Are you as good as you possibly can be?

16 10 2011

This is Roger Federer. Currently he is 3rd in the ATP World rankings. His record of 16 Grand Slam (GS) titles, including 10 consecutively, along with 23 finals appearances has him regarded by many as The Greatest Tennis Player ever. The other man is Paul Annacone. His highest ATP ranking was 12. In 7 years on the ATP Tour he never progressed further than a Grand Slam quarter final. Paul Annacone is Roger Federer’s coach. Previously he had coached a little known Californian by the name of Panayiotis Sampras. Most people called him “Pete”.

It is clear in tennis that leading players continue to excel not because of personal insight and innate talent but because of the input of coaches such as Annacone who can observe and guide their charges to even greater performance that they themselves may no longer or ever have been able to achieve. The suggestion that a player as good as Federer can improve or has a coach would surprise few. Many however would be uncomfortable with the knowledge that technical specialists such as Consultant Surgeons aren’t as good as they possibly can be and don’t have coaches to help them achieve optimal performance.  What is not suggested by either of these facts is that the performance currently achieved is unacceptable, merely that it is not not exemplary; Federer wants more Grand Slams and surgeons want to excel.

I raised this In my previous post . It may be uncomfortable to hear of shortcomings in performance, difficult to action and even harder to change consistently but if that improvement is possible for Federer or for a surgeon surely that achievement is of greater import than the disquiet, arrogance or ignorance resisting it. Personally, I’m interested to look at my practice both within the theatre and outwith to consider opportunities to improve. I’m sure the same could be applied to any clinician and even manager. Who wouldn’t want to be as good as they possibly can be?

Being a leader is not simply about the magic 8-ball.

20 11 2009

There can be no doubt that the NHS without effective leadership will be (is) in trouble. There are many reports, projects, initiatives and clinicians addressing this problem whether it be by meausuring, documenting, planning or even studying the issue. What is interesting me of late is who should be undertaking leadership roles.

In the ideal world it is clear that a leader needs the appropriate

    • desire
    • skill
    • capacity
    • authority

to be an effective leader.

The characteristics that separate one clinician from others and designates them as a clinical leader are not however clear. The reasons why colleagues make the move into leadership will affect their ability to deliver in this role and simply being the only volunteer, selected by rota or even the best at interview does not necessarily embue the candidate with the characteristics that are required for success. Previous blog posts have atested to the value of developing effective, employed junior managers, thru’ schemes such as the MBA, into senior managers utilising their experiences gained in the realities of the task and blending and refining this with essential knowledge delivered by experts. 

Embryonic clinical leaders have no experience of the realities of management, self select for many reasons not all altruistic and commence work as a necessarily part-time role with no training whatsoever. The environment in which they work is firstly foreign, secondly hostile and thirdly there are few rewards with little support. Would you like that job?

For leadership to be effective the leader has to have the desire to lead the team. Whilst this may seem obvious it is very different from simply balancing budgets, developing the service or achieving targets as required by more senior levels and these priorities themselves may disengage rather than engages the team. The skills to achieve this balance with conflicting stresses are not acquired during clinical training, by osmosis or even simple good sense but take time, effort, mistakes and effective relationships to develop. Little of that is offered to the new clinical manager.

The actual capacity to lead must also be questioned. In a clinical directorate with a budget of millions of pounds do we really feel that the most senior figure, the lead and the encourager can do this job on an adhoc basis even without the time to address the challenge of developing their own role? What is certain is that no-one comes to the task fully fledged or full time. This wouldn’t happen in industry.

Lastly, the authority to lead is not implicit in such posts. It may be a position of managerial superiority but this only effective applies to those who consider that the management structure has this legitimacy. Unfortunately, due to the disconnect between the vast majority of clinicians and mangement, this relationship is seen (and perhaps expressed) as illegitamcy.

Whether all this is true or not it perhaps addresses the fundamental problem of current “Leadership” development programmes. The concept of the programme and the development of indivuals in roles of leaders is somewhat moot until the right leaders are in the job and not just “selected” when everyone else has taken one step backwards.

The artistry of leadership

28 10 2009

There is an artistry to effective leadership.

Expression changes everything.

This post by Garr Reynolds speaks more eloquently than I do.

When the shit hits the fan.

24 08 2009

4 wheels on my wagon

In the European Grand Prix at Valencia this Sunday the Maclaren Mercedes of Lewis Hamilton came into the 2nd pit stop with a 4sec advantage over the second place car of Reuben Barrichello.

Working as a slickly oiled machine the car went up on the jacks, the wheels came off, the fuel pump went in and…then they realised there were no wheels to go back ON the car. After what must have seemed like an eternity the spare set of boots came out of the garage and were fitted. Presumably behind that protective gear there were a few red faces. Following his pit stop Barrichello won the race by 2.3 secs.

Looking at the result we can see Barrichello’s pit times were 8 sec shorter than Hamilton and when Hamilton entered the pits he was 4 secs ahead of Barrichello. Interesting maths.

