NHS culture isn’t just self protective. Like most cultures its internal obsession and expectations can harm the people inside it as much as it rejects those outside.
The NHS’s overriding senior management culture is voluntaristic. It believes that if you as an individual leader hurl your whole self with sufficient force at an organisation, then through force and will you can run the thing. If leadership is a demonstration of powerful individual will, great leadership has great individual will.
There are big problems with this. Early last century some of our bravest individuals led men over the top with no more than a pistol and a swagger stick. Neither those weapons nor their courage worked against machine guns. A leadership generation died in those first few yards and so did millions they led. Being brave, having strong will, only works when the world is easy to change.
If it’s hard - and the NHS is hard - heroism is not enough.
In Brecht’s play Life of Galileo, the Inquisition shows our hero the instruments of torture and threatens to use them if he doesn’t recant his ridiculous new idea that the Earth goes round the sun. Galileo changes his mind. Galileo’s despairing disciple then cries out that he pities his land because it has no heroes. Brecht replies that he pities the land that needs heroes.
If a nation or a system needs heroes to lead it this is a sign of national or systemic failure. To lead it well the NHS needs ordinary people. Real leadership has to identify the power of the material world we are trying to change. Leaders must look cannily inside and outside the NHS for the levers of improvement and work strongly with them and other ordinary people to lead that change.
A leadership culture which yearns for the ordinariness of the day by day human relationship of change will leave the heroes and heroines ranting in their wake.
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