The smallest thing, the biggest difference

I walked into the meeting room, a number of city partners with me, waiting for the arrival of some leading figures from the national voluntary sector movement. Two colleagues were still in the room. I smiled at them and motioned for them to leave so we could prepare for the next meeting. I had just triggered an event that reminded me of the importance of my impact as a Chief Executive, as well as providing the biggest cultural signifier in a big week for leadership…..I didn’t have a clue (all is revealed at the end of this blog)

In many ways, last week was an exemplary week for leadership in the NHS. It was also a week that provided a number of pieces of evidence that leadership in my trust and the city is changing.

Much of the national debate has centred around the statements made at the NHS Confederation Conference. One of the prevailing themes of the conference was the importance of effective leadership in driving service change. Another was the role of leaders in driving effective cultural change in the wake of the Francis Inquiry. Uniting both was a strong message about values based leadership. For those who know me, or who have read this blog, these messages are music to my ears. The development of a prevailing culture of leadership that empowers and values staff to benefit patients is a dream of mine.

Watch key speakers and sessions from our conference again

Mike Farrar at annual conference 2013Jeremy Hunt

This will be essential if we are to tackle the issues set out in key note speeches by Mike Farrar, Jeremy Hunt and David Nicholson. Points included a very real future of hospital closures and radical service reconfiguration and the need to balance this with optimism and confidence. Delivering A&E improvents across a system that delivers better care for older people with new strategies. A ten year strategy that prevents managed decline for services through a big conversation and self care as the norm. Technology as an enabler and tool, underpinned bytransparency and information.

The latter point was exemplified by the launch of #NHSEngage – a guide for Chief Executives. This is something I personally want to see adopted at scale  and am delighted to champion. Share it with your CEO!

NHS Leaders with #NHSEngage sign, launching social media briefing

Back in the trust and across Leeds, there were other examples of a change in Leadership and mood. Some requiring more work, others signalling movements in the right direction. On Tuesday, I spoke at an event set up by the managerial and clinical leads in our Health Visiting service to celebrate the brillinat work they have been doing on “A Call to Action”.  This includes a strong partnership with Leeds City Council on integrated Early Start teams and services as part of our Child Friendly City initiative. This hasn’t always been an easy ride. The best things about the meeting were the honesty of the debate and the response to the question – “Are you a leader”. I wasn’t expecting the response – nearly every card held up was Green for “yes”. As an organisation that promotes “leading from every seat”, this felt a shift.
Leadership- sea of green 4.6.13
That afternoon, I received my 360 degree feedback from staff and partners. I had responses from over 40 people across the system and at all levels in my organisation. The feedback from them matched my self assessment – I know my faults! – which is my first test of these things “Am I self Aware?”. The feedback gave me further impetus to improve where I am strong and address my weaknesses too.
The following day, the system leaders in Leeds met to discuss how we work together and how we plan for the future, building on our strnegths in partnership and recognising new faces and actors around the table. There was a degree of openness and honesty about the changes we still need to make that gives me some hope as well as an understanding of what needed to be done. Even better was the following meeting on transformation,with an emphasis on the good work we have done on integrating health and social care  
At the NHS Confederation Conference, I was fortunate to be asked to speak at the session on a Whole System Response to FrancisMy main themes focused on culture, values based leadership and great governance, allied to a new role for members. My opening point? How did Francis make you feel? “Angry”, “Upset”. “Disappointed”, “Ashamed”, “Guilty” were the responses.  Me too. And I have never been there, know no-one affected or involved….what power the NHS has over us all. Other industries would do almost anything to
strive for such a connection. Let’s use it….The response to the session and feedback was very positive. More affirmation for values based leadership.
On Friday, following a very good Board meeting, I shared a stage with the senior team as part of our team brief session. One of the slots was for our District Nursing Clinical and Managerial Leadership Team to talk through how they have begun to improve services, following issues around delivery. It was a proud moment to watch them articulate leadership that has seen them drive the capacity and demand plans, seen them innovate around how we use patient feedback to drive change in clinical behaviour, seen them explain how they had challenged poor leadership behaviours from “Mood Hoovers” leading teams.
My last meeting of the week, late on Friday.  One of the colleagues I had smiled at on the Monday and gestured to leave the meeting room asked to see me. As I basked in the glow of a brilliant week she told me about how I had made her feel worthless. 
She had experienced a bad morning, things had not been going well and I had turned up with a bunch of “important people”, gestured at the two of them to leave the room, “without even a smile, a word or a hello, how are you?” and made them feel worthless. Wow! It reminded me that the impact we intend does not matter. It is the impact felt that does. I apologised. I then thanked her for feeding back to my face and raising it with me. It stayed with me since. As a reflective person I have thought hard about what it means.
Clearly, it was the best bit of my week. Being reminded that leadership behaviours never stop. And the power of being in an organisation where a member of staff can confront the Chief Executive with negative feedback, safely and honestly.  

14 thoughts on “The smallest thing, the biggest difference

  1. Wonderful blog, Rob, great to see a culture where a staff member can come and tell you face-to-face about how she feels. I think that where staff feel able to do that, it MUST help foster a culture where they, in turn, are open to feedback from patients. This has got to be the way to ensure Mid-Staffs never happens again.

  2. Hi Rob, came across your blog via @NHSE_Dean on Twitter and felt compelled to say what a refreshing read it is. Your honesty, reflectiveness, self awareness and ‘owning up’ are all things that our society needs more of from its leaders. Too often leaders can’ t see beyond their egos or admit to being fallible.
    It is good to see that your colleague felt ‘safe’ enough to express what she felt.Such a level of trust and respect can only come about by having real dialogue, listening, willingness to be vulnerable, connecting with people on an emotional level….

  3. Hi Rob, came across your blog via @NHSE_Dean on Twitter and felt compelled to say what a refreshing read it was. Really liked your honesty, self reflection and awareness, emotional intelligence…all things that society requires more of from our leaders. Too often leaders can see beyond their egos or admit to being fallible.
    Trust is often underrated in organisation and great example of how when trust and respect exist, people are able to ‘speak up’. This can only happen when people are comfortable being and acting themselves, willingness to be vulnerable, there is no fear of reprisals..

    • Thanks Vera – good to get feedback. One of the reasons I raised the issue in the blog is to get others in the organisation to speak up too and give them permission to do so.

      Thanks again


  4. Pingback: The smallest thing, the biggest difference | He...

  5. Wonderfully honest read Rob
    Brilliant motivation for me to keep driving, influencing and leading service change in my sphere of work despite the setbacks.
    Fantastic to hear your supportive viewpoint of the changes your DN team has made to deliver patient care.

  6. I read this blog entry a few days ago – it has stayed with me so wanted to revisit and comment. Just wanted to say this is inspiring – feedback is so important to awareness of style and impact of leadership. Have been very close to offering feedback on a similar feeling undervalued situation with a senior manager given this excellent example, but don’t think they nor our organisation is quite ready!

    • Thanks Lisa – always good to get feedback on my posts. In terms of your situation, it is important that you feel safe enough to offer the feedback. Is there another route? Via 360 feedback or other system?


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