In praise of disloyalty

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Loyalty is such a powerful term and a deeply held value amongst many in the NHS. I would like to offer a counter view. I spent some time yesterday with a fabulous director of HR who ranted for around an hour about the incompetence and poor behaviour of his chief executive. At the end, he thanked me for listening and said it was great to get that off his chest since there was no-one else he could talk to about it. He thought it enormously disloyal to share any of these doubts or criticisms about his boss with his team and his colleagues. It made me consider how disabling this is, and what unintended consequences we face as a result.

My husband has a habit of giving very open feedback to people who gather at the top or bottom of escalators, or speak in quiet coaches, or cut in front of him in their car. ‘They need to know’ he’ll say as he bellows ‘idiot!’ out the window and I slink under the dashboard. But he’s got a point, how will we ever change our behaviour if we don’t understand the real impact it has on others, and how do we know what that impact is unless people let us know.

Conversely what is the impact if there is some huge collusion about not speaking out in danger of being disloyal? I am no fan of deference to hierarchy, and can point to the times in my career where that has had an impact. I do believe in treating people with respect. But in terms of integrity I think we need to reassess our priorities here: loyalty to those in senior positions to us, or congruence with our values and behaviours.

Of course there is a way of doing this well and with positive intent – my husband could do with some development about his feedback approach. But credit to him to giving the feedback directly to the person in question. That’s important of course – well intended elegant feedback is crucial, whether you are speaking to those in positions of authority or not. Everyone deserves that respect. But having raised your concerns is it then a requirement of you to back people up if they continue on the path they have chosen – doesn’t that make you complicit in their behaviour? And how many people have risen to positions of power with everyone around them knowing their faults but no-one speaking out? Then they suddenly come to a crashing end and the only one surprised is them – we all knew they were going to come to a sorry end but didn’t admit it to them or anyone else.

We may choose to justify this behaviour with a cloak of professionalism, but if we are defending to our staff, a boss demonstrating indefensible behaviours, then we are complicit aren’t we? And they either believe us, in which case we are perpetuating the problem, or they know we are defending something we think is indefensible in which case why would they ever trust us again? And of course it’s the organisation which suffers and, in the case of the NHS, this means our patients and staff.

I am not talking about whistle blowing here – I think that’s a different issue. This is about honesty about your perspective on someone else’s choices and behaviours. That’s a much greyer area. Interested in your views – as my husband might say – ‘I need to know!’

15 thoughts on “In praise of disloyalty

  1. I ran a session on just this topic yesterday for 25 senior and middle NHS managers, looking at the skills of compassionate management in the context of Francis and how to use feedback with bosses, peers and subordinates (horrible word) to ensure that compassion and care are every bit as much a part of the performance equation as other targets.

    A word that kept coming up was courage. The courage necessary to provide constructive feedback. Perhaps Francis will eventually change the context so that it requires more courage (or stupidity) to squeeze compassion out of the system in pursuit of ‘productivity’. However we need to reflect on why it is that something that should be an absolutely non-negotiable value in our service has become a commodity that can be emphasised or not according to our contractual and legal operating frameworks.

    Once we start to depend on getting legal and regulatory frameworks to drive desired behaviours then I can’t help but feel we have taken a very wrong turn. We do the right thing because it is the right thing. And determining the right thing needs to be a product of the expression values and cultures – not compliance. Perhaps.

  2. Thanks Karen for your honest post. I was going to reply along the lines of “yes – people should speak out more and let their leaders know what they think”. But then I started to think (like you) about how I do (or don’t) handle these things in my personal life. And I thought about how I would deal with challenging my dad.

    I remember the first time I ever challenged my dad – when I was about 16 – over his objections to a boyfriend of my sister’s. His reaction was totally dismissive – and I was very clearly told not to get involved. This led to a frosty relationship between us for some time after that – and I never challenged him again (for a long time).

    I have reflected on that “discussion” numerous times since and realised that I approached it at that time in totally the wrong way – and had given very little thought to his perspective / concerns at that time (i.e my sister’s safety / welfare / reputation etc). I was simply “standing up for my little sister” – and got carried away on the emotion of that (I suspect).

    We have both matured now and we can have a sensible debate – even argument – and we will both respect each other’s views – even if that means (at the end of the day) agreeing to disagree. But at least we acknowledge that we disagree – and both uderstand this.

    The point I think I’m trying to make is that (in my experience) there is a very patriarchal / matriarchal culture in the NHS sometimes (especially within hospitals) – which I think can lead to these sorts of behaviours being played out (in varying degrees) by managers and staff. I think me and my dad have a better relationship now because we are both a bit more emotionally intelligent than we both were back then – and that for me is where the key lies. We need to make sure our leaders / managers are emotionally intelligent enough to be able to deal with challenge from their staff (and – ultimately – patients) in a way which genuinely respects that challenge. Equally, we need to make sure that staff are encouraged to develop their emotional intelligence so that they can challenge appropriately and accept if that challenge is resised or rejected.

