Roger Greene


Navigating the Fog

Successful integrations of Health and Social Care feel like the sum is so much greater than the parts. The citizen receiving such services and support doesn’t see the joins or boundaries. Nor should they.

The converse however is also true. Health and Care systems that are stuck feel like the sum is so much less than the parts.  And that’s bad news because the potential consequences of Organisational (or System) Stuckness can be highly damaging[1], resulting in:

  • Increased attrition or staff turnover.
  • Consistent failure to achieve goals
  • Poor morale and cooperation.
  • Increased internal conflicts.
  • System and structural failures.
  • Flat or declining profit margins in the commercial sector.

With some honourable exceptions, we observe high levels of uncertainty and ambiguity in staff in emerging ICSs, STPs and their constituent organisations, especially CCGs.

The uncertainty means their work environment feels like fog and they feel stuck. And the reality is that such uncertainty can be highly damaging for our mental health and wellbeing. In 2017 38% of NHS staff reported feeling unwell due to work related stress[2].

So what can we do about it?

We recommend starting with developing resilience in both your people and your organisations. We say so recognising that the simple prescription “just be more resilient” risks becoming an overused and abused concept.

The thing with resilience is that it doesn’t just happen naturally for everyone – but it can be developed in an organisation and its people.

In this blog we’re going to focus on personal resilience and we’ll look at organisational resilience in the next blog.

We love Diane Coutu’s take on resilience:

Resilient people possess three characteristics — a staunch acceptance of reality; a deep belief, often buttressed by strongly held values, that life is meaningful; and an uncanny ability to improvise. You can bounce back from hardship with just one or two of these qualities, but you will only be truly resilient with all three. These three characteristics hold true for resilient organizations as well.…Resilient people and companies face reality with staunchness, make meaning of hardship instead of crying out in despair, and improvise solutions from thin air. Others do not.

Diane Coutu, How Resilience Works, HBR. May 2002.,

In the uncertainty and ambiguity of the emerging world of Integrated Care Systems, how would you rate your own resilience against those 3 characteristics?

3 observations and 3 questions for you:

Observation 1.  We know from social neuroscience research that whether we see things as potential threats or rewards has a dramatic effect on our perception and problem solving, with implications for decision-making, stress management, collaboration and motivation.  The more ready we are to engage with the ICS development, the more likely we are to find good solutions.

Question 1. How ready are you to accept that the ambiguity and uncertainty – the unsettling and disorienting fog – is what it is?

Observation 2. Strongly held values are your compass or radar in the fog. If people know you are working with good intent and meaning, you will be forgiven any errors you make along the way.

Question 2.  How strongly do you find meaning in the work you’re doing and how does it align with your values?

Observation 3. If you can tick questions 1 and 2, you’re well placed for this one. Your ability to improvise and bounce back into shape is really strengthened.

Question 3. How well do you use your ability to improvise in the development of your ICS when the going gets tough, another obstacle appears, or you just feel stuck?

How well did you do?

If you’d like a conversation about personal or organisational resilience, please get in touch with

If you’re interested in learning more, read more of our series on Unsticking Stuckness

[1] Buelow et al (2012). Is your Corporate Footprint Stuck in the Mud?, Lee, M, HBR 2014, Too Many Marketing Teams Are Stuck in the Past. McHugh, J. (2018). A Stuck Company D Turnaround or Workout?

[2] NHS Staff Survey 2017.