Dame Ruth Carnall today wrote an excellent article in The Guardian talking about essential leadership qualities for the NHS. Using her article as a base I’d like to expand upon it using her experience and ideas to talk about our own beloved industry of dentistry.
I am drawing my own conclusions after having spent 25 years in the dental industry and mixing these together with the empirical grounding I received during my MBA and the psychological behaviours of human beings that I have been taught when Certifying as a Master Practitioner of Neuro Linguistic Programming, The ideas expressed here are my own.
I’ve quoted Dame Ruth’s article verbatim and added my own comments underneath for how this could pertain to dentistry.
1. Demonstrate shared values The NHS is a system of interdependent parts, and the success of one part is dependent on the success of another. The glue that binds these together is a set of values, so leaders need to demonstrate these values in all that they do.
The importance of values cannot be overstated here. One of the very first things that anyone is taught in business school is the importance of starting at the beginning, and this is where values come in.
Values our what drivers, values are the things we pay the most attention to, and with this in mind it is clear to see that the values of an organisation need to be shared across the entire company.
So where does it go wrong?
Too many layers of management
The first area that I believe this goes wrong in is where there are too many layers of management. What can often happen is that senior management have a set of values and criteria which are honest, decent and ethical. By the time this is filtered down through to middle management and more junior levels the original message gets lost.
A key driver of this is managing by Key Performance Indicators (KPIs). Senior managers have a high-level vision which match the values for an organisation, in working out how to implement this in the business middle managers have a tendency to set these as KPI’s – the staff then follow and match their behaviour to ensure that KPI’s are met.
We can end up with an organisation that is not in touch with his true values and is only functioning to match big set of criteria on a spreadsheet.
We see this in dentistry too – if a practice principal is not absolutely clear about the values, when they set their KPI’s the staff can end up performing to meet these targets and miss the whole point of the targets in the first place.
With the recent trouble in the NHS, this has been clear to see from the outside.
A lack of honesty about the true nature of the values
Consider this. An organisation that is owned by outside shareholders exists for the purpose of making money for the people that own the business. Fair enough really.
The values of the people that own the business can be completely different from the values of the people delivering the service. And so there is a mismatch.
The espoused values of the business owners (shareholders) could be that they want X when in actual fact what they really want is money. This can lead to KPI is being set that fulfil the money values and miss the point of actually delivering high-quality healthcare to the patients.
This is why FHP has been set up as an employee owned company. The employees who deliver the service are owners of the business and so completely in touch with the values which have been set to deliver high-quality healthcare.
2 Don’t be, or become, cynical Even against the sombre background of last week’s Francis report, there is no place for cynicism in a leader. It can sap energy from everyone around you and certainly those who work for you.
In NLP we have a concept called ‘meta programs’. These are programs that we run unconsciously in our mind for everything that we do, we have programs we run to fall in love, decide which dreamt of by and indeed how to treat a particular patient.
One of the most damaging programs (in my opinion) is the ‘away from/towards’ meta program.
In the pursuit of oral healthcare some patients are motivated by NOT wanting to have horrible teeth, whilst some patients are motivated by wanting to have perfect teeth. Do you see the difference?
One of the motivations is a way from horrible teeth was the other is motivated towards perfect teeth. The treatment protocol is obviously the same however when we extrapolate this to a leadership situation the same thing can happen.
Some leaders can be motivated by the absolute fear of their business failing, and others can be motivated by the absolute possibility of their total and utter success. If cynicism creeps into your life and you demonstrate that you are motivated by the fear of your business failing then this can lead to negative thought patterns not only for yourself, but for your staff-which ultimately leads to a reduction in patient care.
3 Build bridges Commit to working across the silos that bedevil the public sector. Patients need seamless care, not care in silos. NHS staff must connect across boundaries to achieve this. Inside the NHS, this might include surgery and medicine, primary and secondary care, mental health and community care; outside the NHS, connecting with social services and education.
“Work across the silos..” this is not a phrase I’ve heard used in dentistry, but I have indeed seen a silo mentality. Silo working is when an individual or group of people huddled together and adopt a particular thought process. I’ve seen it in practices between clinical and non-clinical staff, almost an us and them situation.
Overcoming this silo mentality,, and in fact acknowledging that it is going on in your business is absolutely vital for your success.
One of our challenges when we took on the first practice in FHP was to ensure that the practice team did not have a ‘we are the clinical team’ and ‘you are the management’ mentality. I’m pleased to say that they didn’t think this way, and they to be congratulated and thanked for being open with us, however I acknowledge that it would have been easy for them to adopt this.
No business can move forwards if there is a ‘them and us’ silo working mentality which is so prevalent in larger companies.
Again in FHP this is why we have adopted an employee ownership model so that the them and us are the same people!
4 Be resilient Be willing to absorb uncertainty as a leader, and give as much certainty as you can to others. Do not lie, and make it clear if you don’t understand, or don’t know, something. Absorbing general uncertainty, especially at times of change, enables a leader to provide some stability, allowing staff to be effective in difficult circumstances.
