Saturday, 9 July 2011

He who cannot obey cannot command

Last Tuesday, I gave  a talk on Change Through Leadership (not sure if the capitals are necessary, but judge for yourself) at a small conference organised by NHS London. It felt like a big deal. It wasn’t. But it felt like one - mostly, because Andrew Lansley was due to turn up. He didn’t hear my talk, so I thought I would blog about it, so that he can catch up on what he missed.

When he did arrive, it was to announce the launch of a new NHS Leadership Academy, to build on the various Leadership programmes that are in place throughout the country, and particularly London, and to give a national profile to leadership and its development. The details are still to be established, and I have to admit, that I still do not have a particularly clear idea of what this academy will look like, and what gap it will actually fill.

I spoke about what I had achieved on the clinical leadership programme, both in terms of improving patient care and experience, and personal development. The timing of the talk has coincided with a couple of big things in my life: one is a personal crisis, which I am not yet ready to talk to you about, and the other is the Tour de France, which I am always ready to talk about.

The Tour de France is the Grand Opera of sporting events. Dismiss it as an event at your peril  - it has everything. The one thing you need to understand about cycle racing is that up to 30% of your energy is spent overcoming wind resistance, and that when you are cycling behind someone, they do this work for you. This very simple principle plays out in a number of ways, and means overall that no one man can win the Tour de France by himself. Every man who has won the race in the modern era has done so with the considerable backing and support of his 8 team mates.

Being a team leader and persuading your team mates to ride for you is more complicated that just being the best rider - you have to have leadership, and you have to have it in spades. The work that the team does for its leader involves team members physically burying themselves. The suffering, sacrifice and commitment that these chaps show is often superhuman, and half hearted efforts get you nowhere.

I think that I have learned a lot about leadership from watching the Tour de France, and one of my favourite examples was Bernard Hinault, the patron of the race in the late 70s and 80s. He won the Tour five times, and it was clear that his team mates would walk through hell for him. There were a number of factors that led to this, but key to his approach was reciprocity - he struck a deal with them: they would ride for him to win the big race, the Tour de France, but in other races, and on quiet days in the Tour, he would ride for them. It wasn't always about him. He represented and protected his team mates, organising protests with race organisers and making sure that they were treated well.

But there is one picture that I want to share with you

This is a picture of Hinault leading Greg Lemond up the murderous Alpe D’Huez in the 1986 Tour de France. Remember, it is always easier to ride behind someone else. In leading Lemond up this climb, he was in fact leading Lemond to victory in that year’s race. That in itself says a lot about the man Hinault. What however, speaks even louder about him is the fact that at the time this photo was taken, Hinault had won the previous year’s race, and in doing so, had equalled the great Jacques Anquetil and Eddy Mercx in winning the race 5 times. In 1986, the French public were quite clear -they wanted their hero Hinault to go for a record breaking 6th title.

There are of course many subtexts to this story, but in the two weeks that preceded this stage, Lemond had proved to Hinault that he was the man that the team should ride for, and up this legendary climb, Hinault did the hard work for Lemond.

This anecdote captures for me something about leadership that we don’t hear often enough - that leadership is not about the leader, it is about the outcome. Benjamin Franklin said it well when he said that ‘He who cannot obey cannot command’


  1. as always stimulating and interesting. but i would disagree that this sort of leadership is applicable to Clinical Leadership.

    in la Tour, the purpose of the team is to get their principal to the top of the Classifcation Generale, the Yellow Jersey. This brings the whole team huge reward and each individual within the team be he domestique, climber sprinter or principal plays their part which itself may be variable. The same is not true within the NHS.

    Leadership within the NHS is itself a poorly defined and worked out concept not the least the perceived legitimacy of leadership as management. The reasons behind this are complex but partly due to the lack of acceptance of the unitarist approach of senior management and the pluralist approach of the clinicians. This might be viewed as the analogy of le peleton where immense speeds are achieved by the group working together, constantly driving on towards what appears to be a common goal. However, come the last 500m, it is abundantly clear that there are a multitude of individual and team tactics at play all with disparate goals. The challenge of Clinical Leadership is to surely to address this problem. What drives clinicians I believe is not the same ultimate reward as perceived by management and this challenges its value and ultimately its legitimacy.

  2. In the TdF,there are many different goals that teams chase - from the GC, to stage wins and sprints and the different jerseys. The point about leadership I was trying to make was that leadership is not always about achieving one's own ambition, and that one's personal interest sometimes must be sacrificed for the greater 'good'. Hinault demonstrated that at times, and we in medicine would do well to notice that. It is my experience that in many fields of life, progress is often interupted by personal greed and selfish ambition. It is not always about the patient and the care that they receive, but it really should be. I will blog further on this, as my response is in danger of becoming meandering and bloated....