Saturday, 14 May 2016

On a raft without a paddle

Werner Herzog's cult movie 'Aguirre, the Wrath of God' opens with a shot of a Spanish baggage train weaving it's way down some steps cut into an Amazonian mountainside. As the shot zooms back, the scale of this path carved into the hillside becomes apparent - they start at the sky, and seem to weave their way into the bowels of the earth.

Aguirre is a notable movie with for a number of reasons- it is dark, weird, beautiful and atmospheric; Klaus Kinski is terrifying - up there with the Child Catcher from Chitty Chitty Bang Bang (you know I'm right). He doesn't do or say very much, but there is always menace, and an ominous verbal tick punctuating the movie foretells all manner of darkness. But what has always grabbed me is the story of its making: I was told (who knows how reliably) that Herzog wanted to recreate the reality of the conquistador's progress through the Amazon rain forest by undertaking a conquistador's progress through the Amazon rain forest. Let's call it Method Directing. Those steps on the mountain in the opening scene weren't there before the movie was made: Herzog got the cast and crew to carve them. They weren't very happy about it, but what could they do? They were marooned in the jungle with a maniacal director and a scary actor fully absorbed in a scary role. 

There's a moment in the film when the group needs to make its way down the Orinoco on rafts. There's no CGI here, and from I can work out, he put the cast on one wooden raft, the cameramen and crew on another, and pushed them down the river. He clearly didn't get much footage from it (he repeats certain shots), but the picture of fear on the actors faces is not faked: they were being pushed down some rapids in full 16th Century attire on hand-made wooden rafts. 

I thought of this scene recently at the British Geriatric Society conference, during a conversation about leadership. Herzog displayed the form of leadership that involves putting your team on a raft and sending them over the white water, while waving at them from the bank. This reminded me of some of the leadership behaviours I have witnessed in the NHS over the last 10 years. It seems to be particularly prevalent at the moment at the top of the health tree. 

I wonder if Herzog was angry that he got so little footage from this escapade, and gave his crew a bollocking. Let's imagine he did. Perhaps his crew could have pointed out that on a wooden raft, they didn't have appropriate camera rigging to get steady shots, that they couldn't capture decent sound while being on a different raft to the people they were filming. Perhaps, they argued that they spent so long worrying about their personal safety, whether they would be OK without life-jackets, that their minds weren't entirely focused on the job at hand. In fact, one could argue it's a miracle they captured any footage at all.

Sound familiar?  Ever get the feeling that we've been put on a raft, pushed down the river, while people shout from the safety of the river bank that we need to work harder and be better? Look after an ageing population with increasing complexity? You can have some more money, but we want you to save even more through being more efficient. Provide elective and emergency care across 7 days? You can't have any more money for this, but we will magically pay you more, while keeping the overall salary budget the same. 

The NHS is currently Herzog's crew on the raft. The major problem with this whole situation is that the patients are the cast on the other raft, and they too haven't had much say in how the whole process works. It's not hard for them to act the role of scared explorers on a raft, because the only difference is that they didn't know they were explorers.

The scenario I describe relates to a still prevalent leadership style within the NHS that is counter-productive. You can push people down a river, but usually, you only to do it once. Next time you go near water with them, they will keep you between the river and them. Perhaps you can argue that the end justified the means, but you'll have to make your own assessment of the price of art (or happy healthcare workers).

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