Work-life balance
Achieving the impossible?
Written by: Andrew Vincent. Published: 2nd June 2010
As the NHS apparently moves towards a more workforce friendly approach to organising its human resource, we examine whether more controlled hours, flexible working arrangements and better pay add up to that elusive aspiration known as work-life balance. What else plays a part and how can you best adapt your working practices to suit the modern era of healthcare?
What is work-life balance?
Work-life balance means different things to
different people and even different things to
the same person over time. It is thus difficult
to define precisely, although the complexity
is readily understandable. Did the more
traditional Senior Registrar working 80+
hours per week have more or less work-life
balance than an ST5 soon to be confined to
48 hours? The answer is often the unpopular
and politically incorrect ‘yes’, especially if that
person viewed work as a vocation about
which they were passionate, had few family
ties, believed that exceptional doctors had
their learning as grounded in experience as
theory and was set on advancing through
the profession at the maximum rate.
Ironically, under those circumstances, that
person was probably also safe in practise,
suffered fatigue only rarely and had reserves
of energy, along with a feeling that life
was on track. However, the opposite could
equally be true, with that person suffering
constant fatigue, more prone to mistakes
and feeling that medicine took over their
life, perhaps sometimes even questioning
whether it was all worth it.
Work-life balance is more about assessing the relative importance of different areas of your life and then applying yourself in a way that consistently delivers for all of them. The key denominator is you. It’s your game plan and it should be based on a combination of the aspirations you have in all areas of life and your own internal wiring, drivers, beliefs and values. Tiredness and fatigue comes not from doing too much but from getting the balance wrong, highlighted both by people who work at a high rate but then play vigorous sports at the end of the day, remaining energetic and ready for the next day’s challenges versus others who work minimal hours in undemanding but unsatisfying jobs who complain of lethargy, demotivation and low energy.
So, work-life balance is less related to the demand on your body and much more dependent on the degree of match between your behaviour and your inner blueprint for a great life. That makes it pretty difficult to achieve work-life balance without first understanding the inner blueprint – the first imperative!
Work-life balance in healthcare
The core driver or motivation for many
people entering healthcare is to help people
in a very meaningful way, whilst engaging
in intellectually stimulating activity. This
driving force stems from two fundamental
human needs, contribution and growth,
and links to the age-old premise that we
all have a purpose. Consequently, it is not
difficult to see that working as a doctor or
nurse, for instance, becomes a vocation
rather than work, much akin to Mother
Teresa’s devotion to a life of helping the
poor. Equally, the human needs of certainty
and significance were also well provided for
by the workplace, with secure employment
unaffected by market forces and a doctorpatient
relationship that was built on trust
stemming from patients holding doctors in
the highest professional regard.
In the NHS of old, this resulted in many people working extremely long hours with enormous personal effort to ensure delivery, receiving their reward not in extra salary but in the underlying feeling that the right thing had been done by the patients. That isn’t to say that the work wasn’t taxing or that many people felt a constant pull between professional responsibility and the need for a life outside work. However, if you ask the same group about the present and evolving working environment, you’ll find a strong trend towards a degradation of morale, despite the hours being more controlled and the salary being superior. When you probe more deeply, you can certainly see how the modern environment leads to this, see below.
| Need | Effect of the modern environment |
| Contribution | The effect of constant media bombardment around health service failures, coupled to an ever increasing difficulty in providing the ‘ideal’ healthcare to each individual results in many doctors feeling that they are doing the wrong thing more often than they should. |
| Growth | The European Working Time Directive coupled to ever increasing service demands to meet stringent targets has resulted in many consultants feeling that they have slipped back into a worker bee role more than a clinical leadership role for which they had worked so hard for. |
| Significance | New found worker bee status, coupled with significantly less autonomy in how you deploy yourself or what products you can prescribe, leads to a growing feeling of being less significant than of old. |
| Certainty | The market economy in health, with tenders, new provider types and competition from previously collaborative colleagues does nothing to reassure healthcare professionals over the security of their employment or even that they know how to operate in such an alien environment. |
It is clear that definition of the medical role in healthcare needs a radical rethink in order to support professionals in re-attaining a strong sense of purpose that ultimately restores their sense of wellbeing and work-life balance.
Successful work-life balance
The key to successful work-life balance is
attaining satisfaction across all fundamental
human needs in a way consistent with
your values. Additionally, ensuring that
satisfaction or balance is achieved in all
major roles is just as important. If we take a
typical consultant as an example, we might
define the areas needing to be balanced as:
|
• Certainty • Variety • Significance • Love & Connection • Growth • Contribution • Doctor |
• Service Leader • Teacher/ Mentor • Husband/ Wife • Parent • Self • Friend |
Balance is where that consultant feels they are having all of their fundamental needs met through activity that also delivers success in each of their roles. When this is achieved you feel energetic, motivated and have a sense that you are progressing or delivering in life. Vital to this process is gaining an understanding of what activities, behaviours and patterns deliver for you as an individual in each of those areas.
Where balance erodes
Let’s say, for example, that Mr Consultant
has derived his need for significance and
contribution from his role as Doctor but a
loss of autonomy in that role along with a
focus on targets and sometimes arbitrary
measures, means that it no longer delivers
a satisfying result in any of these areas.
Naturally Mr Consultant fights harder to
restore the balance, often resulting in more
work whilst also resulting in greater fatigue
through stress. This now detracts from the
quality and quantity of his experience as
spouse or parent, resulting in a downwards
spiral further away from balance. This is no
different than consistently working too many
hours, knowing that your children would
benefit equally from your time and simply
shows how the interrelationship of the
factors affects work-life balance. It also helps
to explain why people under stress often
seek to ‘simplify’ life as a potential solution.
Strategy for restoring balance
Using the same example, Mr Consultant can
move towards greater balance by examining
each important area or role in life and
determining two things:
- What set of goals, behaviours or activities would restore that area to satisfactory?
- If that area were pushed from satisfactory to ‘wow’, what would it look like and what would you be doing?
