In todays ever more regulated and scrutinised healthcare environment, it is very easy to throw our arms up and give up on trying new ideas a.k.a innovation. Here are things I tell myself daily to fight that temptation:
If you always do what you’ve always done, you will always get what you’ve always got.
Everyone has ideas. A few have the audacity to act upon them.
An idea on the ground is worth ten in the head.
If everyone backs your idea at the start, maybe it’s not really there, yet.
If everyone is opposed to your idea after you’ve had your say, maybe it’s not there yet, either.
If you have ever been seized by an idea, you’ll know the unmistakable feeling fluttering in your gut. I have learnt that when I stop asking ‘What If?’ and stop experimenting with new ideas, I lose interest in the people and work around me. So I fight the temptation to automatically go with what’s comfortable or convinient.
It takes a brave mind to enter unchartered waters, it takes a tough heart to stay the course.
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)
As a self professed geek, I have to say that I am pleased to see so much interest in technology’s role in healthcare a.k.a e-health. One of the things that I like about the current direction of travel is the increasing involvement of clinicians in informing and driving e-health.
I am also aware that others are not so keen on the increasing use of technology in healthcare, for various reasons. Instead of widening the gap between those of us who do and those who do not believe that technology will revolutionise healthcare, I have made a personal and professional choice to share my experiences of driving efficiency and service improvement using technology. I am doing this in the hope that it will open up channels for more dialogue and debate to explore the drivers and barriers to wider adoption at scale.
Having just recovered from the E-Mental Health Conference that I helped to host last month, the coming months are going to be very interesting as I present the ‘My Journey’ Youth Mental Health App and hear others’ experiences of using technology in healthcare. I am going to be listening and speaking at the following events:
Three months ago, I received a call and my mission, if I chose to accept it, was to bring together thought leaders who are active in the mental health digital and social media arena. It was with total and unashamed glee that I accepted this request to arrange an event to explicitly celebrate the increasing role of technology in mental health care.
After getting over my nerves of presenting the learning and results from my Mary Seacole Award project from 2011, I joined in with fellow Tweeps who made sure Twitter joined the celebration in Mary Seacole’s honour. You can see the summary and stats from the #seacole Twitter activity below:
These are indeed interesting times. Not least of all because we are all expected to achieve more with less. I am one of many thousands of people who signed up to work for the health of this nation. It is a rewarding job. Often it is also a very challenging job. This evening some of us were invited to Downing Street where our efforts were honoured by the Prime Minister, David Cameron.
Today was about acknowledging these challenges but also celebrating the shared ambition to focus on 3 things:
I am by no means an expert on any of the above. But I feel I am in the thick of it when it comes to being part of the drive to promote each and every one of the above points. I am passionate and committed enough to know that to achieve more from less, we need to:
Capitalize on difference (Diversity)
Ensure fairness in all our endeavours (Equality)
Strive for excellence (Quality).
The essential vehicle needed to achieve the above is leadership. The speakers at this evening’s event made a good point when they said that disciplines such as the Military and indeed the Police are very comfortable with the notion of a leader: someone at the helm of the group’s efforts and inspiring through vision and example. In nursing, this is still somewhat a new and novel idea that needs nurturing through developing new nursing leaders who will not shy away from taking their rightful place alongside others striving to improve this nation.
Are you ready to take on this challenge and take up your rightful place?
I have been grappling with the many facets of equality and rebellion lately and thought I would share my observations:
When I was a kid growing up in Malawi, I was taught to always listen to my elders and obey authority. The lessons of what befell those who were disobedient were told as bedtime stories and graphically illustrated in political rhetoric. So its not surprising that I spent the first 12 years of my life as a very quiet, at times extremely shy and obedient child.
My schooling in South Africa at the age of 12 changed all that. I remember a turning point when my passive obedience was shattered: I was a new kid adjusting to being a foreign student in a country steeped in a rich and complex history. South Africa was on the brink of democracy with Nelson Mandela about to take up presidency after being released from 29 years on Robben Island. The air was thick with racial tension and uncertainty. On one of these eerily tense mornings, my new head teacher shoved a red circled timetable into my nervous sweaty palm and asked me why I had not been attending my Afrikaans language classes.
It took a while for me to work out a few thoughts in my head. I thought about the question he asked and wondered why there was no Zulu, Xhosa or Tswana or any of the other Bantu languages on the curriculum. I wondered what this meant in terms of valuing all races equally. As I stood there craning my neck to look at his towering figure, I lost my unquestioning obedience and respect for authority. And I liberally and quietly told him as much.
I got detention for the first time ever that day. And you know what? I enjoyed every single second of detention spent in that dusty school library. I enjoyed it so much that my walk from class to the library was always one of exaggerated pride and often accompanied with high fives from other students. I never did attend a single Afrikaans class that year. I instead spent my time mobilizing other students to do the same and sit out Afrikaans classes until Bantu languages like Zulu and Xhosa were on offer.
It wasn’t long before all manner of students were going home to tell their parents about this set of unusual play at the normally placid and peaceful school. Whilst the faculty figured out how to avoid embarrassing publicity and how best to change the curriculum whilst saving face, my classmates and I spent time reading books about people who had been moved to action by something that just felt wrong and unjust. People who had felt small and fearful but still challenged powerful and unjust authorities. We debated on different styles of defiance from the likes of the vocal radical Malcolm X to quiet and unassuming activists like Rosa Parks. We read and discussed books like The Power of One and cheered on the characters who were united against Apartheid despite being from the disparate Black and White worlds of the then divided South Africa.We especially relished the part when the main character, Peekay proclaimed ‘Little beat big when little smart. First with the head, then with the heart.’
By the end of the semester, detention was no longer detention. It was a stimulating hub for debate and discussion, for students and teachers, on how power works and how to peacefully overcome inequality. Some might say that we were foolish to take on the very people who would determine whether we passed high school or not i.e. the faculty and school board. And to some degree, I suppose we were. For a group of 13 year olds, there was a lot at stake, but doing nothing seemed to carry a bigger stake. You might be glad to hear that a happy class of 1997 graduated with little incident and that most of us had a passable level of Afrikaans and a Bantu language under our belt on graduation day.
Looking back now, I see that traces of this ability to challenge the status quo remain within all of us, but all too often it seems harder to activate as we get older. This led me to read up on organisational activists by leadership and innovation thought leader, Helen Bevan and Breaking Through Leader Yvonne Coghill. I was both amused and enlightened to read and see illustrations of people who had started their careers with a determination to improve things for those who use their services/companies but soon lose this drive and instead opt into conforming. Sometimes at all cost.
Numerous literature suggests that there is a distinction between being a leader and a rebel. Whilst I agree that the two are by no means the same, I believe that a good leader stands up for what they believe in and moves people to act in order to rebalance power more fairly for the better good of all. However, anyone working in an organisation nowadays is faced with a conundrum: according to Harvard Business Review, most companies do not value heretics and instead reward conformity and obedience. The value of those who dare to question and challenge the status quo should never be underestimated. Even IBM’s successful resurrection as an internet leader is ascribed to a group of rebels who shook things up and ultimately brought the computer giant into the 21st Century. So it seems to me that the ability to rebel effectively is a skill that needs to be nurtured alongside the ability to move others to act and challenge the status quo. This can in turn be a mitigating force against a company’s stale ideas or social injustice. A rebel has to use transformational leadership in equal measures to their defiance. Because a rebel who doesn’t move others towards collective action, ends up without followers and is nothing more than a rebel without a cause.