New Year Greetings & Best Wishes for 2010 For All My Beloved Simplicity Friends.

I received this message this morning from JK - our dear friend and regular Simplicity contributor - thank you Sir!

"My Dear Trevor, Annie and one and all in the Trever's Simplicity Forum,

Wishing each and every one of you and your family a Very Happy, prosperous, peaceful,purpose filled and contended New Year 2010.

May Almighty The Supreme continue to shower his Grace and Blessings on each and every one of you and and your family members through out 2010 and bring Happiness and Brightness in your life & work.

With abundance of Love, Reverence & Regards to you all my friends.

Yours in Simplicity Friendship.

J.K"

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Happy Christmas

My sincere best wishes to all Simplicity readers - have a great time over the holiday period and thank you for your continued support to my Blog in 2009.

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The recession ... getting better or worse?

Maybe it’s just me but it feels like the recession is getting worse rather than better.

For the first time since I became self employed five years ago my work commitments beyond three months ahead are looking gloomier than usual. I am not at the panic stage but I am working hard to seek out new opportunities against a background of reducing budgets everywhere.

I am sure the UK economy will recover but I suspect there will be neither a magic bullet solution nor an overnight improvement. It is a case of being patient, determined, focused and grateful for work that comes along. I have been fortunate enough to have been very busy since I left my comfort blanket of the NHS in 2004.

It has been a fantastic journey and I would not have changed a single thing about it including all the uncertainly. There has never been a time in those five years when I have been without work and whilst the future looks a bit uncertain at present I remain optimistic.

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Even more faith in our front liners

I've been looking through my training sessions work diary for the last 12 months.

Turns out I’ve met around 1000 front line healthcare employees during 2009 in training sessions that I’ve run. Never mind what they may have learned - hopefully they will have learned the odd thing or two in our session together – they will definitely have learned from each other through the networks they create for themselves.

More importantly though - what have I learned?

Here are a few thoughts on reflection about an extremely busy year alongside these front line folks:

• I’ve often said front liners know all the answers all the time. I’ve not changed my view – 2009 has strengthened my view if anything.

• Front liners are capable of taking on far more responsibility than the boxes the system puts them in.
  

• Front liners are very modest about their own abilities and skills.

• Front liners want to do a great job for patients.

• Managers must learn to let go of more of the power they have thus allowing front liners to get on with the job.

• Managers must be there for support when front liners need it – they are well capable of judging when they need help.

It is always an absolute pleasure for me to work with these folks. I thank them for allowing me to spend time with them in 2009 and I look forward to meeting at least another 1000 front liners in 2010.

The great news is front liners do a terrific job and they are keen to learn more.

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Best quote I've seen this year ....

"We don't stop playing because we get old .... We get old because we stop playing"

LOVE IT - LOVE IT - LOVE IT!!

Don't know about you but I still don't know what I want to do when I grow up!

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'Gimme More Money' or I won't play

So, the Royal Bank of Scotland (which by the way is now owned by us, the tax payers) wants to pay £2 billion in BONUSES across the group for its performance in 2009, with £1.5bn going to its investment banking division.

We are told today by Government Minister, Lord Myners that at least 5,000 bankers in the UK will earn more than £1m this year whilst the median wage in the UK is just over £20,000 a year, and yet some bankers expected, as a matter of course, to receive bonuses, in addition to their salaries, of millions of pounds.

The Directors of Royal Bank of Scotland have threatened to resign if they are not allowed to pay these bonuses. I say let them resign – the whole lot of them - call their bluff. Let these children throw their toys out of the pram. The morally obscene bonus payment culture has to stop.

Let me just remind myself of the story so far …

The Royal Bank of Scotland, along with other banks, screw things up so badly that in Autumn 2008 they go ‘cap in hand’ to the Government (that's you and me) to bail them out with massive amounts of tax payers money. ‘We’ tax payers ‘give’ them that money to keep them afloat and EVERYONE agrees the scandalous immoral bonus payments to bankers must never be allowed to happen unchecked again.

