The humility virus - reassessing the meaning of leadership during Covid-19

“We don’t hire smart people to tell them what to do. We hire smart people so they can tell us what to do” – Steve Jobs

Over the last seven weeks I have had unexpected personal experience of the NHS – the UK’s National Health System – as it has grappled with the coronavirus pandemic. It has been a sobering insight into the stark differences in efficiency and effectiveness between centralised and decentralised organisations, the former driven by bureaucrats, managers and accountants, the latter by frontline workers.

I have long been a staunch advocate of Lean Thinking, a set of organising principles pioneered in the 1950s, which turned Toyota into the world’s No 1 car manufacturer. Unfortunately, the term ‘Lean’ has become widely discredited in the UK, synonymous with job losses. This is the opposite of what Toyota conceived and implemented. They guaranteed that jobs would not be lost due to ‘Lean’, and they empowered the front line to drive the rest of the organisation, with spectacular, sustained results.

This is what Steve Jobs was describing in a different industry years later.

Lean Thinking, properly understood and practised, remains the answer to many critical problems of organisational performance, as this article explains with reference to the NHS and Covid-19.

(This article is a 10-minute read)

Getting sick during coronavirus

On Monday 23rd March, the day Prime Minister Boris Johnson announced the coronavirus lockdown in the UK, I was sick and getting sicker. My symptoms were not coronavirus – it was obvious I had an infection of the urinary tract, and potentially the kidneys. The previous night I had not slept – I did not sleep for three more nights.

On Friday 20th March I had suddenly become ill - faint, feverish, with a stabbing pain down my left leg into my left foot. The worst symptoms passed quickly, but I called the doctors’ surgery. My own GP was on leave, but a doctor called me back and prescribed antibiotics which I collected that afternoon. Things were already in crisis mode – GPs and their staff were fearful of contracting coronavirus. Face-to-face GP appointments were rapidly drying up for all bar those deemed the most urgent cases.

Almost a week later I ended up in the Acute Assessment Unit at our regional hospital. Blood tests, x-rays and CT scans revealed a raging infection rapidly heading towards sepsis – blood poisoning. I was detained in hospital for four days whilst my system was repeatedly flushed with powerful intravenous antibiotics. I learned that I need surgery, postponed indefinitely due to coronavirus.

The CT scans also revealed an infection in my lungs. I was immediately quarantined, and swab tested. The consultant doctor told me he was 99% certain the lung infection had spread from the lower body and I did not have coronavirus. However, since the swab test results took three days, I was sent to the eponymous Ward 19 – the first isolation ward set aside to treat suspected Covid-19 patients.

Concerns about organisational health

My arrival in Ward 19 coincided disconcertingly with the first shift of nurses arriving to care for Covid-19 patients. They did not know each other. The hospital had decided to break up established ward teams and reallocate them for Covid-19 to work with people from many other wards whom they’d not worked with before.

I’m sure the hospital managers had a logical rationale for this decision. However, when dealing with a crisis my first instinct as a leader is to try to keep existing teams together. Cohesion and mutual understanding are vital ingredients when faced with danger, uncertainty, and the unexpected. Stress levels are high – individual and team performance and wellbeing is better where familiarity, trust and thus confidence are sustained. In the research study Great by Choice (2011), Jim Collins and Morten T Hansen discovered that teams which perform outstandingly well under pressure maintain a surprisingly high level of consistency and stability of action. Compared to teams whose performance is mediocre or poor, they are slow to restructure or make other radical changes, particularly where there is no hard evidence that it will work better. 

It was depressing to observe an environment in which front line workers were not authorised to use common sense and solve problems for patients. Talking to nurses, I realised that the majority were afraid, unwilling, or uncertain to do anything for which they might conceivably be criticised. An example was finding me a mobile phone charger so I could call my wife and father, and email or text friends. Several nurses said they couldn’t help. Two said they would bring me a phone charger but didn’t. Eventually one leant me her mobile phone to call my wife. It was all random, hit and miss. There was no standard solution to a simple recurring problem with a disproportionate positive impact on patient wellbeing.  

