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healthskills

begin with the end in mind

Making Sense of Chaos - the value of leadership

begin with the end in mind healthskills 2-14 The Crescent, King Street, Leicester LE1 6RX t: 0800 652 3322 e: info@healthskills.co.uk www.healthskills.co.uk


healthskills

begin with the end in mind

‘‘

If your actions inspire others to dream more, learn more, do more and become more, you are a leader.

’’

John Quincy Adams

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healthskills

begin with the end in mind

Welcome to Making Sense of Chaos - the value of leadership In the following pages we will share with you our thoughts, experience and personal insights into the fascinating world of leadership. Designed to be both inspirational and thought provoking, there are contributions from Healthskills Directors and Associates formed from recent observations and considerable experience. You can learn more about our work at www.healthskills.co.uk or follow us on Twitter.

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healthskills

begin with the end in mind

The Words of a Visionary How are you getting on with your New Year Resolutions? Are you feeling fitter? Managing your time more effectively? Losing weight? Or, like most of us I suspect, we’re struggling to be a bit better here and there, and allowing the negative opinions of individuals around us to creep into our consciousness, and erode our confidence, drive and self-motivation? In 2005, Steve Jobs delivered an inspirational speech to graduating students at Stanford University. A year earlier he had been diagnosed with the cancer that would eventually kill him. The commencement address is one of the more venerable traditions of American academia and because Jobs died at a relatively young age (56) I suspect that his words are destined to become something of a classic.

Jobs never allowed the opinions of others to drown out his own ‘inner voice’

In the speech he reflected on his personal philosophy, hindsight, and how he had found his ‘inner voice’ and I’m repeating some of them here because they reveal something of Job’s humanity and personal leadership – wise words in a transient world. “No one wants to die. Even people who want to go to heaven don’t want to die to get there. And yet death is the destination we all share. No one has ever escaped it. And that is as it should be, because death is very likely the single best invention of life. It’s life’s change agent. 4


healthskills

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It clears out the old to make way for the new. Right now the new is you, but some day not too long from now, you will gradually become old and be cleared away. Sorry to be so dramatic, but it is quite true. “Your time is limited, so don’t waste it living someone else’s life. Don’t be trapped by dogma – which is living with the results of other people’s thinking. Don’t let the noise of others’ opinions drown out your own inner voice. And, most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary.” Jobs never allowed the opinions of others to drown out his own ‘inner voice’. One of my favourite stories about him is about the moment when the Apple design team presented him with the first version of the iPod. He looked at it for a while, weighed it in his hand and then said: “It’s too big.” The engineers protested that it was a miracle of state-of-the-art miniaturisation. Jobs walked over to the fish tank in the corner of his office and dropped the prototype into the water. He then pointed to the bubbles that floated from it to the surface and said: “That means there’s still some space in it. It’s too big”. End of conversation.

By Mark Greenfield 5


healthskills

begin with the end in mind

Courage in Leadership It is often said that leadership is easy in good times; it’s when the sea gets rough that true leaders emerge. There are many recognised characteristics of exemplary leadership, but do we too often overlook courage as one of them? In a recent article Major General Tim Cross describes the following: “For courage to be authentic, it must encounter fear, and then prove itself superior to that fear. By fear I mean the kind that has us shaking at the top of a cliff as we prepare to abseil down. It may We can admire virtue and be a physical activity or more importantly it may be rail against corruption but something completely different – like the danger of our loss of reputation, of our job or something we without courage we too value highly.

are corruptible. “It has been well said that courage is an underpinning virtue, the one that makes all other virtues possible. That’s what we mean by the courage of our convictions. If we lack the courage to hold on to our beliefs and values in the moments when they are tested, then they are superficial. We may

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healthskills

begin with the end in mind

want to be men and women of honour and integrity but if we lack courage we never will be. We can admire virtue and rail against corruption but without courage we too are corruptible.� As the Health Service tracks into probably the most profound transformation since its inception, there has never been a bigger role for courage amongst its leaders, at every level. Leadership is about to be severely tested, and there has never been a bigger need for courage and consistency in its application

By Charles Marshall

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healthskills

begin with the end in mind

Transforming Shakespeare – Versed in Change The RSC has now completed its major Theatre Transformation project, delivering a stunning new building with the plans completed on time and on budget. It can be easy to look inwards and lose focus on those we serve during major change. So what fascinates me is how the RSC has grown its customer base and strengthened customer loyalty through the demolition and re-build of its theatres. Losing its main theatre site in Stratford, the organisation may have ‘gone in on itself’ but no, it found ways to draw in existing and new audiences. I believe it achieved this by offering some TLC. Talking to audiences and local people at events, through blogs and other media... finding out what was important and hearing reaction to plans. Listening to the feedback and offering comments, making changes based upon reaction of users (audiences) and others being affected by the changes (local people and businesses).