Interviewed immediately after the race the team principal Martin Whitmarsh when asked specifically about the incident said, “It didn’t affect the outcome of the race…we lost the race because we weren’t quick enough (on the track).”

Interviewed immediately after the race, driver Lewis Hamilton refused to allocate blame to the pit crew and said, “We win and lose together… these things happen.”

When the stuff hits the fan most adults fully recognise their error. It is not always necessary to specifically or openly point it out; those with insight hopefully learn. Sometimes leaders attempt to protect the reputation and “feelings” of a team by publicly sidestepping or even denying problems. Other leaders openly accept the problem, avoid blamestorming, and unite the team in moving forward despite the problem.

Was there really a problem? Did it really affect the result? How is the reputation of the team affected by each approach? Which leader would you prefer to lead your team?

Docendo discimus – we learn by teaching.

18 08 2009

Some positivity today.

I am privileged to work alongside some very talented people including anaesthetists, surgeons, physicians, nurses, radiologists, administrators, and technicians. I believe one of the most important things these people do is not the individual roles that they perform but the passing on of that expertise to allow others to do the same.

There are few out and out geniuses, whose talent and production is so special that it must be considered a gift of some higher power and cannot be taught. The rest of us have been nurtured, admittedly from variable starting points, but we must all accept that few of us are where we are today without the supervision and support of someone who has gone before.

SenecaI was prompted by an email to remember one of my teachers and as I teach and encourage myself I see the truth of what Seneca the Younger said, “Docendo discimus (we learn by teaching)”. The value is immense; it shares and develops many but the reflexive nature develops the teacher too.

This I think is an essential of many jobs but none more so than in leadership.

Confirming evidence trap- i KNEW it!

21 02 2009

It’s obvious really isn’t it? You can clearly see that the defender (in blue) has made contact with the ball and therefore, whether in or out of the box, it is a fair tackle.

It’s obvious really isn’t it? You can clearly see that the attacker (in red) has clearly been scythed down  inside the box and it must be therefore be a penalty.

It’s obvious really isn’t it?  Cristiano Ronaldo (in red) will go down like a sack of potatoes at the slightest gust of breeze. The man is a born cheat. That’s a fair tackle.

It’s obvious really isn’t it? Just because Cristiano Ronaldo has a reputation (justified or otherwise) for “going down” in the penalty box no-one ever believes that a tackle on him is unfair. That’s a penalty.

We seek data from the information presented to us, but, as in the ladder of inference, we must also be aware that subconsciously we seek out information that will confirm our beliefs and understandings about the world and at the same time ignore those that confound such views. This is the “confirming evidence” trap.

The reason for bringing this up here is that I am hoping to identify issues that may confound  the true view of information I gather for my thesis and also to highlight the risk of such behaviour in leadership and management.

It is essential that as information is gathered that evidence is sought from both sides of the debate and that equal rigour is applied in determining its veracity. One must accept that personally held views colour interpretation and be honest in our assessments potentially even seeking confirmation from alternate sources.

This does not necessarily mean our views are wrong, merely that we should seek evidence from all sides of the debate before making decisions.

Who would be a referee eh?


11 02 2009

The House of Commons Select Committee is currently tearing strips off the Four Horsemen of the (Financial) Apocalypse : Stevenson, Hornby, Goodwin and McKillop.


In the harsh spotlight of retrospect, pointed questioning and publicity the four are apparently being held to account for what appears to be most of the current and future economic ills of the country, as well as probably Albion Rovers poor away form and possibly even the poor uptake of MMR vaccinations.

The Times has a useful hate short list of “ The 10 people most responsible for the recession,” which includes our own Prime Minister as well as the previously mentioned Fred “the shred” Goodwin  additionally dubbed “The world’s worst banker”. Quite an epiphet for the man who was in charge of RBS in 2006 when Royal Bank of Scotland were (allegedly) amongst the top ten banks in the world.

Of course there is also the “if I’m going down I’m taking you with me” of  Mr Hornby and his opinion of Sir James Crosby at the Financial Services Authority, his predecessor at HBOS.

Now I know nothing about banking but what strikes me is that only two years ago all of these people were considered amongst the most talented in their field by people in their field. How times have changed. Or is it just they are the focus of the blamestorm?

In a previous post I tried to quantify just what managers bring to a football team. Tony Adams who took over at Portsmouth has slumped to an inseiffolliet score (I.S) of 0.13 and understandably moved on to spend more time with the family. What is less understandable is the situation at Chelsea where Luiz Felipe Scolari has just been sacked. The man who took Brazil to World Cup victory in 2002 then Portgual to European Cup Runners Up in 2004 and semi finalists in the World Cup two years later has become the focus of blame for Chelsea’s failure in the current season. Scolari has a reasonable IS of 0.6 but that clearly wasn’t good enough.