Here we are, just 12 months later and they want to pay themselves enormous bonuses again .... and the implicit message is .... to hell with the rest of the population on a median of £20,000 per year and struggling to meet their mortgage payments.

This is of course the TRUE face of capitalism.

Those capitalist myths about ‘trickle down of money’ are just that … MYTHS pedalled by the very people who line their own pockets and see absolutely nothing morally wrong in what they do.

As Lord Myners said today… Bankers need to join the real world.

I can’t make up my mind if it is ignorance, arrogance, ineptness, no morality, no principles of integrity, no conscience or simply lack of personal insight.

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Be Bold – Push at Doors

Here is a practical tip for aspiring leaders. Push at doors because, in my experience, doors that may be seen as closed are more often than not ajar.

This was brought home to me most when I got Sir Alex Ferguson to endorse my book simply because I rang him direct – spoke to his PA and managed to get an exchange of correspondence with him that resulted in the book endorsement

The ‘easy’ option would have been to tell myself it was impossible to actually get to the great man but when I pushed at the door, sure enough, it was ajar.

It has always been my experience that the thing that holds us back most from being bold enough to achieve what we really want is our own reluctance to just ‘try things’ that might seem out of our reach. I imagine many people give up because they fear a negative or non-response.

I remember Tom Peters saying he asked his friend Bob Waterman when they were both senior consultants at McKinsey ‘How do you become a partner at McKinsey?’ and Waterman replied – ‘You just start acting like a partner and they will make you one.’ – So he did and they did!

I’m not pretending this is easy for some people and of course we are not all Tom Peters. Another important thing to remember is that Being Bold mustn’t be confused with being pushy, over confident or at worst arrogant. We have to have some insight about when the door is shut or even locked. That insight is partly about intuition and partly experience. But I really don’t think it's terribly complicated.

Like any other management or leadership skill we have to practice to make it work for us. I’m sure with practice we will get better about making the right call about pushing at the door or recognising when the door is definitely not for opening.

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Cross Country and Virgin - Chalk and Cheese

Regular readers of Simplicity Blog know that I travel almost all my business miles by rail.

I've often congratulated rail providers publicly on this Blog for their excellent service. On Thursday I had an awful customer experience on a Cross Country train from Chesterfield to Birmingham New Street. I got so annoyed that I fired off an email on Friday to the rail public watchdog called "Passenger Focus - Putting Passengers First"

When service is excellent I like to tell the provider ... when it is absolutely crap we should also tell them.

This was what I wrote:

"I just wanted to vent my feelings.

Yesterday afternoon/evening I STOOD (along with probably 30 other passengers) for the entire journey on a Cross Country train from Chesterfield to Birmingham New Street. The announcements over the tannoy were awful – a very low volume and the announcer clearly had no idea that his diction is dreadful and indecipherable. No refreshments at all. It was - by a mile - the worst journey I’ve had on a train for five years and I travel about 5 times per week on average on business.

Contrast this with my onward journey with Virgin from Birmingham New Street to Coventry. I walked on to the train – a completely different ‘feel’ to everything about it. No problem finding a seat. The very friendly and reassuring voice of a pleasant train manager came over the tannoy to welcome me on board and tell me the details of the journey. I strolled along to the refreshments carriage – an absolute pleasure to be dealt with perfectly by a charming young lady who smiled a lot.

The contrast between Cross Country and Virgin was like chalk and cheese and I guess my question has to be is how the hell did Cross Country get that contract over Virgin – do the people who award the contract not take into account customers opinion?

Please do let me know what you can do with my feedback. For instance, can you forward this email to both Virgin and Cross Country on my behalf please?

Ironically enough I was returning from Chesterfield having just delivered a training session on customer care!!! – This journey gives me plenty of REAL data for future customer care workshops.

Hope to hear from you."

I will let you know if I hear anything!

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Malcolm's New Blog!

