Important people around us

There are important people around us. People who look you in the eye when you speak to them, and listen carefully to what you say. People whose immediate response when you ask them for help is 'Of course, what can I do?'. People who do more, care more, invest more in both themselves and those around them. They are always learning and share their knowledge freely. People whose names come to mind first when you're thinking who to ask.

They are leaders without a title.

Because being a leader is much more than a title, and often the best leaders aren't always those near the top of the management tree. But if they are, then it's a sure sign of a great place to work.

We can all be a leader without a title. And by doing so, you will live a more exciting, productive, fulfilling and inspiring life that you thought imaginable.

Leaders without a title:

  • Get stuff done
  • Help others get stuff done
  • Take responsibility
  • Know that self-development never ends
  • See change as a positive event
  • Are a master of their craft
  • Have a vision
  • Understand emotional intelligence
  • Cultivate relationships
  • Develop their coaching skills
  • Build community and help others succeed
  • Develop more leaders
  • Are a force of good, rather than negativity in the workplace
  • Smile. A lot.
  • Chose their words well
  • Are compassionate
  • Care deeply

If you want to become more important, move your focus from your job title. Just start being a leader where you are right now. Everything else will follow.

I know many people who sit at the lowest levels of organisations who have no authority. But absolutely are leaders. Because they’ve made the choice to look after the person at the left of them, and to take care of the person to the right of them. That is what it means to be a leader. A position of authority simply means that you get to operate at a greater scale and influence more people.
— Simon Sinek

Here is what Simon says about creating environments in which those around us will thrive.

 

Unsure where to start? Start with why. Work your strengths and utilise the powers you already have. Spend some time understanding your weaknesses, and turn them around. Find blogs, books and people who inspire you.

Ask others for reading material and join a leadership journal club. Never heard of one? Nor have I, so let's find some people and start one.

Discuss...

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Deep work in a superficial world

We all want to be valuable. We want to do things that are rewarding and contribute positively to the world around us. We would like the same for our children and those over whom we have influence. I finished reading a book this week that asks us to take a moment to consider carefully how we go about this. The suggestion that we need to make some specific changes to our daily lives to make it happen. 

By way of historical examples, Cal Newport outlines very eloquently how, throughout history, men and women who were highly productive and successful engaged in what he calls deep work. He argues persuasively that the creep of superficial activities which have become commonplace in our society, has the potential to either derail our best intentions or - if we manage ourselves well - make us more successful than we could imagine.

What exactly is deep work?
Deep work is professional activities performed in a state of distraction-free concentration that push your cognitive capacities to their limit. These efforts create new value, improve your skill, and are hard to replicate.

Deep work is what is necessary to achieve every last drop of value from your cognitive and intellectual capacity. Deep work is what moves you forward in your career. To be of significant value in our modern economy, we must do two things:

  1. Master the art of quickly learning complicated things
  2. Produce the absolutely best work possible

And both of these require depth.

So what’s new?
It goes without saying that the last 30 years has brought huge changes in how we interact, with both those around us and the work that we do. The change that is singularly responsible for much of the difficulty in commitment to deep work is that of network tools. This broad category includes communication services like email, SMS, social media networks like Twitter, Facebook and information websites such as BuzzFeed, Reddit and a whole host of others whose aim is to distract you from work.

Newport demonstrates that the rise of these tools - combined with ubiquitous access through smart-phones and networked office computers - has fragmented our lives. And this fragmentation cannot accommodate deep work.

But I’m busier than ever!
And the counterpart to deep work is that of shallow work. Shallow work is by contrast non-cognitively demanding, consists of logistical-style tasks, often performed while distracted. These efforts tend to not create much new value in the world and are easy to replicate.

Unfortunately, much of our days are spent engaging in shallow tasks. It is very easy to fill a significant portion of our days, remain reassuringly ‘busy’, but not moving forward in our big plans to better the world.

