The Leadership Blog of Wylie Coyote
by David Wylie Head of Podiatry NHS Greater Glasgow & Clyde
What drives The Coyote to never give up may never be known, however his will to succeed serves as an inspiration to us all. It’s also fun to watch him get crushed by a boulder.
A GENEROUS EXCELLENCE
Gore Vidal, the American writer is quoted as saying “It is not enough to succeed. Others must fail.” The context of the quote is unknown – however such Machiavellian attitudes are not always confined to the pages of literature. The potential satisfaction to be derived from the failure of others, regardless of personal performance is a deep seated challenge for all leaders.
It is particularly challenging in the ever more transparent world of NHS service performance since this mantra has two opposite – yet equally toxic – effects upon organisational performance.
Firstly, the knowledge that there is another service doing less well than my own provides a level of self-congratulation and relative complacency that can lead to an acceptance of sub-optimal performance as the cultural norm. There is no point in ‘pushing the envelope’ to achieve what Otto Von Bismark described as the ‘Art of the Possible’ (meaning it’s not about what’s right or what’s best – it’s about what you can actually get done) if others are failing and continuing to fail. Why should I push to improve and drive our service with the long suffering staff along the Kublar-Ross change curve1 with its roller-coaster of emotions and challenges? Why not simply keep my head down and accept mediocrity as success? The implications of such fatalism are unfortunately evident across many Health & Social Care systems and services in Scotland
Secondly, and potentially even more perniciously, is the adoption of this attitude within services that are succeeding and performing well. When leaders of high-performing services assume a position of superiority, taking as much satisfaction from the hapless efforts of others as from their own success – the organisational impact is equally damaging. “I’m great (and you’re not)” behaviours2 are a significant root cause of poor performance within the NHS. This is true not only at service level, but also within the behaviours of individuals, whose personal excellence (by comparison with others’ relative incompetence) can fuel a culture of empire building on the foundation of an over inflated ego that hoards greatness and shares nothing. In this world:
- demand for highly specialist clinical skills becomes a symbol of greatness regardless of whether the problem actually requires that level of first-line intervention;
- post graduate education becomes a hidden repository of secret knowledge used to further a single career and disseminated to no-one;
- promotion becomes an organisational balcony from which to rule with sanctioned, unchallengeable authority.
One of the most powerful antidotes to these dystopian parodies of leadership is illustrated in Catherine Ryan Hyde’s novel Pay It Forward which was published in 2000 and adapted into a film of the same name, distributed by Warner Bros. In Ryan Hyde’s book and movie the ‘Pay if Forward’ philosophy is described as an obligation to do three good deeds for others in response to a good deed that one receives. Such good deeds should accomplish things that the other person cannot accomplish on their own. In this way, the practice of helping one another can spread geometrically through society, at a ratio of three to one, creating a social movement with an impact of making the world a better place.
Within AHP services across NHS Scotland, this simple approach has the potential to unleash significant and rapid service improvement on scale. Services that have achieved a high level of performance – either by intentionality, opportunism or (usually) a combination of both – should be provided with opportunities to be generous with their excellence. These should be neither self-congratulatory nor other-disparaging. They should be marked by a generous excellence.
Many highly performing services have begun their improvement journey by doing the simple things extraordinarily well. The simple things are not difficult – but they do require focused intentionality. The governance foundations of a current, detailed Service Specification; a clear Service Delivery Model based on the Service Specification; a robust Workforce Plan based on the Service Model; a Service Improvement plan that shows where the service is heading, supported by Organisational Development and Learning & Education Plans tied in with eKSF and meaningful Personal Development Planning are all eminently achievable by any service within existing resources and governance frameworks. Indeed they are essential in driving service improvement into sustainable operational change.
Any service aspiring to excellence will have all of these basic, foundational elements in place, up to date and operational. Yet these essential ingredients of excellence are absent in significant numbers of NHS AHP services across Scotland. Services that have these in place, and are delivering the high performance enabled by such governance, face a different challenge. Succeed in building the local service empire, rejoicing in the relative failure of others or ‘Pay it Forward’?
A generous excellence knows only one way.