The deep wounds of moral injury

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The below article featured in The MJ magazine.

A study conducted by the TUC suggests one in five public sector workers is “actively considering” leaving the sector. More than one in four workers questioned said that government policy on pay particularly has led them to consider a career move. Broader responses suggested “serious disillusionment”, complaints of excessive workloads and a sense of being undervalued.

So, to briefly explore this in the context of senior management and leadership roles in local government. I have been writing about the public / private sector pay gaps for many years. Whilst remuneration has always been part of candidate mobility, my sense is of a growing issue around middle and senior management retention for other reasons.                            

Regular readers of this section of the MJ (and the preceding recruitment adverts), will have noted an upturn this year in the volume of vacancies and well-publicised retirements. Is workload and a sense of being under-valued part of this? The pension cap has historically been the most obvious explanation for early retirement at senior management and board-level and is not unique to local government, so I don’t think pay policy is to blame. Customer satisfaction in local government has remained high in recent years, so the value of leaders’ work is understood. Senior civil servants have always worked incredibly long hours and with high workloads. So, what has changed? What might be causing the “serious disillusionment” seen in the TUC research? Is anecdotal talk of “burn-out” in the sector an actual thing?                          

Perhaps one possible explanation is moral injury. Moral injury is understood to be the strong cognitive and emotional response to events that violate an individual’s moral or ethical code. From what I can see, the concept emerged in professions such as the police service and Armed Forces, but is increasingly being seen in the public sector.  In the context of the pandemic, moral injury has been found to be one of the greatest challenges reported by the NHS amongst frontline health-care staff and is significantly associated with post-traumatic stress disorder and depression. Moral injury can be another person’s act of omission, such as a perceived lack of PPE for a healthcare worker, or that the standard of care that a social worker would usually expect to deliver, is impossible because of an excessive workload.                                

Failure to prevent moral injury by the organisation or those leading it, as much as bearing witness to the impact of leadership decisions on the front-line, can lead to long-term emotional and psychological suffering. Unlike post-traumatic stress disorder, morally injurious events do not necessarily involve a threat to life, but instead a threat to an individual’s deeply held beliefs and trust. It can materialise in profound feelings of shame, guilt and anger.                             

As policy, guidance and the law changed rapidly and multiple times during the pandemic, local authority leaders had to respond as best as they were able and at considerable pace. Often there was little time to consider the impact on decisions other than protecting the public. But at what cost? Could moral injury be part of early retirement or career-change decisions? I am not sure that there is an evidence base to draw this conclusion, but I think we have a collective responsibility to be aware of its potential impact on how leaders represent in an appointment process and be mindful of their belief systems.               

We need to place even more emphasis on understanding “values”, “ethics” and “morals” in our recruitment decisions. People who have suffered moral injury are less likely to talk about their altered beliefs for fear of negative judgment. We might see this in a leadership profile, perceptions around “confidence” or “leadership impact” or responses to interview questions about an individual’s personal experience of responding to the pandemic.                              

Treatment approaches to moral injury focus on forgiveness, acceptance, compassion and making amends; what would strike me as exactly the type of compassionate leadership traits and approaches that we look for in local government and the wider public sector. I don’t think there is any need to panic about “burn-out” but instead to continue to be mindful of the pressure that leaders are under and curious to explore the positive impact of their personal values and belief systems on their workplace. Leaders with emotional intelligence, high morals and empathy for the impact on the front-line of their decisions are precisely the leaders we need for sectoral and systems recovery.                  

Nick Cole is a Senior Consultant in our local government practice.