Why Working Harder Isn’t Getting You Further in the NHS
Most NHS women leaders I coach tell me the same story. They’re working harder than ever, racing from one meeting to the next, firefighting problems, replying to emails late into the night. Yet despite this relentless effort, they end each week wondering what difference they’ve actually made.
It’s a paradox many recognise: the harder you work, the less progress you feel. And it isn’t simply about personal time management or motivation—it’s about the system you’re operating in.
Research consistently shows that NHS staff are at higher risk of burnout than the general population. A survey by NHS Employers found staff were 50% more likely to suffer from chronic stress than people in other sectors. Burnout doesn’t just drain energy, it also reduces effectiveness. In fact, psychologists call this the “diminishing returns of effort.” Push harder, and each extra hour produces less value than the one before.
This is compounded by the way the NHS measures and rewards its leaders. According to The Broken Ladder report (Investors in People, 2025), 80% of NHS managers are promoted for technical expertise, not leadership ability. The result is a culture where “doing more” is valued over “leading better.” In practice, that means leaders are buried in tasks rather than developing people, shaping strategy, or creating space to think.
To make matters worse, many leaders never receive formal training in how to lead people in such a complex system. A Financial Times analysis recently revealed that only one in five NHS leaders has had senior management training in the last five years. Without support, leaders default to what feels safe: working harder, putting in extra hours, and saying yes to everything. But those behaviours rarely lead to recognition or promotion.
And yet, the women I work with also carry another set of unspoken pressures: the need to prove themselves, the fear of being judged, the discomfort of taking up space. These internal voices combine with systemic pressures to keep women trapped in a cycle of overwork, invisibility, and exhaustion.
So if harder isn’t working, what will?
The answer lies in shifting from effort to impact. That doesn’t mean slacking off. It means recognising that the best leaders aren’t the ones who carry the most, but those who create the conditions for others to succeed. It means being brave enough to delegate, to prioritise, and to protect time for thinking.
A few simple practices can help start the shift. Try ending each day with five minutes of reflection: what went well, what drained me, and what will I do differently tomorrow? Map your team’s strengths, and delegate tasks that play to those abilities—this not only lightens your load, but helps your staff grow. And most importantly, protect your energy. Boundaries around rest and family time aren’t indulgent; they are essential for effective leadership.
The truth is, the NHS doesn’t just need women who work harder. It needs women who lead with clarity, influence, and purpose. And that starts when you stop equating effort with impact, and begin working in ways that truly move the needle.
