In favour of focus

I have recently started running lessons. As you can imagine this has elicited an element of mocking from my nearest and dearest, who have been questioning just how bad my running must be. Despite their derision, I am finding the lessons enormously helpful. Why? Because they give me focus. It is perfectly possible to run for hours on end, making no real progress and the same mistakes again and again. But the lessons have given me an opportunity to check in with my style, make some focused tweaks and, four lessons in, I’m running faster than I was all last year.

So what’s this got to do with anything I hear you ask? Well, I work with leaders from across the health system at all levels and it’s so apparent, now more than ever, how busy everyone is. The build-up to the implementation of the Health and Social Care Act on April 1, and the weeks that have followed, have left leaders dealing with ambiguity, colleagues leaving, others trying to establish themselves and, frankly, it’s hard work. One of the key things I think leaders need is the opportunity to step back, to enable them to look at what they’re doing and to make some decisions about where they want to focus. This space for ‘critical appraisal’ might be in a coaching conversation, with a peer or mentor, or on a leadership development programme.

One of the exercises I have been using of late looks at ‘crucial conversations’ – those vital conversations that you know need to be had but there never seems to be quite the right time or place to do it. We use very talented actors to play the other party (generally with frightening accuracy) and ask participants to rehearse the conversation, knowing that if it goes wrong there are no repercussions. What I hear time and time again is that the most useful part of the exercise is in the preparation questions, mainly in answering the very simple question ‘what would a good outcome be?’. It’s consideration of this question that often enables leaders to think about the different approaches that could be taken.

Let me give you an example. I was working with someone recently who needed to have a conversation with a colleague about their performance. She was really worried that the individual would become highly aggressive towards her if she tried to tackle it, but knew that the conversation had to be had. We rehearsed it and helped her think through what she needed from the conversation – in this case it was for the other party to take responsibility and accountability for their actions. As a result the approach to the conversation was not combative, and when she ran it for real the outcome was better than she had ever expected.

Changing practices and behaviours in response to the Francis Inquiry report is at the front of many people’s minds at the moment. But creating the right culture of care to make sure we offer the best service possible for our patients won’t happen by accident. Nor will it happen if well-intentioned people just keep running the way they always have. It’s going to take some focus, some real intent. As the Francis report identified, we need boards who are committed to improving care for patients, and people working throughout the NHS who are prepared to stand up and challenge poor care when they see it.

So here’s my challenge (to myself as much as it is to you): what are the three things you are going to focus on today/this week/this month? What small tweaks or changes could you make to the way you do things that will better engage your team, improve your efficiency or offer direct improvements to patients? Sometimes a good look at your style is a good place to start.

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