What Is Perfectionist Thinking And How It Impacts Registered Managers

"If managers who are considered good by their peers and team are removed for infractions that are beyond their control, the organisation becomes oppressive."

Healthcare and Social Care systems are often webs of complicated and interconnected processes. How can we make care service provision better AND ensure managers tasked with it are supported correctly?

Topics covered in this article

Setting Unrealistically High Standards

Separating People From Processes When Identifying Failure

Understanding That Processes Are Linked, Not Independent

Stresses Of Management Lead To Attrition

Let’s Abandon Perfectionist Thinking In Social Care

What Is Perfectionist Thinking?

Perfectionist Thinking Creates A Revolving Door For Home Managers

Setting Unrealistically High Standards

I attended an interview for a Registered Manager’s job at a large corporate care group some tie ago.

There were two senior managers at the interview.

I had written my first book and they seemed intent on finding fault with it.

I almost walked out of the interview.

What stood out for me what how, on the one hand, they claimed to give very kind care.

And yet, on the other hand, they explained and showed they wouldn’t accept errors from their Home Managers.

Care AND intolerance. Hmmm. Let’s look at that..

What they were doing was setting their organisational bar very high and pointing out that if people don’t reach it, they’re out!

For me, this explains part of the problem at a provider level: when bars are set TOO high.

After all, does it help residents and the staff team by removing a Home Manager for relatively minor issues (for instance, high agency / low occupancy due to factors mainly outside their control)?

No, it creates uncertainty and a breakdown of trust.

If managers who are considered good by their peers and team are removed for infractions that are beyond their control, the organisation becomes oppressive.

Some in the staff team may nod or even laugh along, but trust is destroyed.

You will never get a sense of excellence in a service without trust between the staff and the management of the service.

Separating People From Processes When Identifying Failure

An expert on this is Dr Umesh Prabhu (a former NHS Director who has made it his life’s work to help doctors that are being bullied in the NHS).

He has said that the most serious disciplinary breaches that could ultimately lead to dismissal were:

- Criminal acts

- Serious misconduct

- Fraud

- Inability to safely perform the job due to substance issues

The point he makes is that it may be a simplification to just blame the doctor.

It is more important to differentiate and investigate between service or process failures and a qualified professional being incapable of performing their role to a reasonable standard.

Understanding That Processes Are Linked, Not Independent

I worked in logistics and manufacturing and studied in this area before moving to healthcare – what the best minds within these disciplines do well (lean / world class methodology / The Toyota Way) is focus on the interdependence of tasks and processes, look at how the work is done, leading to an outcome.

It is a useful way of looking at desired outcomes in healthcare, after all, it is also a set of policies, environment, culture, job structures, norms and behaviours all combined that lead to outcomes.

This is known as “systems thinking”. It’s a holistic way of looking at things – very relevant for healthcare settings but sadly not widely reflected in performance management practices at an operational level at this time.

Stresses Of Management Lead To Attrition

If you combine the effect all three (unrealistic expectation, separating people from service failure, and siloed processes) then it can lead to high levels of attrition in Social Care management.

If they are exposed to one or more of these stresses Registered Managers have little option but to leave (before they are asked to leave).

The solution?

Abandon procedures built on ‘Perfectionist Thinking’.

Let’s Abandon Perfectionist Thinking In Social Care

In my experience in running Care Homes there is often a cover up or denial of wrong-doing.

For instance, if you’re liaising with a hospital that has got something wrong you’ll often be faced with a denial instead of an admission.

Likely, this relates to a concern about being held accountable - whether legal or reputational.

And yet, concerns about an individual’s risk to their employment if an error is admitted, whatever the cause, is unhelpful.

It may lead them to cover up the mistake so that they keep their job.

If the ultimate cause is a failure is due to business process (and not the individual’s failure to perform their role to standard) then the issue will arise again and again.

The key thing we should remember is that wherever there are processes and people in any scale with high volumes of tasks, there will be breaks in process (mistakes).However robust we are in encouraging compliance with processes things can become unpredictable at times.

The more interactions you have, the more interlinked processes there are, the higher the statistical risk that something will go wrong.

If an organization is in denial of the fallibility (even if small) of a system it is vulnerable to a culture of cover ups - which in turn can lead to bullying and shaming.

All the time the healthcare system can’t allow for legitimate mistakes and learn from them it serves to limit the whole sector.

In some care providers, there is a strong culture of blame.

This is inevitable when we don’t separate the individual from the systems they are working within.

This needs to change and the stakeholders need to support a changed approach: from the CQC to Commissioners to the directors overseeing care services.

This is known as Perfectionist Thinking.

What Is Perfectionist Thinking?

Perfectionist thinking is a type of cognitive error according to one of the forefathers of Cognitive Behavioral Therapy (CBT) models, Albert Ellis.

As Dr Prabhu outlines, bullying and blame-culture, when it is a result of Perfectionist Thinking, diminishes the healthcare system overall because it doesn’t differentiate between staff that are good (who make rare or very occasional mistakes - which is everyone) from those who are actually unsafe in their jobs.

The first group of staff may need more support, more coaching, development, or to change their role to play to their strengths.

Whereas those who are actually unsafe in their jobs need to be identified and removed, or at least retrained and found a role that is more suitable.

Perfectionist Thinking Creates A Revolving Door For Home Managers

In my current nursing home, I have five new nurses who’ve been home managers or clinical leads and deputies - they’ve all got burned out and have stepped down previously despite long and successful careers to that point.

I wrote about all of this in my 2nd book in 2018 (Leadership Secrets for Care Home Managers) and the pattern hasn’t stopped.

Many providers are still looking for that unobtainable “perfect” manager / leader and when it doesn’t work, the search restarts.

This collective behaviour impacts the eligible pool of Care Home Managers and leaders.

The individual’s CV is compromised.

They take it personally, lose their confidence and drop down or even drop out of the sector altogether.

In turn agencies and providers wonder why they find it hard to recruit a good Home Manager or clinical lead.

All care recruiters want to find a manager who has a lovely straight line of just a few jobs with long tenure.

But when the industry hire a manager with an impeccable record, and then finds fault with them (measured against an unrealistic set of goals) and dismisses them for minor problems then they are diminishing the pool of available Registered Managers.

This is not a sustainable system.

The better approach is to show support and understanding.

That approach works for all but the most serious / extreme Care Home problems.

Healthcare organisations should strive for excellence of course.

But they should do so with a learning culture behind that mission.

They should be open to fallibility, and honest about mistakes.

And they should task their senior management to do the same, leading by example.

There has been considerable research on this approach too.

The analysis and data shows that the culture of the best performing organisations over the long-term involves effective leadership and trust, staff engagement, honesty.

These are simple ideas of course, but they are not always easy to embed in an established organization.

If you want to read more about this body of work, I can recommend the following:

Peter Senge, “The Learning Organization”

Peter Drucker, “The Practice of Management”

Jim Collins, “Good to Great”