

Implementing middle-out strategies, such as empowering wellbeing first responders, alongside top-down and bottom-up approaches, ensures comprehensive support for employees. Using evidence-based methods and integrating wellbeing data with HR systems allows for proactive management of staff wellbeing, preventing crises before they arise.

Ultimately, fostering a culture of psychological safety and high wellbeing not only improves individual performance but also drives organisational success. By taking these steps, organisations can create environments where employees feel valued, supported and motivated to contribute to their fullest potential.

References

1. Chowdhury MR. What Is the Mental Health Continuum Model? Positive Psychology. 1 September 2019. https://positivepsychology.com/mental-health-continuum-model/#continuum.
2. Government of Canada. Mental Health Continuum Model. https://www.canada.ca/en/department-national-defence/corporate/reports-publications/health/r2mr-aide-memoire/mental-health-continuum-model.html.
3. Sbarra DA, Hazan C. Coregulation, Dysregulation, Self-Regulation: An Integrative Analysis and Empirical Agenda for Understanding Adult Attachment, Separation, Loss, and Recovery. Personality and Social Psychology Review, 2008; 12(8). https://doi.org/10.1177/1088868308315702.
4. Nene EN. A study of the relationship between anxiety and co-operative behavior. 1998. https://uzspace.unizulu.ac.za/items/5b809a3d-3dec-4e81-b244-1b4e6455c4d0/full.
5. McDonagh C. (n.d.). Stress can reduce you to a small child. Express, 2014. https://www.express.co.uk/life-style/health/543974/Stress-can-reduce-mental-ability-to-a-child-s.
6. Paviour M. The Vampire Default: And the Brain Science of Healthy Relationships at Work and Home. 2024. https://www.amazon.co.uk/Vampire-Default-Science-Healthy-Relationships/dp/0954365496.
7. Price JL. Free will versus survival: brain systems that underlie intrinsic constraints on behavior. Journal of Comparative Neurology, 2005; 493(1): 132-139.  https://doi.org/10.1002/cne.20750.
8.  Stevenson D, Farmer P. Thriving at Work: a review of mental health and employers. Department for Work and Pensions and Department of Health and Social Care, 2017. https://www.gov.uk/government/publications/thriving-at-work-a-review-of-mental-health-and-employers
9. Bergland C. (n.d.). How does anxiety short-circuit the decision-making process? Psychological Today, 2016. https://www.psychologytoday.com/intl/blog/the-athletes-way/201603/how-does-anxiety-short-circuit-the-decision-making-process#:~:text=The%20PFC%20plays%20a%20pivotal%20role%20in%20executive,PFC%20that%20are%20critical%20for%20making%20smart%20decisions.
10. Boddy C, Miles D, Hartog M. Extreme manager, extreme workplaces: Capitalism, organizations, and corporate psychopaths. Organization, 2015. https://doi.org/10.1177/135050841557250.
11. Brain States. Mental Health and Wellbeing in the Public Sector. https://www.cariwellbeing.co.uk/public-sector-wellbeing/.
12. Paviour M. "Brainy" Neuroscience for Engaged People - A Handbook of NeuroChemical Leadership (2016) Brain neuroscience for engage leaders. 2015. https://www.amazon.co.uk/Brainy-Neuroscience-Engaged-People-NeuroChemical/dp/0954365437.
13. CIPD. Emotional engagement at work. 2011. https://www.cipd.org/uk/knowledge/factsheets/engagement-factsheet/.

About the Author

Maria Paviour is a multi-award winning occupational psychologist and best-selling author who has 25 years’ experience specialising in the neuroscience of wellbeing in the workplace. Maria is also a wellbeing tech developer and through this she has provided granular data on the wellbeing of the nation and published a number of studies revealing the problem of ‘brave face syndrome’ and ‘zombification in the NHS’. Maria uses entertaining metaphors to explain the science of culture, and why we should be focusing on brain states of employees in the NHS as opposed to focusing on the failure of care – to achieve clinician and employee psychological safety in order to achieve patient safety. As an ex-NHS whistleblower, Maria has experienced all sides of the patient safety issue and has subsequently been involved in ‘think tanks’ to drive out bullying and improve NHS culture.