Thursday, 22 April 2010

True Leadership: getting real

We Brits have a maddening love / hate relationship with the NHS. We know, frankly, we’re damned lucky to have the services of some of the world’s best medical carers freely available at the point of need. The past thirty years in the UK has seen neonatal death plummet and that most basic statistic of all, life expectancy, increase — all this at a significantly lower cost in relation to GDP of private systems.

In a peculiarly British way many of us seem to be saying that the whole thing is terrible but the people are wonderful. We often express profound admiration for the people who actually look after us, but frustration with the system — bureaucratic, Balkanised, political (in a bad sense). Of course medical carers are not infallible, and some degree of snafu occurs in all human endeavours, but it has to be minimised when lives are at stake, and community hospitals are public places. Healthcare leaders, with their own stresses and pressures, prone to cynicism and denial, are always on stage. If people screw up in most industry and commerce, earnings per share dip. Get it wrong in yours, and people die. This can lead to a paralysing fear of failure that hobbles all effective leadership; a kind of defensive pact with mediocrity.

Cue the most inspiring leadership day I have spent in a long time — not a course, but a day visit with colleagues from Milton Keynes (where chaplaincy is in need of a reboot) to Wexham Park Hospital, which serves Slough and East Berkshire. Peter Blackshire, co-ordinating chapain, and colleagues gave generously of their time, and involved leaders within the hospital from palliative care and nursing services, along with the chair and CEO of the Trust.

It’s no simple Polyanna-ish story.

Heatherwood and Wexham Park Foundation Trust has had struggles and serious public failures in the not-so-distant past, and has undergone its own sometimes painful reboot.

If you’re trying to lead in a recovering organisation with limited resources, how does hope arise, and the ability to turn things round?

  1. The foundation of everything is realism about what’s amiss, but refusal to give in to it, blame others, or collude. It’s values not target driven, and works hard to connect people with the reasons they wanted to be practitioners in the first place, not synthetic goals. Again and again we were struck by openness and lack of management hype. At first this seemed weird, but as it became plain many people were interested in the unvarnished truth, everything came into focus. No boasting, no hype — just workmanlike pragmatism, and a dogged focus on values. We heard about the temptation to be driven by targets to the extent corners are cut. When you stop being target-driven, you actually take a hit — but the hit is an act of faith that if you stick with your values and resist cutting corners, in the end, you will do a better job. That takes real courage and, dare I say it, faith. I wish some churches felt freer to be honest about what’s not working, more rigorous in not cutting corners and tolerating crapada.

  2. Hospital Chaplaincy is not running a Church in a hospital, but delivering siritual care across the board in collaboration with others. Healthcare systems are like water systems — everything affects everything else. If there’s poison in the system, everybody gets poisoned. If different trades take hierarchy or status more seriously than the over-riding point of the exercise, or their part of the action more serously than other practitioners’, attention is distracted, the practitioner community compromised, and patients harmed. Managing chaplaincy isn’t about being nice to chaplains, but everybody respecting everybody else, and honoring everyone’s role in the delivery of the service. Everyone is a practitioner, and the task of everyone else is to maximise their own performance in such a way that all practitioners can function in an integrated, aware and self-aware, way. If you’re angry, use the energy to raise your own game, don’t turn it against someone else. The unity and integration of the whole depends on respect, fuelled by open communication.

  3. The most stressful and wearing place to work is somewhere where you can’t be yourself. In life, in healthcare, in Church, hypocrisy is like Japanese knotweed, or fire at sea. There is a continual drag towards it within the system (what Christians call “the fall”) and open communication with mutual accountability is the only medicine. Communication needs to be as clean as you can make it, remembering at all times that God gave human beings two ears and one mouth.
I came away with much to ponder, not only about hospitals, but about leadership and certainly about the ways we do Church. It also sowed real seeds of hope about a new kind of chaplaincy in MK.

Particular thanks to those who led us through the day; squirm and duck for the credits — It’s an unforgivable sin for some British to acknowledge other people’s work, especially in the public sector, without being cynical and/or nasty about them, but this is what I want to thank you for:
  • Peter Blackshire (Co-ordinating chaplain) — There’s lots to work out, but you’ve got a real team, and it shows. Many ministers, and healthcare professionals, say they want to work as a team — few acually do. Insecurity and Ego compromises their best efforts. Your clarity of purpose and consistency shone through. May your trolley arrive soon!
  • Clare Culpin (Director of Nursing) I found your awareness of everyone as a practitioner, courage and realism, refreshing and inspiring. I seldom meet anyone who has come through 20 years plus of leadership in medical care with such a focussed and lively sense of how things actually work together.
  • Fiona Lisney (Palliative Care Consultant) showed me how soft and hard skills (to use conventional distinctions) actually can work together to help patients at what could be the most awful time of life, the journey home. You actually demonstrated how to get a system working for patients.
  • Julie Burgess (Chief Executive) We were overwhemed by your realism, you will to listen and respond to anyone, your awareness of your context, along with your uncompromiseing commitment to your core values. The heart of your leadership seemed to be willingness to take risks in not cutting corners. I wish there were more of that kind of faith and courage around.
  • Chris Langley (Trust Chairman) Perhaps it comes from the retail background, but your will to take the people the trust serves seriously came over clearly. Assertive loudmouth leadership like the Apprentice on TV gets organisations so far — but to excel you need something very different — passion and humility, openness and rigorous commitment to making the syetem coherent and effective.

3 comments:

wifeofacurate said...

My Dad died in 2008 in the Critical Care Unit of the QA Hospital in Portsmouth. He was/and indeed still is a priest. It was vital to him to receive Communion before he died and thanks to the care of the Chaplain concerned he did just this. He received Communion one day and the day after my darling Daddy died. He was 62.
My family will be eternally grateful for the efforts of the staff in the CCU where he was treated for a month and forever grateful to the wonderful Chaplain who granted his last wish.

ramtopsrac said...

This is really inspiring and timely as someone currently part of a small group trying to discern the values that my church will seek to live out over the next few years!

We're a troubled place at present, and I wonder if or how the idea of forgiving is lived out at Wexham Park between staff? I know its not a medical term but I'm very aware that when we try and live along a set of intentional values we will make mistakes - how does dealing with that work?

Bishop Alan Wilson said...

WoC thanks for your moving testimony to the way chaplains can link in people to their faith in hospital — very much the classic pattern, and I was inmpressed how it did't seem that had been lost at WP. but rather enhanced by better integrating the work of chaplains with everybody else.

ramtopsrac, thanks for raising a really fundamental question in any organisation — forgiveness and the way failure is handled. Whilst I don't know the answer, the people I met would, and I wish I'd asked!

If had to extrapolate a answer from what was said, I think it would be something like "each falure matters in its own particular way to particular people. The whole system is there to make sure indicidual failures do not scupper the whole any more than is inevitable. A strong values ethos combined with pragmatism breeds humility and realism when things go wrong. I imagine some staff find it easier to forgive than others! and to be forgiven!

Really healthy churches can really show a new way of responding to failure — but not so healthy ones are ften hung up on perfectionism and unrealistic expectations all round, perhaps.

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