Trauma is being recognised in the NHS not only at patient level, but within staff at service level, and increasingly at an organisational level (arguably, we could start to see traumatised ‘systems' too).

An organisation can become traumatised as the result of a single event, or persistent stressors which ‘overwhelm its ability to cope, leading to dysfunctional patterns of behaviour and broken connections'. There are classic hallmarks of a traumatised organisation, such as dysfunctional relationships, fear and reactivity. All of the classic signs of individual trauma can be prevalent too, such as hypervigilance, defensiveness and disassociation.

Organisational trauma can cause extreme over-reactivity in the forms of high staff turnover, burnout, emotional/explosive reactions to relatively normal management requests. Conversely, while there are many causes of poor performance, organisational trauma can be the cause of under-activity such as inertia or paralysis in decision-making (‘we don't want to get it wrong'), very low staff turnover – people terrified of change.

 The common causes of organisational trauma

The reasons organisations can become traumatised are plenty but the most common we would cite are:

• The cost of caring* – Firstly, and at a fundamental level, if this is an organisation which is dealing daily with ‘high-expressed emotion' (see also whistleblowing below). This can be as a result of the emotional cost of caring and is prevalent in mental health inpatient and CAHMS inpatient services. If staff are not supported to process their own trauma this can have a cumulative effect resulting in ‘compassion fatigue'.
• Shame and fear – A ‘scandal' that may be in the media and is causing staff across the whole organisation to feel shame and/or distress. All resources are being diverted to fixing the crisis and the organisation is operating in an unusual and highly reactive environment which is influencing decision-making.
• Apathy and coping– Leadership churn, performance pressure and restructures can lead to managers and staff adopting a ‘coping' stance where they turn inwards for resilience rather than upwards in the chain of command. This can also put services on the pathway to becoming closed cultures.
• The release valve – Whistleblowing and external concern raising with frequent Freedom to Speak Up (FTSU) cases, or grievances being raised. This is indicative of an organisation that is pressurised with issues not being culturally accommodated or addressed via normal internal governance processes.

The risk of not recognising and addressing organisational trauma 

*The most immediately recognisable and shared experience of organisational trauma (cost of caring) would be the Covid pandemic. In our external review work we are still reminded of the legacy of what NHS staff went through during this time. Staff lost colleagues, in some cases their own family members, they were working in terrifying circumstances day after day, under intense and enduring stress and pressure.

Many organisations have simply ‘evolved' out of this trauma, carried on with work, with staff who have carried on absorbing pressures without recognising the lingering and damaging impacts of organisational trauma and what they went through.

Many teams became ‘trauma bonded' through this time and this might now be impacting upon their ability to change, accept new people or accept new ideas. Adverse events and ‘strategic shocks' can have a disproportionately negative or emotional impact; and if you are seeing this within your organisation it might be time to consider the presence of unresolved or lingering trauma which needs to be processed.

How do we address organisational trauma?

With organisational trauma, there is a cumulative effect. Like a pressure cooker, unless there is a steady release valve and controlled distribution of stressors, then an organisation can become normalised to the trauma response; this doesn't get any better without intervention.

Firstly, recognising that your organisation may be traumatised is important. Steeping up occupational health and organisational development responses is key. Giving staff permission to ‘feel' and to reflect is important and allowing emotional processing to occur in a psychologically safe way may be required.

Values and behaviours are key in supporting a traumatised organisation, the most important of which is kindness.

Strong, emotionally intelligent and compassionate leaders set role model behaviours and they can ensure that staff feel ‘seen' and that their experience is valid. They provide an environment and infrastructure to allow trauma to be acknowledged and processed, to the betterment of the whole organisation.