Delving into the human and the humorous, from her wealth of experience in health and social care, Levette Lamb shares her insights on what makes great leadership.
Levette is the Regional Patient Safety Advisor with the NI HSC Safety Forum (Public Health Agency) which works collaboratively with stakeholders to drive improvement in safety and quality in health and social care using internationally recognised theory and practice. She is a registered nurse who has worked in a range of nursing and management posts including time spent at DHSSPS leading on a range of multi-professional improvement projects across the region.
Levette is also a founding member of the Health Foundations “Q” programme and also lead for Q in N Ireland, and a graduate of the Institute for Healthcare Improvement (IHI) improvement advisor programme. She has facilitated a range of training on Human Factors, which is about understanding human behaviour and performance and using this to optimise the fit between people and systems to improve safety and performance.
Last year marked the 70th anniversary of the NHS. What stands out for you as the best examples of leadership you have seen in health and social care services?
The first thing that springs to my mind is that everyone should be a leader in healthcare. Sometimes when we put individuals up on a pedestal, it makes other people feel that they can’t reach it. Some of the best leaders that I have seen have been the porters in the hospital who see the way how we are organising our appointments structure and suggest a way that it could be improved. Or the domestic supervisor who is struggling to retain staff in a low-paid job and is able to motivate them to do more over and above what their job description says. And, also it goes right up to the CEO who has to stand up and take all the flack for all the rest of us when things go wrong.
I think for me, the main thing about leadership is making people feel safe, allowing them to flex and have that ability within their role but knowing that there is that safety net for them there in the background. We never go through anything but periods of change in healthcare; it just feels unending that there is something new around the corner all the time. That can be very uncomfortable for people if you are just not comfortable with change. Leadership roles are just vital in holding the whole thing together.
How then can a good leader bring stability and reassurance to people?
As I said to my daughter the other day who is nineteen and who was in a panic about something, I told her that the first thing you need to do is to shut up; you have two ears and one mouth for a reason. I think a really good leader in time of concern and flux listens, just sits and listens to people’s fears and concerns and is able to empathise with them that they have either been in that situation before or that they are going to get them through it. That ‘I have your back’ type role; the rock in the never-ending stream of things that is going past you gives that feeling of stability.
Feeling safe is so important and we spend a lot of time in work to feel unsafe. That transfers into clinical leadership. Clinical leaders are vital and they maintain the morale of our system out there on the ground when things are really busy and chaotic in terms of low staffing numbers and agency staff. Having that really solid clinical leadership is vital. It permeates the whole system and from your chief executives to your frontline leaders whether that be your ward sisters or others.
One of my favourite lines from one of my staff nurses has always been ‘Levette, the mood you come in in is the mood we go home in.’ She was absolutely right! Knowing yourself – ‘know thyself’ – as how in how I affect other people in that leadership role is absolutely vital.
People look to you, whether you want it or not, people do look to you. If you’re in bad humour, if your head always down, if you look afraid, if you look like you might bend in the wind, then there is no psychological safety for your staff who are having all of their own issues at the same time as you. So, sometimes you just have to steel yourself at the bottom of the stairs, put your game face on and then you go!
You work with a wide range of people locally and regionally in networks and forums inspiring people to collaborate and innovate in networks and forums such as the Q Community. What for you makes for great collective leadership?
A central purpose. I’ll take it from my clinical background to start. As a Ward Manager, we always set out at our team meetings with the first question, ‘What is our purpose?’ and that has not changed. People may laugh at you for that and think, well as a Ward Sister you should know what your purpose is but sometimes that purpose can change on a fluctuating basis depending on your client, the targets or the objectives of the organisation. So, having a clear purpose and then everyone setting out their stall in agreement that that’s what they have to do and being able to look outside their own boundaries is key.
