Creating the conditions where care can thrive: four actions for clinical leaders

High responsibility and low control can lead to burnout. Sharon Nash shares reflections from clinical leaders on steps organisations can take to prioritise the health and wellbeing of staff.

What we heard

‘The ultimate burnout factory is all the responsibility with no control.’

That line from our recent clinical leadership roundtable on wellbeing landed hard, and spoke for everyone in the room, from clinical directors and wellbeing specialists to policy makers, chief people officers, and alumni from our clinical leadership programmes. It captures the core truth of the wellbeing challenge: this is not about fixing individuals, but about designing organisations worthy of the people who show up for them every day. That truth became even clearer as leaders described how it plays out in daily working lives.

Barriers to wellbeing

When participants described barriers to wellbeing, they began with the basics: a place to eat; somewhere to sit together; rooms to see patients; parking availability; protection from racism and abuse. The tension was palpable: ‘take your break’ meets ‘there is nowhere to go’. This is not indulgence; it is fulfilling the basic infrastructure requirements to ensure that staff can operate effectively.

One participant voiced what many feel: that these are decade-old issues that continue to constrain the basics of safe, human work. In an era that often frames wellbeing as personal responsibility, what is really needed is organisational accountability too. This pervasive lack of safety takes us beyond burnout, to moral injury, when staff are unable to deliver the care they were trained to give.

Engagement instead of burnout

A former medical director described a shift many of us recognise: the need to move away from organisational gaslighting, ‘be more resilient’, toward organisational holding, in which organisations create conditions where care can thrive. He argued that the opposite of burnout is engagement, where energy, connection and purpose flourish. Leadership is pivotal here. If we want safer care, fewer complaints and improved productivity, we need engaged staff, not simply more activity.

Responsibility with control

As one participant put it, the burnout factory is built when responsibility is high, but control is low. Agency is not a nice to have. It is the difference between a high stakes job you can love and a role that drains you. Too often we invest in leadership as doing or as performance, for example how to author a report, but real leadership is about listening well, holding anxiety, stewarding values, and convening conversations that repair trust. Participants named the need for investment in leadership capability – dedicated time to learn and lead well.

Language, power and metrics

The conversation turned to a tougher question: are we recreating the very power dynamics we claim to challenge by clinging to a metrics-only mindset? It was acknowledged that while there was a need to invest in quantitative metrics for staff wellbeing, measures such as professional fulfilment often get overlooked. Data can be helpful if we use it to surface a balanced truth, for example tracking professional fulfilment levels, not just attrition curves, and it can lead to co-producing change with those most affected.

Wellbeing beyond the NHS silo

The conversation then converged on a simple truth: wellbeing reaches far beyond any single organisation’s perimeter. Roundtable participants spoke about partnerships with policing, social care, local government and community organisations, recognising that staff safety, patient behaviour and public expectations do not sit neatly in vertical structures. Others reminded us that VCSE partners have been quietly practising relational and restorative approaches for years; their challenge is access and traction, not ideas. What might we learn from this sector? The bigger the pressure on wellbeing, the more we should borrow what already works in other parallel sectors.

What people are carrying

The conversations brought us to the subject of moral injury explicitly: the distress of seeing patients wait longer, deteriorate or receive care that falls short because demand is high and there are too few staff. We also named the hidden costs of the ‘burnout cliff’ (performing well until suddenly you can’t), and how often women in particular sustain empathy at the price of deeper exhaustion. This was not about individual weakness, but about the costly trade-offs in a system that depends on people’s professionalism, values and sense of duty to keep going.

So, what next?

Four actions to prioritise wellbeing

The strongest theme to emerge from the roundtable discussion was agency. The mood was one of taking back power, not having to wait for a national plan to start behaving as if wellbeing were core business.

Four practical moves emerged clearly from the discussion:

Closing reflections

What we heard in the roundtable was not just critique, but commitment. The NHS was built on the belief that care should be there when people need it. To honour that mission now, we must care just as fiercely for the people who deliver it. When we restore their sense of control, fairness and community, we don’t just protect wellbeing, we rekindle purpose. And purpose is the most renewable energy we have.