The addiction of distraction
Consider the scenario: you are queuing for lunch and are going to be standing there for 5-10 minutes. You’re on a 20-minute bus journey to the city. How comfortable are you at being bored? Do you reach into your pocket for your smart-phone? Check your email, Facebook feed, Twitter updates, Instagram feed etc? How difficult is it to just stand or sit there and do nothing at all?

One of the necessities for doing deep work, is the ability to sit down for significant periods of time, focused on a single activity. Newport, through a range of examples based in cognitive psychology, leads us to the inevitable conclusion that ‘The ability to concentrate intensely is a skill that must be trained.’ And an important corollary of this need for practice to strengthen our 'mental muscle' is that we must simultaneously wean our minds from a dependence on distraction.

The author walks us through the uncomfortable link between our obsession with multitasking, society’s chronic state of distraction and the resulting effect both of these have on our ability to work deeply. He highlights that the use of a distracting service itself does not reduce our brain’s ability to focus. It is the constant switching from low-stimuli/high value activities to high-stimuli/low value activities, at the slightest hint of boredom or cognitive challenge. This teaches our mind to never tolerate an absence of novelty.

The solution
The main of the book is etched around Newport’s 4 main rules for developing a rewarding life of deep work. These are:

  1. Work deeply
  2. Embrace boredom
  3. Control social media
  4. Reduce the amount of shallow activities in your day

Filled with evidence from neuropsychological research, Cal shows us how to work deeply, including the necessary approaches, rituals and the need for time out. He demonstrates the importance of embracing boredom and scheduling times for internet use - a way to take breaks from focus for distraction, rather than the other way around.

His discussion of daily scheduling is much like that of other GTD-style approaches, but with a focus on quantifying the depth in each of the activities we do. And he has a strong belief that not only can all this (usually) be completed in a 40-hour week, it actually has to be, to have available the required time for recharge. 

Summary
For me, his book has opened my eyes to my own overwhelming inability to just do nothing. It came at an opportune time, as I’m also spending time focusing on the importance of mindfulness meditation, so the two are complementary.

I believe that his writing is even more important for our children, whose brains have developed in this distracted and dopamine-dominated world. We need to make some of these decisions for them, and teach them the importance of his methods. Because in a world of distraction and superficial work, only those who can go deep will be the ultimate winners.

I purchased Deep Work through Book Depository. This is not an affiliate link.

Discuss...


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Handwriting vs computer based note-taking

More evidence and discussion this month suggesting that writing by hand is superior to taking notes on a computer. An article in the Wall Street Journal references a Princeton & UCLA study that found students who wrote their notes appeared to think more intensely about the material as they wrote and digested it more thoroughly. Laptop users on the other hand took longer notes, writing much verbatim. As one of the researchers stated 'Ironically, the very feature that makes laptop note-taking so appealing - the ability to take notes more quickly - was what undermined learning'.

Congnitive neuroscientist Jared Horvath at The Science of Learning Research Centre in Melbourne said in The Australian newspaper article, 'We like to think that the brain is like a computer … but everything we know about how memory works suggests it’s all relational and conceptual. We don’t necessarily remember facts, we remember concepts.'

For those of us who like to have our notes on a computer for ease of access in multiple locations, this is somewhat depressing. There is always the option of handwriting and scanning. I've personally tried a range of options including direct notes into the software by which I run my life: Evernote.  I've used standard journals, note cards and Livescribe, the pen that writes in ink but automatically syncs to online storage.

The answer to this is in Dr Horvath's quote above: memory is relational and conceptual. It is exceedingly difficult to take memorable notes as pages of linear text, whether handwritten or typed. The benefit of handwritten notes are the inevitable drawings that accompany them: the doodles, words within circles, red pen underlining and arrows underscoring relationships between ideas.

Mind maps as a solution?
I do believe we can have the best of both worlds and recently I've been testing various mind map solutions. The advantage of mind mapping is that it forces you to interact with the content, to think deeply about concepts and how it all fits together.

When I read a text, I like to have a summary to come back to. Something to remind me later about the key relationships and messages. And to prompt me about the various detail and how it all fits into the bigger picture.