    Not an easy one by any means – but workshops like the one described by Mike above are a step in the right direction.

    1. Thanks for the comment, sorry I haven’t replied earlier. i think your comments are spot on and it is about maturity, I hope our programmes provide some support, but i think you can tell from the responses here that this is such an issue for people. Maybe it is a bout working in an environment that is so much about our own values, that having them crossed is such a significant challenge for people

  3. Thanks for sharing your stories – common ground for many people in organisations I think?
    It raises lots of questions for me about the focus of leadership development in the NHS. Some of these are around how we might explore the sorts of cultural or organisational ways of thinking and responding that you describe here – whilst the stories are familiar, the understanding of why this occurs is often avoided.
    There are lots of bigger questions about why a Trust might be unable to have a conversation about challenge and openess, what behaviours are sustaining that, and so on – and questions for leaders about what sort of ‘leadership’ practice is it that avoids this territory. These are big and difficult areas to inquire into of course. I agree courage and choice of approach are really crucial, and so might be our desire to explore with colleagues the difficult stuff, the avoided questions and the values we put to one side when under pressure?

  4. At our health service in Australia we are teaching ways of ‘speaking up’. The Harvard simulation group have taught us the ‘2 challenge rule’ which could provide a respectful basis for giving such feedback to senior executives. The two challenges are questioning with genuine curiosity (I haven’t seen this approach before. I’m interested to know why…..) and then, if you aren’t satisfied with the response, questioning with concern (I’m really worried that this approach could have negative consequences, can you explain why you think it will work?) in the clinical situation, if there is serious concern, you would call for help!

  5. I agree courage, curiosity and concern are all great ways to open a discussion / debate and express a different view. My observation of working with senior people in the NHS is the lack of confidence and skills in giving and recieving feedback. I find a parent – child culture very prevalent – often termed paternalistic /maternalistic. I would like managers to treat each other like adults and feel confident in their own skills to give feedback (with positive intent) and also confident in the skill of the person recieving the feedback to be able to recieve it well. I fully support more investment in these crucial and often neglected skills.

  6. Thank you for this honest and thought provoking viewpoint. I completely concur with what you say and understand from both personal and professional experience how difficult the challenge of getting heard can be in these type of situations. Political correctness is the most damaging aspect of communication in my opinion. Too much energy and time is spent on trying to work out how, where, when and if taking the risk of saying it as it is, is worth the potential consequences. Personally , I am possibly too forthright and have been bullied, challenged and reprimanded for speaking my truths in the best interest of patients and staff. I have however survived and continue to err on the side of what I can live with in any given situation. I have a rule that I must follow for myself, If it interferes with my sleep then I must find a way to confront what is disturbing me. On the positive side, although in the minority of cases, I have benefitted from the humility of others who have been prepared to listen. Courage, confidence and knowledge are the basic requirements of any professional in a leadership position. All too often, these are not evident. I wish I could say that the findings of the Francis enquiry would enable a change in the culture of healthcare, but I am very doubtful. How much evidence of change was seen as a result of the Bristol scandle?? 10 years after the report was published Professor Sir Ian Kennedy provided an update which in my view was very powerful in that there were critical areas of recommendations which had not been taken on board. Amongst these, is leadership, and culture change. Beating the same old drum, I am afraid!!

  7. Thanks all for your comments and stories. Giving feedback in a way which is really constructive, with positive intent and at the right time is so important. I think Mike’s workshop sounds spot on. There is the other issue though – what do people think of that: assume you have given feedback to the person in question and done that well and their behaviour continues to be poor or their performance inadequate, are we required as professionals to only speak positively about them to other people, can we openly critiscm our boss to those who work with and for us? Is that ever acceptable or always disloyal and unprofessional?

  8. A very interesting article, topic and thread. In the NHS it does take courage, integrity and contact with people. Without these qualities it is impossible to lead to obtain positive outcomes. It is a great pity that the top NHS leadership often forgets this. The exit from the NHS is often engineered for those with the traits that are so essential to graet practice.

  9. Is disloyalty ever acceptable? Absolutely. Few would contest the right of a soldier under a dictator to be disloyal to an oppressive regime by removing or somehow disassociating themselves from it. But should you simply walk away, or stay and try to fix it from within?

    My personal view is that this is an issue of integrity which, of course, will often require the moral courage suggested by earlier posters. If I feel that something is unacceptable, whether from superior, peer or subordinate, then I must have the integrity to challenge it. If I fail to challenge it then I clearly have insufficient conviction about the issue’s importance and I believe I forfeit my right to whinge about it to anybody (except perhaps my long-suffering partner).

