There's a definition of health which is the ability to adapt and self-manage in the face of life's changing circumstances. When someone is diagnosed with a long-term illness it represents a fundamental challenge to them - the narrative of the life they had envisaged has changed for ever and how well they live depends almost entirely on how they adapt and self-manage.

Responding to this challenge is a journey of change to understand the new challenges one faces, find acceptance and meaning, learn new skills, discover sources of support, build on existing relationships and discover and develop new partnerships. It relies on that person having power and control to set their own agenda and goals and to work collaboratively with others to realise these personal outcomes. Becoming a successful self-manager is about taking control, resisting helplessness and a dependence on others to tell us what to do.

Health professionals have traditionally been the managers of people's health, building on their success of fixing previously incurable acute diseases. However, they have inappropriately retained this approach when dealing with people with incurable long-term conditions, assuming control and responsibility and coaxing people to change their ways to achieve targets and goals that they see best in order to achieve a greater good.

The paradox is that health professionals have been trying to manage people in need of becoming their own self-managers. People often default to learned helplessness in the face of such zealous ‘doctoring’.

It's not dissimilar to the difficulties people working in health care have faced with the challenges of adapting to the demands created by changing medicine and society. The danger is that they default to learned helplessness by being managed, coaxed into targets and goals that make little sense, solutions are imposed and they develop a reliance on being told what to do.

Perhaps leaders can learn from the principles of self-management and help our workforce develop their own solutions based on their own values and aspirations, working collaboratively, building on relationships and networks of peer support?

The traditional role of policy makers and managers will need to change from target setter to one of a coach and enabler, helping people with agenda and goal setting, and working together to align and coordinate support according to capabilities to realise these goals. Successfully delivering this role requires empowerment and trust. It can be challenging as it requires building the confidence, knowledge and skills of the workforce to see themselves as active agents of change. It also requires a culture change for policy makers and managers to reflect on their own values and cede control and power.

It's a fundamental shift in the relationship, from a traditional paternalistic (I prefer parentalistic) professional-patient relationship to one where individuals and organisations are empowered and supported to tap into their own potential; to be in the driving seat of change.

If health care economies are to promote and support self-management and release the resources and assets of patients, these principles will need to be mirrored in the way we support and realise the capabilities and talents of our workforce. For organisations to be healthy and for outcomes to improve, individuals within them will need to see that they can take control and be the lead partner in change. They will need to be supported to adapt and self-manage. At the heart of this, as with successful professional-patient relationships, is a need for policy makers and managers to listen, empathetically seek to understand and work in partnership, within a culture of compassion and positive regard.


Graham is a GP and National Clinical Lead Self Management and Health Literacy, Scottish Government,


Lynne craven

So powerful! As someone who has lived with MS for 20+ years I have often said learning to support self-management is like learning to live with a long-term condition. You have put it beautifully in this blog, thank you!

keef feeley

The skill of self-management (called self-regulation in the U.S.) is one of the 8 skills of healthy happy successful people but like all skills requires lots of practice (thousands of hours?) and the correct (five) learning requirements, so are not developed to a great level by everyone (or most!). Locus of control has been known for many years as has Walter Mischels research and more recently the research by Carol Dweck (Mindsets), they all demonstrate the need to develop and measure the skill of self-management but since societies still prioritise academia and written exams (a Victorian concept) it has been marginalised.

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