Sunday, October 23, 2016

Not for all

Leadership. Ethereal. Magical. Inspiring. Sexy. Disdain. Mockery. So many terms can be used to it- and I have always watched all the debate with a relative amount of mirth. I am pretty clear on this one- I have not done any leadership courses, got any badges, instinctive by nature- and the best teacher has perhaps been time. And studying careers of sportsmen, their leadership styles- but most importantly having decided early on to surround myself with folks whose judgement you trust- without batting an eyelid.

So what is it that ails the ethos of leadership? Leadership quangos abound, courses drip feed into your email boxes, conferences spring out of nowhere-and yet..every analysis of the NHS tells you one story- "lack of leadership"…why is that? Is it because we don't have the right type, is it because we don't have enough do-ers or is it because its nowa term which is abused as a career opportunity? Or is it simply a mixture of all three? Throw in the climate of fear we live in…the urge for our leaders to be perfect, the public flailing from an army of arm chair critics- and is it is also a factor pushing the best talent away?

My personal observation has been all of those have contributed to it- and I have always held the belief that leadership isn't for everyone. It isn't. You can couch it in any way you want, drape it in sophisticated language- but it simply isn't for everyone. The need to do so is also driven by the fact that the system in its drive to get more leaders went to the other end f the pendulum and made being a follower…unsexy and unattractive. Let me make it very clear- it isn't. Any leader worth their salt is only as good as those who follow him/her- following isn't unsexy, following is an integral part of the trust you have in your leader, an integral part of making the whole thing work…an integral part of delivering care, an integral part of delivering outcomes.

Throw in then the leadership buzz of "Moving on" or indeed " bringing everyone together". Look at history- and look again- who do you want to pick? Gandhi? Kennedy? Alex Ferguson? Obama?  Lincoln? And then think whether their success was in spending years and years in trying to get everyone together- or was it after a point where they had a critical mass of believers and enacted their vision? Leadership isn't easy- its not for everyone.

The belief that leadership involves compromise is true indeed- but to an extent. In many cases, in a healthcare environment, in many cases, compromise means compromising the position of only one group of people…patients. When you build a risk register for example and compromise on your time line to make a "Red" to a "Green"- you only compromise the patient- no one else. YOU-as a leader- still take your salary home. The patient whose care has been graded as a "Red" is still suffering- think of that.

So we need to have a think about this- who or what is a leader? And debate it properly? In all spheres of life, a leader is determined by your outcome and accountability. A fact which somehow doesn't work in the NHS- or rarely does. Why is that? Is it to encourage anyone to have a go because of the title or is it because we aren't brave enough and lost our focus in the world of leadership quango?

So- leadership…No- its not for all- and lets stop insisting it is- we do disservice to the individuals we are going false belief to-and most importantly to patients- who suffer from leaders who don't have the requisite skills. Leadership is tough- leadership is about having a tough skin- sometimes its a very lonely place, a tough place- a place beyond the glitzy award ceremonies- and thats where  you earn your corn. So if you want to be one- stand up to be counted, judge yourself on outcomes and be ready to put your hand up when you get it wrong.

Leadership isn't for all. Sorry to disappoint- but then again…following is pretty cool too.


  1. Hi Partha,

    There's a really good article in the BMJ this week by Sir Bruce Keogh on the importance of valuing junior staff: "some of the most important leaders in the NHS are the doctors who work on the front line, inspiring the next generation". Very interesting comments too about the need to win arguments in private at the top levels of NHS leadership.

    One of our (non-clinical) managers commented this week on just how flat our Consultant hierarchy is - he comes from a forces background. We have one CD for 115 consultants in my department, and to an extent we all share the responsibility to lead at a local level, and to inspire the next generation of doctors.

    I remember an inspiring talk given by our chief exec a few years ago, using the analogy of political leadership - you will only achieve what you wish with the support of those voting for you.

    With best wishes,


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