Sleep and conflict: A time to prescribe workplace mediation in the NHS?

Sleep deprivation is affecting an increasing number of people who are embroiled in conflict. I recently asked 72 people who had been engaged in the process of workplace mediation in the NHS on a one-to-one or team basis about the impact of conflict on their sleep. An overwhelming number of 64 commented that their sleep had been affected in a moderate or significant way. One person from the North chose to use his periods of insomnia to send emails to colleagues at 3.00am voicing his discontent with how he felt he had been treated. The business case for workplace mediation in the NHS has suddenly been bolstered.

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Sleep (or the lack of) is gradually making its way up the ladder of health epidemics faced by the UK population. Latest research points to a link between loss of sleep and conditions such as Alzheimer’s, cancer, diabetes, obesity and poor mental health. With the exception of three people asked, no one was achieving their recommended seven hours of sleep. Conflict was cited as the main factor. Sleep loss is said to be costing the UK economy £30bn per year. This is about 25% of the annual NHS budget. When one is in conflict, it can trigger a process of rumination as they think constantly about the conflict and what it means for them personally. One person who was asked, commented that even though he gets into bed by 10.30pm, he lies awake until after midnight thinking about the situation he is encountering. After a few hours of broken sleep, he finally senses he is about to drift into a deep sleep and then the alarm clock goes off.

The business case to which I refer is not simply another aspect of the economic imperative for mediation. It is much broader than that. Having personally mediated many disputes across the NHS, it feels as if conflict and sleep loss is becoming a matter of public health or indeed a matter for board intervention. It is also of course a case of the health system taking care of the health of its own workforce. My research on Mediation and Organisation Diagnosis in the NHS indicates that on average, it takes 19 months and two weeks before a conflict situation goes to mediation. A simple calculation tells us that someone could have 589 nights of disturbed sleep before a Trust puts the mechanism in place for mediation to happen. Let’s remember that the NHS has about 1.6 million employees. The potential scale of the problem is huge. Many of these cases, could have been solved within a week or so if managers and leaders were better equipped to have difficult conversations. 

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The research also indicates that sickness and absence levels for those in conflict situations is 2.6% higher than average. The correlation between sleep loss and conflict is growing but as yet, no one seems to be doing anything about it. Conflict is inevitable in today’s places of work. It is particularly prevalent in health. It is well known that the NHS is facing increasing amounts of pressure on the front line. I was in an Acute Trust the day after the announcement that non-urgent operations should be postponed until the winter crises has subsided. I witnessed the tension and strain this had on staff. I even saw how this impacted on an HR Generalist supporting a divisional function. In situations like these, it is just a matter of time before tempers become frayed and colleagues fall out with each other. In a notion that I describe similar to the services provided by an A&E department, Trusts should have a system with a similar objective, to nip conflict situations in the bud at the earliest opportunity. Admittedly, this might not be possible in four hours but, four days, four weeks or even four months would be progress on the situation faced by many Trusts at the moment. 

In a recent case, a manager with more than 30 years of experience described how an episode which led to long term sickness absence of one of her team members resulted in her experiencing sleepless nights due to conflict for the first time in her career. This was coupled with unusually high levels of anxiety. She had begun taking Zopiclone – a sleeping pill to help her. Her dispute was resolved in one day using mediation. It is high time that mediation is added to the list of medication prescribed by GPs or pharmacists.

The world of sleep science is still relatively small. However, large masses of evidence are being published.

Around 20 large epidemiological studies have reported the same clear relationship: the shorter your sleep, the shorter your life. For example, adults aged 45 years or older who sleep less than six hours a night are 200% more likely to have a heart attack or stroke in their lifetime, as compared with those sleeping seven or eight hours a night. A lack of sleep also appears to hijack the body’s effective control of blood sugar, the cells of the sleep-deprived appearing, in experiments, to become less responsive to insulin, and thus to cause a prediabetic state of hyperglycaemia. When your sleep becomes short, you are susceptible to weight gain.

This data and its link with conflict is presenting an overwhelming business case for the NHS to take the management of conflict seriously. Prescribing mediation in certain cases is a good first step. Dr Steve Boorman presented a clear case for Health and Well-Being management practices in the NHS almost ten years ago. If he were writing the report today, I would expect to see the issue of conflict and its impact on sleep deeply embedded within the report and its recommendations. This issue rapidly becoming a ticking timebomb and one which the NHS needs to grip with expediency. It is quickly becoming a problem of epidemic proportions.

Clive Lewis OBE DL

Helen RobinsonMediations