I run a monthly event in my Trust where we get staff together to talk about how healthcare affects them. We ask a staff member to share a personal story of triumph, error or emotions. The conversations that follow encourage attendees to consider how they would feel or react in a similar situation.

Recently we heard an incredibly honest and open story. Despite numerous successes, amazing achievements and national awards our presenter described feelings that at some point he would be “found out”, that the only reason he was in his job was luck, and it was only a matter of time before he was sent home for being a fraud. It took a really good management course for him to realise that these thoughts were normal, that lots of people get them and that they even have a name – ‘imposter syndrome.’

I get it too. I often wake up from a weird dream in which I haven’t passed an extra part of the College exams. Details are always fuzzy but it tends to be something to do with A-levels and a practical test I should have completed before becoming a consultant. I wake up with exam dread and a strange fear that I am not properly qualified to do my job. I haven’t quite got to the level of keeping my certificates by my bedside but it is very nice to rapidly realise it was just a dream and I don’t have to get revising.

What also came out of our discussions were not only how many other people had feelings like this but also some of the particular reasons we may see this in healthcare. There is hierarchy, always someone more senior to you, someone with more qualifications, colleagues who seem to achieve more, publish more and be on every committee.

Recognising your own successes as a perfectionist

We are surrounded by successful individuals, yet not recognising we are one ourselves. We also have many perfectionists in healthcare, because it is a useful trait to have when you are looking after people. But perfectionism can seed doubt – you may be reluctant to apply for roles if you are not 100% sure you are the right person or have the right qualifications. If you struggle with taking risks, you feel safer not taking such chances with your career and this could hold you back.

These feelings can be useful though, a kind of internal self-check. Without an internal voice of doubt could we be too reckless, too confident and potentially cause harm? It is really important if you are in a position leading a team that you make sure you highlight what has gone well.

We all have that human tendency to concentrate on what goes wrong, forgetting how much of the time everything goes well. Take a moment to celebrate success every now and again, both your own and the team you work in. Build it into meetings, thank people regularly, send a letter or email when you see good things, just take time to recognise what people do.

Knowing when to ask for help

Our presenter had a particularly bad patch when he became overwhelmed, when he didn’t feel he could ask for help for fear of being found out, when he was working through his lunch breaks and so he nearly gave it all up. He was ready to leave his job in healthcare and head back home to where he would get more support from his family.

What got him through this was a great friend who just said “yes you can”, “go for it” and “keep going”. He also had a good supportive manager who gave him time, listened to his worries and organised some training for him. He realised it was OK to not know, OK to ask and OK to need help.

He has gone on to even greater success since.  He now leads a large team and is an ambassador for a new national programme. He is supporting others to apply for the same training opportunities he had.

Supporting your team when ‘imposter syndrome’ arises

‘Human beings, who are almost unique in having the ability to learn from the experience of others, are also remarkable for their apparent disinclination to do so.’

Douglas Adams: Last Chance to See

It made us think what we can all do in our own teams and departments to make sure that no one quits because of their ‘imposter syndrome.’

• Celebrate success rather than concentrating on criticism and error. Keep a balance at all times and don’t apportion blame. We have a GREATIX system in the Trust where you can report great things, a direct counterpoint to the DATIX system where errors are reported.
• Our feedback should be frequent and developmental rather than bland and “satisfactory”. Make it your normal to seek feedback personally, if you are willing to receive feedback people will take it from you much more happily. 
• Make the space, place and time to get together to talk about plans, decisions and being out of your comfort zone. That is the role of a leader, learn how to do this well.
• Find, train or assign mentors or coaches to everyone, especially at times of change. Coaching is a great way to support people without being overbearing. Learn how to have a coaching conversation rather than telling people what to do in every situation.
• Create diverse teams and accept each other’s flaws. You don’t have to be good at everything to be good at your job.
• Accept that being good enough is OK and worry less. I know this is not easy in the healthcare setting when we have to get everything right. We work in systems and people look after each other, watching for potential error. As long as those people feel they can speak up to you, things will be OK.

Even though I heard all of this, I know I will get that dream again, some things will just set it off. I want to make sure no one gets to the point of such severe doubt they might leave. We have so many talented people in healthcare and so many of them will have ‘imposter syndrome’ but not know it.

Talk about it, get more people to just have a go with new innovative ideas, with leadership, projects or research even though things may not work out. It really doesn’t matter, honest. We have to support people to try, give them advice and help in a way they appreciate if they don’t succeed – and never berate someone for having a go.