Nothing strengthens authority so much as silence

A few weeks ago, David Dalton, Chief Executive of Salford Royal NHS Foundation Trust, spoke at a leadership lecture at the Fund on the journey he had been on to realise his vision of Salford Royal becoming the safest NHS organisation in England. Several of the things he highlighted had a big impact on me.

I found David to be more quietly confident than charismatic pace-setter in both style and substance. He talked about his role as a leader, though always referred to that role in the context of the wider organisation – without the support of which he assured us he couldn’t have delivered his vision. When asked by someone in the audience what would happen to Salford Royal without David Dalton he replied, ‘it's not about heroic leadership; it's an approach co-created with the great people around me and not dependent upon me at all'. That response was in keeping with his message throughout the lecture – the days of heroic leadership are past and teamwork must triumph over hierarchy if we are to achieve the culture change necessary in the NHS. This reinforces the collective leadership philosophy we advocate here at the Fund.

David talked about the importance of having an open culture in organisations, particularly the importance of both giving and receiving feedback. He admitted that he finds giving feedback hard, and that it takes practice, but referred to a quote by Leonardo da Vinci that has stayed with me ever since: ‘Nothing strengthens authority so much as silence’.

I was really inspired by this quote. Whatever the reason may be for not speaking up or giving feedback – fear, lack of confidence, deference – if you feel silenced and disempowered, that has an impact on you as a person and on your ability to do your job to the best that you can. If you are a clinician, what impact does it have on how you treat your patients? We know from the work of Michael West and colleagues about the impact it can have on patient care when staff feel undervalued. We also know that often people don’t speak out as they feel silenced by those they perceive to be powerful.

I worked with someone once who rarely acknowledged the work I did for them. They would ask me to complete work and I would complete it, to a high standard I thought but I couldn’t be sure. There was no recognition of my work, only requests for more work. Looking back, I was silenced by authority. I felt unable to speak up about what I needed in order to do my best, which in turn led me to feel undervalued and de-motivated. Perhaps being acknowledged for your work wasn’t important to my colleague – we are all different and are motivated by different things – but it was important to me.

I recognise that I could have asked for feedback and I didn’t. Feedback is a two-way street; we all have a responsibility to speak out and give feedback to the people we work with regardless of position, power or status. As my colleague Katy Steward said recently in a conversation with leaders about culture change: ‘Leadership is a social process not an organisational chart’.

Margaret Heffernan spoke to a similar message at the Global Health Leadership Forum which was hosted by the Fund recently. She referred to the concept of organisational silence as a ‘dangerous threat’ to the success of any organisation. Her challenge to the group of global leaders was: ‘if people in your organisations don’t speak up then how will you know that they are telling you what they really think?’ We are failing as leaders if those we lead don’t feel able to tell us what is really going on in the organisation, through fear of the consequences. If you want people to give their best then your job as a leader is to enable that, not silence it.

To say nothing is a choice. If you remain silent then others will take your silence as acceptance. The power lies in using your voice.

Watch Chris Ham's interview with David Dalton

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Comments

#224176 Abeyna Jones
Occupational Medicine Registrar
Kings College Hospital

I strongly believe in collective leadership and wholeheartedly agree with the philosophy at the King's Fund.

Silence is perhaps one of the greatest obstacles we have to overcome in society and this is a result of fear of being ostracised for your opinions.

I value organisations that lead by example, so although I am pleased there is significant representation of women at a senior level amongst staff at the Fund, in all honesty I do question how the Fund addresses other inequalities in representation at this level and can these strategies be applied to the NHS?

I do also feel that obvious groups such as women, BME etc are mentioned frequently, but we continually forget about age. Naturally our current leaders are those with decades of experience and prestige, but already we discriminate against our youth. Is their opinion of lesser value? Who ensures their voice can be heard? They are our future so I would think it would be an obvious solution. I have learned from individuals of all backgrounds and ages and I use their experience to strengthen my own perceptions in life. A great leader is someone that can motivate and inspire, and there have been plenty of examples in the media recently of young adults who have demonstrated those characteristics.

#240183 Mandip Kaur
Programme Manager
The King's Fund

Dear Abeyna,

Many thanks for your comments on my blog. I appreciate you taking the time to read it and comment.

You raise some excellent points - this is an area we are beginning to think about more explicitly at the Fund and hope we can share this learning more widely in the system. However, I don’t believe there will be a single or quick solution to any of this – what we are talking about here is culture change which takes time and commitment and is a journey rather than a one-off intervention.

My view is that the first step is looking around you and being aware of the situation and then using that data to inform thinking. Only then can you begin to think about why the situation is how it is, what needs to change and how you might go about doing that.

I completely agree with your point around including less ‘obvious’ groups; another example is around socio-economic backgrounds. The point for me is around valuing difference of all kinds and that not being limited to protected characteristics alone. Some differences are obvious, some less so, this doesn’t mean one should be privileged over the other.

I can also personally relate to your point around age and though I didn’t mention that explicitly in my blog I believe that youth can be a big factor in speaking out and also in being listened to. Unfortunately, youth has traditionally been associated with inexperience – I believe that is beginning to change, albeit slowly. Part of my work at the Fund involves working on our Emerging Leaders programme developing leaders early on in their careers so hope we are to helping support younger leaders in some way.

If you would be interested in talking about any of this further (I would!) please get in touch m.kaur@kingsfund.og.uk / 020 7307 2610 It would be great to hear from you.

Mandip

#410140 Steve Turner
Managing Director
Care Right Now (CIC)

Great blog...

There are important links here for the message of having an open culture with the new Care Quality Commission inspection framework 'well led' assessment; the Freedom to Speak Up Review (due to report in January) and the implementation of the Berwick Review into patient safety.

I am more optimistic than ever that the culture of fear, which has so badly hampered some NHS organisations and compromised patient safety, is being replaced by a just culture with real accountability for everyone.

Collective leadership is the way forward, and these initiatives are taking it beyond just words.

#497113 Melanie Walker
CEO
Devon Partnership Trust

Mandip good to see you at the NHS IQ event last week. I have just come across this blog which I enjoyed but also reminded me of the discussion we had about the quiet voice and the value and importance of difference. I hope to see you again soon

#543435 Mary E Black
Programme Director/ NHS Leadership Academy Exec FT Programme
Homerton University Hospital Foundation Trust

Mandip

Great blog - silence reverberates. What is not said is noticed as much as what is said. Have you come across the history of extroversion - some very good books on this recently including Quiet, the Power of introverts in a world that can't stop talking.

I think if you have not read it you would like it!

Kind regards

Mary

#543789 Mandip Kaur
Programme Manager
The King's Fund

Thank you Mary. I am reading Quiet at the moment in fact!

Thanks Steve and Melanie for your feedback on my blog also.

Best,
Mandip

#544203 Tushar
self employed

I was searching through t net finding t actual meaning of t quote that Mandip u referred in ur article..Thanks a lot for ur deep thinking.

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