How to Make Reasonable Adjustments When Teams Are Under Pressure | Neuroinclusion in Healthcare

Healthcare is one of the hardest places to get neuroinclusion right because the pressures are real: understaffing, high cognitive load, shift work, sensory overload, urgent decisions, unpredictable routines and limited time. That can make reasonable adjustments sound like a luxury rather than a necessity. But in practice, the opposite is often true. When adjustments are delayed or treated as optional, teams lose talent, staff burn out faster, and avoidable friction makes already pressured environments even harder to work in. The NHS Workforce Disability Equality Standard (WDES) 2023 guidance notes that a quarter of disabled staff do not believe their employer has provided the reasonable adjustments they need, and that disabled colleagues are more likely to experience harassment, bullying or abuse. 

A doctor in a white coat, with a stethoscope around his neck, uses a smartphone to stay connected and manage patient care efficiently.

That matters in healthcare because disabled and neurodivergent staff are not a side issue — they are part of the workforce that keeps services running. NHS Employers’ disability inclusion guidance makes clear that disabled staff have a right to reasonable adjustments, including flexible working as an adjustment where needed, and that these rights sit alongside normal flexible working rights rather than beneath them. In other words, adjustments are not goodwill extras to be squeezed in when the rota looks kind. They are part of how a safe and inclusive employer functions. 

The challenge is that healthcare workplaces are often built around speed, stamina and adaptation to constant change. That can hit neurodivergent staff particularly hard. A 2025 qualitative study on reasonable adjustments for autistic clinicians found that autistic clinical professionals experience numerous workplace challenges and highlighted the importance of safe disclosure, support for self-advocacy, and adjustments that are offered and maintained rather than treated as one-off fixes. The printable version of the paper summarises key messages such as embracing neurodiversity, understanding masking, providing safe environments for disclosure, and maintaining accommodations over time. 

That last point is especially important under pressure. In healthcare, support often breaks down not because people disagree with the principle, but because systems default to urgency. A manager may fully intend to help, but if the process for getting support is slow, unclear or overly medicalised, the adjustment arrives after the harm has already been done. The BMA’s report on disability in the medical profession found that only 55% of disabled doctors and medical students who required reasonable adjustments said they had obtained them, with barriers including lengthy and complex processes, slow or partial implementation, and poor engagement from employers. Under pressure, those kinds of delays are not neutral. They turn manageable difficulties into capability concerns, sickness absence or attrition. 

This is why neuroinclusion in healthcare should start with a simpler operational question:

what friction can we remove quickly, safely and consistently?

Some adjustments are not large, expensive or disruptive. Acas’s guidance on adjustments for neurodiversity notes that support should be offered whether or not someone has a diagnosis, and gives examples including written instructions, quiet working space, more processing time, noise-cancelling headphones, assistive software, changes to communication style and flexible working where reasonable. In pressured healthcare settings, that might translate into things like clearer handover structure, advance notice where possible, written follow-up after verbal instruction, predictable supervision, reduced unnecessary context-switching, protected quieter space for admin, or adaptation of certain communication norms. 

The phrase “under pressure” also changes the conversation because many clinicians and healthcare staff fear adjustments will be seen as unfair to colleagues. But good adjustments are not about making work easier in a vague sense; they are about removing substantial disadvantage so someone can perform their role effectively. Leicestershire Partnership NHS Trust’s employment guidance for autistic staff states this clearly: reasonable adjustments are aids specific to the person that help them do their job, and the duty arises where they would otherwise be placed at a substantial disadvantage. Framed properly, adjustments are not in conflict with service delivery. They are part of what makes sustainable service delivery possible. 

There is also a patient care dimension here. Healthcare tends to separate staff support from patient safety, but in practice they are linked. A 2025 Frontiers review on occupational ADHD research notes that adult ADHD symptoms are associated with poorer work outcomes including higher burnout, reduced task performance, absenteeism and safety risks. That does not mean neurodivergent staff are unsafe; it means poorly supported staff in high-demand roles are exposed to greater risk when environments are designed badly. Better support can therefore improve not just staff wellbeing but reliability, communication and safety-critical performance. 