I was a Hospital Co-ordinator for a while which meant that I had oversight of the whole hospital and it was a fascinating job. You saw everybody’s troubles. I wonder if we sat everyone down and asked if we know our collective purpose if we would have had the same answer? I once asked that question ‘What is your purpose?’ of senior ambulance crews and it was really interesting to hear the different responses to it. Some said that their purpose was public health, some said that it was transporting people from the scene of something to hospital, others said that they were the front face of the NHS. Very different responses! It’s an interesting exercise to do. If this is our purpose, what does that mean to me?
You know the NASA example when someone who is the domestic is asked that question and they reply ‘I’m here to put somebody on the moon.’ We used to say to our domestic teams on the wards that your job is infection control not cleaning the floors.
It’s where people see themselves fitting into that greater good and see their contribution I think is where you get collective leadership.
Where you don’t get collective leadership is where people feel isolated, that their contribution is not valued. This is where they don’t see where they fit or they feel like a maverick or a somebody who is not essential to the organisation and that they are treated in that way or they are also not given information.
That cohesion of a team, knowing what team you fit into, knowing that team has each other’s backs rather than ‘Here comes the physio today, they are bothering us,’ but rather that everyone is seen as part of the team. The respiratory nurse for example is not just coming in to see patients but that her contribution is there to help the ward. I think that then transcends into where we are now.
My greatest example at the minute is where we do our work with the maternity team. We have a maternity collaborative here in Northern Ireland who has been going there over eight years. If I said that when we started we didn’t like each other very much, that would have been an underestimation. At that point there was not a lot of trust, not a lot of sharing, not a lot of cohesion. It was very a much a lot of maternity units who talked about things but didn’t do much. It’s the usual story of a journey: we’ve been through the peaks and the troughs of a lot of stuff. However, at the end of it, we have a maternity collaborative who exemplify collective leadership.
With the maternity collaborative, if for example, there is a serious adverse event in one Trust, someone will ring to ask if we can put this on the agenda for the next meeting as there will be learning from it. If there is new NICE guidance, this is the first port of call so we can do it one way for Northern Ireland. This is true collective leadership where people are willing to share openly about things which have gone wrong and willing to stand up in front of their peers and do that knowing that they have the psychological safety to do it. So, for me, that is all a matter about building trust.
What for you was the turning point in the maternity collaborative for you which told you this is working and people do feel safe and have trust?
We had one learning session where one of the Trusts stood up and presented a serious adverse event. I felt the support from other people in the room coming forward for those individuals who were standing up there and sharing it. We didn’t do as a dry presentation; we did it point-by-point as in ‘It’s 2 o’clock in the afternoon, this is what’s happened, what would you do now?’ It was like a lived experience for people in the room. The support for the individuals standing up and sharing a difficult case was palpable. I think there was a turning point there where people felt that that was a really worthwhile exercise and think maybe they could do that too.
In collective leadership, the trust has to be there and I don’t think that you can underestimate the time it takes to build trust. That’s not to say that there are still hurdles along the way with some ‘robust’ professional conversations!
There is also something about collective leadership about getting small wins that people see they can trust the model that you are selling. The worse thing that you can do is to shove in another buzzword, i.e. ‘We’re here to do collective leadership!’ and watch people running for the trenches thinking ‘If I hang on long enough, she’ll go away!’ whilst they wait for the next buzzword. There is also something about ownership in getting collective leadership and getting those small wins early and hanging on to people.
What insights would you give to someone who is an emerging leader in health and social care which you think would be most useful for them?
I think probably the first useful insight is the one I shared earlier, the mood you come in in and the one others go home in. The thing that sets the tone and the culture within your unit, your ward, your organisation is your current and potential, future leaders. Knowing that that is your power base rather than the traditional power base; knowing how you can influence the morale in a unit, the production in a unit, the performance of staff is really vital.
