Darwinism for NHS leaders

This content relates to the following topics:

It’s a challenging world for NHS leaders right now, and there’s a strong sense that you have to be tough to survive. But will the most successful leaders in the new NHS environment be those who are most able to compete or those most able to co-operate?

You might be forgiven for thinking that a blog that draws on Darwin’s theories of evolution would be all about competition, but is that the only characteristic needed to survive and thrive? Other thought-leaders, including Richard Dawkins, who wrote about ‘The Selfish Gene’, advocate an individualistic ‘heroic’ approach to change. For Dawkins, ‘selfishness’ is a behaviour that increases the chances of survival and justifies the promotion of competition and individualism in politics and economics, as well as in social and personal life.

But, co-operation and interdependence are also important for successful evolution. Darwin himself notes in The Origin of Species, ‘...in the long history of humankind (and animal kind, too) those who learned to collaborate... most effectively have prevailed.’ And Dawkins is also clear that the practice of exchanging things with others for mutual benefit (reciprocity or – perhaps more simply – co-operation) underpins successful evolution.

I was reminded of this when working with senior NHS leaders in the north-west recently. At the final event in our nine-month leadership development programme, we staged a simulation: delegates were allocated to different groups, all with a different, and sometimes conflicting, interest in one of the most challenging health problems we currently face – ‘How can we develop effective, high-quality and person-centred services for growing numbers of frail older people?’ As far as possible, groups represented services across the health spectrum, including social care, housing, the commercial sector, charities, sports centres and even the Department for Work and Pensions. Faced with a challenge that no single organisation could address effectively, that presented a real threat to the survival of the system as a whole, what would the leaders do?

Well, they co-operated. They shared information, listened more than they talked, showed curiosity and courage, took risks and built trust. As one participant commented: ‘It wasn’t a real situation but the partnerships we developed were real.

Delegates have since told us that they gained a lot from the exercise because it gave them the opportunity to look outside their own environments, where they were leaders, at the bigger system, where they were players. Collaboration extended beyond the boundaries of their immediate team, beyond their organisations, to the system in which they worked.

In Darwin’s terms, individual evolutionary success may have initially been linked to having the most appropriate tools, but it was only through sharing these that the conditions emerged to allow a whole system to benefit.

In our daily interactions as leaders, sharing should be motivated by recognition of ‘the other’, and seeing their wellbeing as connected to, and supporting, our own. For our leadership programme delegates, survival as individuals meant recognising that their futures were linked, and that supporting each other created better outcomes for everyone. Or, as Andrew Carnegie put it, ‘...the ability to work together toward a common vision, the ability to direct individual accomplishments toward organisational objectives... is the fuel that allows common people to attain uncommon results.

Related content


Tom Lyscom

Horizon Scanning,
Centre for Workforce Intelligence
Comment date
24 July 2013
I very much enjoyed your blog Belinda, and you can have quite a lot of fun with these metaphors you have put forward.

In the same way that for Dawkins it is the gene, not the organism or group, that can be described as if it was acting in its own interest, could it be values and attitudes, rather than leaders themselves, that appear to be striving to prevail and the best of which must win the day?

I am currently doing some work at the CfWI considering issues on the horizon for future leadership in health and social care. We may soon be publishing some thoughts including asking whether values and attitudes need to play a more central role in (natural?!) selection processes for health and social care leadership? I hope I havent stretched your metaphor too far, and I would be interested to hear your thoughts.

Thanks again for the stimulating post.



john heritage

Divisional Director,
5 Boroughs Partnership NHS Foundation Trust
Comment date
25 July 2013
Thanks Belinda - as insightful as ever. I really enjoyed some of the simulation stuff similar to this you did on my programme via the NW Leadership Academy....real food for thought!

Cheers John

David Welbourn

Visiting Professor,
Centre for Health Enterprise, Cass Business School
Comment date
25 July 2013
Helpful application of metaphor, though it becomes more helpful to cut through some of the misunderstanding about Darwinism. It isn't just about survival of the fittest as commonly stated. It is perhaps more true to Darwin to think about survival of the most adaptable. This then embraces both the characteristics of competition and collaboration, each applied when that is the most relevant type of relationship to achieve the optimum outcome. A leader's ability to adapt style will become increasingly important in a more interconnected and complex world.


Comment date
26 July 2013
Thanks Belinda you remind me of an article I wrote for my MSc a few years back on exploration and exploitation in the commissioning arena. I hypothesised that people can be either but that perhaps the best is a combination of both. Like you I referred to Darwin and the need for commissioners to adapt to changing situiations. Some years on it has been so true......

Peter Davis

Care- assistant,
BB Healthcare
Comment date
28 July 2013
It is perhaps unfortunate that the title of Dawkin's book has pervaded so much of our culture and discussion, not least because it implies that genes, in being 'selfish' , have intentionality, the opposite of Dawkin's 'intention', perhaps. We are still stuck in the dualistic problems of 'nature verses nurture', 'left verses right', 'private verses public', 'mind or matter', 'science or religion' etc, when varying combinations of all factors in flux have influence.

The field of epigenetics reveals that experience and environment affect the expression of genes i.e. that genes - 'selfish' or not - do not always initiate behavior. Contextual relevance plays a most important role. Some people have physical ailments due to long-term emotional factors leading to psychosomatic induced conditions and some people have, after long-term physical ailments or pain developed emotional disorders and depression, which in turn feed back into their condition. It is more a human intellectual need for certainty and being in control that more simplistic material and mechanistic understandings have prevailed, and to our detriment; and we may be paying too much heed to Dawkin's unfortunate expression. It may be worth considering, for helping to induce in us some humility, that quantum physics - which underpins biology - suggests that light can be seen either as waves of energy or particles of matter when looked at - or measured - in different ways. Maybe 'evidence' is more a matter of how we look at things, not what we look at.

Adaptability may mean knowing what behaviour to apply or how to respond most relevantly in any given situation as it arises. This ability to 'contextually respond' may be the greatest asset we could cultivate, and not just in healthcare. It would also undermine our tendency towards complacency in practice by encouraging our intelligence to remain active and responsive to people's needs, not just going through the motions in healthcare, which I see too much of.
This is just a reflection from one in the thick of it from the coalface of direct, hands-on care for the elderly. Thanks for stirring the grey matter Belinda.

Add your comment