Malcolm pictured with his son at the launch of "Its a Goal" at Manchester United Football Club in 2006

My friend Malcolm McClean – well known entrepreneur and Director of Bearhunt has started a Blog.

In 2005 Malcolm wrote “Bear Hunt – Earn Your Living by Doing What You Love” published by Capstone, which has since been translated into Chinese; Turkish; Romanian; Korean; and a special version has been created for the Indian market. Malcolm says “You would expect me to say this, but these principles really work – whenever I get stuck or distracted I get a coffee and re-read Bear Hunt myself as a reminder to keep on doing what I’ve been doing. Ever since that momentous decision to do great things with great people, I’ve been able to do something that we all should aspire to – earn my living just by doing what I love.”

Malcolm is not only one of the most creative thinkers I’ve come across in business but crucially he is also a ‘doer’ – he gets results.

Among his achievements Malcolm was the founder of the brilliant initiative “It’s a Goal” which engages young men in football to reduce the incidence of depression in a target group of the population where depression is often ‘kept under the carpet’ and not talked about. The initiative now involves 4 professional football clubs in England including my beloved Manchester United.

Malcolm’s new Blog can be seen at this link http://www.bearhunt.org.uk/Blog/

I’m sure you will enjoy reading it and I hope you will respond to Malcolm’s views.

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Dreaming of a Holy Night

We are delighted that our Church in Coventry is to have Graham Kendrick appearing for one night only on Tuesday 8th December as part of his his US and UK tour. The concert tour is called "Dreaming of a Holy Night."

If you click on the arrow under the picture of Graham in the side bar you can hear more about the concert.

Graham has his own own website is at this link where you can read more about him and the tour http://www.grahamkendrick.co.uk/index.php

Graham Kendrick has been described as a ‘father of modern worship music.’ For more than 30 years he has been at the forefront of Christian music in the UK having written and recorded hundreds of songs, many of which are well known around the world, including Shine Jesus Shine, Knowing You, The Servant King and Amazing Love.

Graham is based in the UK and travels internationally participating in tours, festivals, conferences and training events, as a worship leader, speaker and performer.

Judging by the reviews of Grahams similar tour last year we are in for a memorable event in Coventry and by clicking on the picture below you can see details of how to obtain tickets for the concert - a very reasonable £10 per ticket!!!

PLEASE TELL YOUR FRIENDS TO TELL THEIR FRIENDS!

It hurts!

On Monday this week my 4 year old grandson Sebastian had an accident at school. This resulted in a trip to the hospital for an overnight stay and surgery on Tuesday morning on his broken arm. Here is a picture of the brave young soldier in his hospital bed. I'm sure all parents and grandparents are just like me - seeing our own children or grandchildren suffer pain hurts us.

The great news is Sebastian is much better and back at school tomorrow (Thursday).

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This made me laugh

My darling wife Annie found a brilliant birthday card today for my son Simon. It is hilarious so we scanned the card and here it is.

I thought it was really funny - hope you agree.

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Apologies for absence :-)

Sincere apologies for being away for a while – work commitments have meant I just have not had enough time to Blog as much as I would like. That in itself is great – we all have bills to pay - and it’s good for my health to be busy. But I genuinely miss making my regular postings on Simplicity Blog. However, I’m back and I will find time in the next few weeks to get back to regular Simplicity postings.

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Another thank you to rail providers

I’ve just been reviewing my work diary over the last month.

1st to 31st October - 19 days on train journeys – a total of 55 individual trains given various changes.

Train slightly late: 2 occasions
Significantly late: 0 occasions
On time or early: 53 occasions

I would say that’s superb given the complexity of rail travel and the number of variable factors.

Just as with the NHS there are often sweeping generalisations about poor rail services in England.

Rather than listen to those doom spreaders I speak as I find and as I have said many times on this Blog I feel we have a very good rail service in England.

The last month has again confirmed my opinion.

So thank you Virgin and Cross Country (both pictured above) These are the two main providers I've used in the last month.