Ensuring TLC will help to release that genie of support and engagement.

Communication to ensure we were fully informed about progress, including the challenges along the way. All that TLC released a genie... genuine excitement and an enthusiasm for involvement. This has resulted in thousands visiting the building, even before the theatres opened, and events being fully booked. 8


healthskills

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Another key element of the project was to look outwards by creating a Complete Works festival involving international theatre groups. The skills, experience and networks will now be put to use in a World Shakespeare Festival (WSF) as part of the London Olympics culture programme. As Deborah Shaw (Director of WSF) explains, this emphasises the importance of building networks and creating partnerships. So, as we face continued uncertainty in health & social care, let’s strengthen the focus on our patients and users. Ensuring TLC will help to release that genie of support and engagement. Plus, look outwards to partnerships and networks. Let me close with a few quotes from the bard; ‘Our doubts are traitors, and make us lose the good we oft might win, by fearing to attempt.’ ‘Nothing comes of nothing.’ And finally remember, ‘to thine own self be true’ and ‘be not afraid of greatness.’

By Dr. Mary Holmes

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healthskills

begin with the end in mind

Dealing with the chaos and managing the “mess” Healthskills has recently started working with new NHS clients. Some of them are completely new NHS entities while others are traditional organisational units. The common thread between them is that all are facing an environment in a significant state of flux. This, in my opinion, is not simply about the usual constant change state of the NHS Enabling Performance Far from but rather about how far away • Say yes to the mess agreement from certainty and corporate • Encouraging connectivity agreement they seem to be. • Fostering diversity This almost state of “chaos” • Challenging habits and assumptions that exists is a real challenge • Supporting initiative for leadership presently and • Reducing power the seemingly gathering policy Managing Performance differentials uncertainty merely adds to • Technical/rational • Keeping people motivated decision making the mix. The true leadership • Simple structures challenge has only really just Close to • Effective procedures begun. agreement • Monitoring/coordinating • Providing direction

Near to certainty

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Far from certainty


healthskills

begin with the end in mind

We often use the work of Ralph Stacey to make sense of this world and describe it with the graphic to the left. During environmental challenge leaders need to be in an enabling performance mode which is where habits and assumptions need to be challenged During environmental as described in the circle above. This facilitates leaders to move towards the left and the square where managing challenge leaders need performance becomes more critical as the organisation moves to a sense of stability. The interesting phase is where the two to be in an enabling shapes intersect which is sometimes known as the “chaordic� state where there is some sense of order but chaos still exists. performance mode This I think is where the strong leader can emerge and take the organisation towards the box state. Trouble is of course that it isn’t normally too long before they get pulled over to the circle again as the world changes with the same cadence that night follows day!

By Paul King

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healthskills

begin with the end in mind

Looking at Leadership Healthskills is currently working with a number of GP Commissioning Consortia to support their development of effective leadership and decision making processes. Taking a pragmatic approach that recognises that the majority of GPs are ‘full-time GPs’ and ‘part-time GP Commissioners’ means that we have the opportunity to explore different models of leadership that break away from many traditional hierarchical models. The absence of a full-time GP ‘chief executive’ with leadership distributed within a GP ‘executive’ has initiated discussions on what we mean by ‘shared leadership’. Increasing joint working across GP Commissioning Consortium and their Local Authority encourages new thinking on collaborative leadership.

Collaborative

David Cameron recently announced that the economic regulator in the new NHS landscape, Monitor, “will now have a new duty to support the integration of clinical leadership services – whether that’s between primary and secondary care, mental and physical will be essential care, or health and social care”. Collaborative clinical leadership will be essential if we are not simply to produce ‘talking shops’ of well intentioned doctors, nurses and allied health professionals who have shared transformational ideas but struggle with implementation of complex service change. The recently published report from The King’s Fund Commission on Leadership and Management in the NHS explores the need for a new ‘post heroic’ model of leadership involving multiple ‘actor’s working across organisational and professional boundaries. Our ongoing work with clinical leadership is founded on a belief that the ideas of Kouzes and Posner based on the 5 Practices of Inspiring a Shared Vision, Model the Way, Enable Others to Act, Encourage the Heart, and Challenge the Process develop leadership behaviours that are collaborative and facilitate cross boundary working, engaging professionals who do not see themselves as ‘full-time leaders’. I have recently re-read some of Emmanuel Gobillot’s ideas: “What if management thinking to date has been directed at the wrong problem? What if leadership literature’s focus on formal authority and organisational structures has been at the expense of the ‘Real Organisation’ – the powerful network of informal relationships 12