    However, I believe it is the responsibility of everybody in an organisation’s hierarchy to have challenging adult conversations with their bosses. Without challenging things, how will the organisation develop to its full potential? How will unintended consequences be identified and avoided? How will the issues of those at the coalface be represented to those on the board – for the benefit of both parties and the organisation? Only by everybody pulling together as a team will any organisation truly achieve maturity and this is where it is so important to have a positive organisational culture.

    So, what about when you have challenged something and no change is forthcoming? Well, we come back to integrity again. Clearly no single answer will suit every situation, but possibilities range from ‘at least I had my say and raised their awareness’ to ‘please accept my resignation’ or reporting it to the relevant authorities. There is always a way to escalate an issue if we feel strongly enough about it. But how strongly do you need to feel about something before your happiness / career / mortgage gets put on the line? Each of us needs to make that assessment and (as a previous poster said) decide whether we can sleep with a clear conscience at night. Sadly, some appear to sleep with alarming ease, but I have done my best to inculcate in my family and the workforces I have been responsible for that it is not enough to stand by and watch. We must all act. We must all take responsibility for the part we have to play in making our environments better. Every day.

  10. Great discussion. Great leaders encourage feedback of all kinds, good and bad. If you don’t know what people really think, or block this out you can’t address it, and this sets up an environment where good people go elsewhere. The key word for me is integrity.

    …or am I being too simplistic?

  11. Really interesting blog and comments. We have worked really hard to normalise the use of feedback and i believe as a leader it is my responsibility to ensure i create a safe environment in which feedback positive and developmental can be given. We have open discussions about reflection and giving and receiving feedback with positive intent and have moved on to start looking at peer feedback facilitated through the team leader as part of the PDR process. I am struggling though with one scenario where an individual wishes not to engage as they are overcome with fear at the thought of not being aware of something they may consequently become aware of. My attempts at reassurance and unpicking the concern have so far failed. Reflecting on some of the comments personal values and past experiences clearly play a key role in both the giving and receiving of feedback.

  12. After going through a very difficult suspension and disciplinary procedure, for something which MAY have been seen as being derogatory against the trust I worked for, I ended up resigning. I had previously a 33 year unblemished career.
    I had been subjected to persistent bullying for two years ,by a matron who I felt had very poor clinical and leadership qualities. When I raised any concerns about patient care, staffing or the competency of certain staff, I was made to feel I was the person at fault. My allocation, management skills, ability to manage stress where all questioned. I went off sick for a short period due to work related stress. When I returned to work I went to OH and raised concerns about the individual. I had a stress risk assessment with the now DON and told them everything about the bullying and the impact staffing had on the safety and care of patients. It was all put down to a clash of personalities. Mediation took place and the bullying continued for another 14 months. I was not the only person who voiced concerns about patient care and safety…however I was probably one of the few that spoke out.
    My mother died suddenly last year and after a short period of sickness I returned to work, 6 weeks later, just before a night shift I was rung by this person and told I had to come in to work for a discussion, I refused and when I said If I did come in I would want my union rep with me I was told NO. I was seen when I went on duty that night and told I was being investigated…I was so upset I naturally spoke to my “friends / colleagues” when I went on duty. I was suspended the next day…they call it exclusion to protect the investigation. I had worked almost 20 years in that trust, I have only spoken to about 6 people since that time, apparently people were told they where not allowed to contact me. I will not go in to the investigation, as far as I’m concerned it was farcical. The point I want to make is, during the most devastating period of my life, my mother had died, suspended from something I loved and was born to do. I was excluded from everything I was familiar with, I was isolated and alone….people I asked for help from ignored me. Sometimes I wonder how I got through it….then I thank god for my family and the few people who remained in contact with me and gave me the strength to carry on. I think I have been very naive, I’ve always thought policy, procedures and documentation was there to benefit the staff….that’s not entirely true. I think my experience has shown me it is actually used to protect a poor and corrupt management culture, poor leadership, hide poor care, promote bullying and breeds fear in staff.
    I have now left the trust and have singed a confidentiality clause, the rumours are I left because I was ill, or I retired. This is not true….I could not work in an environment were it is acceptable to lie, bully, ignore, isolate and tolerate poor care. I no longer trust people and will probably be unable to be the nurse I once was.

    1. Thanks for sharing your powerful story and I am so sorry you have had such a distressing time. It underlines everything that has been said here about integrity and courage, these really aren’t simple ideas to tackle, nor easy problems to solve. But it is important to keep the debate open and create a space to have these difficult conversations. I wish you well.