I recently wrote an article on the three ways that healthcare has to change, summarising some evidence on leadership and engagement. Here is the mind map summary that I created as I brought together the information, organising it into a format that allowed me to fit it into my bigger conceptual picture of how these things work. Click on the images below to see them larger, or pinch-zoom on a mobile.

After trying several different solutions, I have settled on iMindMap, developed by Tony Buzan, who is said to be the inventor of mind mapping. I've used it in various settings, e.g. whilst reading, in meetings to take summary notes of discussions, and to brainstorm ideas and help me nut out concepts I'm learning. I've used it for teaching too. The software has a few options for brainstorming or note taking on the fly, the idea being that you come back and tidy up the relationships and final layout afterwards. Once you have a map created, you can add images; visualisations with content have been found to aid long term memorisation. The software's presentation mode can be used to share ideas to an audience, focusing on one area at a time, slowly building up the bigger picture and emphasising conceptual relationships: here's an example. There's a mobile version of the software too.

Finalised mind maps can be stored as images, PDFs or printed out on paper; I have several on my wall at work to remind me of important information. It's easy to quickly review a large text that has been detailed in a mind map, prompting the memory of not only the main concepts, but keywords anchoring the detail too. 

The question is whether students in a lecture can mind map at speed on a computer, keeping up with a tutor. Generally content is available in books and via university online learning portals, so if they keep it broad & conceptual, I bet they can.

Buzan has written a book 'Use your head: unleash the power of your mind'. It covers much more than just mind mapping, and for anyone looking to improve deep learning & memory, it's a great read.

I haven't seen any research comparing mind mapping on a computer with hand written notes, but if you're looking for a way to achieve the deep learning gains of handwriting in an electronic storage solution, computer-based mind maps are definitely worth a try. Let me know how you get on if you do. A free online mind mapping tool is GoConqr - by example, here's a map I created to summarise a medical study published last year.

Either way, we should probably be advising our students that typing their notes in class isn't the best idea for learning. 

Discuss...

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You are awesome!

Everyone seeks it, we all need it, it's free to give to others and when you go out of your way to be a giver, you will feel great too. This short is quite wonderful, enjoy :)

Seek an opportunity to validate someone each and every day, and watch those around you grow.

Three ways health care has to change


At the weekend I read an insightful publication from The King's Fund, a UK organisation that reviews and makes recommendations about health policy. It's about 50 pages long, but for me the take away messages are summarised below. The original publication is here.

The way we work needs to change in 3 ways, and all have the potential for big reward for both professionals and patients of the future. And if you're a junior doctor or medical student - don't switch off, this is especially important for you!

  1. Greater focus on engagement
  2. Leaders at all levels
  3. A new approach by hospital management


1. Focus on engagement
The principle values that underpin engagement in our workplace are those of:

  • openness
  • collaboration
  • empathy
  • listening to and supporting each individual

There is clear evidence in healthcare that having an engaged workforce results in reduced stress, reduced absenteeism, increased motivation, fewer errors, lower hospital infection rates and even reduced mortality. Happy staff = happy patients.

We build an engaged workforce by focusing on both individuals and teams within the hospital. All staff need:

  • An understanding of the values of the organisation
  • Clear tasks
  • Satisfying jobs that utilise their skill set
  • Groups to be brought together in a meaningful way
  • A team focus on quality
  • Autonomy & involvement in decision making
  • Encouragement and celebration of success


2. Leaders at all levels
There is a growing recognition that to be a good doctor of the future, it's no longer enough to be head-down in clinical work. Intense sub-specialisation and the devolution of many aspects of care to the wider MDT, means that we all need the skills to help build and be part of an effective team. We all need leadership skills - and from day one of the job.

There is a need for medical leadership to be taught in medical schools, for every doctor to recognise that their role as a professional is not limited to clinics, ward work or the operating theatre. These are the baseline expects. All doctors need to understand the dynamics of the teams they work in, appreciate the values they personally bring to, and adopt within, the service. We need to invest energy in the relationships and behaviours that will make our whole team a success.

