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(Un)reasonable Adjustments · MSKMag OutLoud

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  Unreasonable Adjustments,
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  written by Glen O'Humeral,
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  sponsored by Physiomatters Premium.
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  SPEAKER_00: Definitions of reasonable adjustments, unofficial but entirely reliable.
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  The employee,
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  anything that allows me to do my job while never being
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  inconvenienced again,
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  ever.
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  The manager,
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  anything that doesn't require rewriting the rota or attending
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  another meeting.
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  SPEAKER_00: The colleagues.
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  Anything that doesn't mean I pick up your shifts,
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  your caseload or your endless size.
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  SPEAKER_00: HR.
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  Anything we can paste into a policy document to demonstrate
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  compliance without
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  SPEAKER_00: committing to action.
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  SPEAKER_00: Employee health and well-being.
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  Anything that can be delivered in the form of a mindfulness
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  webinar at 2pm on a
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  SPEAKER_00: Tuesday right in the middle of a clinic.
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  SPEAKER_00: Ah, reasonable adjustments.
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  SPEAKER_00: A phrase so slippery it could double as a banana skin on a corridor.
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  SPEAKER_00: The NHS loves it.
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  SPEAKER_00: Simple enough to print on policy posters,
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  SPEAKER_00: vague enough to keep it HR in full employment until the sun burns out,
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  but not with enough staff to actually implement fair and
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  reasonable adjustments.
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  SPEAKER_00: The word reasonable itself is the first trap.
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  SPEAKER_00: Reasonable to whom?
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  SPEAKER_00: The trust?
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  SPEAKER_00: The line manager?
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  The staff member who insists their desk be precisely 87cm high
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  lest their lumbar
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  SPEAKER_00: spine crumble like a dunked rich tea?
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  Or the patient waiting 14 months for an appointment wondering
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  if the whole system
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  SPEAKER_00: could do with a slightly more urgent adjustment of its own?
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  SPEAKER_00: Let's not forget the employee perspective.
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  SPEAKER_00: Many staff sincerely believe that their particular requirement,
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  be it noise cancelling headphones in a busy office or an
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  emotional support cactus
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  SPEAKER_00: in the staff room,
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  SPEAKER_00: must surely outweigh such trivia as,
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  SPEAKER_00: say,
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  SPEAKER_00: seeing patients or the needs of their colleagues.
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  SPEAKER_00: After all,
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  one can't pour from an empty cup and what better way to refill
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  it than with a
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  SPEAKER_00: sit-to-stand desk,
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  SPEAKER_00: an additional tea break and perhaps a personal sherpa to carry the mug.
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  SPEAKER_00: Meanwhile,
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  SPEAKER_00: managers,
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  often unsuspecting clinicians who thought they'd signed up to
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  fix frozen shoulders,
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  SPEAKER_00: not frozen rotors,
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  SPEAKER_00: are left playing referee.
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  They must weigh the noble aim of inclusivity against the
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  practicalities of
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  SPEAKER_00: departments already held together with duct tape and existential dread.
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  Should Jenny be allowed to work exclusively from home because
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  she finds the
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  SPEAKER_00: lighting oppressive?
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  Is it fair that Dave insists on a bespoke ergonomic chair that
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  costs more than the
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  SPEAKER_00: annual physio budget,
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  when the waiting room still has furniture held together by hope
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  and infection
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  SPEAKER_00: control wipes?
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  SPEAKER_00: It's not just about decisions, it's also about secrecy.
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  These managers are asked to adjust quietly,
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  confidentially and compassionately.
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  The requirements of one employee's well-being against the loud
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  eye-rolling and
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  SPEAKER_00: unsolicited advice from the rest of the department.
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  Like a clinician treating a patient with an OA knee who also
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  has plantar fasciitis,
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  SPEAKER_00: every adjustment made in one area seems to flare up another.
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  Add in the fact that the only training provided was a two-hour
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  e-learning module
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  SPEAKER_00: written in 2009 and you have a recipe for managerial tendinopathy.
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  SPEAKER_00: Chronic overload, no rest days and very little prospect of healing.
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  There's the awkward truth that not all reasonable adjustments
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  marry happily.
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  One staff member's ADHD means they thrive on chatter,
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  spontaneity and flexible timekeeping.
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  SPEAKER_00: I'll be there eventually.
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  While their autistic colleague flourishes with quiet structure
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  and their day nailed
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  SPEAKER_00: down to the minute.
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  SPEAKER_00: The result?
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  SPEAKER_00: An occupational oxymoron.
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  SPEAKER_00: One person's reasonable adjustment is the other's sensory nightmare.
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  SPEAKER_00: Managers are left playing mediator,
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  trying to harmonise oil and water with nothing more than a
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  policy in a hope that
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  SPEAKER_00: the next time will be easier,
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  SPEAKER_00: when the staff member inevitably leaves as soon as they are competent.
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  SPEAKER_00: The cruel irony is that staff who genuinely need adjustments,
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  the colleague with a progressive neurological condition or the
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  one recovering from
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  SPEAKER_00: surgery,
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  SPEAKER_00: etc.,
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  SPEAKER_00: now find themselves queuing behind a mountain of dubious requests.
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  SPEAKER_00: Their legitimate needs risks being trivialised,
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  dismissed or endlessly delayed because the term reasonable
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  adjustments has been
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  stretched further than an overzealous hamstring in a beginner's
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  reformer Pilates
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  SPEAKER_00: class.
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  SPEAKER_00: For them,
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  SPEAKER_00: the process feels like support and more like months of paperwork,
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  SPEAKER_00: inconsistent progress and no guarantee of improvement.
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  All of this is neatly reinforced by society's current obsession
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  with permanent
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  SPEAKER_00: happiness and total comfort.
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  We live in an age where the faintest whiff of inconvenience is
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  treated like a red
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  flag for occupational health and where negative emotions are
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  seen less as normal
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  part of a human being and more as a sign you need a bespoke
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  wellbeing strategy.
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  SPEAKER_00: Resilience?
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  SPEAKER_00: Overrated.
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  SPEAKER_00: Tolerance?
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  SPEAKER_00: Obsolete.
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  SPEAKER_00: And personal responsibility for managing your own adjustments?
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  SPEAKER_00: Why bother when you can let someone else rearrange your role,
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  dim the lights and deliver your high protein snacks right to
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  your ergonomic throne?
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  SPEAKER_00: The idea that work might occasionally feel like,
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  SPEAKER_00: well work,
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  now seems positively archaic as though suggesting someone with
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  a stiff neck try
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  SPEAKER_00: moving it a little.
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  SPEAKER_00: And patients?
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  SPEAKER_00: Oh yes, those mythical beings.
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  One suspects they might not care whether their clinician uses a
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  kneeling stool or a
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  yoga ball as long as someone actually shows up to see them
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  before the NHS is no
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  SPEAKER_00: more.
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  In the end,
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  reasonable adjustments are a bit like evidence-based medicine.
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  SPEAKER_00: Everyone agrees in principle,
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  SPEAKER_00: no one agrees in practice,
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  SPEAKER_00: and someone always ends up with a flowchart.
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  Perhaps the only reasonable adjustment is to accept that
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  nothing is reasonable.
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  SPEAKER_00: Everything is an adjustment,
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  SPEAKER_00: and particularly in the NHS,
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  SPEAKER_00: all of it will require another committee meeting,
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  SPEAKER_00: another e-learning module and a small miracle,
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  SPEAKER_00: or at least a strongly brewed cup of tea.
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  SPEAKER_00: Now, I've spent far too long sitting on my beanbag writing this.
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  SPEAKER_00: I need a brew!