What to Do When You Can’t Fix the System

[00:00:00] Rachel: The system is broken. You know it. I know it. And nobody is coming to rescue us anytime soon. So what do you do when you’re stuck in a system you can’t fix, but you still feel responsible for everything?

[00:00:12] Rachel: So in this episode, we are going to be diving into a powerful mindset shift, and we’re gonna be talking about how to move from feeling completely powerless, like everything’s happening to us, to being powerful, where actually things are happening because of us, even when you’re working in a system that feels really, really broken.

[00:00:30] Rachel: So we are gonna talk about why blaming others, even when it’s very justified, actually keeps you stuck. We are gonna talk about a simple model that you can use to, to take back control and get some clarity.

[00:00:44] Rachel: This is a You Are Not a Frog quick dip, a tiny taster of the kinds of things we talk about on our full podcast episodes. I’ve chosen today’s topic to give you a helpful boost in the time it takes to have a cup of tea so you can return to whatever else you’re up to feeling energized and inspired. For more tools, tips, and insights to help you thrive at work, don’t forget to subscribe to You Are Not a Frog wherever you get your podcasts.

[00:01:11]

[00:01:11] Rachel: And let’s be honest, working in healthcare right now can feel really, really impossible. We know that systems are under pressure, staff are stretched, people are leaving, burning out, going off sick, leaving more work for everybody else. Patients, the need has gone up, demand has gone up.

[00:01:26] Rachel: And you may well have found yourself thinking, well, I just can’t do this anymore. Nobody’s listening to me, and why should I even try? Now, that feeling you get when you are really stuck where you are feeling a bit like a victim. The victim mentality, well, that is what we call below the line thinking.

[00:01:41] Rachel: And you can get stuck in this way of blaming people, And even though it’s totally understandable, it’s very difficult to move forward and you feel very, very stuck.

[00:01:51] Rachel: We often believe that if things aren’t working, then somebody else needs to fix it. So the rota’s wrong, management needs to sort it out. The system’s broken. And yes, that may well be true, but unfortunately waiting for the system to change or even other people to change before things can get better, well, that’s the trap and that’s what keeps you powerless. Because we don’t have any control over either the system or other people. And if you do have some control over the system then I bet you are working really hard to change that bit that you are in.

[00:02:22] Rachel: But unfortunately, we know this, that in the NHS all the bits of the system are very, very interconnected. So no matter how much control you have over your bit of the system, there’s always another bit that’s gonna come along and, and undermine that and make things difficult.

[00:02:35] Rachel: So rather than feeling that for anything to change or for things to get better, the system has to change, we need to understand that you don’t have to change the system to reclaim your power to get unstuck and to make things better, you just need to change where you are on the action stepladder, and you need to get the first steps right as well.

[00:02:56] Rachel: So this is a model, and it was originally described in a book called The Oz Principle, but it’s been used over and over again in leadership training, lots of leadership literature. This shows us how we move from powerless thinking, where we talk about being below the line to powerful thinking where you are above the line.

[00:03:14] Rachel: So if you’re below the line, you’re in the victim mentality, you might be thinking things like, well, I can’t, it’s not my job. It’s, it’s their fault. Above the line, you are in a much more of an activator mindset. Where you make things happen, you’re thinking, well, what’s really going on? What’s my part? What can I do? And let’s do it. Let’s make it happen.

[00:03:33] Rachel: Now, here’s the thing. We might think we are acting from power, but if we are blaming other people, waiting, denying things, and just hoping that things are gonna change, then we are unfortunately below the line. Now this doesn’t mean to say that none of the issues are true, and it doesn’t mean that you can wave a magic wand and everything is gonna get better, and just by believing you can make it happen. That’s not what we’re saying.

[00:03:59] Rachel: But when we are below the line, we have an external locus of control. We believe that the only way anything can be different will be if other people do something. That’s a very stressful place to be because obviously we have no control over other people.