If you are a new leader, getting to know yourself first of all is absolutely vital. Things like doing Myers Briggs was a revelation to me. I work with a colleague who is the polar opposite in her Myers Briggs from me but that’s really useful knowledge for me. Before I would have thought oh, come on because I am your typical big picture person, your connector, your linker and don’t bother me with detail, it just irritates me. In contrast, my colleague is a details person, they want all the details and that big picture stuff is too fussy. So now that we both know that, it’s a symbiotic relationship: whereas I might have the idea about something, my colleague is the grit on the ground and will make it happen. Transferring this into a work scenario of planning a conference or a learning session, I’m all about getting the speakers and the focus for the conference and my colleague is about things like how are we getting the speakers there, what do the numbers look like etc.
Back to the crux of the question, knowing yourself is so important to be a leader. I could be irritating the bejesus out of my colleague and may not realise it then, but now I do and am very aware! So now I would say to my colleague ‘Listen, I’m going to annoy you now and be big picture because I haven’t thought through any of the detail yet…’ By putting that out there though it opens things up.
The other insight I would give is knowing that every interaction with a member of your team counts. We talk about every interaction with your patient counts but every interaction with your team member counts.
Looking beyond your current boundaries is another thing. We can sometimes be very insular in our thinking. Maybe it’s my big picture stuff but I always like to look beyond what we are doing now: what could we be doing in 6 or 10-years’ time? We need to set ourselves big picture goals because if we haven’t got something set out for that time, how are we going to know how we are going to get there and how do your staff know?
You need to harness the energy of others to be a good leader and knowing up front that you can’t do it all. Look over your shoulder now and again because if there is nobody behind you, well, you know that you’re doing something wrong. A colleague of mine, Mary Hinds taught me that. She said to me one day as we were walking up the backstairs one day at the Mater Hospital ‘You know, every now and again I look over my back shoulder to make sure that you are all still there because if you’re not, I’m not a good leader because everyone needs people there with you, behind you.’ There’s none of this rocket science or there’s no mystique in this. We’re not all Bill Clintons or Barak Obamas who can stand on the big stage but those local leaders are the people who count most and make the difference.
Walking the walk is the other important thing. Do not take yourself too seriously, number one. Be able to put yourself out there with whichever team of staff you are working with, understand their context and their working environment. The worst thing you can do as a leader – regardless what level of the organisation you are working in – is to lock yourself in an office and see yourself as untouchable.
I think it happens because people can get sucked into ‘I have to be here in the office, I have to respond to every email that comes in within a 5-minute turnaround and that may not be the important thing. The important thing might be taking yourself out of your office and walking down to your staff team to have a conversation.
The other thing about the mood you come in in is that it also can apply to emails. The mood I receive an email in is the tone I answer it back in. The whole reliance on electronic communication has removed the so much of interpersonal relationships with people. It can be very easy to interpret an email when it comes through in a negative way when it was not sent with that intention. It could have been just that somebody who was just short of time just dashed it off. However, if you read it in a bad mood, before you know it you’re then into tapping these responses back and forward instead of getting up of your ass and speaking to the person.
We talk about leadership development programmes and training programmes when sometimes it’s just the small, common sense things. Things such as at least once a week, walk down and just see your team, know yourself, check yourself, have you got a central purpose, give yourself a bit of breathing space and don’t take yourself too seriously. A laugh a day is essential as also is laughing at yourself once a day which is vital!
On a personal level, what is the most useful thing you have learned in to lead a fulfilling life?
Just getting a good balance between life and work but knowing that you should always put family first is it. We can all get sucked down the rabbit hole of ‘If I wasn’t here and this wasn’t be done etc.’ However, we are all replaceable. Sometimes it takes a little bit of wisdom and experience to get to you to that stage as it can be difficult to explain that to somebody for example new in a management position because you have to live it.
