Trust

Trust

I’m writing this on June 24th. I woke up this morning to the news that the UK had voted to leave the European Union. Anyone who follows my social media feeds will know that I voted to remain, and I am feeling pretty confused, upset and very worried about what this might mean for the future of this country. Clearly not everyone will share my views (over half the country it would seem!), and I am not sure I want to do a blog about the referendum, but one thing did occur to me that seemed worthy of comment.
Trust. 
Or rather, the lack of it.
I could not help but notice that the majority of senior politicians from all parties (with a few notable exceptions) were strongly advocating that we should remain in the European Union. In addition, leading experts in finance and economics were highlighting what they saw as the risks of a leave vote. It seemed to me that many of our elected representatives were not listened to, were not trusted. During the referendum campaign Michael Gove famously said that “the people of this country have had enough of experts”, and it would seem that this resonated, and was possibly true. This is a scary thought. That we are electing individuals to make decisions on our behalf, and then not trusting them to do that with our best interests at heart, and also that non-elected experts are not being believed. 
As a doctor I have also experienced this. Think only of the MMR vaccine – I have had patents clearly not prepared to trust my advice about its safety and benefit. I have also had many conversations with patient about changing drugs where they will not believe or trust me when I tell them  that a cheaper drug is not necessarily a worse drug.
Where there is lack of trust, things start going wrong. Where there is lack of trust we become fearful. Where there is lack of trust we pull up the drawbridge and start building walls. Where there is lack of trust we look inwards instead of out towards others.
Stephen Covey has written a book entirely about how he sees the power of trust aiding businesses, speeding up negotiations and smoothing the way for good things to happen. My job as a commissioner relies on collaboration and cross-organisational working. My job as a GP relies on collaboration and cross-organisational working. We can’t do that effectively  without trusting each other. Working on relationships and developing trust is vitally important. It is so often overlooked, and so often seen as the ‘soft and fluffy’ stuff rather than the difficult and important stuff. I once heard Chris Ham of the Kings Fund say that “The soft stuff is the hard stuff.” This is undoubtedly true, and not only is it hard, it is important. I would say that nothing is more important. 

Without trust, we struggle to build relationships. Without relationships, we struggle to do anything. 

This short blog, therefore, is about the need to build relationships, and the need to trust each other. If we instead decide to throw up walls and barricade ourselves behind them, we can look forward to a life of isolation and fear. I mentioned Stephen Covey earlier. His father wrote the very famous book 7 Habits of Highly Effective People. If you have never read it, I would recommend it. In the book Covey talks about the need to achieve independence,  but that a greater goal beyond that was interdependence. We can achieve so much more together. I’m not sure people really get that. We are so wrapped up in the need to stand up on our own two feet that we forget that there is only so much we can do as an individual, and (deliberately repeating myself) so much more we can do together.


My message today, as the UK embarks upon a new and more distant relationship with our European neighbours is that we should spend time on our relationships. That we should work on understanding each other, warts and all. And that we should work on mutual trust, because that, ultimately, is what makes things happen.

Follow Jonathan on Twitter @DrJonGriffiths

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No words?

No words?

My social media feed has been filled with posts about Jo Cox MP. I’m sure yours has too. I’m not sure where or how to start this blog, but writing about anything other than the multitude of awful things that appear to be going on in the world just didn’t seem right. I noticed some people shared the news on FaceBook simply by saying “no words”. In some ways that’s how I feel, yet I’m going to write some.

I’m generally a positive, up beat kind of guy. I see the best in people, and expect people to behave in ways that align to my own values. In the face of Jo Cox’s murder, which comes swiftly on the back of terror attacks in Orlando, I am confronted with the reality that some people’s values are so far removed from my own that I am left confused and lost for words. We like to believe that life is good, and getting better. We like to believe that we can do or achieve anything if we put our minds to it. We like to believe we can persuade people to do what’s right. I like to believe all of those thing. Am I being naive?
I cannot help but think about the individual stories of pain that are behind the headlines we read. We see the numbers of people killed in Orlando. 49 people in a nightclub. 49 people out to enjoy themselves, with no thought of malice or intent to harm. 49 people with relatives, friends, loved ones. 49 people who have left behind scores of people personally affected, bereaved, traumatised, scared. 49 people whose deaths will continue to affect the lives of those who cared for them. Jo Cox had a husband and children. She will have had wider family members, friends, colleagues and constituents who valued her leadership and advocacy. 