Leadership isn’t about being an extraordinary person, it’s about being open and accessible, with an emphasis on team work, collaboration and removing barriers to communication. It reflects a desire to see the world through the eyes of others, taking on their perspectives and working with their ideas. Often, it’s about challenging the status quo.

So how do you start being a leader? You start now, right where you are, with the people and teams that you interact with on a daily basis. Think about how you can bring a focus of engagement to those around you. Find others to share the enthusiasm and help them too. And look out for opportunities to engage with managers who are open to a new approach in how they work as well.

3. Management: devolved authority
For too long the pervasive style of senior hospital management has been ‘top down’, a command and control culture, with a demanding focus on targets (e.g. Emergency Department access times, surgical waiting lists, etc). Recognition and reward is closely linked, ensuring the medical and nursing teams are constantly paying attention to these priorities - not that they aren't worthy, but often it's to the exclusion of clinical and team goals of an equal or greater importance.

Unfortunately, in many hospitals, a target-focus has been linked with a reluctance to delegate control to middle managers and senior clinicians. Staff become robbed of the authority to make decisions, there is a reluctance to collaborate with teams about changes that directly affect them, leading to demoralisation and ultimately poor patient care.

We need a new management style to breathe life into our hospitals. We need hospital managers to recognise the importance of engaging both patients and staff, with a rethink of the way power and responsibility is distributed within organisations. If there are problems on the floor, senior medical and nursing staff should be consulted about the issues and engaged to find solutions. They are usually in the best position to understand the dynamics of what will and what won’t work.

Managers need to bring clinicians into leadership roles, ensure that leadership and decision-making is distributed throughout the organisation. Control over how clinicians do their job is the biggest predictor of an engaged, happy and functional workforce - 'no decision about me, without me'

Discuss...


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The 5 daily language habits that will boost your engagement

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Gordon Tredgold outlines here the 5 daily habits that leaders need to do to increase engagement with those around them.

Whether you're the medical student taking your first patient history (yes, they look up to you too!) or the Director of Medical Services setting the standard for the hospital, leadership engagement is key for all of us.

To summarise:

  1. Show your enthusiasm - it's infectious, and the more enthusiastic you are, the more your team will be. But keep it genuine.
  2. Smile more - smiling helps reduce stress and increases feelings of positivity among our team, as simple as that.
  3. Listen more - to build respect and trust. And guess what - you'll likely learn something valuable as well.
  4. Share more - the more you communicate, the more involved they will become. Communicate your goals, enthusiasm, commitment, and progress. People need to know.
  5. Praise more - what gets recognised gets repeated. Don't save it for only the major achievements. Be specific, timely and liberal. Be constantly on the look out for opportunities to praise those around you. The happiness and commitment in your workplace will rise as you do.

Sounds easy, but the wonderful thing, is that it actually is easy. And those around you will both grow and thank you.

If you think this is important, join the positive leadership movement and talk about these issues. Share/like on social media, so others know you believe in it and the word spreads. Be the change you want to see in our health care systems.

The 4 disciplines of execution

'I know what I need to do. I just don’t know how to do it'

We know that we want to bring strong leadership to our workplace. We have put thought into the strategies that we think will succeed. But how do we move forward? What principles do we need to put in place to ensure success?

I recently came across a discussion about a book called ‘The 4 Disciplines of Execution’. A book that builds on extensive case studies to describe 4 disciplines (abbreviated 4DX) that help organisations implement high level strategies. I believe there might be something in this for medical leaders who want to bring positivity, strength, purpose and direction to their own leadership. 

So what is the 4DX framework, and how can we adapt it to our goals?

Discipline #1: Focus on the Wildly Important
The more you try to do, the less you actually accomplish. Execution should be aimed at a small number of ‘wildly important’ goals. This simplicity will help focus energy (yours and your departments) to bring real results. As David Brooks wrote in ‘The Art of Focus’: ‘If you want to win the war for attention, don’t try to say ‘no’ to the trivial distractions you find on the information smorgasbord; try to say ‘yes’ to the subject that arouses a terrifying longing, and let the terrifying longing crowd out everything else’.

