Imposter syndrome: how it makes NHS managers doubt their abilities

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I’ve met some truly brilliant people in my 20 years working as a leadership developer, senior manager and executive coach. People with impressive track records of delivery.

People who command the respect of their peers, bosses and especially their teams. They’ve all had their own styles, their particular strengths, and their unique foibles. They’ve delivered their impact not by following a generic blueprint of excellence but with their own brand of leadership practice that works for them but wouldn’t work for everyone.

There has however been one trait common to almost all. Almost every leader I’ve worked with has expressed a clear sense of personal doubt. They’ve expressed it in different ways. Some have said “I’m making it up as I go along”. Others have confessed a deep-seated and yet suppressed feeling that really, they’re not up to the job and will be found out any day now.

They are experiencing imposter syndrome.

You might recognise it. Despite the apparent evidence of your competence, when imposter syndrome hits, you’ll remain convinced that you do not deserve the success you’ve achieved, dismissing this as luck or fortuitous timing. Psychologists might describe the phenomenon as you failing to internalise your accomplishments, unable to believe that you yourself are deserving of the position you’ve achieved.

I say almost every leader experiences imposter syndrome. But not all – there are two types of leader that do not. The first is a mighty rare creature: a cross between a caricature of Mother Teresa and Gandhi – someone who has spent years in introspection and self-improvement, and who is “in their own skin”. Such leaders have transcended imposter syndrome and accept that they, and all those around, are simply doing their best. They are a joy to work with.

It’s the other category that you need to be wary of. These are the true imposters. They should be justifiably nervous having been successively promoted beyond their true level of competence. However, facing up to the fact that they are way out of their depth is too scary. Their denial buries their doubt allowing them to cloak their ineptitude in a suit of misplaced self-belief. Their aim is to beguile their colleagues into believing the emperor’s new clothes are more than the self-constructed projections of a very poor leader in denial. I know a couple of such pseudo-leaders, and they’re dangerous. By the way, if you read that last sentence and thought it might be you – then it’s probably not. Real pseudo-leaders wouldn’t entertain the necessary doubt!

I was asked recently whether I thought imposter syndrome was more prevalent in the NHS than other sectors. Initially I thought it was a naïve question driven by the undeserved yet frequent bashing our NHS leaders get at the hands of media and politics. Yes, I’ve seen imposter syndrome in NHS leaders – but I see it everywhere, it’s ubiquitous.

Then I reflected on the two most read and shared blogs on the NHS Leadership Academy website. The most read blog tells the story of NHS staff doing amazing work as they removed a tumour from a 10-year-old girl’s brain. Just behind in the social media engagement league table is my imposter syndrome blog, which explores NHS staff doubting their abilities. The juxtaposition of excellence and doubt intrigued me.

If imposter syndrome is more present in the NHS then it’s not because there are more imposters there. Quite the opposite. Genuine leaders populate the NHS – be they clinicians or managers – focused on patient care and engaging their teams to do the same.

However, the system doesn’t help. Healthcare is a demanding landscape to work in. At a macro level, the system applies pressure through targets, regulation, and government control. And the prevailing white noise is one of “you’re not doing well enough”. At a micro level, providing care is emotional labour, and care-fatigue is a risk for those working in a system where support, encouragement and reward are not as universal as they should be. The prevailing culture whispers to people’s doubts and feeds imposter syndrome.

What’s the antidote? At one level, it’s ever better leadership that instead of undermining people’s confidence supports hardworking NHS people in building self-belief. At a higher level, it’s changing the dominant voices in the media and politics from attack to pride. We have the best health service in the world. Let’s celebrate that fact.

4 thoughts on “Imposter syndrome: how it makes NHS managers doubt their abilities

  1. Amazing to read !! The ‘ imposter syndrome ‘ formed the thread of my reflections throughout my Nye Bevan submissions ,does it ever subside ? It actually feels like the ‘ friend ‘ who grounds me now! It’s easy to believe the rhetoric and ego stroking when in an executive position. Imposter syndrome keeps it real if it’s managed !! Friend not foe !

  2. This happens particularly when there is a lack of clarity in what they are doing. It can also be a symptom of chronic lack of reward system that exists in the NHS.

  3. How naive of me I never knew imposter syndrome existed. I was under the impression that I was lacking in confidence or ability because of my constant doubts. I will now use these doubts in a more constructive way.