[00:04:15] Rachel: Getting above the line is about taking that control back, that locus of control, making it internal. An internal locus of control means that you believe you always have a choice, however small. Now, often it’s not the choice that you want, but that doesn’t mean you don’t have a choice. It just means you would love to have some different options, but they’re not being presented right now.

[00:04:37] Rachel: So if you don’t shift to above the line to having an internal locus of control, the system will always win. But you can start to navigate even really, really difficult circumstances with clarity and peace if you start to have this internal locus of control.

[00:04:53] Rachel: So I just wanna pause here and ask you something. You know, if nothing changes for you, if you do stay below the line believing that nothing will change unless the system changes and that that’s down to other people, and if you carry on just hoping the system will suddenly wake up and take care of you well, I’m afraid things are gonna go very badly and you’ll hit this eventually. So if you stay below the line, you’ll feel helpless. You’ll blame the system. You’ll try over-functioning to fix what’s broken, and that, as we know, leads to exhaustion, bitterness and resentment, and real disconnection from what used to matter to you.

[00:05:30] Rachel: Now we think that being a victim, it means being very, very passive, but we can also be a victim and be very, very busy just working our arses off, just ’cause we think that’s gonna fix stuff. But if we keep existing below the line, then actually the risk is we leave medicine altogether. That’s if we don’t burn out. And not because you don’t care, but because you actually haven’t got anything left to give and you never really learn how to stop, get above the line, but you can choose something different.

[00:05:57] Rachel: So the other choice you’ve got is just to climb up the action step ladder, step by steps that we can get above the line, because let’s just recap below the line, you’re feeling uncertain. You can’t do it. You start to blame other people and you are just hoping. If you start to climb the action stepladder, you are able to pause and reflect, and you stop carrying all that stuff that wasn’t yours to carry in the first place, and you work out what is yours to carry and what’s not, and you can think about, well, how am I gonna act from something that I want to do from intention, rather than just feeling really bad and guilty about everything?

[00:06:34] Rachel: And you’d also be able to address this really difficult question, which is where do I need to set a boundary and let the system fail so that I don’t. And that’s what starts to shift, and that’s where you really start to make a difference, but without sort of wearing yourself into the ground on the way there.

[00:06:49] Rachel: So you have a choice, really. You can say below the line, stuck in blame, suffering, burnout, just waiting, thinking it’s everybody else’s faults. Or you can start to step up the action step ladder towards real ownership of stuff, towards clarity and ultimately peace about what you’re doing. So even though the system’s not gonna change tomorrow, you can, you can shift your mindset and that will really change everything.

[00:07:13] Rachel: So I just want to pause for a minute and think about why so many doctors just give up when they’re trying to change the system. What happens when you do step up, but you’re staying below the line? So often you see the problems and you think, well we can’t keep working like this. We’ve gotta change something. And you know, if that’s you, you are not alone. And lots and lots of really brilliant doctors, they do set out to improve things, but somewhere on along the line it just becomes too difficult and they either back off, or they give up. And it’s not because they don’t care, but it’s because they’ve unknowingly made the process really unsustainable.

[00:07:48] Rachel: So I’m just gonna list a few of the biggest mistakes that doctors make when they’re trying to change their system. and these mistakes just leave them completely exhausted and ready to walk away.

[00:07:57] Rachel: So, number one, they’re fighting the wrong battle. So you might see a symptom, like a, a rotor gap or, or poor communication. You try and fix it. But underneath there’s a deeper root cause, you know, really unsafe expectations or a toxic culture or unrealistic workload. And then you might fix the communication, but that root cause that starts coming back and you start to feel like absolutely nothing works. So before diving in, you really need to ask, what’s really driving this? And am I just treating the surface symptoms? You know, putting the sticking pasta on, or are we really addressing the root here?

