A Love Supreme

20 10 2010

In case anyone was wondering- I passed!  My thesis was accepted and now I am a Master! And yet I recognise I’m not, I shall always be insei, rather than sensei.

I shall blog more of my thesis over the next few weeks but perhaps my most insightful moment I had was one day from the deadline when I stumbled into an analogy that helped me (at least) have an understanding of clinicians and their work and the interaction with this by management: clinicians are in love with their work.

The intensity, depth and true nature of that love is variable as is the love of ice cream, a football team or for a child. It is a relationship that has potentially spanned over 30 years since beginning as medical students and may have been desired for years ahead of commencement. This is no one night stand. The love relationship is completely individual and deeply personal.  Clinical practice, a reflection of the individual clinician in their beliefs, character and skills is the outward expression of that love. Clinicians will go many, many extra miles for their love, put up with many disappointments and hurts simply to maintain their love seeking their reward principally from their love. Whilst it would be naive to suggest clinicians would work for free, the majority would report that their reward comes principally from their practice not their employer.

This is the reason for the poor engagement between clinicians and managers.

Clinicians are in love with their job and view external influences upon this relationship the same way any one of us would view external interference upon a personal relationship. Similarly suggestions by external agencies of measurement or efficiency of this relationship are met with disdain. The validity of the conceptual position may be questionable but the analogy allows understanding of the difficulties encountered. The different realities and understandings of clinical leadership may be understood by use of  the analogy. Clinicians regard effective clinical leadership as that which facilitates the development of their individual love relationships in stark contrast to the managerial directive and restrictive expression of leadership.

Engagement can be seen as the evidence of the love relationship. Importantly this engagement is with either patient groups or a clinical practice and not with the greater organisation as is desired by the unitarist view of management. It should be clear that this love relationship is monogamous. As such, blundering attempts at “engagement” by another suitor in the form of forced appraisal, insincere “conversations”, imposition of “core values” and attempts at corporate branding are seen as cheap as garage forecourt flowers.

The astute amongst you will recognise the photo in my avatar and the connection with the title of this piece. Regarded by many as one of the greatest jazz albums ever, “A Love Supreme” by John Coltrane is an expression of love and thankfulness. It is at times impenetrable, at others openly joyous but all the while a deeply personal reflection and expression of love. Can you imagine the engineer stopping Coltrane half way thru’ and telling him how it could be played more efficiently, with less notes?


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