The occupational health physician: afraid of the boss

In many organisations, there is an inverse relationship between hierarchy and psychological safety. The more dominant the boss, the less likely employees are to speak openly about what's really on their minds. As occupational health physicians, we see the consequences in our consultations: pent-up frustration, anxiety and exhaustion. It doesn't have to be this way. And changing it needn't be complicated.

I've had a cold for about six weeks now. To be fair, I've been prone to them all my life, but since Covid, having a cold has become a much bigger deal. I've tested myself more times than I can count – always negative. Sometimes I still go into the office, and none of my colleagues says: “Maarten, what are you doing here? You've got a cold. You shouldn't be here.” The reason is simple. I'm the managing director – and a fairly assertive one at that. You don't just tell the boss to go home. That's why I make a point of seeking out colleagues, asking what they think and sharing my own views. It helps me understand what's going on, prevents important conversations from taking place only behind closed doors and, above all, gives me input I can actually use.

There are many kinds of boundaries

Wherever there's a power imbalance, people are more likely to hold back their feedback and push themselves beyond their limits. We've seen extreme examples of this in the media over the past month, and rightly condemned them. But the conversation shouldn't stop there. It's also worth asking how safe people feel within your own organisation. And I mean safety in the broadest possible sense. After all, sexual boundaries aren't the only boundaries that can be crossed.

Consistently working excessive hours, organisational problems that never really get resolved, restructures that drag on indefinitely, or the constant stress of feeling that nothing you do is ever quite good enough – all of these can have a negative impact on employees' wellbeing and energy. At the same time, employees are unlikely to speak up about these issues unless they feel genuinely safe. Instead, they keep quiet, bottle things up and carry on. Until, eventually, we see them in our consultations as occupational health physicians.

There's nothing wrong with stretching yourself

To be clear, there's nothing inherently wrong with occasionally pushing your boundaries. Work isn't always going to be enjoyable, and people don't grow by staying in their comfort zone all the time. The question is: when does stretching your limits become crossing them? When is the intention still reasonable, and when has it gone too far? Those are conversations we need to have with each other – openly and honestly.

That doesn't happen automatically, but it doesn't need to be overly complicated either. There are two things organisations can do. The first is to have a confidential adviser available – and make sure they're a good one. Not, to borrow John de Mol's words, simply “a reporting point” that employees are expected to approach before anyone can do anything about a problem, but an actual person. Someone employees feel comfortable talking to, and who also actively looks for signs that something may not be right. And make sure employees know who that person is and how to reach them.

Practising feedback

The second is to practise giving and receiving feedback. Occupational health physicians are skilled at creating a safe environment in which people feel able to say what's really on their minds. And you create that kind of environment by actually doing it. Managers and employees can simply agree: we're going to give each other feedback. Positive feedback, but also the things that are more difficult to hear. And we'll talk openly about how that feedback affects us. You can have a fair amount of confidence in where those conversations will lead. Most managers don't want to lose their employees tomorrow, and most employees don't want to start looking for a new job tomorrow either. Both sides want to make it work – and make the best of it together.