The Power Of Bringing Yourself To Work

John Quincy Adams said, “A leader leads by example, whether he intends to or not.” Although he was US President a couple of centuries ago, his statement remains universally applicable to this day. It’s human nature to emulate leaders’ behaviours, either through respect or fear (hopefully the former), and, in the main, subconsciously so that you ‘fit in’. I’m not suggesting that everyone becomes a ‘chip off the (often) old block’ but, if there is effective honest leadership throughout your organisation, then there would be no need for behavioural or accountability frameworks. Everyone would be ‘bought in’ and everyone would understand theirs, and all others’, contributions.

So, why doesn’t it work?

Start by asking yourself this question: When you come to work do you REALLY bring yourself to work, or is it your ‘work’ self? If someone from work met you in a social environment, not connected to work in any way, what would they see? Would they recognise you? Presumably your family and friends like the ‘real’ you outside of work, so why not share that in the workplace too? And, while you’re not being you, you’re expending considerable mental effort consciously behaving in a way that is not natural to you. Exhausting, isn’t it?

If you behave differently at work than you do at home, how do you think other people in your organisation are behaving? What if some of the senior leadership, who model the perfect example of inclusivity, compassion, openness, etc. are finding it even more exhausting than you as they’re actually narcissistic psychopaths (apparently, up to a fifth of NHS CEOs have psychopathic tendencies)? It’s no wonder that you find it really hard work because, chances are, you’re not ‘living’ your organisation’s values (which most likely fit with your own unconscious value set in any case), you’re actually emulating a narcissistic psychopath’s portrayal of the values, which they find incredibly tiring to achieve themselves.

And, you’re not being true to yourself. So, what are you going to do about it?

There is a growing concept of having a ‘to be’ list but, for it to work for you, the top of your list has to be “be you”. It can be daunting to ‘be you’ when all around you aren’t being themselves but it’s really empowering if you can achieve it. Everything you say and do doesn’t need to go through your internal ‘work behaviours’ filter, freeing up your mind to be more receptive and creative. If you can manage to do a supermarket shop, or eat out at a restaurant, without those around you thinking you’re a jerk or getting arrested (or both) then you should be able to fit in at work being just you. After all, your own values are unlikely to be a million miles away from your organisation’s. How liberating!

By exposing your real self to your colleagues (clearly not literally as you will get arrested, see above) their trust in you will grow, as they start to bring their real selves to work your understanding of each other will build, and so will your team’s effectiveness. Vulnerability can be a powerful tool in strengthening a team, and demonstrating leadership.

That’s all well and good, but what about the narcissistic psychopath?

Unfortunately, these individuals often have prominent positions in organisations and their subliminal behaviour can pervade the workforce deep into its roots. However, a psychopath is unlikely to garner much in the way of genuine respect, and their behaviour is most likely emulated through fear of doing otherwise. In a growing pool of openness it becomes increasingly difficult and tiresome for those with a genuinely differing value set to hide behind their facade. Eventually their behaviour will be exposed for what it is, and they will be unable to continue how they are. The result is likely to play out in one of two ways: either they will leave, or their behaviour will develop more extreme and divergent tendencies from the collectively held and expressed genuine value set that they increasingly expose the weaknesses in their facade.

It's highly unlikely that these individuals will leave of their own accord; it would simply be too ego-bruising and the loss of power unthinkable to them. Instead, life at work for everyone around them becomes more difficult as their behaviour and decisions develop a desperation all of their own. Some of this fallout may be directed at you and, because you've brought your 'real' self to work, can test your personal resilience.

How are you going to survive others' desperate behaviours?

This is where some 'authorities' counsel against bringing yourself to work, to protect you from what is ostensibly unacceptable behaviour. The problem with this as a coping mechanism is that it's hard work maintaining a persona that isn't naturally you, keeping an (un)conscious eye on your own behaviour distracts your brain from getting on with the task at hand, and you end up being so exhausted that when you get home you're no longer capable of being the 'real' you your family and friends know and love. 