Managing uncertainty is extraordinarily difficult, particularly for healthcare professionals. As providers of healthcare we want to know that everything we do has empirical grounding… X leads to Y leads to Z.
The Word that pops out to me here is change in the current economic climate both the public and private sectors are experiencing difficult times, this means as a business owner we are forced into a situation of turbulent change.
I remember clearly, when studying change management in my MBA, we had a neat little equation to remember – and that was change only happens when A+B+C>D where:
- A = a shared understanding that the current situation is negative and we need to move away from it.
- B = a shared understanding of the possible future and how good it can be.
- C = a safe and simple first step.
- D = the cost of change.
So as leaders we need to ensure that our team understand that the current situation is negative and we need to move away, we need to have a shared understanding of the possible future and how good it can be plus the team need to be able to see a safe and simple first step. Only if the sum of all of this is greater than the cost of change to the individual will any change happen.
If you experience resistance to change then we we have either:
- neglected to share how bad the current situation is
- neglected to share how good the new future can be
- not made a safe and simple step clear enough
5 Support new ideas Support people to take risks, because risk is crucial to innovation. But be clear about the difference between good people taking risks, and sometimes failing, and incompetence.
Once again as healthcare professionals we have a tendency to be risk averse, we want to know that we are doing the very best for the patient. This has a tendency to work its way into a general management and leadership style, not always to its benefit.
One of the biggest lessons I learned on my MBA was to treat success and failure as the same thing. What ever happens, whether you succeed or fail always ask the following questions:
- What did we do right?
- What did we do wrong?
- What was it that led to this outcome, did we plan it this way was it an accident?
6 Communicate clearly and honestly Try to communicate to staff, patients and other parts of the public sector with as much clarity, simplicity and honesty as you can. Too often in the NHS we hide behind our structures, processes, jobs and jargon, which act as barriers.
This is a general rule of communication, always speak the language of the person who is on the other end of your communication. If you are talking to one another dental person then using dental jargon is fine. If you’re speaking to another business owner then using business owner jargon is fine.
Structures and processes are vital for any business to succeed – always blame the process not the person, is often a mantra! However, beware.
Management by application to structures and processes is rampant across many businesses. People blame the system and structure for their own failings, and failed to take responsibility for their own actions, naming a tick box, a system or a structure.
We absolutely need to enhance the systems and not blame the people, but ensure that your team are motivated to take responsibility.
One of the companies I studied in my degree was Toyota under its management by Taichi Ohno. They had a system for manufacturing cars which will revolutionise the industry, being able to produce far more cars with less resources than anybody else.
One of the issues they noticed was that if there was a problem with a certain part of the manufacturing process no one would take responsibility. This led to cars at an earlier stage of the process backing up at that particular point. Ultimately meaning the cars were not coming off the production line.
Toyota introduced a system called ‘Stop the Line’ and it gave any individual in the manufacturing process the authority to stop the manufacturing process across the entire manufacturing line if they noticed a problem. By doing this they were able to dedicate the resources to solve the problem, get the manufacturing process up and running again quicker and resolve problems faster.
Systems and structures were in place, but people had the authority to take action. They do not advocate their authority to the system, rather, they took it back and managed the system.
7 Manage upwards Take “managing up” seriously whether it is your line manager or the board. Challenge where it is appropriate and right to do so, but by delivering on what is required, you can create the maximum possible space to do what you want to do in your organisation.
The concept of managing up and down is virtually eradicated with an employee ownership company, which is why we believe this is the right route for healthcare in the UK.
8 Manage time carefully Think about how you use your time. It is easy to focus on what seem like important meetings, but people judge you and your values on the way you spend your time.
The point that jumps out to me here is about congruence. As human beings we notice in congruence in others, they standout a mile when a person is not being congruent. When someone has told you something have you ever thought ‘he’s lying’ or ‘I don’t believe you’ without actually having anything further to go on?
Have you ever met someone that you don’t particularly like from the very first encounter?
The chances are that this person was acting incongruently.
If you talk all day about worklife balance and ensuring you get enough sleep, then work until 11 PM every night you are not acting congruently.
If you insist that your staff are polite to one another, and then you bark at one of them you are not acting, congruently.
People will absolutely judge you by your values and the way you spend your time, there will also judge your values on the way you act every day. The values of the organisation need to come from you as an individual, you need to live them, breathe them and be them every single second of every single day.
Your dental practice will be built as a reflection of yourself, so make sure the mirror is clean!
9 Say sorry and thank you These are the most important words in the language of leadership. Some behaviour can be interpreted as bullying very quickly if you don’t go back and say sorry. And no matter how senior, everyone enjoys getting a handwritten note to thank them for something they have done.
And on that note I will leave you, thank you to Dame Ruth Carnall, the chief executive of NHS London for the inspiration in writing this blog post.
The ideas and thoughts in this blog post represent the personal ideas and thoughts of Mark Oborn.