After three days the swab test results for coronavirus came back negative. The following day, Monday 30th March, I was discharged from hospital with instructions to self-isolate at home for 14 days. The consultant told me I’d been in a ‘dirty’ (he corrected himself – ‘hot’) environment and should shower as soon as I got home, wash all my clothes, and wipe my shoes with disinfectant. I was relieved to get away before the coronavirus storm broke in earnest.

A few days later I received a large box of medical supplies, far more than I needed. I’ve also called the surgery to stop the continued delivery of further unwanted medical supplies, and to remove antibiotics from my prescription list as I don’t need them anymore. If my experience is representative, there is tremendous opportunity to reduce waste in the NHS.

Important lessons for leaders and managers of other organisations

It’s ironic that the opening quote for my article comes from Steve Jobs – not renowned as the most inclusive, team-oriented leader of the last few decades! However, in his second, hugely successful, period at Apple, Jobs subjected himself to weekly coaching from his close friend and Apple Board member Bill Campbell (see the superb Trillion Dollar Coach (2019) by Eric Schmidt, Jonathan Rosenberg, and Alan Eagle). Campbell, who understood effective leadership better than most and had a huge impact on dozens of Silicon Valley leaders (hence the book’s title), undoubtedly influenced Steve Jobs’ leadership style for the better.

The NHS is the No 1 daily topic in the UK news. Brave doctors and nurses are performing heroic service for the nation – we rightly applaud them. We should not forget workers in care homes either – they are the largely forgotten, undervalued, heroes and heroines. Shockingly, far too many workers in the health and social care systems have lost their lives to coronavirus.

The pandemic is highlighting many examples at macro and micro level that much is wrong with the NHS. Whatever one’s political beliefs, it is abundantly clear that these problems will not be solved by throwing more money at the problem, though there are undoubtedly areas of the NHS which are underfunded.

The greatest problem however is leadership and culture. Umesh Prabhu confirms this. He was Medical Director for two NHS hospital trusts in the North of England and is now a tireless international campaigner for organisational reform in the healthcare system, especially in the UK and India. He says the single greatest challenge is the calibre and ethics of leadership and he is right. Independent research studies across all areas of human endeavour consistently prove that the presence or absence of effective, evidence-based leadership is the largest single determinant of organisational success or failure.

What does great leadership look like?

·       It listens rather than tells. That way it learns something. This is also often referred to as ‘management by walking around’, though….

·       It clearly understands that management and leadership are two completely different things. Management is about completing tasks successfully. Leadership is about inspiring people to engage fully and freely to create outstanding short-term and long-term results. Far too many organisations, the NHS included, suffer from blind, unthinking, obsessive managerialism, which stems from Henry Ford, Frederick Winslow Taylor, and theoretical economists. Though originally perhaps better intended than it now appears, it is effectively the worship of ‘professional’ management and administration as the be-all-and-end-all. It subverts human beings as inanimate cogs in a mass, faceless system of production and consumption. It is arguably responsible for many of the biggest problems which humanity now faces, including the burgeoning mental health crisis and climate change.

·       It puts people centre stage rather than tasks and abstract outcomes. It seeks to create a great experience for customers/service users, employees, suppliers, and other key stakeholders. For example, my vision of a great NHS (with integrated social care) would be a system designed and continually improved by front line nurses, doctors (GP and acute), and care workers, focused on eliminating mistakes, wasted activity and cost whilst giving patients the best possible treatment, experience, and sense of mental, as well as physical, wellbeing. Hospital is a stressful place for patients, often unnecessarily so. The faster diagnosis takes place the better for all concerned, including for costs in the healthcare system. For instance, an artificial intelligence-based app could have pointed me and any of the various GPs whom I spoke with from 20th to 26th March to the most likely cause of my illness, based on my existing case notes. Indeed, it could have been predicted long before it happened, potentially allowing preventative action to be taken, better for me as the patient and less expensive for the NHS and thus the taxpayer.

·       It inverts the pyramid. People at the front line are empowered to drive the organisation, hierarchies of management are flattened out, and the role of senior people is to serve the front line and remove obstacles for them. I often quote the motto of the British Army Officer Training College at Sandhurst: “Serve to Lead”. If it’s good enough for the military, it’s good enough for everyone else.

