An NHS trust recently apologised for what it called a toxic workplace culture in healthcare. But what does that actually mean? 

An independent review of NHS Lothian’s women’s services highlighted: 

• Bullying and poor relationships between managers and staff 

• A culture of fear around speaking up 

• Delays in patient care linked to staffing shortages 

It’s difficult reading. Behind these headlines are real people. 

• Staff trying to cope under relentless pressure 

• Patients and families dealing with the impact 

The word toxic is often used to summarise all of this. But that label can hide more than it reveals. These problems aren’t just about individual behaviours, they’re about systems, relationships, and long-term strain. 

These are rarely about one person. They usually indicate: 

• Normalised negative behaviours 

• Unresolved tensions and lack of open communication 

• Staff withdrawing or avoiding conflict 

When staffing is short and workloads increase: 

• People switch to survival mode 

• Empathy and teamwork decline 

• Self-protection replaces collaboration 

Trust is the foundation of any effective team. Without it: 

• Communication suffers 

• Blame becomes more common 

• Problems get hidden instead of addressed 

This reflects low psychological safety. Staff don’t feel safe to raise concerns, even when care quality or safety is at risk. That silence is dangerous.

I’ve supported NHS teams where: 

• Pressure never lets up 

• Staff are burnt out and emotionally switched off 

• Keeping your head down feels like the only safe option 

• People who started their careers full of care and commitment now feel detached