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  • Amina Aitsi-Selmi



None of us has ever set out to work in a toxic work environment, yet so many of us find ourselves feeling trapped in them. A European survey found that the levels of toxic workplace behaviours including violence and harassment were between 10 - 20% (20% in the UK).

In the US, a national survey estimated that 27% of adults had experienced bullying - with bosses representing the majority of bullies - yet 72% of employers denied, discounted, encouraged, rationalised or even defended it…

Defined as a work environment with “relentless demands, extreme pressure, and brutal ruthlessness” (Macklem, 2005), toxic workplaces are characterised by dysfunctional relationships at all levels, lack of trust, lack of transparency in decision making, favouritism and bullying.

Employees in a toxic work environment operate consistently in increased anxiety states; feel insecure about their work; are more frequently absent and may even be unable to work, with consequent impacts on productivity and costs.

If the organisational leaders have dysfunctional, competitive relationships, the impacts can trickle down the hierarchy leaving middle management and staff confused and unable to work effectively.

For example, you may find yourself worrying regularly about who to copy into emails so as not to make a “mistake” that will trigger political mayhem!


Research findings, including those of Michael Marmot’s Whitehall study, show that the experience of lack of control and effort/reward imbalance in the workplace with an absence of support systems is associated with raised blood pressure, increased heart rate and stress hormone (cortisol) release.

This in turn can lead to physical illness such as heart disease alongside the mental health consequences of toxic workplaces.

The toxicity is thought to be more stressful for women as they are more sensitive to hostile or stressful interpersonal situations than are men…


The NHS is an example of an organis

ation where toxicity levels are rising dramatically as a result of drastic system-wide, government initiated changes as well as austerity policies.

A 2013 study of almost 3000 NHS staff showed that 20% of staff reported having been bullied by other staff and 43% reported having witnessed bullying in the last 6 months. Male staff reported higher levels of bullying.

Bullying (or “abusive conduct”) and witnessing bullying were both associated with lower levels of mental health and job satisfaction, and higher levels of intention to leave work. Managers were the most common source of bullying.

My personal experience in the NHS is that navigating the career structure requires a certain level of stoicism, as one colleague put it: “staying under the radar”.

Interpersonal conflicts have been dealt with by those in charge in a range of ways from a mediated discussion to the ostrich approach (ignoring it and hoping the problem would go away until an escalation occurred).

There is a sense that the job is too important, so petty disagreements should be avoided. However, this leaves the door wide open for abusive behaviour to go unchecked.

At the organisational level, the NHS has come under extreme pressure from the recent political initiatives that have targeted:

- doctors (by restructuring their careers and cutting their salaries);

- hospitals and wider health services (by strengthening the market principle and opening services up to private providers); and

- public health (by ejecting it from the NHS, neutralising its political advocacy for health at national level and eroding its professionalisation).

Doctors and health staff are put in ethically impossible positions where they have to choose between caring for their patients and caring for their families.

Clients I work with describe the heartbreaking dilemma of leaving on time to pick up their kids meaning that a patient may not receive specialist attention until the next day and managers refusing to address the situation.

In some cases, further reductions in the number of doctors are implemented even though the clinical teams are already struggling.


There is light at the end of the tunnel. Some countries particularly in Scandinavia have clear procedures for dealing with toxic behaviours in the workplace.

Last year, the NHS published its first national, integrated whistleblowing policy, with the aim of standardising the way that staff are supported to raise concerns within NHS organisations.

While these policies are not a panacea, it’s important to be aware of avenues for intervention and support.

If structural support is unavailable and you find yourself isolated, you can go back to your inner-resources to change your situation. It requires a refocusing of energy away from habitual patterns to a process of change.

Conscious change is a highly energy consuming process that is often underestimated but if conducted properly can lead to enormously beneficial outcomes.

The process starts with curbing the negative cycle of thinking and emotions that you may have unwittingly become caught up in and reclaiming your own power to change things.

The strategy that you follow will depend on a variety of things. But there are ultimately 3 options, as Eckhart Tolle puts succinctly: “If you don’t like a situation leave it, change it or accept it. All else is madness”.

Similarly, Maya Angelou used to say: “If you don’t like a situation, change it. If you can’t change it, change your attitude about it”.

As adults, this is the reality we have to contend with. Which of the 3 options you choose will depend on your personal circumstances and you are in the best position to explore and make that decision.

Starting with acceptance can make it easier to move into one of the other two possibilities.


The process of change to either leave your current job or change your experience of it, can be broken into a number of steps.

Based on Tony Robbins’ highly effective process of transformation (The Seven Master Steps for Creating Lasting Change) these are:

1) Understand and appreciate your situation and your role in creating it:

- What are the underlying beliefs, values and needs that inform your decisions? Gain insight and use it to align your needs (e.g. for material security) and values (e.g. contribution; creativity) in a conscious way.

2) Tap into your most desired goal:

- Get clear on what you really want at this point in your career or life.

3) Lay out a set of empowering alternatives:

- What options do you have? Don’t be afraid to brainstorm liberally. Allow your imagination to create the possibilities. Your logical mind can then kick in to fill in the gaps and identify the next steps.

4) Identify potential challenges and reframe them in solvable terms:

- Beware of any victimised, negative talk that casts you in the role of the helpless. There is always a choice.

5) Be consistent with your actions:

- This includes overcoming your own mental blocks or resistance to taking any particular course of action. What you want is usually not as difficult as you think.

6) Make sure you develop habits and relationships that support the process.

- As you step out of your comfort zone, set up your environment to support you and cushion (psychologically and emotionally) the discomfort of taking risks.

7) Always relate your goal to a purpose that is bigger than yourself.

- This is the ultimate and the most important step. If you are operating solely for your own ego, you will soon burn out or run into further problems, not to mention procrastinate and lose momentum.

If you link your goals to a bigger purpose, you will be able to get through obstacles and recover the sense of power and fulfilment that is missing in your current situation.


One of my clients set a five-year goal last year to take her career to the next level and become a thought leader in her field to support African development.

Within a few months she had been awarded a prestigious fellowship at Johns Hopkins’ school of public health as an Emerging Leader in Biosecurity and is on her way to the White House.

Another felt it was impossible to step out of reactive clinical work and have more time to work on improving patient pathways in ophthalmology but has since become a Fellow at the National Institutes of Health and Care Excellence.

With courage, self-belief and focus you may find that your goals are much closer than you think.

Why do I care about getting my clients, including multicultural female doctors and health experts, into leadership positions?

Because in the current times of Trump and Brexit, I believe it’s more important than ever to get a diversity of voices to the table, break down the walls of the corridors of power and help to level the inequalities of the 1% world we live in, in whichever way possible. Questions, comments or interest in coaching? Email me on

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