healthskills

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that doesn’t appear on any organisational chart?”. Gobillot is strong on the notion that leadership is contextual; using as one example that of Churchill. Churchill was perceived as a very effective leader during the war period but was then rejected by the British people in the general election that immediately followed. He goes on to write about the ‘connected leader’ working in an informal organisation made up of relationships of people working within and outside of the formal structures. So the ideas of distributed (non hero) leadership have been around for sometime – I wonder why we are only now beginning to recognise their value? Is it because of Gobillot’s ideas of contextual leadership? Has it taken the breaking down of formal PCT structures and the ‘birth’ of loose structures that GP Commissioning necessitates to bring Gobillot’s (and others) ideas to the forefront? Gobillot proposes 5 steps to ensure that your organisation is fully connected to its stakeholders and is therefore resilient: • Understand the ‘actual’ – the make-up of the social networks in which they operate • Map out the ’real’ gap – understand the gap between the ‘actual’ inspirations and the ‘formal’ accountabilities • Evaluate your impact – understand the impact you have • develop connected leadership characteristics – there is always room for the development of effective leadership behaviours • Build a supporting context – a leader is nothing without a supporting context The development of collaborative leadership behaviours will be essential if we are to deliver the reforms that are essential to ensure the survival and growth of the NHS. Take time to reflect on your social networks and collaborative skills. By Anne Tofts 13


healthskills

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Thinking differently… whilst on Orkney The challenges we face in health and social care require us to think differently …. here I share with you some of my thoughts stimulated by a recent visit to Orkney. On the return walk from the Old Man of Hoy, I entered a small croft museum high on a hill. Among the many interesting artefacts was a newspaper cutting. It described how two men from this settlement had Building on existing invented the suspender. Their original plan was to keep up links can foster new and dungarees; others developed their idea!! Creativity can be found in the most obscure places and situations.

profitable partnerships

Created for one need... don’t stop there... explore further applications. Look in unexpected places for unexpected things. Being on Orkney one is frequently looking out at Scapa Flow and its rich naval history of WW1 & WW2. These same waters are now being harnessed for wind and wave power. Regeneration and sustainability can flourish... they are important principles in everything we do.

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Orkney has strong historical links with many nations; for example, the Hudson Bay Company recruited many Orcadians. This was celebrated in 1999 when over 300 people with ancestral links returned to Orkney for a Homecoming celebration. Many Canadians still return as tourists and to work there. Building on existing links can foster new and profitable partnerships. Earl Thorfinn the Skull Splitter, a Norwegian with strong links to Orkney was probably not a chap you wished to meet on a dark night (or any other time!) but his name lives on as local ale. Think differently about the past... it may offer marketing opportunities and a good story!

By Dr. Mary Holmes

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healthskills

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140. 8. 111,352. No, I’m not kicking off this thought piece with a number code worthy of ‘Tinker, Tailor, Soldier, Spy’. 140 miles was the distance covered by the comedian David Walliams in his epic swim the length of the Thames for the charity Sport Relief. The swim took 8 gruelling days and Walliams used 111,352 strokes to get from Lechlade to London. I’m sure many of you, like me, were inspired by someone who although not a natural sportsman (but a pretty handy swimmer!), found a cause worth committing to and demonstrated enormous resilience in achieving his task. Resilience is a common theme when demonstrating effective personal leadership and Walliams talked about his inspiration coming from a cause he really believed in and a strong desire not to let his followers down.

Resilience is a common theme when demonstrating effective personal leadership

Joe Simpson, the climber who sustained multiple injuries in a horrific fall in the Andes, describes his resilience in his book ‘Touching the Void’. He found the need to continuously break the big tasks

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healthskills

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into a series of small steps, to maintain momentum and set new targets. As a result he managed to crawl back to base camp when he had been given up for dead. Looking outwards and deciding that the external environment was not conducive to achieving his goals was a key resilience strategy for Mo Farah, who moved his family to Oregon at the end of 2010, to be able to train with a new coach, a move that inspired him to win the world 10,000m title in South Korea. Personal leadership and the need to understand what drives our own resilience are crucial strategies to maintain our effectiveness when our environment proves challenging.

