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What is Effective Leadership?

Our clinical lead for Spine, Johan Holte discusses his experience of working with Versus Arthritis and what leadership means to him.

I am an MSK champion for Versus Arthritis which means I am on their leadership course.  They recognise that there is a need for more MSK leaders and they feel that they can support some clinicians in becoming better leaders in their field.

Applying for the program was interesting in itself. You had to write down what you wanted to do as a project, but also what you understood leadership to be and where you ‘sat’ in relationship to that.  When I went for interview there were five people in the room and they stated that this was not an ordinary interview.  The interview was about learning and understanding you, as a person, and they said they already liked me as a person but we wanted to understand me better, and really get under my skin. I have never had an interview where you had be so honest and open and show your weaknesses and vulnerability.  In most interviews you bring out the best and shine and polish it. This was the complete opposite.

Some of the questions asked were ‘how do you know you are an effective leader?’ and I thought; ‘I don’t know what an effective leader is.’  I see some people who I aspire to be, who are effective leaders, but I also said, if you look at Donald Trump, he’s a leader, not one I would aspire to be, but is he effective? 

I don’t know how to be a leader because I always felt leadership is this elusive term I didn’t know how to be one.  I do reflect and learn from my mistakes.  For example when chairing a meeting and delivering something quite direct and you could see that didn’t go down well. That made me think I need to learn how to rephrase things.  Or you can see someone do something in a meeting really well, like seeing how Zoe Nicholson would conduct a meeting and how she talk and bring her points across. 

Since then there have been three modules so far and there’s another one in September and another one in December with graduation next year. The modules do give you some tips and techniques and I was taught for example on how to project.  We had an actress in and she showed all these different archetypes of people and who you could choose to be.  You can be the Jester (or fool), or you can be the Monarch.  We then had some role play which was really interesting. They allowed us to play the same situation but in different characters, and then see what the response was from the group. It has been very experiential learning. I was surprised how easy is can be to play the Monarch or the jester, and sometimes you have to choose which one you are going to be when you are in a meeting. 

What have you learned about leadership?

I learned that I like to connect with people and I am a facilitator. I am not a Director type (like a Monarch / King).  I don’t like to play the authoritarian.  Sometimes I would rather be the Jester, but that doesn’t always work.  I do gravitate to the Jester more naturally, but it’s not always the right way to approach a situation. 

Another exercise we did was a 360 and evaluation. That has been really useful, to see where I place myself, and how others see me. The conclusion is I’m very much a people person.  That was a real eye opener for me because I can remember having discussions or disagreements with (a colleague) who is very process driven and ‘this is the process we need to follow’ and my first question is how is that going to impact on the team, the admin team, how is it going to make them feel?  I think colleagues considered me to be negative, and I couldn’t understand where that came from.  Now I do.  My natural tendency is, ‘okay you suggest this so this process is really important to you, but what you haven’t really thought very much about is how this is going to impact on the team’ and have you taken other people along with you? So when something new is implemented, I need to think, ‘okay so that will have an impact on people, and I need to identify what’s important, and how we can do this together.’

I learnt to listen more and try to understand what you are telling me and where you are coming from. However I also learned I need to recognise where I am coming from. And I have learned to say says ‘I have got questions around this,’ rather than stating, ‘no because…’ This course has enabled me to learn a lot about myself and I now think being a good leader is all about self-knowledge.

I thought, naively perhaps (before embarking on this leadership course) that I wanted to be a leader such as Barrack Obama, a leader who is charismatic and is a great orator. The leadership course teaches you that you can learn some techniques etc, but really you need to be true to yourself.  I may never be a ‘charismatic’ leader, and that’s okay. What I have also learned is that you don’t have to do it all, and you don’t have to know it all. I now know what my strengths are, but more importantly, what my weaknesses are and what I do not like doing (and will take me a long time to achieve them if I have to do certain tasks). It is better if I concentrate on the things I am good at and someone else can do the things that they are good at, and they enjoy doing.  I just need to make sure I have got the right people in my team with the different skill mix that is required to do the job. There is much less pressure on myself that I don’t have to be the smartest and know it all and do it all. 

If you take the example with my colleague again who’s much more process driven, I can take the team along, and they can work out the process of how we get from A to B. Having diversity in your team is vital to get a project to a good finish.

Leadership for me is now really all about, what makes me tick, what’s important to you and how do I hear other people and express myself in the right way.  What do I do, what impact do I have and how does that make others feel?  Being more honest and open around how I feel has really helped my leadership journey.  I am entirely grateful to Versus Arthritis for allowing me to be on this course, they have my gratitude for the rest of my life, because I was really low before embarking on this course and they have really changed the way I see myself, the world and I have made friends for life as they have put such a nice bunch of people together from all different fields of healthcare.  It’s really helpful to be able to draw on all their different experiences.  It is not only a great network to be part of, but also a resource and safety net when you need it.

Reflecting back on the reason why we have bonded so well, which is another thing I have learned, is if you want to create team cohesion you need to allow the time for that to happen. You cannot rush it.  I think with COVID that team cohesion has become really difficult to foster because you can’t get 20 people in a room anymore.  How can you create a space now, without getting people into a room and allowing them to chat and allowing them to know who is the person behind the Advanced Practitioner (AP) title? In a virtual space this is a lot harder to achieve. It is important to see your colleagues in a different light. We have been very much driven by targets and numbers (not anymore), and if we don’t allow people to connect, it leads to unsatisfied people I think. Part of the course is that you also have to do a project. Mine was around Cauda Equina Syndrome and just mapping out what happens in A&E at the moment.  However because of Covid 19, the priorities in A&E have changed and this is not a priority for the trust at the moment. I have changed my project now to the Virtual MDT, which I feel is a success story which we can perhaps talk about next time! Thank you for your time to listen to me.

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