A phenomenological enquiry into the personal resilience of NHS executive leaders in England

Turner, Adam (2022) A phenomenological enquiry into the personal resilience of NHS executive leaders in England. PhD thesis, University of Worcester.

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Abstract

Executive leaders within the National Health Service (NHS) operate within a highly pressurised, constantly changing, and performance focused environment. They are burdened with bureaucratic regulation, political and public scrutiny that emphasises their inadequacies over their successes (Janjua, 2014; Rose, 2015; Timmins, 2016). Personal resilience is needed to operate effectively as an executive leader within the NHS (Rose, 2015; Kelly et al., 2016) yet a review of the literature identifies that the personal resilience of NHS executive leaders is an understudied phenomenon. This study addresses this gap in knowledge.

Interpretive Phenomenological Analysis (IPA) was utilised to explore and interpret the lived experience of being personally resilient for nine NHS executive leaders in England during 2017 and 2018. Participants hold portfolios representative of the executive director of nursing, medicine, finance, human resources, operations, and the chief executive officer. Three superordinate themes are identified including: being exposed, developing personal resilience, and moving forward. These findings add new knowledge in relation to the stressors facing NHS executive leaders, how they experience personal resilience, and the distinguishing enablers of their personal resilience.

Stress from personal exposure, various forms of loss and moral issues are identified as distinctive stressors in relation to participants’ executive leadership roles. The perceived intensity of this personal exposure, loss of humanity, and identity issues distinguish participants against the stressors documented within the existing body of leadership resilience literature.

Participants experience personal resilience as a continual process of seeking out and taking action against stressors. This challenges the well documented concept within resilience theory that defines personal resilience as a response. Metaphorically ‘becoming stuck’ uniquely describes being unable to be resilient for these leaders. An alternative perspective on the established ‘fight, flight, freeze’ stress response is offered in relation to these findings.

Personal resilience is enabled for these leaders by actively seeking out ways to develop their resilience, the transferable qualities surrounding their perceived personal energy and motivation, utilisation of positive framing, and a complexity of supportive relationships. The purposeful, complex, and interconnected nature of these supportive relationships adds a unique multi-directional perspective surrounding the utilisation of social support for this leadership community. These findings also augment our understanding of the concepts of thriving, posttraumatic growth, psychological capital, and the broaden-and-build theory of positive emotion in relation to personal resilience of these leaders.

Findings in this study align to the perspective that personal resilience is a complex, dynamic, subjective, and contextual phenomenon. Future lines of enquiry are presented to further augment understanding of this phenomenon for both NHS executive leaders, and the leadership community more broadly.

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