Have you ever been attacked by someone whose life you were trying to save? Have you ever been asked by the police to identify human remains? Taken a phone call from someone trying to save their dying child? Probably not, but this is all part of professional life for many people working in Britain’s National Health Service. For some, such ‘extreme work’ is part of their daily reality.

These experiences emerged as we (with colleagues Paula Hyde and John Hassard) spent time with Nurses, Managers, Paramedics, Emergency Call Handlers and Dispatchers and others as part of an immersive three year study of working life in the NHS. Some of these experiences were recounted in interviews, or as we accompanied people throughout their working day. We spent a day with call handlers at an Emergency Control Centre who took 999 calls from people at the worst moments of their lives – but also, occasionally, the best; more than one had talked someone through delivering a baby. Good or bad, what struck us as researchers was that many of these were matters, quite literally, of life and death. In light of this, we were surprised by how young many of the call handlers were; people in their early to mid twenties, some having just swapped the lecture theatre of a university for a busy inner city emergency call centre.

While the theme of ‘life and death’ ran through the research (maybe not surprising given the context), not all of the work we saw involved horror and high drama. Often, it was more a matter of pace of work, as well as the stakes involved. Managerial meetings are perhaps not the most obvious setting for fast paced, high intensity work, but in an organisation under as much pressure as the NHS, they were often conducted at a tempo quite in contrast with that we ourselves were used to. Once again, what is at stake is key – the importance of various performance targets, for example on waiting times or infection rates, meant that statistics flew back and forth with dizzying rapidity. While hard targets for example are important to the organization, they also had a more overt, and immediate human element. With allowing a patient to breach a waiting target, or the hospital running out of beds very much not the ‘done thing’ for the NHS manager on the spot and wanting to stay in their job, things can get rather frenetic as the possibility draws near – phones are hammered, favours are called in, patient moves are co-ordinated with some haste, wards are opened, oxygen tanks checked… and disaster is (usually) averted.

Spending time with an ambulance control centre manager, we asked him at intervals throughout his 12 hour shift to rate the level of intensity of work. At 10am things were pretty calm at ‘level six’, but as the day drew on and the weather worsened, road traffic incidents began to mount up and demand for ambulances rose. By 4pm the manager was dealing with cars – which might or might not contain decapitated teenagers – stuck under bridges, ambulances breaking down, and borrowing a helicopter from another ambulance service in order to fly someone hundreds of miles for a lifesaving operation. While his team of 15 junior colleagues were almost as busy, it was the manager to whom the most critical incidents were handed. At the same time, he had to deal with personnel issues such as probation and sick leave. We had never, until observing this manager, seen a phone ring as soon as it is put down – over and over again. The intensity level by 4:30pm?-‘ten, but here it can go up to eleven’….

The ‘rapid fire’ problem solving we saw in this and countless other instances gave us the sense of ‘manager as fighter pilot’, critical decisions made rapidly in an environment of pressure and intensity. Other researchers had noted similar levels of intensity, with David Buchanan’s research team, for instance wondering if healthcare jobs were becoming ‘extreme jobs’ (Buchanan 2011). While the NHS colleagues we spoke to all accepted their lot as part of their job as professionals, high levels of stress lurked, unspoken, in the background, and levels of stress in the NHS are formally reported as being very high. Aside from the intensity of work, many people we spoke to, particularly managers, found that the amount of work they were expected to get through seemed to be increasing. Very often, work was taken home to be completed in evenings and weekends, because the large volume of paperwork or data entry simply could not be dealt with in the hospital/ emergency control centre/ ambulance station because of ‘constant interruptions’

Widening the sociological discussion further, we have become interested in how intense work and long-hours cultures are increasingly understood as ‘the norm’ in contemporary workplaces. Increasingly, many people take long hours and very intense work for granted, believing it to be inevitable; an unspoken part of the employment contract. In an attempt to characterise this situation, commentators have used seemingly paradoxical or tautological phrases such as ‘normalized intensity’ (McCann et al 2008). For many in the twenty- first century workforce, extreme has become normal, normal has become extreme.

As part of our developing interest in extreme work in all its forms, we are running a stream at the 2013 Critical Management Studies conference here in Manchester, and there will also be a special issue of the journal Organization on this theme; please look out for further details and calls for papers, or contact us at edward.granter@mbs.ac.uk.


  1. Buchanan, D. (2011) Are healthcare management jobs becoming extreme jobs? , Cranfield Healthcare Management Group Research Briefing 7. Cranfield University, UK.
  2. McCann, L., Hassard, J. and Morris, J.L. (2008) ‘Normalized Intensity: The New Labour Process of Middle Management’, Journal of Management Studies , 45, 2: 343-71.

Acknowledgement and Disclaimer

Our project was funded by the National Institute for Health Research Health Services and Delivery Research (project number 08/1808/241). Visit the HS&DR Programme website for more information. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS&DR Programme, NIHR, NHS or the Department of Health.