Category Archives: Management


WHO 2019 definition – occupational experience characterized by:

  1. Exhaustion (feelings of energy depletion)
  2. Cynicism – increased mental distance from one’s job, or feelings of negativism related to one’s job
  3. Reduced professional efficacy

The MBI-Human Services Survey (MBI-HSS) was published, followed by other versions, including one for teachers and one for medical personnel (MBI-MP). Gives scores for each of the 3 fields. No cut offs, just a continuum, although higher scores across all 3 would clearly fit with the WHO definition.

Attempts have been made to use the tool to then define or screen for burnout. But WHO never called it a disease or disorder, but “a legitimate occupational experience”.

Better to talk about the actual feelings – Overextended, Ineffective, Disengaged – cf Engaged – high scores across all 3 fields.

Organizations should not use the MBI in isolation. Other tools exist such as Areas of Worklife Survey (AWS), which looks at workplace culture in terms of workload, control, reward, community, fairness, values.

[Harvard Business Review 2021]

Burnout Assessment Tool (BAT)? 2 forms – core dimensions and secondary dimensions.

Confidence as a doctor

As a doctor, you want to feel confident in your abilities and your diagnosis, you certainly don’t want to question yourself constantly. Equally, your patients want to feel confident that you know what you are talking about, and will probably get better more quickly if they do (placebo effect).

Most people can smell bullsh*t from a mile off if you try to say something you don’t actually think or believe. Typically, your words (vague) and body language (evasive) will give you away.

At the same time, the over confident doctor is dangerous. Arrogance is also very unattractive. So there is a balance.

What do we mean by confident?

Confidence is a sense of belief in one’s own abilities. But of course you can have a strong belief in your own ability when you have no talent at all. So the kind of confidence we want to have is probably the sense of certainty that you can do something reasonably well, even that you can then do it without really needing to think too much about it at all.

It isn’t a character trait! And of course there isn’t such a thing as a “confident person”, because it depends on the skill being considered. Great athletes can be terrible public speakers, for example.

How do get more confident?

It’s cultivated by early childhood experiences of course. How were you encouraged to think about your own efforts and abilities? But no reason you can’t gain in confidence, or at least make your confidence commensurate with your competency. Some people may have more baggage to deal with, of course.

So first step must be to gain competency – which means understanding the basics, practising the skills, and recognizing when things fall outside what you have seen so far. Repetition is key, clearly.

Secondly – if you feel you are straying outside your comfort zone, is there any way to get more information? Do you have notes you can check? Do you know which are the best resources? Do you have a person you can ask safely?

Thirdly – can you see what factors are hindering you from performing at your best? Tiredness? Distraction?

The story you tell yourself

Of course you are not perfect. You will make mistakes. You will forget something. You cannot know everything. But is there anyone other than yourself who expects otherwise?

So rather than concentrating on the negatives (which is probably natural, given that in the evolutionary survival game, you really don’t want to end up wounded, poisoned, lost or dead as often as you get lucky), can you tell yourself that you are ready for this, that you are trained for this, you have worked for this, you work reasonably well in almost all conditions?

That mistakes do not cancel out everything you get right the rest of the time?

Although there is a time to be self critical, there are definitely just as many times if not more to be self friendly, and this can be hard for us if never modelled.

You need to practice positive self affirmations, if you want them to count when under stress. Confidence is like a bank balance that needs constant deposits. List the things you have done well in the past. Spend time each day reflecting on what went well. Spend time looking ahead and envisioning where you want to be. This should be the movie playing in your head.

The “shooter’s mentality” – any missed shot is a temporary slip, and just means the next shot will be successful. Any successful shot confirms that you are on a roll of consistent success.

And how do you think of other people’s success? Do you always equate confidence with arrogance, laziness, complacency?

Stand up straight with your shoulders back

Rule 1 of Jordan B Peterson’s 12 Rules for living.

“Standing up straight with your shoulders back is not something that is only physical, because you’re not only a body. Standing up means voluntarily accepting the burden of Being. You see the gold the dragon hoards, instead of shrinking in terror from the Dragon. It means deciding to transform the chaos of potential into the realities of habitable order. It means willingly undertaking the sacrifices necessary to generate a productive and meaningful reality.

“People, including yourself, will start to assume that you are competent (or at least they will not immediately conclude the reverse). Strengthened and emboldened, you may be able to stand, even during the illness of a loved one, even during the death of a parent, and allow others to find strength alongside you when they would otherwise be overwhelmed by despair.

“Then you may be able to accept the terrible burden of the world, and find joy. Look to the victorious lobster.”

See also the benefits of the Superman pose.

The cherry on top

Put in the work – the studying, the practice, the questioning, the reflection.

Then decide to tell yourself – “I’ve done the work. I know what I need to know. I’m going to deliver now. I am enough for this time and this place.”


Leadership is not the same as management: yes, it’s about people and systems and getting things done.  But it’s more about inspiration, long term goal setting, encouraging people in their own journeys.

Can all be a bit alpha and masculine.  Yet lots of evidence that a compassionate style is more effective.  Study by Jonathan Haidt (New York University) shows that if employees are moved by the compassion or kindness of their leaders (a state he terms elevation), the more loyal they become to him or her, even if it isn’t directed at them personally.

We are especially sensitive to signs of trustworthiness in our leaders, and react strongly to “arsehole” behaviour.  

Not only does an angry response erode loyalty and trust, it also inhibits creativity by jacking up stress levels. Positions of power tend to lower our natural inclination for empathy, so it is particularly important as a leader to be self aware, and actively practice seeing situations form their employee’s perspective.

Key challenges – junior doctor training, MCNs, HEAT targets, centralization vs local demand.  Opportunities: improvement, efficiency.

Circle of influence (Steven Covey) – small subset of circle of concerns.  Note potential for stress and disillusionment in face of concerns, at time of need for motivation and creativity!  Always potential for extending circle of influence…

SWOT analysis: strengths, weaknesses, opportunities, threats.  Build on strengths, mitigates weaknesses, capitalize on opportunities, tackle threats head on.

To maintain trust and confidence – stay in touch, know your people.  Have a common platform rather than being seen as separate.

  • Direction and purpose – conflicts?  Wrong activities?
  • Align systems/processes – bureaucracy?  Slow processes? Going through the motions?
  • Know the people – do they say what you want to hear rather than being honest?
  • Release potential – and frees up your own time!
  • Influence and communicate – perception does not always equal reality

Transactional vs transformational styles:

  • Problem solving                   Coaching
  • Power based authority                        Influencing but no authority
  • Conservative                           Creative
  • Lack of growth                       Woolly
  • Work harder as philosophy     Change for change’s sake
  • Vulnerability to change
  • Thorough
  • Safe

Vision – relevant, strategically worthwhile over years, concordant – should stretch capabilities and self-image

Determines Mission: standards and values

Then in turn Goals (organisational), Strategies, Action plans

Having the broader goals and strategies helps services align, and allows stepwise change within a comfort zone rather than radical revolution with panic

SMART Plus objective – specific, measurable etc Plus clarification about why it’s important, acknowledgement and recognition.

Barriers should be flagged up as next steps – need to keep a “wildly important goal” (WIG) on the agenda of each meeting to maintain perspective.