Jonathon Gray
The COVID-19 pandemic has created the conditions for collective leadership across the Cardiff and Vale University Health Board. Our leaders have demonstrated their capacity for rapid decision making and have often pioneered bold and creative approaches to their work. These conditions have come about through a combination of purpose and passion. Our purpose has been to recalibrate our clinical services in response to a novel coronavirus to ensure that we were able to continue providing the best possible care for those who needed it most. Our passion is to care for our community in the most effective and humane way imaginable. This combination of passion and purpose seems to have opened up possibilities for working in a new way.

I think it is worthwhile to reflect on this in two ways. Firstly, it is commonplace to hear that people act boldly when given permission to do so. This assumes there is, in certain individuals, an innate capacity for bold leadership, just waiting to be unleashed. I am sure there is some truth in this assertion and the motivation for such audacity will be different for each of us. For some, the opportunity for self-expression will be welcomed; for others, it will be the chance to show one’s ability in the hope of peer-recognition, perhaps even career advancement; and for others such calculation will be secondary to a sense of moral imperative. This line of reflection, then, is about those who are quick to intuit some kind of advantage by moving towards a potential space, rather than away from it, even though the prospects for such advantage are unknown. Secondly, there are individuals, who will, at some level, have a vision for how their workplace could be reimagined. Like the first group, their intuition may well lead them towards opportunities, but rather than seeing a potential space, they also see the potential to do things differently based on an idea, a vision, and the hope of what they might achieve.

So, for the first group – let’s call them passionate leaders – what kind of barriers stand in their way and what can we do to harness their passion? What kind of experience and training do we need to develop their judgement and tutor their appetite for risk? How can we nurture their embrace of the unknown and teach them how to innovate, create, and implement their ideas. Giving staff the permission to be bold, and allowing them to make changes for the benefit of the people we serve was a central theme of the Health Board’s Amplify programme which ran in the summer of 2019. So much has happened since then but this key goal remains a constant. It is also the purpose of our new Spread and Scale Academy which ran, for the second time, this March, to help such leaders define their ideas and optimise their impact. It seems likely that from amongst our passionate leaders, will emerge a smaller number who will be more typical of the second group – let’s call them purposeful leaders – and that such leaders exemplify the ability to not only ‘do the right thing on a difficult day’, as the late Professor Aidan Halligan used to say, but to also make work meaningful and purposeful for those around them. They have a vision which is sufficiently capacious for others to inhabit it fully, and they have a sense of conviction, that generates confidence in others.

But where do new ideas come from? Just because something is “the way we’ve always done it” does that mean it is the best way of doing things? Maybe, but then again, maybe not. What enables a leader to judge when tradition serves as an rock, a strong foundation on which to build, or when it serves as a rock in one’s way, an impediment to progress? When a new, radical way of thinking and doing things comes along we must be ready to embrace it and the people behind it, instead of squashing them into the pre-existing moulds of our system. There is a great deal to be learned from fully embracing new ideas, even if such ideas are not ultimately adopted by others. For in attending to new ideas, one is forced to reappraise the value of the status quo. I am reminded of T S Eliot, “Do not let me hear of the wisdom of old men, but rather of their folly, their fear of fear and frenzy, their fear of possession, of belonging to another, or to others, or to God. The only wisdom we can hope to acquire is the wisdom of humility. Humility is endless.”

We want to break down organisational barriers, ensure that our staff have a shared vision and sense of purpose, and implement models of leadership that have high levels of trust and support with much lower levels of hierarchy and bureaucracy. There are other incredibly complex systems to which we can look for guidance on how to achieve this. Take NASA for instance, on the Apollo 11 mission, the average age of Mission Control was just 28 years old. The flight controllers were hired based on their qualifications and skills, rather than their experience, and a huge amount of trust was placed in them to make snap, often life-and-death, decisions. Meanwhile the flight director, Gene Kranz, viewed his role as that of an orchestra conductor: guiding the individual players and steering the overall direction without interfering with the decisions they made.

One of the flight controllers, Steve Bales, was just 26 at the time of the moon landing and when Buzz Aldrin and Neil Armstrong reported that the landing craft was going too fast and might overshoot its landing spot on the lunar surface, it was down to Bales to make a decision – either to abort or continue. Make the wrong choice and that decision could have cost $153bn, a decade’s worth of work and the lives of two astronauts.

It took just 15 seconds from the time of the initial alarm for the team to take the information from their computer systems, analyse it, and make the decision to continue the mission. It was not Kranz who made that decision, it was the experts on the frontline who had Kranz’s full confidence and support. Speaking about his experience of Apollo 11, Steve Bales, said, “We didn’t know we couldn’t do it, so we just did it.”

There is a lesson here for those of us in senior positions. While experience is obviously a key part of organisational success, we cannot deny that these are the types of decisions our young staff members are making every single day. The lives of our patients are often literally in their hands. It is our responsibility as managers to empower them, support their decision-making, and, when they want to deliver change, give them permission to do so; we cannot continue to obstruct change with “we’ve always done it this way.”

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