·       It does not dictate structure, process, and content to the front line. It does not seek to control or micromanage. It does not second guess – instead, it responds to and is effectively accountable to the front line.

·       It does not pretend it has all the answers. Instead it asks intelligent questions which prompt discovery and insight, which in turn lead naturally to improved performance.

·       It hires smart people and trusts them to tell leaders what to do. It is not threatened by smart people – in fact, great leaders are characterised by a willingness to hire people smarter than themselves.

·       It creates a psychologically safe space where people can speak openly, admit honest, well-intended mistakes with no fear of consequences, and experiment to improve organisational performance and results. It is engaged in a perpetual quest for learning and personal growth.

·       It takes place at all levels and in all directions within an organisation – ‘up’, ‘down’ and ‘sideways’. Because leadership is so poorly taught, and people misunderstand so badly what it is, they fail to see that they can exercise leadership, or allow it to be exercised, no matter where they sit within the organisation. It also means that people with leadership skills are ignored because they don’t have a management role which ‘entitles’ them to exercise leadership. This is extremely damaging to organisational performance, health, and wellbeing.

·       It is driven by the recognition that teams, not individuals, create great performance. We remain dangerously obsessed with the mythical quest for perfect leaders and simply cannot accept that like gold at the end of the rainbow they do not exist. Our obsession enables us to be hoodwinked too easily by confident, charismatic people, often charlatans, narcissists and/or sociopaths. Then we wonder why we constantly feel disappointed or betrayed by our ‘leaders’. We get the leaders our ignorance deserves.

·       It is full of paradoxes – seemingly contradictory ideas which are both true. It’s not either/or, but both/and.

·       It is humble and willing to show vulnerability, which paradoxically is perceived by its followers as a reassuring and encouraging strength. They are even more willing to follow and likely to be inspired by a leader who is genuine, honest, and fully human, rather than someone who is acting out a role.

·       It is an art and a science (another of the paradoxes), and it takes a lifetime to master. But it is fun, hugely rewarding, and arguably one of the most important things a person can set out to do in life. We need effective, evidence-driven leaders more than ever.

Conclusions and key questions

Because it is so topical, I’ve used my recent experience with the NHS in this article to highlight critical issues about leadership, organisational effectiveness, and building high performance cultures.

Leadership is terribly understood and thus subject to unfounded opinion and misinformation. There is a wealth of information from history and research which can teach us what great leadership looks like. It should be taught alongside basic skills throughout school. All of us, irrespective of our background and orientation, have leadership potential - the ability to inspire and engage others. A microscopic fraction of it is realised. The potential is vast.

Here are some important questions for you to consider for your own leadership style and organisation:

1.     What can you do to overcome the fragmentation of teams caused by lockdown and social distancing? How can you preserve, nurture, encourage and build on the existing social cohesion within your organisation during these unprecedented circumstances, turning these essential qualities to advantage?

2.     Centralised approaches to running organisations were already coming under pressure before coronavirus. They are now even more challenging to sustain. How can you apply the correct principles of Lean Thinking to build a nimble, adaptive culture led by the people at the front line who are almost certainly ‘smarter’ and better informed about business realities than you are? How can you harness technology to help you do this?

3.     How can you ensure that you and your organisation are tapping fully into the knowledge and skills of all employees and other key players (suppliers, customers, sales agents, distributors, business partners, non-executive directors, peers) to limit the damage and turn this unprecedented situation to advantage?

4.     How can your team exploit the disruptive change from Covid-19 to design a radically better experience for your customers/service users, and importantly for your suppliers, business partners and other key stakeholders?

5.     Is your style overly managerialist? What changes do you personally need to make to become a more effective leader in the eyes of those who choose whether to follow you? Are you open to being coached? The most successful 21st Century organisations have embedded coaching into their cultures and select and develop only those managers who are a) coachable; b) able to coach others.

If there is any good news to be found in this crisis, it is this: coronavirus is an unprecedented opportunity not only to restructure businesses, but to unlock the creative human potential within them in pursuit of worthy, sustainable and inspiring objectives. Humility, courage and determination will be rewarded.