November looks almost as busy for me on the rail network and I'm optimistic!

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I'm Proud of Diversity in Britain

Last night (Thursday) I watched in shock, amazement and embarrassment the appearance of the leader of the British National Party, Nick Griffin on BBC TV’s popular programme Question Time.

It therefore felt very timely today that I went to a celebration of Diwali where I met about 150 Asian Carers who live in the city of Coventry. I am a Director on the Board of Coventry Carers Centre and this was an opportunity for me to go along and meet these Asian Carers who provide care for members of their families and/or friends who are either ill or have some form of disability.

I had never been to a Diwali celebration until today and I found it a very moving experience.

Unlike Mr Griffin and his British National Party I am very proud that my country is so rich in diversity. It provides an opportunity for me to continue my life education. My journey is always enhanced when I meet the type of caring loving people I met today.

Mr Griffin might like to consider taking time out to go along to a Diwali or similar cultural celebration in his neighbourhood. He might just learn something about people from other cultures than ‘white English.’

I’ve spent my entire career working alongside thousands of non-British, non-white people in all aspects of healthcare including Doctors, Nurses and many other professions and my life has been enriched by this. Our Church in Coventry has a Zimbabwean fellowship and when these folks from Zimbabwe take an active part in our services they add immensely to the experience for all of us.

In summary I am delighted that the likes of Mr Griffin represent such a tiny proportion of people living in Britain. Mr Griffin and his cohorts hold radical, racist views that I do not wish to be associated with in any way. The only positive I can draw from Griffin appearing on such a high profile TV programme is that it will solidify the absolute disgust and contempt that fair minded people in Britain have for Griffin and his British National Party.

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Stupid, stupid, stupid!!!!

I have chuckled to myself about these things for years and I’ve always put it down to something that we can all laugh about.

Now I am getting a bit irritated about these things. What is really getting me at the moment is the absolute stupidity – I can’t think of a kind word – of some design ideas.

How the hell can the people who invent/design these things take any pride whatsoever in their job. Or maybe it’s just me and I should perhaps just get out more.

These things may appear petty and nit-picking but to me they are important. They illustrate why I never simply accept the concept of ‘expert’ in design or innovation. No person with one iota of common sense would introduce these things.

Here are just a few of the things I’ve noticed that drive me mad! You will have other examples and I’m sure you will let me know:

1 Toilet roll holders positioned in public toilets (on trains and in hotels in particular) in places that require the person sitting on the seat to be a contortionist to reach the toilet roll. Then when you do finally reach the toilet tissue the roll doesn’t ‘roll’ and you end up with the tissue breaking off at every perforation!

2 Those vacuum sealed clear plastic surrounds on electrical goods like memory sticks that are simply impossible to open without getting a knife or a pair of scissors and literally hacking your way through to the product. We risk amputations of fingers just to get to our precious appliance.

3 Tomato ketchup plastic sachets that simply refuse to tear despite your best effort - even with your teeth! – I mean who carries pair of scissors or a knife into a motorway service station when all you want is a burger with ketchup!

4 Milk cartons that require a corner to be cut off to enable pouring and doing it results in spillage every single time you cut the corner.

5 'Post it' note sealed packs that are simply impossible to get open (and that includes attempting to tear the thin covering with your teeth) without scissors or a knife.

We can and should laugh at these things but on the other hand I think there is a serious issue here. This stuff is so simple and yet it doesn't get any better. Why in hells name don't the designers try these things out before they are applied in practice?

Front line employees would never do anything so stupid.

For instance – it’s surely possible for someone to sit on a toilet seat and - without having the IQ of Albert Einstein - work out where might be difficult for people to reach the tissue!!

Surely the person who designed those vacuum sealed packs tried them out with a small group of guinea pigs before the product is mass produced – CLEARLY NOT!!

Maybe I am missing something obvious but if so I just cant see it ….

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Carry on trusting ......

As regular readers know I’ve often written on Simplicity Blog (and in many other places) my firm belief that front line employees should always be TRUSTED to just get on with the damn work.