Individual stories get lost in media headlines
.

As you look around you will see that the world is not always a great place. There is murder, terrorism and war. The are floods, earthquakes, volcanic eruptions and hurricanes. There are illnesses and diseases. There are individuals facing the consequences of these things all the time.

From my perspective as a GP I see the personal stories of loss and struggles with illness. Many of the people I see don’t look ill, yet their outward appearance is not a reflection of their inner turmoil. One of the points of a previous blog was that you never know what others have gone through, or are going through right now. We may all change our social media profile pictures to show solidarity for Paris, Brussells or Orlando, but this doesn’t happen often for the person living down the road who’s just been bereaved. Yet the trauma of losing your loved one to a sudden heart attack can be just as real as if they had been the victim of terrorism. 
The world is full of personal tragedies. Most of them will never make the news. They are tragedies nevertheless. As a doctor and a health commissioner I need to remember this daily. I need to remember that people are people, not numbers. I need to remember that those seeing me may be anxious, troubled or stressed. I need to remember that treating all with care and compassion can make a real difference. Personal greetings, taking time, listening, understanding. Small, easy things, yet full of such power to help.

So, what should we do in the face of the awful things we see in the world? Should we rage and shout and threaten and seek to take revenge? Surely not. Filling the world with more hate just plays into the hands of those inciting violence. If my life experiences, values and beliefs  have taught me anything it is that we should love. Not a word often used in professional circles, but one I would like us to reclaim.  There should be more love in the world. Why do we leave this most powerful of emotions to the song writers, poets, novelists and film makers? Let us remember that the patients we treat love and are loved. Let us acknowledge that for many of us we are driven by a love for those very same patients, towns, and communities. Even more, can we acknowledge our love for our colleagues and co-workers? For the people who make our working lives more fun, more interesting, worth getting out of bed for?

What am I saying then? What is my conclusion following all that is going on and how does it relate to the NHS?

I think I am saying that we should love and not hate, talk and don’t shout, welcome and not push away, give and not take, be open not closed. These attributes and values need to apply to us all, but I can clearly see how a compassionate, caring NHS needs to embrace them. Wouldn’t the world be a better place if we all acted like this? Wouldn’t the NHS be a better place if we treated individuals  as individuals. I have previously quoted the NHS constitution in my blogs. I will end by quoting the first paragraph again here:

“The NHS belongs to the people.
It is there to improve our health and wellbeing, supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives. It works at the limits of science – bringing the highest levels of human knowledge and skill to save lives and improve health.
It touches our lives at times of basic human need, when care and compassion are what matter most.”




Follow Jonathan on Twitter @DrJonGriffiths 

The Queen, Ernest Shackleton and Elizabeth Garrett Anderson

The Queen, Ernest Shackleton and Elizabeth Garrett Anderson

The Central Cheshire CCGs have worked with the North West Leadership Academy and AQuA to put on a Clinical Leadership Development Programme. I was fortunate enough to be asked to provide an introduction, and thought I would pull my thoughts together into a blog for you.
I started with an intro about myself and our local health issues, the financial challenge and the need for clinical leaders. I’m not going to replicate that bit here, but I then talked about three people who have recently had significant anniversaries, and considered some leadership lessons from them. From the photos, everyone recognised The Queen, a few recognised Ernest Shackleton (but all had heard of him), but only one or two recognised Elizabeth Garrett Anderson (and only they had heard of her).
The Queen