Again, it also goes back to having good role models as leaders. I once worked for someone who said ‘You know I don’t expect any of you to be on your emails after 6 o’clock at night’. Great, but then they would spend all evening sending you stuff on email after 6 o’clock at night. Then it’s a situation everyone getting sucked in as if one person then answers it then do I need to do the same to look efficient etc. So, walking the walk and having good leaders around you is key to getting good balance between life and work.
Loving your work is another thing. If you don’t love it, leave it. If there’s no love for it, it just sucks the life clean out off you. I knew my time in one role was up when I was just seeing different faces but the same problems and I thought that I’m no good for this anymore because I’m burnt on it so it’s time for me to go rather than me stay and make everyone else miserable.
When people are in that situation of disliking their work or job so much, they just suck the mood out of everything. You are never going to get anywhere with those people because they will never motivate or inspire anyone as they cannot motivate or inspire themselves. There is always a way of going and finding something different to work at so if someone is so unhappy in their job, they should plan to leave, don’t stick at it.
The other thing is being able to motivate people which keeps the fire in you. Being able to see things getting done, being productive in what you do, being able to light that fire within people and not underneath them.
To keep that balance, you do need to find the funny in every day. I think that as a leader, you need to be seen to have a sense of humour so your staff feel that they can show one! With this, work is more enjoyable: you’re not fearing coming into work and it’s a pleasant work environment. When it gets busy, it gets really busy and we’re all there working hard with our heads down but you know tomorrow might not be as bad as that and we’ll have a laugh tomorrow, go for a coffee and take a break.
Who has inspired you most in life/work?
In a clinical role, patients can inspire you everyday as they are going through difficult times as are their families and they just put their heads down and get on with it. You see miraculous things happen on a regular basis. I noticed the other day on Twitter which made me smile, was a staff nurse from one our hospitals, or it might have been a Junior Sister, had written and recorded a song for dementia patients. I thought fabulous! People like that, people who go that little bit extra inspire me.
From a work perspective, an inspiration would be a paediatrician Don Berwick who set up the Institute for Healthcare Improvement in the States based on his experience of something going very badly wrong. He always tells his own personal story of the night when something went badly wrong of him as a doctor working with a child. He’s a great motivator. When you hear him speak you want to leave the room wanting to do something and wanting to challenge yourself. He is absolutely superb.
If you were going down the celebrity stage route, it would be Ellen DeGeneres. I never used to watch her at all then I watched something on YouTube and wouldn’t that be just a wonderful job! She’s always giving things away to people and making a difference even in small way to people which I think is great. I think she’s fabulous! What she has done for the whole LGBT community is huge as such a well-known personality who can carry that whole message that we’re all the same; it’s just the labels that others give us which makes us different.
How do you think coaching can help people in leading their lives and work?
I suppose it’s a summary above of all that we have talked about. Our greatest resource is ourselves and the people behind us. It’s about how we can keep ourselves on track and others on track. We’re very good at teaching the technical skills such as how to put in a line or a drain. I think that we have been less on the softer side of knowing yourself, knowing others and team interactions. We’re learning a lot more now from aviation about team and crew resource management.
Still underpinning it, we still have a lot of lone wolves out there but it’s just the way they’ve been trained and brought through the system.
Bringing in the coaching model, more of that, the coaching conversations helps to get back on track. It’s very easy to go down that rabbit hole and get shoehorned into something where you can’t see the wood for the trees and you don’t where you are going. It’s about being able to have those structured conversations if you like. It helps to have that space to be able to think through things, to unpack things and repack them in a way which makes sense to you or to others.
The things that I see people crying out for at the moment in the health and social care service are information on data, how to present data, how to get it through to people, how you can do it, work on human factors and the third one is coaching.
Of those three things, the data one; it’s about how we can use data to change hearts and minds, so at the end of the day it’s all about people. It’s absolutely all about people. They’re not crying out for technical information on how to do XYZ. The greatest resource we have in healthcare is people. If we don’t know how to motivate them, how to keep them, how to retain them and how to challenge them to change things, we’re going to get no transformation.