How to Tackle Toxic Environments
Updated: Sep 26
Driven to tears, this person confided in me her day-to-day struggle of working in a toxic environment. Her revelation was heart-breaking, and her words impacted me so much I felt compelled to write about this.
Over the past 25 years, I have worked in private and public organisations, big and small. For the most part, I have enjoyed my time immensely. But, unfortunately, there have been organisations and contracts while self-employed that I have chosen to leave, due to what I felt was a negative and, at points, toxic organisational culture.
Organisational culture can be hard to describe, but when negativity or toxicity sets in, it is impossible to deny.
Why am I interested in this? At THC, it is our mission to influence positive change in Primary Care. But, when we are faced with a toxic environment, trying to deliver a meaningful change initiative can feel impossible.
Projects ultimately fail if they are not built on a firm foundation. Your staff will leave. You will waste money. People become ill and risk their financial stability, and, in the case of healthcare, patients will unnecessarily suffer. We are all aware of the Mid Staffordshire Review and the death of Baby P.
Last this summer, NHS Improvement published the Interim NHS People Plan, which documents the ambition to make the NHS a better place to work. This feels like the right time to build on the discussion of organisational culture and leadership which is taking place right now.
Getting Started | A collaborative effort
The topic of leadership and organisational culture and behaviour is huge, so I put a call out on social media to ask my followers and associates, as well as my own team, for their thoughts on toxic organisations. I asked them:
I was overwhelmed with responses, and I would like to personally thank those who gave up their time to share their stories and help me with what’s probably the most important blog post I have ever written.
To respect confidentiality, the identities of contributors will be kept anonymous.
Toxic organisations | How does it start?
Toxicity starts subtly.
Gradually, an organisation's values and morals seem to drift from your own, and from what the organisation used to be.
The gradual nature of the change and the slow realisation that there's a problem makes it especially hard to spot. There are often grey areas, making it possible for issues to disregarded as people make a move to protect themselves and justify their actions. This is where doubts start to creep in:
Communications become distorted. Blame needs a host and sometimes, unintentionally, well-meant conversations turn into gossip, which then festers.
The gradual drift of values means it often takes the situation to becoming extremely toxic and unmanageable for colleagues and personnel to finally feel it and see it for what it is.
A toxic environment can also result from increasing pressures, targets, bureaucracy, increasing obligations, increasing workloads, constant change or a significant event.
Toxic Organisations | How does it continue?
Contributors shared: “It starts at the top and trickles down; encompassing fear, groupthink, dogma, ego, inadequate HR, otherwise known as lack of positive leadership.”
When it comes to fear: “as soon as there are obvious repercussions for disagreeing (from a look to a harsh word, to formal action), the majority of people just keep their heads down, and the toxicity can continue unchallenged” (Anon Contributor).
Toxic Organisations | What does it feel like?
Contributors shared that a toxic organisation feels:
How to manage it if you make the choice to stay?
One contributor told me how they wrestled with the decision of whether to stay or go:
“I think that you have to look inside yourself and decide what matters most to you. For plenty of people that will be job security, so they will choose to keep their heads down and start looking for another job elsewhere.
“Feeling that you have the confidence and power to take a stand is difficult for all of us and will feel frightening as there may be a personal and career cost. For me, the confidence to push back has come from a number of places, and I am lucky to be in the position to do so. These were due to:
Knowing I am respected by my organisation's stakeholders and will be listened to if I blow the whistle
The confidence in myself to find another job
Taking active steps with my partner to put us in a financial position whereby we can survive for a few months without me working
The strong support of friends, family and a few colleagues, who all agree that the problem is the organisation, not me!
“Those things taken together have empowered me to stay and push back, from the position of strength that I can resign any time I like and that a resignation on a point of principle would be supported by those around me. Most people, unfortunately, don't have that luxury” (Anon Contributor).
How to fight/ change it?
Contributors pointed me to policies and legislation:
1. Health and Social Care Act 2008 | Regulation 20 – Duty of Candour
The intention of this regulation is to ensure that providers are open and transparent with people who use services and other 'relevant persons' (people acting lawfully on their behalf) in general in relation to care and treatment. It also sets out some specific requirements that providers must follow when things go wrong with care and treatment, including informing people about the incident, providing reasonable support, providing truthful information and an apology when things go wrong.
The Care Quality Commission can prosecute for a breach of this regulation and can move directly to prosecution without first serving a Warning Notice.
Published by the NHS in 2015, this review was set up in response to continuing disquiet about the way NHS organisations deal with concerns raised by NHS staff and the treatment of some of those who have spoken up. In 2016, Freedom to speak up: raising concerns (whistleblowing) policy for the NHS was released. This is a national integrated whistleblowing policy that will help standardise the way NHS organisations should support staff who raise concerns.
These policies set the standard of what is and what is not acceptable and a framework for managing concerns, but we know that it takes positive leadership, commitment and investment to create, maintain or rebuild a positive organisational culture.
The NHS Interim people plan cites that:
Its everyone’s role
Although culture starts from the top, it is everyone’s responsibility to uphold, create, support and maintain a positive work environment for the sake of the individual, their colleagues and patients.
If a toxic culture is too strong to influence despite the support from others, policies and legal protection, our health and wellbeing must prevail, and we must protect it for ourselves and our families.
That said, we are likely to underestimate the impact we can have, and it’s worth remembering that:
Our voice has the power to impact many, but we must be brave and have the confidence to lead by example and speak up.
Tara has an MBA in Healthcare Leadership and Management, published in the London Journal of Primary Care and hosts The Business of Healthcare Podcast.
Tara has written blogs for the NHS Confederation, appeared on the General Practice Podcast and the You are Not a Frog Podcast with Dr Rachel Morris.
A mother of 3 children, working with healthcare professionals is not just a job for her, it's part of everyday life. Tara’s youngest has Type 1 Diabetes and her middle child has the kidney condition, Nephrotic Syndrome. She has developed a huge passion for helping others to deliver excellent care.
Find out more about THC Primary Care and follow her on Twitter.
Tara is the MD of THC Primary Care that provides:
Interim management to Primary Care Networks
Training to PCN Managers and Coaching to PCN Clinical Directors
Facilitation to primary care teams