Cultural issues related to allegations of bullying and harassment in NHS Highland: independent review report

8. A Few Words about Human Nature

"It's not our differences that divide us, but our judgments about each other."^[13]

Introduction

8.1. In this chapter, I offer some general views on the underlying psychology which tends to fuel so much conflict. I believe that understanding some of this fast-growing area of science is helpful as context for what follows in the report.

8.2. It seems necessary, at a deep level, to explore and understand why individuals and organisations behave as they do, especially when under pressure, and to find enduring remedies, not transient sticking plasters. Current research into behavioural psychology and neuro-science provides an excellent resource to draw on. This deeper work is, it seems to me, critical to a sustainable future.

Complexity

8.3. In this review, I have been struck by the reality that this is all much more complex and multi-layered than anyone might wish, or like it to be, and reflects the ambiguous, paradoxical and uncertain nature of so much of human life. Nothing is black and white. For me on each step of the way, another layer of the onion was revealed. There is no straight binary conclusion to be reached. The situation is better viewed along a continuum, with a spectrum of experiences and realities, often dependent on time, place and circumstance.

8.4. In my day-to-day role as a mediator and facilitator, I have a working assumption that nearly everyone is trying his or her (or their) best in the circumstances in which they find themselves, even if they struggle to do so. We are told that there is a positive intention behind most behaviour and that most people make the best choices they can given the information available to them at the time.

8.5. How many of those reading this report would not acknowledge that most of us are trying our best most of the time? I also find it useful to take the view that very few people are motivated entirely by ill will. Life is complex and there are usually several sides to a story. Much depends on where you start from, your perspective, as this rudimentary illustration shows:

Fight, Flight or Freeze

8.6. People's perceptions become their reality. Perceptions, we know, are shaped by many factors. And what people say may not always be what they really believe, feel, mean or need. Modern neuro-science and behavioural psychology help us to understand well that we tend to be shaped by our experiences, our biases, our prejudices, our need for protection, our fear of loss of face and so forth.

8.7. Our survival instincts, fight, flight or freeze, override the rational mind very easily. Our self-preservation instincts are very strong. These may lead to covering up what is embarrassing, threatening or causes us to look bad. After all, looking bad, public exposure, can be among the most painful and humiliating of human experiences.

8.8. Under pressure, our default setting is to protect ourselves from external threat, whether physical, psychological or social. We seem to have no choice – our brains are wired that way (see, for example, Daniel Kahneman: Thinking, Fast and Slow^[14]). This stems from the survival behaviour (located in the primitive part of our brains) inherited from our early ancestors who faced constant physical threats to their very existence. Fear is a strong force and triggers defence and/or aggression. We are complex creatures, each capable of acts of great kindness and also of acts of cruelty to others, often in close proximity to each other.

8.9. Though physical threats are less relevant now, we are still hardwired to feel shame and to fear blame when the threats are social and our dignity or sense of self is challenged. Our basic instinct for self-preservation, often by using force or dominating in other ways, can be stronger than our instinct to preserve a relationship.

8.10. Relationships may break down when the need for individual self-protection overrides our need for connection. We tend to denigrate, belittle and criticise others, who in turn may experience loss of esteem, misery and abandonment – and react accordingly. Colleagues are undermined. We avoid contact with those outside our group. We rush to judgment. Uncertainty prevails. Others around us are adversely affected.

Mixing People and the Problem

8.11. As the writer Ken Cloke has observed, "it seems easier to turn each other's lives into a living hell than to apologize, rebuild trust and restore intimacy and collaboration in conflicted relationships."^[15]

8.12. Or as an NHSH staff member put it: "I despair of the culture where a sincere apology is not even considered as a first option even in respect of just good manners. Rather fear of showing weakness and fear of comeback or litigation is the overriding reaction."

8.13. So, we end up mixing up the people with the problem, when what we really need to do is to try to separate the individuals involved from the underlying issues, even if the individuals themselves appear to be the problem. Small matters can be quickly blown out of proportion. Our energy can easily focus on adopting our particular position and blaming or shaming others with whom we disagree. We become entrenched. Our anger may be directed towards the "enemy".

8.14. Behaviour can become – or be perceived to be – threatening, aggressive, intimidating, domineering and emotional. We all recognise how easily we use the scapegoat mechanism as a foundation for the formation of many social groups and cultures. We need another group to be against in order to form and sustain our own group, our tribe.