Autistic clinicians are another example of where the usual assumptions can be misleading. A 2024 BMA article challenges stereotypes that autistic doctors cannot handle pressure, communication or unpredictability, and instead emphasises that autistic people can flourish in medicine. That matters because stigma often stops adjustments before the conversation has even started. If the hidden assumption is that “real” clinicians should simply cope, then support gets framed as weakness. Neuroinclusion requires shifting that frame: the goal is not to lower standards, but to remove unnecessary barriers so people can meet them more sustainably. 

In practical terms, there are three healthcare-specific areas where accommodations matter most.

First: communication under load.

Busy wards, clinics and multidisciplinary teams rely heavily on verbal handover, interrupted conversations and rapid change. For some neurodivergent staff, especially in high-pressure environments, the combination of speed, ambiguity and interruption is the main problem, not the clinical complexity itself. Small changes like confirming key actions in writing, using structured handover formats, clarifying priority tasks and agreeing how urgent changes are communicated can make a disproportionate difference. This is very much in line with the practical approach set out in Divergent Thinking’s workplace assessments, which focus on reducing friction in workflow, communication and working routines rather than treating support as purely medical. 

Second: sensory and environmental load.

Healthcare settings can be loud, bright, crowded and unpredictable. That is not always avoidable, but some elements are more adjustable than they appear. Quieter spaces for documentation, flexibility around where non-clinical work is completed, access to sensory supports, and minimising unnecessary background disruption can all help. NHS Employers’ article on embracing neurodiversity in the workplace explicitly recommends open conversations, positive language and practical support to better enable neurodivergent staff to thrive in their roles. 

Third: maintaining adjustments during change.

This is where pressured services often fail. A support arrangement may work well until the rota changes, the employee is redeployed, a manager changes, or the team enters winter pressure mode. NHS Employers’ report on disabled staff experiences during COVID-19 found examples of disabled staff describing lack of support, lack of consultation and poor communication during redeployment. That is a useful warning for healthcare more broadly: adjustments need to survive operational stress, not collapse under it. 

This is also why some NHS organisations are looking at infrastructure, not just case-by-case fixes. NHS Employers’ guidance on managing a centralised workplace adjustments budget argues that centralising resources can remove barriers and speed up access to support. In a pressured healthcare environment, that matters because line managers often hesitate when they think every adjustment request creates a funding or bureaucracy problem for their local budget. Streamlining the mechanism can make inclusion more operationally realistic. 

For line managers, the most important shift is probably this: stop treating accommodations as a special process that begins after certainty, and start treating them as a practical management response to an identified barrier. Acas’s guidance on asking for reasonable adjustments frames this as a discussion to understand the situation and agree support together. In healthcare, where time is tight, this kind of practical and collaborative framing is far more workable than a rigid “prove it first” culture. 

For organisations, the wider point is cultural. The NHS equality, diversity and inclusion improvement plan is explicit that improving belonging and staff experience is part of improving the NHS. Neuroinclusion in healthcare should therefore not sit in a silo as a one-off wellbeing issue. It belongs in workforce strategy, management capability, retention planning and service sustainability. 

If you want to make this practical in your own setting, a useful place to start is not “what diagnosis does this person have?” but:

• What part of the job creates the disadvantage?

• What adjustment would reduce that disadvantage?

• How quickly can we trial it?

• How do we make sure it survives rota changes, manager changes and periods of service pressure?

That is the difference between supportive language and operational neuroinclusion.

If your organisation wants more practical support, you can explore Divergent Thinking’s workplace assessments, browse the Divergent Thinking blog, or look at the wider Divergent Thinking neuroinclusion offer. In healthcare especially, the goal is not just to talk about accommodations. It is to make them workable when the pressure is on.