You’ve done it again. Someone needed a task doing, nobody else stepped forward, and somehow it ended up on your list…Again.
It’s not that you’re bad at saying no – it’s that you genuinely don’t know where your job ends and someone else’s begins. And in a system as stretched as the NHS, that ambiguity doesn’t stay abstract. It turns into extra hours, swallowed resentment, and the kind of exhaustion that doesn’t shift after a weekend.
Occupational psychologist, Leanne Elliot, has a name for what’s happening: role clarity failure. It’s not a personal weakness, it’s a structural problem – and it’s recognised in psychology as a genuine psychosocial risk factor.
When nobody has formally defined what belongs in each person’s role, conscientious professionals fill the gaps. They do it because they care, because the stakes feel high, and because the alternative – letting something fall through the cracks – feels unbearable. But discretionary effort in an under-resourced system doesn’t produce a culture of excellence. It produces burnout.
In this conversation, Rachel and Leanne get into the mechanics of how this plays out in healthcare settings: why micromanaging often comes from fear rather than arrogance, why clinical risk is used as a justification for indispensability that actually increases risk in the long run, and why preserving performance at work while your home life falls apart is a sign you’re heading for the cliff, not proof you’re managing fine.