8.15. Scapegoating occurs too easily: We hate or blame others, projecting our pain elsewhere, rather than recognising our own weaknesses and negativity. "She made me do it." "He is guilty." "He deserves it." "They are the problem." "They are evil." We seldom consciously know that we are scapegoating or projecting. It's automatic, ingrained, and unconscious. Because of our wiring, people literally "do not know what they are doing".

8.16. Many readers will be familiar with the Drama Triangle^[16] in which people can fall into, choose and rotate the roles of victim, rescuer or persecutor, perpetuating a crisis rather than breaking the cycle. So easily can the language of the persecuted in turn appear to others to be that of persecutors. Even describing someone as a "victim" brings with it inherent risk. Perhaps in the NHS, with its traditional role being one of seeking healing, matters are more complicated for "rescuers".

Assumptions, Perceptions and Biases

8.17. I suspect that the cognitive or unconscious biases (institutional and individual) operating in all of us have been at play in what has been happening and is alleged in NHSH. It is said that we jump quickly and intuitively to conclusions, assuming we are correct, based on our own incomplete knowledge of the world, our prior experiences, our prejudices, our expectations, our fears and hopes, our assumptions.

8.18. We can become wilfully blind to the bigger picture or to contradictory information as what is known as confirmation bias takes hold. Our seeing and hearing become selective. We acquiesce in inappropriate behaviour in order to avoid conflict.

8.19. To survive, we may simply not see or hear what should be obvious to us. Our responses to a situation are shaped by those prior assumptions and perceptions. Very often these are wrong but, if something is asserted often enough, we may come to believe it - even if it is not wholly or even partially true. We may then end up trying to persuade others of its truth and adopting measures to maintain the fiction.

8.20. On other occasions, we will subconsciously devalue what is said by people we dislike or by whom we feel shamed or threatened, while overvaluing the words of those we admire or who are part of our group or tribe. Our human tendency is to judge the behaviour of others with whom we disagree as a reflection of their character and ill will towards us; in contrast, we describe our own (and our tribe's) behaviour as acceptable, and attributable to the circumstances in which we find ourselves.

8.21. There is apparent safety in being with apparently like-minded people, especially if we feel under threat. Silos are built. It feels better to be part of the group than to be excluded, not to rock the boat or speak out, for fear of being ostracised. This is all entirely understandable. However, when the environment is not a safe one, these aspects of human nature can lead to disorder and dysfunction.

8.22. In an organisation where self-protection has come to dominate, it seems that relationships may inevitably breakdown. Alternatively, people may compromise their own dignity to try and preserve relationships. Consequently, as Ken Cloke puts it, we often elect to remain silent and suppress our true beliefs and feelings, or pretend to agree when we really don't, or even leave the organisation rather than risk a loss of intimacy and connection with people we care about - or challenge the thing we fear.^[17]

8.23. It can all become cyclical and self-fulfilling. Relationships suffer, communication is poor (or non-existent), nobody seems to listen, information is concealed, concessions appear to be a sign of weakness, common interest and mutual respect is lost. And all of this is enormously costly in time, morale and money. It increases risk and is truly a zero-sum situation.

Why Does Any of This Matter?

8.24. Why are these points relevant to this review? Because it is likely that all of this is just as true for those involved in NHSH as elsewhere. It helps us to understand many of the situations described in this report. In particular, we should not underestimate the role of fear in much of what has occurred at many levels. More importantly, perhaps, it seems to me that we all need to understand these facets of human behaviour if the underlying issues are to be addressed and resolved with long term sustainability. One cannot separate this theory from the real world.

8.25. In this regard, I note an excellent book entitled Embodied Conflict by a mediator colleague from Oregon in the United States, Tim Hicks (no relation to Donna Hicks, quoted in paragraph 4.22). He writes: "It's interesting to think about the violence we see in the world, whether at the level of interpersonal relationships or at the societal and global levels, as a public health issue."^[18] These words resonate particularly with this review.

Choices

8.26. We can choose to behave differently. To do so, we need to find and welcome ways to overcome the automatic, unconscious, easily triggered fight or flight instinct located in our reptilian/limbic "old" brains and to engage the neo cortex, the "new" part of the brain, which helps us to think and act in a more measured, thoughtful way. We know that this takes conscious effort and is energy consuming. We need the right environment to do this. Creating that environment is the key to a successful modern workplace and to a successful NHSH.

8.27. We may think we know much of this already but it is not so easy to apply. It needs to be learned and understood. We have the capacity to be self-reflective and to change behaviour. We need to take responsibility to do so. What follows can be read with all of this in mind.