Friday, March 6, 2015

The reality of leadership



Leadership is always a tricky one. Debate about what it actually means always is interesting as it brings out a range of views- starting from "its all about values" to "its a natural skill not all have". Then you get into the areas of discussion such as "we are all leaders in our own ways" and suddenly it becomes a cosmic discussion while at the same time, review after review tells you the NHS lacks leadership, especially of the clinical type.
Sometimes we confuse the term leadership with charisma and thereby it becomes even more complicated...is a leader about whether they have delivered outcomes or is it just the inspire factor? Is Obama a leader or just a charismatic speaker? Views differ...and we never quite get anywhere.

For the cricket  affectionado, think of Stephen Waugh..one of the acclaimed leaders in the world of cricket. To some, he was lucky to be in charge of some of the greatest players in 1 team..whats so tough about leading that sort of team to victory? To others, he brought together a disparate group of brilliant individuals and forged a team, one of the greatest ever. To others, he simply bullied other teams, used every tactic in the book..to simply achieve one goal...a win. To many more, he was n incredibly kind hearted man who did some amazing work for children with leprosy in Calcutta...little kids for whom he was just Steve-da, an affectionate term for brother in local lingo.A leader? A bully? A philanthropist? A legend? All about perspective, isn't it?

So what about the NHS? Firstly, what makes a great leader? Someone who has forged a great team spirit but not delivered patient based outcomes? Someone who has happy staff, happy patients but not much in way of delivery? Someone who has developed amazing services for patients but not bothered much about keeping others happy? Some would say we need all of that...but history has taught us time and again that not to be true, not to be rarely possible. I see many leaders quote Gandhi at the drop of a hat. History will tell you he was perhaps the biggest rebel for many Indians but one of the biggest troublemakers for British Raj. One man's freedom fighter is always another mans terrorist. Leader for some, troublemaker for another. All about your perspective....the debate continues.

The question is always why so many clinicians stay away from leadership roles. Well...what would attract someone to it? In general, for right or wrong, there's a few factors, either in isolation or combined which draws an NHS Consultant towards these roles. They are...Glory, Power, Altruism, money. I appreciate we would all like to believe that altruism should drive us all but it ignores the reality of life. Money isn't much of a driver for many firstly because the financial reward is pretty average for leadership roles to start with- not to mention it's not really a huge issue for folks who are in the top 4% of the country as regards salaries go. As ever, there are exceptions, but financial reward is hardly a draw.

What about power and glory? A huge draw for many and whether we like it or not, the NHS is awash with folks like that. Let me be crystal clear..that doesn't diminish what they can offer, their passion is worth emulating and there are examples of great care driven by individuals such as that- but for them, glory, either self or the department has been a major driver. I will be honest, time may have tempered my desire but I started my leadership journey because I wanted to put Portsmouth on the map of diabetes care, make it one of the best.
Time teaches you the biggest currency isn't the title you hold, but the influence you carry but hands up, that has been my personal driver. Which brings us to altruism- there will always be people for whom that carries a significant part...the problem with that is the sustainability and also the ability to balance your personal life. The NHS is astounding in its ability to ask those who do a bit more...to do a bit more..one more time..one more time for the patients. Every one of us has a limit..everyone of us has a life..altruism only goes so far...at one point, the rubber band stretches, it snaps..and in 1 fell swoop, you lose the power of altruism as well as that individual.

The problem as always is of the NHS a being awash with leaders without track records..good speakers, good motivators but a bit thin on the ground as regards delivery. We spend too much time describing a shiny world, spreading the goodness of optimism but it needs balance. It needs realism, stories of leaders failing, stories of how the first hurdle was the toughest one, how adversity is a part of life in the NHS and how lack of resources are impeding progress. Did I hear someone say "Resilience"? More different words crop up but we need to be more realistic about what we are asking our optimism filled, leadership cadets to do. Otherwise in the real world, disenchantment sets in quick and you lose even the ones who have been inspired by your slides on a pretty PowerPoint.

The million dollar question is whether all the leadership bodies can walk away from a mutual session of backslapping after an annual session or Twitter chat..feel that's enough to justify their existence or whether a new ring of leaders will come through armed with the knowledge of what both success and failure looks like. The NHS needs clinical leaders...and it's running out of volunteers pretty fast.  An edge could be a cutting edge of the new frontier..it could also lead to the face of a cliff. Leadership is rewarding, can be fun..but it's tough and spiked with failures too

Temper the optimism with realism...and then the future looks a bit..better.

Next week: NHS Change Day...progress or another year of banality? A personal view..

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