By Mark Greenfield

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healthskills

begin with the end in mind

Getting to the root of the problem Leadership is complicated, we all know that, but in the current climate it is also absolutely critical. Clearly the leader needs to set the tone for the context in which they are operating and paint a compelling vision of the future and take people with them through the deployment of an authentic strategy and direction setting process. The challenge is that leadership is not only about strategy setting, policy analysis, tactics and robust forward planning. Sometimes it has to focus on problem solving “in the moment” and all too often followers look to the leader as having the “Wisdom of Solomon”. This can be tricky for the leader and compounded by the fact that operating inside the age of global austerity, the pressure to come up with the answer can be particularly acute. However, if the problem is not considered from all angles, then all too often the solution can be seen as knee jerk and while leaders can appear decisive, credibility can quickly evaporate if the problem or issue has not been really solved. The role of the The role of the leader is therefore to facilitate a solution to leader is therefore to the root cause of the problem and there are some interesting techniques to assist. One tool is known as the “5 Whys”. By facilitate a solution repeatedly asking the question ‘why?’ (use five as a rule of thumb), you can peel away the layers of an issue, just like the layers of an onion, which can lead you to the root cause of a problem. The reason for a problem can often lead into another question; you may need to ask the question fewer or more than five times before you get to the origin of a problem. The real key is to avoid assumptions and logic traps and encourage the team to keep drilling down to the real root cause. 18


healthskills

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The following is a real example to solving a problem in Washington DC: PROBLEM: The Washington Monument is deteriorating quickly and is costly to maintain. Q1. Why is the monument deteriorating? A. Because harsh chemicals are used to clean the monument Q2. Why are harsh chemicals used? A. Because harsh chemicals are needed to clean the bird droppings and there are lots of birds Q3. Why are there lots of birds? A. Because the birds eat spiders and there are lots of spiders Q4. Why are there lots of spiders? A. Because spiders eat small flies and there are lots of small flies Q5. Why are there lots of small flies? A. Because the lights at dusk on the monument attract the small flies SOLUTION: Turn the lights on half an hour later

By Paul King 19


healthskills

begin with the end in mind

Messy Beginnings Someone said “beginnings are often messy” and it is rare that we start with a blank page. We begin with baggage and history, others preconceptions and even our own perceptions of what we can or can’t do. Clinical Commissioners are embarking on their new adventures and immediately recognise this “messy start”. However ambitious and engaging Describing that long term their own visions for their local communities, this must be achieved with varying financial positions, current vision is a key leadership relationships and levels of engagement. Clusters looking to start a different role in the commissioning process that enables us landscape have old roles and ways of working to to take control and be overcome and providers beginning their journeys to Foundation Trust status are looking for a new beginning effective in a messy world. but will be bringing an entire organisation with them. At Healthskills, we have borrowed a key line from Stephen Covey – “Begin with the End in Mind”. This describes a personal leadership process that enables us to describe a personal mission statement giving us a changeless core from which we can deal with external change. Describing

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that long term vision is a key leadership process that enables us to take control and be effective in a messy world. “We may be busy, we may be efficient, but we will only be effective if we begin with the end in mind.� But that can be difficult to hold on to short term, so we will often work with clients and set our own intermediate goals to acts as steps towards that vision. The key question to ask yourself is: What has to happen over the next 90 days to make this a really successful 3 months for me or my organisation? It is a challenging question but a useful exercise to focus that new ambition on short term successes towards the long term vision.

By Ann Hepworth

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‘‘

Rely on your own strength of body and soul. Take for your star self-reliance, faith, honesty and industry. Don’t take too much advice — keep at the helm and steer your own ship, and remember that the great art of commanding is to take a fair share of the work. Fire above the mark you intend to hit. Energy, invincible determination with the right motive, are the levers that move the world.

’’

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Noah Porter


healthskills

begin with the end in mind

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Get in touch with us.

Please talk to Mark Greenfield on

t: 0116 275 5540 m: 07771 655382 e: mark.greenfield@healthskills.co.uk

healthskills 2-14 The Crescent, King Street, Leicester LE1 6RX e: info@healthskills.co.uk w: www.healthskills.co.uk

Making Sense of Chaos - the value of leadership  

Our thoughts, experience and personal insights into the fascinating world of leadership. Designed to be both inspirational and thought provo...

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