Just another day in the life of a passionate health worker & lifelong learner.
I am a mental health nurse with 15 years experience working with people with a lived experience and their carers.
I have very little interest in focusing on what is wrong with people and prefer to focus on people's aspirations and what is right with them. I care about equality and the small things that remind us of the bigger picture.
I love art, music, novel ideas, psychology, science and the way in which these various entities intersect. I am blogging in an entirely personal capacity. My views do not reflect my employer's.
This is from the book “12 Years as a slave” by Solomon Northup, describing how cotton picking was managed on the plantation.
“An ordinary day’s work is two hundred pounds. A slave who is accustomed to picking, is punished, if he or she brings in a less quantity than that.
There is a great difference among them as regards this kind of labor. Some of them seem to have a natural knack, or quickness, which enables them to pick with great celerity, and with both hands, while others, with whatever practice or industry, are utterly unable to come up to the ordinary standard. Such hands are taken from the cotton field and employed in other business.
Patsey, of whom I shall have more to say, was known as the most remarkable cotton picker on Bayou Boeuf. She picked with both hands and with such surprising rapidity, that five hundred pounds…
As I am soon to reach the milestone of 10 years working in the NHS, I thought I would reflect back on one of the most pivotal factors that has influenced my overall experience: Leadership. I approached the selection of this topic with some caution – I am sure most people are probably sick to death of trendy topics like leadership and the various psychosocial theories that have come out over the years. So I thought I would try to approach the topic from a slightly different angle by looking at the chemistry of leadership (bear with me here).
How Leaders are Made
There has always been a debate about whether good leaders are born or made. In a recent video by Simon Sinek titled ‘Why Leaders Eat Last’, he makes a compelling argument that good leaders are made, not born. In a compelling 45 minute video, he lays out some of the biology underpinning great leadership:
A leader is nothing to do with rank. Leadership is a choice. Anyone who puts their self interest aside to protect the people next to them and improve things around them is a leader. It is therefore important to note that not all people in authority are leaders. Some are there entirely to look out for no one else but themselves. This is not leadership.
So what is it that drives good leadership? Well apparently its more scientific that I thought. Bear with me as I try to explain:
This is the reward chemical which makes us feel good from crossing off tasks as achievements. We feel good when we cross off set goals and plans because our brains release dopamine. This mechanism is used in business and industry to motivate performance via targets. It feels good to get 100% achievement against targets and the buzz from this achievement makes us want to do it again and again to get that same buzz.
However, dopamine comes with a warning as it can be highly addictive. This would explain why the banking crisis occurred – like with all addictions the rewards for achieving targets overshadowed everything else. Bankers were willing to sacrifice everything and everyone to get that next dopamine rush from reaching targets. I can’t help but wonder what implications this has on the use of targets in our healthcare system.
Moving on to another chemical and one which is coined THE leadership chemical: Serotonin is said to be responsible for feelings of pride and status. It is why public recognition makes us feel good. All those awards and public acknowledgements of achievement release Serotonin. This explains why an e-mail with a certificate attachment saying ‘Well Done’ doesn’t have quite the same effect as standing in front of your loved ones, peers and team as you are given an award.
The interesting thing about how Serotonin works in this situation is that at the same time that you get a rush of that Serotonin and fill up with confidence, your peers/boss/team also get a rush of that Serotonin and share your sense of pride for being part of that achievement. This strengthens connections, raises confidence and status but also sets into motion a cycle where we want to repeat that feeling of pride and achievement. So we seek other opportunities to get other awards – to get another rush of Serotonin. This might explain the multi award winning streaks we see with some individuals and teams…
However, the expectations laid out by the actions of Serotonin can also lead to a loss of confidence and trust in our leaders. As demonstrated above, Serotonin strengthens the social contract between a leader and their team. We have no issues with our leaders getting the bigger office or more pay. In fact, the promise of a repeat of another Serotonin rush from a team win, means that most followers voluntarily give their leaders the best of whats on offer and some special treatment too. This is not on the basis of teams believing the leader is necessarily better than the group, but on the premise that the team believes that the leader is there to shield them from danger. Serotonin (and the confidence boost it gives) drives good leaders to run towards danger in order to protect the team. The group invariably grows to believe that they are all in it together and are looking out for each other with the leader at the helm.
However, when this social contract is broken – when the person we believe to be our leader sacrifices our safety for their own gain or we feel they have failed to protect us, then this trust is lost. The result of this is a new focus on self preservation. With the trust broken, individuals feel unsafe, they stop going that extra mile to get another Serotonin boost and connections weaken. At the same time, another chemical kicks in and initiates the fight or flight response.
That other chemical is Cortisol – the stress chemical which has preserved our species from the stone age till now and probably for centuries to come. Simon makes the important point that humans have not outlived dinosaurs or the saber tooth tiger because we are stronger or smarter but because we protected each other by working in groups and knew when to fight and when to run. Cortisol is great if there is an imminent threat as it helps us run or fight the danger. As part of our response to danger, Cortisol shuts down systems that are unnecessary for fighting or running e.g. our immune system and the system responsible for growth. This enables our body to focus on fighting or running. Once the danger passes, our Cortisol levels should subside.