Little introduction is required. HM Queen Elizabeth II had her 90th birthday this month and must be one of the most famous people in the world. She has lived her life in the public domain more so than any previous British monarch, and the Information Age has been responsible for this.
It is worth remembering that she never thought she would be Queen. Her father was never expected to be King until his brother abdicated. Nevertheless, she did not shy from the role and took it on. This in itself bears consideration – just when you are at your lowest, grieving your father’s death, is when you are thrust into your role as Queen. She is unable to have anything significant happen to herself or her family without it being splashed across the world’s media. Just think on that for a moment – if your children’s marriage breaks down, or if your daughter-in-law tragically dies in a road traffic accident, how do you manage that? You manage it in relative obscurity, you can deal with it as you choose, quietly if you prefer. The Queen has no such choice. In fact, you will probably remember the criticism she received following the death of Diana. 
When you lead, you open yourself up. When you lead, you will be subject to criticism. 
Something else. By my count The Queen has undertaken at least 114 international state visits during her 64 years on the throne. That’s a lot of small talk. It’s a lot of smiling, shaking hands, waving and talking about the weather. I think it’s a lot more than just small talk though. It’s about representing your country, advocating, smoothing things over, relationship building and relationship maintenance. These are all essential attributes of leaders. You need to spend time collaborating and working with others. External networking is key. I think the Queen is probably pretty good at that. 
I will move on now, but first leaving you with this quote from Her Majesty.
“I know of no single formula for success. But over the years I have observed that some attributes of leadership are universal and are often about finding ways of encouraging people to combine their efforts, their talents, their enthusiasm and their inspiration to work together.” ~ HM Queen Elizabeth II

Ernest Shackleton
This year marks marks the 100 year anniversary of the rescue of Shackleton’s crew in the Antarctic. I’m hoping you are already familiar with the story, but will give a brief description as I understand it. Shackleton wanted to be the first person to cross Antartica from coast to coast. You may have heard of the advert he allegedly placed in the newspaper when looking for men to join him – “Men wanted for hazardous journey, small wages, bitter cold, long months of complete darkness, constant danger, safe return doubtful, honour and recognition in case of success.” ~ Ernest Shackleton. Unfortunately there is no evidence that Shackleton actually placed such an advert, but it does give you an idea of the challenges he faced.
Things did not go well for the expedition. The ship, Endurance, became trapped in the ice. Shackleton hoped that the spring thaw would release them and enable them to continue, but instead the movement of the ice as it started to thaw damaged the ship, which eventually sank. The crew had already abandoned the ship by then, and were camping on the ice. It was hoped that the ice flows would drift them towards land, but this did not happen, and eventually they took to the life boats and endured an open sea voyage to Elephant Island – an uninhabited rock far from any shipping lanes, with no hope of rescue. After establishing a camp here, Shackleton and a handful of men set off on a further open sea voyage in one of the life boats to South Georgia. Here they completed a hazardous land crossing of the island to eventually reach a whaling station, and organise a rescue trip for the remainder of the men.
My re-telling does not really do proper justice to the scale of what was achieved and endured. I would suggest you do you own research if this has piqued your interest. 
Shackleton was known as an unusual leader for his time. Someone willing to do any job, adopting a person-centred approach to leadership. During one of the sea crossings he gave up his gloves to one of his men, resulting in Shackleton himself suffering frostbite.
Shackleton was calm in adversity, did not overreact, and was known for his ‘calm and reflective demeanour’. I cannot emphasise enough how important this is for a leader. To be seen as someone who will always be measured, confident and calm. Leaders who are reactive and display their stress and mood-swings are very difficult to work with. Shackleton demonstrated a key leadership trait in my view. A mantra I try to follow when I lead, particularly when doing so publicly, is to lead with ‘confidence and joy’. Not always easy when you are not feeling joyful!
A quote from Shackleton before we think about Garrett Anderson:
“Difficulties are just things to overcome, after all.” ~ Ernest Shackleton
Elizabeth Garrett Anderson



Elizabeth Garrett Anderson was a remarkable woman. 
She was born on 9th June 1836, so would have been 180 last week. I will quote from Wikipedia:
“Elizabeth Garrett Anderson, LSA, MD (9 June 1836 – 17 December 1917), was an English physician and suffragette, the first Englishwoman to qualify as a physician and surgeon in Britain, the co-founder of the first hospital staffed by women, the first dean of a British medical school, the first female doctor of medicine in France, the first woman in Britain to be elected to a school board and the first female mayor and magistrate in Britain.”
Wow. If you’ve never heard of her before, now’s the time to remember her name and what she achieved. She endured continual opposition to her quest to become a doctor. After applying to various medical schools, and being rejected by them all, she worked and trained as a nurse. From what I can gather she essentially just went along to the medical student teaching, learning about anatomy and medicine. She eventually became a member of The Society of Apothecaries, which at the time was a route to becoming a physician. She then became a member of the BMA, and set up consulting rooms in London. While business was initially slow, with people being suspicious of a female doctor, the outbreak of cholera meant that patients soon became less picky about who their doctor was. Her practice and reputation then grew, and the rest, as they say, is history.
It should be noted that as soon as admitting her, The Society of Apothecaries immediately changed their admission rules, closing the loophole that allowed her to join, and thus preventing any other women from joining. The BMA likewise immediately voted to refuse membership to any other women.
How must this have felt, and how did Garrett Anderson deal with this. I can only presume with significant personal resilience and great tenacity. She clearly had a vision of what she wanted to achieve, and continued to pursue this in the face of opposition. Another great leadership lesson. 
A quote from her sums up her approach I think:
“I think he will probably come round in time. I mean to renew the subject pretty often.” ~ Elizabeth Garrett Anderson
Lessons