Pick a few challenges or new approaches that - when successful - will really turn around the way your team work together and provide care. Don’t be afraid to be ambitious, make them ideas that will produce profound, tangible rewards for your team.

Discipline #2: Act on the lead measures
Once you’ve chosen your wildly important goal, you need to measure your success. There are 2 types of metrics for this: lag measures and lead measures. Lag measures describe the thing you’re ultimately trying to improve. For example, you might choose to do some work on supporting your staff. You know that staff who are better supported will be both happier in the workplace and contribute to better patient care, for a whole range of reasons. The relevant lag measure for supported staff is improved feedback at their 6/12 monthly review; or improved patient outcomes if you look even further afar.

As the 4DX authors explain, the problem with lag measures is that they come too late to change your behaviour. Lead measures, however ‘watch the new behaviours that will drive success on the lag measures’. In the case of supporting our staff better, you might choose lead measures such as:

  • number of weekly teaching sessions that occur
  • monthly review of training log book or touch-base meetings staff have with their supervisor, consultant or head of department, just to see how they are doing, and if they need any additional assistance
  • number of update meetings or communications by head of department to keep team appraised of what is happening within the service
  • number of opportunities sought and taken to provide ad hoc positive feedback to members of the team

Of course there are many more activities that are involved in creating an engaged workforce, and these are just a few examples. As you improve the numerical quantity of your lead measures, your lag measures will improve as well. In other words, lead measures turn your attention to improving the behaviours you directly control in the near future, which in turn will ensure the success of your long-term goals.

Discipline #3: Keep a compelling scoreboard
The 4DX authors explain: ‘People play differently when they’re keeping score’. This means that it’s important to have a public scoreboard to drive your team’s engagement toward your wildly important goal. This not only creates a sense of competition, but once the team notices their success in the lead measure, they become invested in perpetuating the performance.

Turning to our example, you might keep a physical document that tabulates all the registrars and RMOs by month and the number of meetings that have taken place. Other lead measures are more personal, so the Director might alone keep a calendar on the wall and check off when she or he carries out a weekly communication with the team in some form or other. Finally, individuals may keep a note on their daily journal or have a recurring ‘To do’ item on their phone that reminds them to seek out individuals within their team to reward with some specific positive feedback.

For other wildly important goals, you might create a public scoreboard for the whole team: e.g. if you decide to do a piece of work focusing on reducing complication rates of some description, it’s important that you have a running score somewhere, so the team knows how it’s going.

Discipline #4: Create a cadence of accountability
To maintain focus on lead measures, this is the final step to put in place. ‘A rhythm of regular an frequent meetings of any team that owns a wildly important goal’. During these meetings, the contributors confront their scoreboard, commit to actions to further the cause and reflect on what happened to the numbers since the last meeting, reviewing their previous actions.

For individuals assessing their own scoreboard, this means a ‘weekly review and reflection’. Where the goals are owned by larger teams, it should include all who are committed to the cause, and be systematic in it’s approach. This might take place at a weekly or monthly team meeting, depending on which lead measures need review.

The 4DX framework is based on the fact that execution is fundamentally more difficult than strategising. For all of us. After reviewing hundreds of case studies, the inventors nailed it down to a few simple disciplines that can help. For most medical leaders, the idea of keeping and reviewing a scoreboard isn’t intuitive. And even if our goals aren’t wide ranging or desperately complex, the 4DX disciplines can help achieve success by aligning our practice with a method that is known to work. 

If you think this is important, join the positive leadership movement and talk about these issues. Share/like on social media, so others know you believe in it and the word spreads. Be the change you want to see in our health care systems.

Running a hospital like a business

Simon Sinek here highlights the medical profession as an example of poor leadership, and the consequences of this.

Hospitals are run like businesses, and the problem isn't the people giving the care - those people are highly trained. The problem is the way those people are cared for.

We all have to own this, by looking after our teams, and guiding them in doing the same for each other.

The video starts right at the relevant segment and lasts 2 minutes. The ongoing conversation about the human factors involved and how all organisations can create a workplace that inspires our teams is very important too.