Bill Clinton used to say the most important attribute of a leader was being there. This gets tested when things go wrong, but also when they are going well.

People watch what you do far more than what you say. The more senior you are, the more they notice.

This is highly relevant to me right now, as we have Monitor among us. There is a tendency for executives to hunker down at such times and become invisible to those they are there to lead. Appearing to pander to regulators can create the impression that boards are more interested in money and hitting targets than patient safety issues, as a recently published HSJ poll suggests.

It is important to note that this is an impression only - the poll revealed that board members who knew what was actually discussed at board meetings did not say they were more interested in money and targets than safety, but that their senior staff thought this was the case. What people think is true can become as important as the truth. The higher your profile, the more people will make judgements based on extremely limited evidence.

Media hazards

We should all be wary of media criticisms of leaders looking old, or tired, or foolish because they have allowed themselves to be photographed next to a toilet or with too much cleavage on show. With so much media and so many cameras, there is a real danger of leaders losing the plot and playing to the gallery.

I thought of this on the day before theLondonmayoral elections when it was reported that the prime minister and the leader of the opposition had been slugging it out over the dispatch box. Does the spectacle of two middle aged men shouting and sweating and taunting each other appeal to the growing percentage of people too disenfranchised to vote these days? Does it create a positive role model for young people struggling to learn to negotiate? And is it a fair portrayal of how two very serious and learned politicians actually behave in real life?

The answer is no to all three, but it is an image that lasts and diminishes us all in the process.

The right impression

So we may say we hate the spin doctors, but we all need to be aware of the impressions we create. In the past week, I have spent eight hours reading or preparing papers, three hours with my chair, nine hours in meetings with the board, six hours travelling, four hours with Monitor, and eight hours in various one-to-one meetings with members of my team.

That's nearly a whole week without being seen to be doing anything of any value by anyone beyond the board.

So I am pleased to say I also spent one hour helping to put the finishing touches to our staff awards ceremony planning, where 450 of our 4,800 staff will be our honoured guests; half an hour getting an update from people keen to progress our cycle to work scheme; four hours at our first research and development conference hearing about how we are adding to the body of international knowledge; three hours in various meetings with senior partners from other agencies; two hours watching some of our senior staff performing in a Gilbert and Sullivan operetta; an hour planning some service visits over the coming months; and a couple of hours writing this article.

I hope the effort has been worth it.

Next time, more about the Monitor experience…..