[00:08:32] Rachel: The other issue that a lot doctors face is they expect quick progress, and you think to yourself, well, if, if I’m gonna show initiative, offer a solution and present the evidence, they will listen. And side note, when I did the Red Well Lead Managed Thrive course, we used to talk a lot about doctors going into these sort of politically charged situations, thinking to themselves, but if I say that this is affecting patients, if I present what the right thing is to do, then that’s gonna happen. Then everyone will just agree with me. Unfortunately, when they fail to realize that people have lots of other motivations, it’s not always to do the best for the patients, sadly, and if you’re coming up against these people who are empire building or just wanting to protect their little bit of the system, even though it’s affecting patients, then actually making just good arguments often doesn’t get you where you need to be.

[00:09:21] Rachel: And systems are slow and people are resistant to change, and when things don’t change immediately, you just feel like you’ve failed. So progress often looks like two steps forward, one step backwards, one step sideways, and then maybe a small fire or something like that.

[00:09:35] Rachel: The other mistake we make is just to take silence or inaction personally. You know, so you’ve raised concerns, you’ve shared things, you’ve emailed people, you’ve had meetings and nothing, and you, you think you’re being ignored because of something you’ve done wrong or your voice doesn’t matter. But it just means that the system doesn’t yet know how to respond.

[00:09:54] Rachel: So we often let this institutional inertia become this personal shame. But you are not the problem. The system is.

[00:10:02] Rachel: The other thing we do is we try and fix structures without changing the deep culture underlying everything. So you might say to a new process, have a meeting, workflow committee, all that sort of stuff. But nothing changes, because the underlying culture of fear, blame, hierarchy, that’s not shifted at all. So you cannot system fix your way out of a culture problem.

[00:10:24] Rachel: And sometimes the most important work is to do with relationships, not just fixing procedures. And also because doctors are very, very capable and they can do things quickly, they just think, oh, I’ll just quickly fix it. I’ll do it myself, and they go it alone. But it’s very difficult to change anything without shared ownership. You hit resistance, you just get exhausted, and then the idea just dies and you’re just too exhausted to resurrect it.

[00:10:47] Rachel: So we need to find allies. We need to find other people and help them get above the line as well.

[00:10:52] Rachel: And finally, when you’re trying to fix the system, you forget to care for yourself. We see this time and time again. You know, you just feel so focused on helping everybody else out that you forget that you are human too. You need to rest, you need to have lunch. You cannot stay late all the time, but you feel so responsible that you just do, and then your voice will disappear and you’ve given up, not because you don’t care, but because you’ve, you’ve burnt out and you’ve run out of energy and time. So you can’t heal the system by harming yourself.

[00:11:22] Rachel: So if any of these mistakes stand familiar, you are not doing it wrong. You’re just doing it like lots of other doctors. We were never taught how to lead change. We were never taught really how to work sustainably. The good news is you don’t have to give up. You just need to do this in a way that doesn’t break you. And the way to do that is get above the line, because you cannot change the system from below the line. You’ll end up burning out. And you need to do it step by step. So let’s talk about how to do it. And the one problem that I see is doctors rush into the final step at the top of the ladder without taking the first steps on the first rungs.

[00:11:59] Rachel: So the first step, the first step above the line is simply facing reality. What is going on? Where are you on the ladder? Are you blaming someone? Are you waiting for somebody to rescue you? Are you just waiting and hoping? Have you given up? So just this awareness can change the whole thing, and facing reality is the first step on the action stepladder.

[00:12:22] Rachel: Without facing reality, then any attempt to change the system, it’s just based on an illusion or avoidance or hope, rather than real clarity and real strategy, and you probably end up fixing the entirely wrong problem. So here is how this first step, the step of facing reality, helps you get above the line and get meaningful change and meaningful action.

[00:12:45] Rachel: Well, facing reality stops you just fighting fantasies. It stops you pretending the workload is manageable. If you just work harder or believing things are magically gonna improve, so it grounds you in what’s actually happening, not what you wish was true, so you stop wasting energy on stuff that doesn’t work.