I’ve always said the best leaders know they should just need to set out the broad parameters of their expectations of employees and then get out of the way and trust the people to get on with the job. I often use the famous quote of Henry Stimson, US Secretary of War in World War Two; ‘The only way to make a man trustworthy is to trust him’

I’m not going to change my mind on any of my core beliefs above. I still firmly believe I am right to trust employees.

BUT ….

It hurts me to the very core when a manager (like one I’m coaching at present) does all the right things about setting clear parameters and expectations for the team and every individual within that team and then some employees totally let down that manager by abusing the trust placed in them.

For a fleeting moment I think to myself; ‘Do I need to change my view about trusting employees?’ …. But I quickly realise there will - sadly - ALWAYS be a small minority of employees who will abuse the trust you place in them.

Am I disappointed – Yes.
Am I angry – Kind of.
Am I surprised – Very.
Most Important - Will I change my views about trusting front liners? – DEFINITELY NOT.

Do you get disappointed sometimes when employees abuse the trust placed in them and if so how do you rationalise it?

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Friend of Simplicity - Gary B Cohen

Today it is my great pleasure to interview Gary B Cohen author of a great book that I've just read called "Just Ask Leadership – Why Great Managers Always Ask the Right Questions."

Gary, as President and co-founder of ACI Telecentrics grew that company from two people to 2,200 employees and reached $32 million in sales at the company’s peak. ACI was recognized as one of Venture Magazine’s Top 10 Best Performing Businesses and Business Journal’s 25 Fastest Growing small companies. Gary is partner and cofounder of CO2 Partners, LLC operating as an executive coach and consultant. His clients run a wide range of organizations – from small entrepreneurial companies to multi-billion dollar enterprises.

Trevor: First of all Gary – thanks for taking the time in your busy schedule to answer a few questions for my Simplicity Blog.

Gary: It is truly my pleasure, and thank you for being willing to share my ideas and the book, Just Ask Leadership, with your audience. As you can see from the title, it would be difficult not to respond to a fellow Asker. Don’t be surprised, though, if I take the opportunity to ask you a few questions as well.

Trevor: I really enjoyed reading your book and found many similarities in your philosophy to my own about business, management and leadership. Not least the need for Simplicity. Do you think some managers make things too complicated?

Gary: Yes and no. To me it really depends on the situation. If you are referring to leading others, yes. If you’re referring to leading an organization, I would say no. I believe many of today’s crises are a result of the complexity of our operating systems. Leaders are applying linear solutions to complex systems.

In a discussion the other day with Joseph Grano, who is currently Chairman and CEO of Centurion Holdings and formerly Chairman of UBS, Joseph stated that it’s not that CEO's are unaware of the complexity of their organizations, but that they’re unaware of the complexity of the products their organizations offer. Leaders don’t and can’t understand every aspect of their organization, nor should they try. They put their organizations at risk when they do. Instead, they need to learn the right questions to ask and where to direct these questions. When leading people, both straight forward and more complex strategies are necessary.

The straight forward aspect of leading is really simple – Just Ask. If leaders did that more than Just Tell, they would see vast improvements in their organisations’ performance. What I don’t want people to believe is that any question, in any tone, will do. The types of questions – and they way they’re delivered - are equally important. Counter to popular opinion, there is such a thing as a Bad Question!

On the complex side of people leadership, leaders would benefit from understanding the brain and how it takes in and stores information. People favor certain types of information and disconnect from others, which has a huge impact on outcomes in organisational trade-offs.

By understanding the workings of the brain, leaders can ask questions that cut through thinking processes and create improved outcomes.

Trevor: The images of a leader telling people what to do rather than asking questions still persists in many organizations. Do you think this style is changing fast enough?

Gary: No, and this is what gets me going in the morning. To live in a free country and to work for a totalitarian company in which the leader always knows best is at worst repressive and at best controlling. In a day when information is more abundant than ever and we have more college graduates and post graduates in the work force, the smartest person in the room is rarely the leader, even though they would often have you believe they are.