As your team grows in strength, so does your collective and individual resilience. A strong team will provide a circle of protection around an individual perceived to be vulnerable, it's simple human nature, and that act of solidarity will further strengthen the team. Before long you have a team around you who really understand each other, look out for each other, and create a safe environment in which to flourish.

Coaching plays an invaluable role, not only providing support to take the first steps to bringing yourself to work, but also in releasing your (and your team's) potential. Very few people afford themselves the time and space, or have the tools, to fully understand themselves and how they are perceived by others. The right coach can be the catalyst you need to explore who you are, and your potential. If this is something you think may benefit you, then get in touch for an exploratory conversation.

actuality.ltd

Understanding Self, Realising Potential

A career path less trodden (part 1): From Med School to Med Director

The following paragraphs outline my route from teenager to Executive Medical Director in the hope that my ramblings may inspire you to tread the path less followed, not simply jump through the hoops the system expects of us, and unlock your true potential.

I've always wanted to be a doctor for as long as I can possibly remember. It didn't have anything to do with wanting to care for or help people, I was simply interested in what we are and how we work. At Medical School I intercalated in Chemical Pathology which involved spending a day each week on the ITU studying the biochemical and physiological derangements of those unfortunate enough to require a bed on the unit. I was hooked, I knew exactly where I wanted my career to head.

At the same time, only apparent to me now on reflection, an embryonic interest in leadership and change was growing. I was elected the Student BMA rep, I took on the Dean to stop the routine use of medical students as phlebotomists, and started to develop a reputation as someone who wasn't prepared to accept the status quo.

I went straight out of house jobs into an SHO post in anaesthesia, and stayed there but not entirely through choice. When I became an SHO, one of the 'lost tribes', you still had to build your own CV. I'm still of the opinion that this is the best way of demonstrating professional maturity and interest, but what do I know? Calman training schemes came into being, and I found myself in a small DGH not affiliated to a 'school' and with no standalone jobs (I was looking for one in Emergency Medicine) to be had. Fortunately for me, but very unfortunately for them, one of the substantive Staff Grades had a significant MI whilst shovelling snow and never returned to work, leaving a vacancy. I liked the town, I liked the hospital, I liked the anaesthetics team (five consultants, five staff grades, a Senior Reg - remember them? - and two SHOs), and they let me grow my interest in ITU. What’s not to like? So, just before my 27th birthday I became a Staff Grade Anaesthetist. Several colleagues, trainees and consultants, told me (in these exact words) that I had committed 'career suicide'.

Whilst having a thirst for knowledge is a pre-requisite to being a good doctor with the satisfaction of developing your own practice, imparting knowledge to others, and seeing them flourish in their careers, is just as rewarding, if not more so. I’m a real fan of ‘alphabet’ courses, the really intense courses taught over a few days which make the candidates feel like they’ve achieved something tangible and applicable at the end of it. I started teaching ALS and ATLS. The instructor courses for these provider courses provided a brief insight into how individuals behave, and how to influence that behaviour to get the most of your candidates. I began to practice these techniques when novice anaesthetists accompanied me in theatre or on ITU, and received positive feedback. I was recognised by the RCoA as a ‘non-consultant career grade' approved to teach, although I’d never sat any of the Fellowship exams as I didn’t need to. I got a kick out of teaching, mentoring… leading.

As the resident senior anaesthetist at a small DGH I often found myself in the back of an ambulance accompanying a patient, whose needs had exceeded the hospital’s capabilities, on their journey to a tertiary centre for specialised care. There’d been no particular induction, we used the same equipment we used on ITU precariously balanced on the ambulance trolley. It wasn’t particularly safe for either the patient or the accompanying staff. The patient’s needs were out of the ambulance crew’s capabilities, the ITU staff (including me) were out of their comfort zone in the back of a moving vehicle, and the patient was… out of it, and reliant on us to keep them safe and alive. Things needed to change, I needed to change things, before a catastrophe happened.

