A “shockabuku” has been defined a swift, spiritual kick to the side of the head that brings about lasting change,

I think that most of us, most of the time live our lives with good intent working  to make progress in areas we are familiar with, venturing occasionally to the edges of our world to see what’s there.

Now and again however, something happens that changes that perspective, and pushes us beyond that edge into new and unfamiliar territory.  

In my case it was a fall that’s smashed up my left hand (which is a  nuisance as I’m left-handed). It has left me looking at things I took for granted from writing and typing to getting dressed through a whole new lens.

I’m very fortunate in that the period the inconvenience will last may be a few months and I’ll get most of the functionality of my hand back. In the scheme of things it’s no big deal, though it has lent a heightened level of empathy with those whose changes are less temporary and more profound.

The shockabuku was delivered courtesy of my experience with the joy of how I am being treated in these circumstances, and what it brings into focus.

The NHS is in the UK news most days mainly due to debates on funding, staffing, political gamesmanship and other areas that seem to threaten its very existence. It can set the tone of anticipation and expectation as you start your journey with them, and the impact one imagines this constant attention has on those doing the work of caring for us.

Nobody told the people who dealt with me. I could not have been dealt with more sympathetically, effectively or professionally. It was clear that resources are tight and the staff were having to do a delicate dance with their desire to look after me, the resources they had to do so, and the performance criteria set for them by somebody in a room far far away. Everything that needed to be done was done. Nothing flash, nothing for television advertisements, just quiet, generous caring competence.

The final outcome was for me hugely positive, and has left me with an ongoing question.

How do we balance leadership in an organisation that has to deal on the one hand with very tight budgets, very specific performance criteria and a behaviourist approach to management, whilst on the other hand  enable and empower teams of talented people who do what they do because they believe in it, and for whom behaviorist style controls (performance reviews, bonuses, forced rankings etc) are complete anathema?

It seems to me that there are two energies broadly at work here. The nurturing energies of those who do the clinical work, and the strategic and controlling energies of those charged with keeping the behemoth that is  the NHS viable.

They are not incompatible. They are mutually essential,

They share a common purpose-  the wellbeing of the Nation, free at point of delivery.

That’s a vision if ever there was one.

Without control, the system would fail. Without the dedication of the doctors, nurses and healthcare teams there would be nothing to control. Because of the pressures, they are mutually dependent but without effective leadership can find themselves mutually antagonistic.

The task of leadership is to find ways for them to dance together.

Perhaps there is something we can learn here from the military doctrine of “mission command”.

Based on a Prussian approach –  auftragstaktik – it was researched and refined by, amongst others, Col. John Boyd USAF, and became a basis for modern strategy, The principle is simple. The strategic leaders role is to be crystal clear about the “why” of the task, and the ‘what’- objective, resources, timescales, constraints etc. The ‘how” is the task of those charged to deliver. Minimal checks and reporting back, no micromanagement, no missives from afar.

Mutual trust based on shared respect.

When faced with rapid and unpredictable change, we have a choice. We can invest our energies in wondering what happened, what might have been done differently, who to blame; or we can assimilate the current reality, and use the energy to turn it to advantage.

I’ve always liked Taleb’s idea of “anti fragility”. Not being resilient to shocks (to get back to normal”) but rather to use the energy to change.

In my own small way, typing this one fingered with  my “wrong” good hand, contemplating the fact I can’t drive for a few weeks and will have unexpected time on my hands, I get it. Not being able to do what I’m accustomed to does not equate to sitting here doing less. It just means doing different. In maybe a slightly weird way, I’m energised by that.

So, my focus for the next few months is to use my freed up time to consider how we might enable those who are driven to do skilled, important and generous things for the love of what it achieves, and those who have to do the hard, less glamorous work to manage the system that allows them to do it to dance together.

To hear the music.



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