The Golden Threads of Leadership and Change –putting the 3 C’s first: Creativity, Criticism and Communication.

Jodi Binning, Podiatry Service Lead, NHS Ayrshire & Arran.

@jodiahpaa

At the last count, in all recent leadership narrative I have looked at, there were 26 characteristics of effective Leadership quoted.  Here eight skills are highlighted in one recent article:

http://www.telegraph.co.uk/finance/jobs/9920854/Leadership-The-eight-essential-skills.html

Everyone has their views and favourite characteristics; folk need different leadership skills for different circumstances – you know how the dialogue goes; it’s all very interesting and all very generic! 

However, if you’re in the same game as me (attempting to make changes to an NHS Service to make it sustainable and higher quality), then I believe there are some golden threads of Leadership which should be placed at the top of the leadership pile; Creativity and Criticism. And for me, the relationship between these two paid the biggest dividends in regard to instigating change and finding solutions; and communication was the catalyst.

The Context – Podiatry Redesign Project – Summary of Components: 

….and commentary in real terms:

 

• Require to discharge 20% of patients by April 2014 otherwise service will implode – Number of new patients far exceeding discharges due to demographics and efficiency savings
• No idea of our impact on patients in 95% of what we deliver – Why haven’t we done anything about this before? Too busy delivering care to measure?
• Need to improve consistency of patient outcomes and demonstrate impact. Evidence pointing towards care pathway approach to organise care but doing this would require restructuring of all staff to deliver care within pathways. This is now huge!

Back to Creativity and Criticism

Although at an early stage, our partnership with third sector, restructuring care and staff around patient need, is beginning to work for us and we are beginning to see the benefits  (discharges now exceed new patients, 500 NHS appointments saved in the initial 2 months etc. etc.).

So what made it work? Whilst it is readily accepted that more creative people are better able to lead change in an organisation and better able to inspire others, research indicates that most of the creative people aren’t given the opportunity to lead.  Twitter followers may have seen recently the research from the Journal of Experimental Psychology by Mueller et al that showed that when employees were asked to rate leadership potential and creativity there was in fact a negative correlation.  We purport to like creative people – but don’t value/recognise creativity in those who ‘manage us’.

My view is that process, governance and culture within our busy NHS lives makes creativity very hard to generate even in those who are naturally creative and who have the capacity and role to lead change. So we have to create the environment and opportunity to be creative since the evidence tells us that creativity is key to sustainable change.  Ordinarily this would result in  brainstorming sessions; the blue sky thinking or team building sessions; but for us the traditional ‘time out to think’ wasn’t the key to successful outcomes.

Enter a new thread of evidence – David Burkus, author of The Myths of Creativity suggests that a creative culture needs to include criticism at its core. Whilst this may not be too surprising- the nature and delivery of the criticism in regard to its impact on our project, I think, was a surprise; and while the laudable principles and behaviours of constructive criticism, ‘critical friends’, and appreciative leadership helped, it did not make the biggest impact either!

Instead – the environments and exchanges where complete conflict was displayed (in some instances with awful behaviours) made the biggest difference. Real conflict was where real diverse viewpoints were displayed and where competition of ideas became pivotal.  It sharpened the emotion, reflection, justification, and made our work more robust, methodical and sustainable and it changed our views.  I guess in regard to learning theories – if true learning has to connect with cognitive, emotional and environmental  aspects to be lasting  – then the true unadulterated criticism allowed this (I’m no psychologist but a Gestalt moment perhaps?!)

Underpinning this was a PFPI methodology which meant we communicated and engaged with as many as we could. Excluding GPs, MSP enquiries and internal enquiries from the Chief Executive’s office we attended 21 difference committees, fora , councils or groups, and many of them were only too happy to give us criticism!

I’m sure if I think about it long enough I’ll begin to add some more favourite leadership characteristics from the ever growing list – so I’m going to sign off with my top 3 before I’m tempted. But before I sign off completely I’ll just leave you with my favourite quote (which I lived and breathed when we were in the thick of it!)…..

‘ be more concerned with your character than your reputation. Your character is what you really are while your reputation is merely what others think you are.’   John Wooden.

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