However, in organisations and teams where the trust is broken and staff feel unprotected, levels of stress and Cortisol remain high. This means that our capacity for growth and immunity remain low. The result is what we see in teams with people who can’t seem to take anything in or learn anything new. This goes hand in hand with plummeting performance and a rise in sickness. It is not by coincidence that this happens, it is an indication that the environment has become too consistently stressful with no reprieve and no chance for Serotonin or indeed Dopamine to rebalance the trend.
But fear not, this gloomy set of circumstance can be turned around with good leadership involving yet another chemical. Oxytocin is the chemical of love. It is a feel good hormone resulting from human physical contact and connection. It makes us feel safe, valued and loved. We can get a rush of oxytocin from touch – something that explains the feeling of trust we get when we shake hands on a decision and get nervous if someone refuses to shake hands, or from simply sitting together and feeling like we are near someone who gets us.
We can also get a dose of oxytocin from doing good deeds. However, trying to game the system by simply giving money to charity or doing something that takes little time and effort doesn’t work. We don’t get the same rush of oxytocin if we try to game this system and it doesn’t feel as good. This is because the money we give is replaceable. But if we spend time – something we will never get back – then we and the person on the receiving end of that time and effort get that warm good feeling as Oxytocin is released.
The above applies in organisations – simply telling a member of staff that you will pay money to solve a problem doesn’t make them feel valued. Responding to a call of help or distress with an e-mail saying ‘I care’ doesn’t make the recipient feel valued. However, picking up the phone or walking to that member of staff to ask ‘How can I help you?’ makes them feel valued. This is why I am a firm believer that walking the floor can never be underestimated – it puts the leader in and amongst the team and releases oxytocin – making both the leader and the team feel good. As it turns out, over time, the build up of Oxytocin in our body protects against Dopamine addiction and improves immunity too so its a win win in my humble opinion.
So what is the above trying to tell us about leadership? The messages I personally take away are:
Leadership is a personal choice made by those who want to improve things around them for the benefit of others -regardless of rank or position;
Teams and leaders do not excel in a system which relies solely on targets to drive improvement;
Serotonin is the Leadership chemical which primes us to repeat success by using public acknowledgement of achievements to share the sense of pride and build stronger bonds with our teams;
Leadership is rewarding but very challenging. Good leaders know that the perks come with many sacrifices. Those who put self interest before the team and fail to protect their teams from harm lose trust and invariably promote an environment of stress and fear.
To drive performance and excellence, leaders need to remember oxytocin and be present with their teams. Take that extra effort to pick up the phone or walk the floor to build/re-build trust and promote the feelings of safety so that people can re-focus on doing their work.
So thats it from my ten years in the NHS. It would be great to hear your experiences and theories on leadership, so please feel free to leave a comment.
This blog post is inspired by Eurythmics: Sweet Dreams (Are Made of This)
Humility is defined as ‘…having a clear perspective, and therefore respect, for one’s place in context.’
As we enter into winter months, I am drawn into a sunny and nostalgic trip down memory lane where I learnt my first lessons on humility. The approaching festive season reminds me of the excitement I used to feel growing up in Malawi as this time of year often meant a family road trip to the lake side (Lake Malawi). Continue reading “Humility”→
Last week was a busy one, i was at EHI Live 2013 in Birmingham on Tuesday and Wednesday and wisely for once chose to take the rest of the week as leave to recover: i predict many of you that know me just fell off your chairs reading that last part!
I was one of the speakers at the HANDI Health App conference as part of EHI Live 2013 and it was a great experience and quite unlike most big events i’ve been too in the past.
Now this is really silly but i must confess that at first i had no idea what i was signing up for. I was approached by Ewan Davis to speak at HANDI Health about my experience of working on the WellHappy app. I’m always more than happy to talk about the app (in fact you try and stop me!) so i quickly…
On the first of September 2013, I took off my cloak of clinical manager to don a new set of responsibilities under the title of CCIO. I have crossed the chasm and decided to explore relatively unchartered territory in my organisation. In my first month in the new role, I have noted that the role of CCIO is still shrouded in a veil of mystery due to its infancy in UK healthcare.
Its been one of those hectic weeks with plenty of surprises. Most of the clinical team that I manage have been on summer annual leave so I have had the pleasure of stepping in their shoes to offer clinical support to the people using our service. I have to say that this was a good week simply because of the opportunity to immerse myself in the experience of the people who use our service and the clinicians who work in the service.
It was also a week of a lot of learning and celebration. On Tuesday, I had the pleasure of bringing together the ‘My Journey‘ app project team for a photo shoot as we have been shortlisted for theE-health Insider Award ‘Excellence in Mobile Health’ award. It was wonderful to catch up with the project group and in particular, the young person who previously used the Early Intervention service and has been involved with the project. A few of us caught up over some coffee after the photos were taken and he informed me that he is due to be interviewed by Surrey’s Eagle Radio after being nominated as Surrey’s local hero for all his hard work. I really can’t think of anyone who deserves this accolade more. Continue reading “Do Better”→