As with any success, there is always an element of luck involved. I raised my concerns with the local ambulance service lead who introduced me to their ambulance stretcher supplier. They happened to be developing a critical care transport trolley in response to European safety regulations but lacked real world experience of the transport of critical care patients. So, with ambulance service colleagues we helped design a fit for purpose critical care transport trolley, persuaded the hospital to buy one, and developed a protocol with the ambulance service that would allow us, and all our equipment, to be returned to the hospital after transferring the patient. 

But, we needed an 'alphabet' course to teach anaesthetists, ITU and ambulance staff how to work together to understand the complexities of a dynamic environment, use the new trolley and keep patients safe. So, how do you go about creating your own ‘alphabet’ course? Well, I started by inviting a small group of fellow instructors to the pub for a chat, we sketched out a full day's agenda and all agreed to write a component of it. Having begged, borrowed or stolen equipment (including an ambulance) we tried out the course on a group of willing volunteers one Saturday... it was a success. I presented our course at a RCoA CPD event, wrote an article in Anaesthesia News, and interest in the course grew. The course needed an academic home, so I approached a local university faculty of health sciences who were happy to assist, bestowing on me the title of Visiting Lecturer, and where it continues to run to this day.

It wasn't all plain sailing though. With the appointment of a new Consultant Anaesthetist, who had the lead for critical care in their portfolio, and the incorporation of the anaesthetics department into a school of anaesthesia, I found myself being utilised simply as a 'jobbing' anaesthetist, and I was removed from critical care and put on the obstetric anaesthetics rota. Whilst some colleagues thoroughly enjoyed obstetric epidurals and crash sections, I felt as though I'd been sent to purgatory.

Not one to simply bemoan my position, I used the time to get more involved in hospital politics, representing Staff and Associate Specialists on the Local Negotiating Committee, and in the process becoming known to the hospital's executive. The trust was in the throes of applying for Foundation Trust status and a shadow board of governors was being developed. Apparently, none of the consultants wanted to volunteer, so when the CEO asked me to take up the position I willingly accepted. The shadow board of governors were enrolled on a development programme, and I started to learn about the NHS for the first time.

The trust was successful in its Foundation Trust application, and by the time my term as a governor was complete, the consultants had realised the potential benefit in being known to the board and there was competition for my replacement. Personally, I had already moved on. Being on the board of governors, witnessing the working of trust board, had made me realise that the only way to influence change was from a formal senior management position. I had already applied for, and been successful in securing, a part-time Assistant Medical Director post at the newly formed regional ambulance service.

The portfolio felt huge. I had responsibility for aligning and consolidating the three former county ambulance services' clinical practice and equipment, as well as being responsible for the clinical governance across a clinical business unit spanning two counties. In addition, I was part of the Medical Incident Commander rota for the region in the event of a major incident. This was a new post, and it quickly became apparent that it justified a full time position. The ambulance trust agreed, and I gave up paid employ as an anaesthetist. I maintained my clinical practice by day release each week, continuing to provide anaesthesia on acute and trauma lists.

Shortly after my appointment I was fortunate enough to be tasked with developing the clinical component, and associated education, for the newly constituted Urban Search And Rescue component of the national Hazardous Area Response Team capability. This provided the opportunity to experience the workings of the Department of Health, and to understand the 'framing' required to make change at this level. I learned that networking is everything, and developing relationships is key to making change. And the way to develop strong relationships is to do what you'll say you'll do, as there are plenty of people who don't. Subsequenty, I was invited to contribute to the development of the major trauma networks, including the development and designation of Major Trauma Centres and Trauma Units, which provided further opportunity to develop my network.

Internally, I was designated Deputy Medical Director and attended board and executive meetings when the Executive Medical Director was away. When the substantive Medical Director resigned I acted into the role as Interim Executive Medical Director in April 2013 which, entirely by coincidence, was the date that NHS England came into being and the NHS re-invented itself (again). It appeared that no-one else wanted the post so I was interviewed and substantively appointed as Executive Medical Director. That's when it started to get really interesting...