I wonder at the value in banking, football, management and even in life, of allocating all the blame on single individuals for things turning out other than the way we’d like it. The attribution of blame doesn’t change things, in itself it doesn’t punish nor reverse the perceived error and importantly it doesn’t in any way help in the redress of the problem. Culturally it appears that what is required is a Biblical type scapegoat upon whom the sins can be laid and then sent out into the wilderness.

Sure we’d all like things to be different but is blaming someone, however complicit, really the way forward?

Let’s run this up the flagpole and see if anyone salutes it? (Management speak)

6 02 2009

Some random thoughts.

The vast majority of managers in the NHS have no management training whatsoever. Most are promoted from other disciplines which themselves do not include any formal management training or assessment.

The few managers that do have formal training will either have a Business Administration qualification or perhaps a very small number with a Medical Management qualification. The evidence that the theories taught on such courses are worthwhile or effective is difficult to come by.

Medicine is not a business. It is not run for profit nor can generate income or customers in the same way.

There is poor interaction between clinicians and management.

winning-photographClinicians have concerns about the level of management skills in the NHS, probably now being mirrored in senior management and the plethora of “leadership” initiatives.

Makes you think, doesn’t it?

The Wisdom of Pooh (or, Seth Godin is OFF my Christmas list!)

24 01 2009

Finding myself turning into a Seth Godin fanboy I have had two recent disappointments. Firstly, the man himself is coming to London to give a seminar. That’s not the disappointment. The disappointment is the price of £115! Heck I’m going to see Bob Dylan (major hero of mine)  and the tickets are half the price. I have a spare one so if you’re interested, drop me a line!

The second disappointment is that Seth dissed Winnie the Pooh! (another hero of mine) and I thought it was time that the Bear of Little Brain got a bit of decent pr on a leadership blog.

In “The House at Pooh Corner,” there is a chapter “In Which Tigger Is Unbounced“. I won’t spoil the story for you but essentially Pooh, Piglet and Rabbit are lost in the mist in the middle of the Forest. Rabbit leads the way, as he does, but despite walking a long way the friends remain resolutely lost.

They were having a rest in a small sand-pit on the top of the Forest. Pooh was getting rather tired of that sand-pit, and suspected it of following them about, because whichever direction they started in, they always ended up at it, and each time, as it came through the mist at them, Rabbit said triumphantly, “Now I know where we are !” and Pooh said sadly, “So do I,” and Piglet said nothing.

Pooh then makes the radical suggestion that if they were to head off and try, once again, to find this same sand-pit, then surely they wouldn’t find it, instead they would find something better “and that would be a Good Thing.”

Predictably, Rabbit scorns the idea and heads off to prove its error. Pooh and Piglet instead accepting that they don’t quite know where they are going but listening for the twelve pots of honey calling out to Pooh from home, set off and are soon having tea with Christopher Robin. Needless to say Rabbit remains resolutely lost until Tigger finds him.

My work situation hasn’t been the best for quite a while now and as a group we have been going round and round in circles still finding the same sand-pit. Eventually, I decided that things were going to be different. I don’t know the right answer or the right direction but I did decided to take the initiative and do things differently.

A lot of people recognise that their course appears more circuitous than direct. Leadership is not necessarily about knowing the end destination and plotting a detailed and true course but simply deciding to take the initiative and do things differently. After all, whether the rewards are honey pots or something of lesser value, they are probably more rewarding than that sand-pit.

Lessons on leadership from Maisy (3)

22 01 2009

Surgical training is an interesting topic and not an oxymoron. Certainly it is not perhaps as modern and as liberal in terms of educational technique as some disciplines within medicine. That said it is neither the “Sir Lamcelot Spratt” school of bollocking and humiliation that it used to be nor perhaps as it is perceived as by outsiders.

I wouldn’t want anyone to think I am any sort of leadership guru, or even necessarily a success. It has always struck me how sportsmen for instance, at the pinnacle of their powers can be advised and coached by someone who probably has never achieved that level of achievement. I merely blog on on the basis of observation and for discussion.

Importantly, as I write once again on dog training I probably need to emphasise that I don’t view my colleagues as furry animals nor have Maisy and I completed our journey of training.

I mentioned in the last post the value in giving a degree of freedom in behaviour. Maisy and I have now reached the stage of being able to go for walks without her wearing a lead. She understands the command “heel” and trots along happily by my left side. Every now and again she looks up. James, the trainer, encourages us to encourage the dog often when they do this with just a simple word or two.

As surgical trainees most of us have experienced the extreme opposite of this approach. Once I even had the temerity to question the lack of encouragement and was advised, “We expect excellent. If you fail to deliver that, we will tell you. Otherwise just carry on. It’s implied.”  I beg to differ.

I’m sure this is the case for so many of us in our jobs. Whilst the encouragement may be implied by the lack of criticism I don’t think the two are synonymous. I’ve found that a small word or two of encouragement is justified, is encouraging and is valued. I would value more encouragement personally.

Lessons on Leadership from Maisy-

3. a little, regular, appropriate encouragement is very valuable

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