How Uniforms Affect Behaviour

Many years ago, I worked as a hospital manager responsible for a big directorate covering wards and community services. I loved being an occupational therapist and had progressed to a general manager as wherever I was in the system, I could see ways to improve it but to do that I had to move higher up in the system. Looking back, I was ill-suited to this post as I hate bureaucracy and hierarchy. My interest was and has always been improving the experiences of people who use health and social care services. I found a better way to achieve this as I explain in my post How to find your perfect job.

Although the experience I am about to share with you happened twenty years ago, the lessons have stayed with me and are relevant today.

The head occupational therapist (OT) was exhausted and badly in need of a holiday but she insisted that she couldn’t take leave because her department was understaffed and the team unable to cope without her. As I was a qualified occupational therapist and my registration to practice was up to date, I suggested that I step in as head of her department for a few days. I had a deputy who could cover for me and I saw an opportunity to get a different perspective on how our directorate was working. 

So, I swapped my suit for an OT uniform and went back to the wards. It was just a different uniform but that day felt as though I was acting in one of those body-swap films. These are the encounters that have stayed with me. They say something about female stereotypes and identity that interest me.

I regularly walked through our wards as a hospital manager. The ward manager would always notice me and find time to have a few words but the other staff and patients rarely paid me any attention. When I stepped onto the same ward dressed in an OT uniform, patients called out, ‘nurse, nurse.’ Hands reached out to me from the beds. I was overwhelmed by the cries from patients in need. There were not enough staff. I wanted to respond to all of the cries for help but I had gone to the ward to assess a patient. As a senior manager, I should have been more aware of the staff shortages. 

As I was walking back to the OT department along a corridor I regularly walked dressed in a suit, a porter clicked his tongue and gave me a suggestive wink. 

Later that day I joined my clinical director on his ward round. My role that day was as an OT and I joined his entourage of junior doctors and students as we discussed each patient at the end of their bed. A male junior doctor was condescending in the way that he spoke to me. I was after all a lowly OT in his opinion. The clinical director corrected him at once, pointing out that he was talking to his directorate manager.

Finally, I waited in the rheumatology out-patients department to pick up some OT referrals. All was going well until one of the consultants realised who I was and went into a rage, claiming I was spying on them.

I was perhaps a little naïve thinking I could just change my role for the day without preparing everyone, and making it clear who I was and why I was there. 

Wearing an OT uniform, I was seen as a caregiver, a porter’s mate – or fancy (I take it that he was being matey and not just flirting), and apparently, I had a perceived place in the medical hierarchy. 

My other uniform, my suit, gave me status, and respect. It also made me an outsider and a threat. 

That day revealed to me the reality of how things worked in our directorate. I wanted to know what was working and where we needed to do things differently. It wasn’t about catching people out. It was about giving them what they needed to do the job in the way that they wanted. 

A comment made by the head OT which I had dismissed as crazy, now made sense to me. She said, ‘When we meet with managers, you are in suits and we are in uniform, so we feel as though we are at a disadvantage.’

The NHS has a culture of hierarchy and there is a distrust between clinicians and managers. Female stereotypes of care-giver, conniving manager, naughty-nurse, or handmaiden put women in boxes. 

Of course, these are snapshots of responses to me when I changed my uniform and took on a different role within an institution. They are striking because of the sharp contrast between the roles, and because I had no time to acclimatise.

However, it makes me think about the uniforms we wear in life and the roles we take on at work and home. Sometimes, we become so attached to a role that we lose sight of who we really are. Labels can define us: our familial relationship to others, our work role, our experience, our condition. 

This blog is a bit different from my usual content but I have been wanting to record this experience for twenty- years. I am interested to hear your thoughts and experiences.

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