So, what have we learned. I think a few simple things, which I will sum up in a list of words. They are characteristics shared by leaders. We can see them in the lives of these individuals. We can learn a lot just by observing and taking note of what we see.
Vision.

Resilience.

Collaboration.

Tenacity.

Persuasion.

People-centred.

I wonder, can you see these traits in the people you look up to as leaders? Can you see those traits in yourself? We can all learn, we can all change. Examine yourself – do you need to move to develop any of these? The good news is, you can.

Follow Jonathan on Twitter @DrJonGriffiths

I thought you were a vegetarian?

I thought you were a vegetarian?


I became a vegetarian in about 2002. I did it for a number of reasons I won’t go into now, and for reasons I still largely hold true today. Over the years, however, I have found myself becoming ‘less vegetarian’. There a number of reasons for this as well, including living in a household with non-vegetarian children! I’ve reached a point now where I am not vegetarian at all. Strictly speaking I guess I became ‘not vegetarian at all’ the first time I decided to eat some meat or fish several years ago – maybe I am just accepting this now.

The question is – how do I tell people who believe that I am a vegetarian, that I no longer am one? I feel this sense of anxiety and embarrassment about this. What will they think of me? People could easily turn round and criticise my change of mind. Am I still holding onto my principles? Am I living out my values? If I can’t be trusted to be a proper vegetarian, can I be trusted with anything?
I think we struggle with people who change their minds. 
You see this playing out most obviously in the political arena. Our political leaders are well and truly lambasted for any inconsistency in their views. It is most certainly seen as a sign of weakness and often as outright lying. As a leader, you need to accept a political element to your role, and be prepared for this – we struggle with people who change their minds.
This is slightly strange though. Are we expected to get things right first time, every time? And what is the purpose of debate if not to influence and encourage someone to change their mind? Surely someone who changes their mind could be displaying incredible maturity and understanding? When the public ramifications can be so adversely significant, someone prepared to say they got it wrong first time must surely have thought things through carefully?
As a doctor, I know that clinical decision making can involve changing your mind as new information becomes available. This might be because of test results, or because of the developing natural history of the illness – if you see me with a cough that you’ve had for two days in the absence of other signs and symptoms I am likely to tell you it’s probably a virus, when you return with your cough not settled after three weeks, however, I might be changing my mind, particularly if you are a smoker… I rely on communication and ‘safety netting’ to ensure patients don’t tank badly of me in these situations. 
Healthcare leaders also change their minds sometimes, usually for all the right reasons. Our former PCT was involved in the closure of some beds in a community hospital. I have been told that they ‘promised’ these beds would be reinstated after building works were undertaken (one of the issues with the beds was the estate – old, unsafe buildings). The beds were never re-opened. The PCT and then the CCG along with the hospital collectively agreed that reopening them on the original site was not an appropriate action to take. We had changed our minds. This did not go down well locally, as I am sure you can imagine. 
We ultimately managed the PR challenge we inherited as a CCG around this issue by consultation and communication. Explaining why, listening, explaining followed by more listening and explaining. 
This is how I think we need to approach any situation where we are changing our approach. Even if we are making changes for the right reasons, we need to communicate this effectively. There is always reputational risk when you are seen to change your mind, and this must not be underestimated.
Having said this I would like to challenge us all to consider why we react in such a negative way when people are seen to change their view. Everyone is entitled to change their mind. When we see this happening, perhaps it’s then we should really take notice of what they are saying. 
As for me – I believe it’s BBQ season…