The worker today wants to be engaged in decisions, making things happen and changing organizations to improve. This was also the case in colonial times: After 120 pilgrims died in Jamestown during the winter there were only 60 survivors left. The deaths resulted largely from failure to take care of the land and common ownership of the colony. With ownership divided so that the 60 people who were left each had their own plots and individual rights, crop production tripled.

When people feel they have a stake in what they do, performance increases. At CO2 Partners, we see this with organizations that change from telling to asking. Our entire educational system was built on knowing the answer. The teacher is the leader and you do what she tells you to do even if you know it is wrong. That was translated to the repetitive processes in our factories, where many thought that questions were unnecessary.

But we’ve seen today how the bad practices of just one or two employees can bring a company to its knees.

Trevor: My good friend Dave Wheeler from Arkansas has great practical experience as well as knowledge of the subject of leadership. Dave says the four most important words a leader can say are ‘What do you think?” – I assume you would agree with that, Gary. Why do so many managers find it hard to ask questions?

Gary: I’m not sure I would say those would be my four most important words, but I would agree that questioning is one of the best disciplines a leader can learn today to be resilient in the face of uncertainty.

Great leaders aren’t afraid to make decisions, too, but they rarely do so without asking great questions first.

Trevor: I have a passion for giving much more responsibility and power to people working at the front line. I would be interested to hear your ideas about how managers can be persuaded to let go of the power to their front line folks.

Gary: We seem to be in alignment on this idea. One of the first questions I suggest leaders ask is, “Whose decision is it?” It is a way to get them to understand at the beginning of each conversation that it does not have to be their decision. And before they can ask any questions at all the leader must trust the people on the team. If they don’t, why bother asking them anything in the first place? The issue of trust does not revolve around getting rid of team members the leader doesn’t trust, but more often the issue is that the leader does not know how to trust.

At CO2 Partners, this is one of the first places we go to help a leader and her company. Most leadership practitioners speak of Trust in terms of making the leader appear trustworthy. It is our belief that this is quite backwards.

Those who have the power must first give trust, which involves a certain amount of risk. There are some very deliberate ways to create this trust and it has nothing to do with time. It is only then that the idea of moving decisions downstream--to the front line-- can be accomplished.

Trevor: Do you have any Leadership heroes and if so, who are they and what is it that makes them stand out from the crowd?

Gary: One of my favorite leaders is Bill McLaughlin. I admit we are friends, and I am sure that has much to do with my rose colored glasses. He was one of the few leaders I interviewed for the book Just Ask Leadership who was consciously competent about using questions as a leader.

Most of the exceptional leaders I interviewed used Just Asking about 70-80 % of the time and were not really conscious of doing this until we discussed it in the interview. Bill knew he did it and was very deliberate about the questions he would ask. Another aspect of Bill that I have grown to admire is his authenticity - not the kind you learn at a seminar but the kind that only comes from deep contemplation and self awareness.

Humility is another aspect that comes to mind – again, not the kind you pick up trying to imitate the Dali Lama, but the kind that comes from seeing people outside of a hierarchy. He seems to see potential in people and help promote them through the questions he asks. He is the lesser part of the equation and the other person is the focus. He has experienced amazing successes and challenges in his career and yet still projects these admirable qualities.

A fictional leader I love is Dorothy from the Wizard of Oz. Next time you watch the movie, pay close attention to how she engages and aligns her team to follow the yellow brick road.

Trevor: Having a style that is all about asking questions might be construed by cynics as a manager being weak. I need to stress that is certainly not my own view. How do you answer those cynics Gary?

Gary: Yes, this is often a first thought shared by many, such as those who see water as weak, although it played a major part in forming the Grand Canyon.

If you ask weak questions (and there is such a thing as a weak question), you may be considered a “Weak Leader”. But there are tough questions that require real action from the listener.