[00:13:03] Rachel: And if you face reality, you find out what the right problem to solve is. Because if you don’t, you just end up treating the symptoms like rota swaps, cover gaps, endless meetings without understanding the real systemic drivers underneath. So if you’re facing reality, you’ll be asking the sort of questions like, why is this happening in the first place? And where is the resistance really?

[00:13:25] Rachel: And the other thing is that facing reality just creates a bit of psychological safety for change. So starting with reality rather than just blaming or denying makes it safer for other people to come alongside and get on board. And you can just work out like, what’s really going on? We are all part of this, let’s look at it really honestly, without any shame attached.

[00:13:45] Rachel: And one of the ways that you can help yourself face reality is just to do our Stressors Hexagon audit. So click on the link in the show notes to download our free toolkit, and that has a very simple audit that you can do to help yourself face reality.

[00:14:02] Rachel: So facing reality doesn’t mean giving up. It just means really acknowledging where you are so you can create change that actually lasts because you’ll be solving the right problem. Because the issue is as doctors, we love to take action, and if you’re facing a really broken system or a stressful situation, your instinct is just to self suffer as fast as possible. So you wanna get right up the ladder towards the taking action bit. You don’t waste time. You don’t sit around. You just like to get things down. So instead of starting at the bottom, you just leap right up to the top. The bit that’s called make it happen. And if you then skip the the first step, which is face, what’s really going on, you build solutions just based on denial or wishful thinking.

[00:14:42] Rachel: Now, the next step on the action step ladder is owning your own part. And if you don’t do that, then you try and fix everything. You feel responsible for absolutely everything, and you have this over responsibility issue. I talked on that in a previous podcast, and we’ll put the link into the show notes. So this is my type one control responsibility mismatch, where we feel very responsible for things that are well outside our zone of power outside our control. And this just is incredibly stressful. And what’s more, it doesn’t work. If you try and change stuff, you can’t control, you can’t. It leads to stress. It leads to us feeling really, really guilty and it leads to overwhelm.

[00:15:21] Rachel: What you need to do is work out what you are in control of and what part is yours to play. You can then work out what you can actually do. So in the action step ladder you’ve got, number one, face reality, number two. Own your part and stick to the stuff that you can control. Because then you’ll be able to work out what you could do. You can find solutions, you can work out what can you, what can your team do about this stuff?

[00:15:47] Rachel: So once you’ve worked out what solutions there possibly are, based on what you can control, will, then that’s the time to take action. Because if you leap to the top straight into action without climbing those foundation steps, well, you’re gonna wobble. You’re gonna fall off the ladder. You’ll waste a lot of energy. You’ll probably lose confidence too, because rather than climbing up, you’re just sort of scrambling around.

[00:16:08] Rachel: Think of it a bit like managing a complex patient without doing a proper assessment. So if you skip the history, the physical examination, the, the test and go straight for treatment. Well, that’s not decisive. It’s just dangerous, isn’t it? You would never do that with a patient. So the action step ladder, it works in the same way. You can’t get to meaningful action without grounding, without facing reality, getting clarity and ownership. Trying to fix the system without taking those lower steps. It’s just like prescribing treatment without diagnosing the cause. It feels like action. It often makes things worse.

[00:16:43] Rachel: So if you’ve been living below the line, blaming others, blaming the system, or feeling stuck, you’re not alone. In fact, you’ve been trained to do that because medicine, wwll we often reward over-functioning, self-blame, that just leads to burnout. You can’t control the system and you can’t fix everything. But you can reclaim your power. You can shift from below the line to above the line. You shift from waiting and hoping into choosing.

[00:17:08] Rachel: And once you are above the line, instead of just rushing straight into fixing mode, you need to ask yourself, have I really faced reality? And am I really clear about what’s going on here? So that I can then own my part and work out what it is that I could do. Stop worrying about all that stuff that’s out of my control, and get really clear on my role and my limits, and make sure I have taken the first steps rather than just trying to leap straight into action straight to the top. Real sustainable change doesn’t come from these heroic leaps. It just comes from climbing slowly up the action stepladder, one clear conscious step at a time.