Sunday, 20 November 2011

Permission granted

I seem to recall a moment in Don Quixote, when The Don decides that he must stand vigil all night, and wait for daybreak to engage some enemy (it might be the tilting at Windmills escapade, but, then again it might not). As ever he is attended by his faithful batman Sancho Panza.

Sancho illustrates well the perils of voluntary servitude, when he is caught short during the night, and not wanting to question the need for his unbroken presence at his master’s side for the duration of this particular nightwatch, decides there is greater valour in shitting himself where he stands than taking himself off discreetly to do his business behind a bush.

I have no doubt that I have recalled the details of this story incompletely - this was a set text at school (I mean, really - a 700 page set text?), and for much of it, I read the words, turned the pages but failed to divine any meaning from it. I was, however, reminded of it during a coaching session last week, when my coach pointed at the plate of biscuits on the table after half an hour and told me that she had put those there as a leadership exercise. It was perhaps with an undisguised level of smugness that I was able to inform her that I had already eaten two choice-looking chocolate biscuits without her noticing. My implication was that the brand of leadership that I exercised was very subtle indeed; no doubt her inference was that I didn’t like to get caught with my hand in the cookie jar.

The general theme here is permission, when we should seek it, and when we should assume it. Have you ever found yourself oscillating with uncertainty between two courses of action, trying to second guess the response both would elicit in the person you know you will have to answer to? It’s like when you take a multiple choice exam paper, and persuade yourself that the answer you went for immediately cannot be the right one, because you remember vaguely somewhere reading that the opposite is in fact true - thereafter, one enters an irreconcilable spiral of self-doubt, uncertainty, and perhaps also self-loathing. The first answer is always right, about 66% of the time.......

On the occasions I have found myself in this position, I have noticed that I always seem to make the wrong call, and come in for criticism later. To begin with, I took the feedback on the chin, reflected, tried to learn and tried to move on. But a pattern emerged - with certain people, I always made the wrong call, and didn’t matter how well I predicted their preferences and ways of working, they always found scope for criticism. Confidence gets damaged, consistent decision-making is undermined, and it becomes very hard to deal with. The truth of course, is to learn that for certain people, you will never be right, and this is not about you, this is about them.

More generally, knowing how to tackle problems, and trusting one’s own abilities to work through a challenge is the product of many different personal traits, but fundamentally, it relies on the knowledge that one is supported by the people one works for and with.

Within the NHS, one often hears about change fatigue, resistance to change, or griping about the relentless wheel of change turning. My own personal truth acknowledges that change within in the health service is not just important, it is necessary: every healthcare process could be improved, and many of them really need to be. What matters, however, is how those changes are made: I hate being told what I should do and why. I much prefer to find my own way there.

Change within the NHS has followed the traditional forms of leadership that underpin medical practice, with heroic leaders, urging the massed workforce to follow them. This vision of leadership was forged on the playing fields of public schools, in order to be played out on the battle fields of the British Empire. Play up, play up and play the game and all that. But this has no place in a modern health service does it?

Strong leaders are important, but following in the wake of the big characters as they charge forwards means that we miss out on the insightful whisper of the little guy, who knows what the real problem is, because frankly, it affects him every day he does his job.

The daily routine of change is to make small and constant improvements to a service, that deliver a better patient experience, and better quality outcomes. This should be the responsibility of the people who work in that service, and they should be both equipped and empowered to make those changes. This involves, among other things, those members of staff knowing that they will be supported in the actions they take.

Don’t criticise someone who is trying their best; pick them up, dust them off, and set them off again. It makes a massive difference.

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