Some examples of tough questions from a boss to his team member might be: “Trevor, what is preventing you from blogging twice as much per week?” or “How might you remove those obstacles in order to meet our overall goal that we agreed to earlier in the year?” Often it takes way more courage to ask and trust than to tell and blame.

Trevor: What one piece of advice would you give to a young manager just setting out on his career path given your own experience?

Gary: Understand that in our society there is a time to provide answers and a time to ask questions. You’ve most likely learned how to answer for the first 20+ years of life, so learn this difference and practice the art of asking. Pick up my book Just Ask Leadership or go to our website www.JustAskLeadership.com and take the Gold Assessment. It is a 360-degree feedback tool that polls 5 people who work with you on your leadership performance in general and Just Ask Leader style specifically. It will provide specific advice on how to improve. We have been studying leaders with this tool globally and have found that trusting others by using questions can have a 20% positive effect on the team’s engagement, alignment and motivation.

Few assessments provide that level of feedback. Buckminster Fuller was a wonderful thinker, and a friend recently reminded me of Bucky’s view on procession. This is the notion of just starting – just put your foot in a direction, even if it is not the right direction.

Most Nobel Prize winners never set out to win. They just started on their path, one thing lead to another, and before long they really became the change in the world that they wanted to see. This is true for anyone starting down any path – the first place to start is starting. Many people get stalled out and this often leads to paralysis.

Trevor: Finally Gary, have you visited the UK and if not do you have any plans to come to this side of the pond? I have a number of US friends who regularly visit my Simplicity Blog and it seems there are many similarities in both our cultures. I’m sure your Just Ask Leadership concept is equally applicable on this side of the water.

Gary: Several fantastic leaders have asked whether CO2 Partners would like to start a practice in England, and those discussions are still active. The book has only been out for a couple of weeks and the interest from the UK has been fabulous. When I was younger, I was an intern at the British Parliament for the Fulham member Martin Stephens who passed away many years ago. I lived off of Queens Gate right off Hyde Park and my memories often draw me back there.

If you or any of your readers know of opportunities to speak in England or Europe, I would more than welcome the opportunity. I gave a speech in June in Hanover, Germany to a company that does business around the world. The audience represented over 20 countries and each took to the Just Ask idea no matter how different their culture was from ours. Similarly, I spoke to the Intel global treasury department last year and there were over a 100 leaders from all over the globe.

The message of Just Ask seems to have resonance all over the world. Thank you for your willingness to help spread the idea.

Trevor: The pleasure is mine Gary - thank you again. I hope some Simplicity readers take you up on that offer of speaking engagements in the UK - you will be very welcome on this side of the pond - your message to Just Ask is so important.

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Friend of Simplicity - Ken Dainton

Today I have immense pleasure in publishing my latest ‘Friend of Simplicity’ interview with Ken Dainton.

Ken is a personal friend (he was best man for my marriage to Annie) and has been a professional management colleague in healthcare for over 25 years. In 1983 I moved 300 miles from my home locality as a (relatively) young and inexperienced manager to a big challenge in a new job in the National Health Service (NHS). I found myself in Torbay, Devon, England – a place where I knew no one.

The first person to make me feel welcome at work in Devon was Ken who at the time was the Administrator (which in those days (all but) meant CEO) of Torbay Hospital which has over 500 beds. Ken was very helpful to me from day one in all sorts of ways. He gave me great support and advice in a completely new locality where frankly, I felt completely lost.

I unashamedly ‘used’ Ken as my 'informal mentor' in those days and actually I still do.

As far as I’m concerned Ken is the best Chief Executive the NHS has never had.

Hundreds – possibly thousands - of people in the NHS have influenced me during my long healthcare management career. Ken – through his wisdom, guidance, experience and kindness has influenced more than most.

I hope you enjoy reading the interview and please respond with questions and/or comments for Ken.

Trevor: Welcome Ken - Please give a brief history of your career.

Ken: Very boring and conventional I'm afraid. I joined the Bath Hospitals straight from school on their local training scheme for administration back in the swinging sixties. We were expected and encouraged to obtain the Institute of Hospital Administrators qualification and leave for higher things. This I did, working in Wiltshire before coming to Devon 36 years ago. I have been rooted to this delightful spot ever since but fortunate to have enjoyed a variety of jobs including planning, HR, and operational management both within the hospital setting and in the community. I retired four years ago but returned on a part time basis. Work is now my hobby.

Trevor: Can you pick a couple of excellent leaders you have worked for and tell me what it was that made them better leaders than the average manager?

Ken: Unfortunately I can only think of one that I have worked for (perhaps that says something more about me than them!) but there are several others that I have worked with who I would single out. The qualities that stand out are integrity; good communication skills; vision; a pragmatic approach and ability to secure alliances; and the personal credibility (ability/knowledge/understanding/judgment/objectiveness) that breeds confidence in colleagues.

Trevor: I’m interested to hear your opinions about the UK National Health Service particularly in the light of the current debate regarding universal healthcare in the US.

Ken: I've lived in the States for short periods and what stood out for me was the number of people working well into their old age, some of them very frail, in order to pay their healthcare bills. The anxiety that was generated was palpable. For a civilised society with top class acute facilities it is barbaric. The NHS offers free at point of delivery, comprehensive, cradle to grave, non judgmental care. But those strengths are also its main weakness in that it tries to do everything for everybody (often backed up by legal action) and thereby creates an impossible funding and ethical dilemma. It seems to me that the ideal system would be the best bits of both-one with minimum bureaucracy, that incentivises innovation, encourages self help and reliance, and is explicit in what it services it provides.

Trevor: What’s your opinion of doctors being involved in management?

Ken: The first thing to say is that not all doctors want to be involved in management. I can understand that because it’s not what they trained for and doctoring is tough enough without any further distractions. However they can't then complain if issues are not addressed to their satisfaction. The second thing to say is that a common misconception of doctors is that management is about sitting behind a desk, dealing with finances or commanding a bunch of recalcitrant staff. Its not. It’s about shaping the strategy; establishing the agenda; setting priorities; keeping maverick colleagues on side; and advancing the clinical capacity and skills of the organisation. It is vital that doctors play a full and leading role.

Healthcare is a dynamic business, there is a political dimension (both local and national) and teamwork is essential to reconcile the many and various competing demands. Without clinical leadership the organisation will flounder.

Trevor: Can a manager from any organisation manage a large hospital? – What are the unique issues in hospital management?

Ken: I see no reason why managers should not be recruited from outside the NHS provided they have the personal attributes necessary. However, there is a steep learning curve that needs to be climbed very rapidly. There is a multiplicity of professions, specialist interests and power bases. Understanding the connections, motivations and dynamics is quite tricky. Learning who the movers and shakers are, both people and positions, is crucial. Taking advice from seasoned operators and tapping into the organisational memory is a key skill.

As with any new recruit the early, honeymoon period is crucial in gaining credibility and it is even more important for external appointees.

Trevor: Looking back on your career can you identify some of the big differences in management say 30 years ago compared to 2009?

Ken: Looking back some of the decision making processes were pathetic. On the other hand we were much more liberated from the vast weight of rules/regulations/legislation that there is today. Thirty years ago there was more thinking-on-ones-feet and initiative. These days the NHS is far more risk averse and there seems to be a written protocol to follow for every little issue. Management can easily deteriorate into a tick box culture and this drives increasing specialisation.

Gone are the days when a young manager could be a jack-of-all-trades (master of none) and learn by taking a chance and making mistakes.

Gone are also the days of the "public service" ethic. There are still pockets of altruism but society has changed. The other obvious difference is that there is no longer a defined career ladder to climb. These days it is more of a flexible climbing frame to scramble across both within and outside the service. Trevor:

What advice would you give to young managers just entering their management career?

Ken: Healthcare is a fascinating subject so:

*Take a professional pride in all that you do.
*Respect, and learn from, all other professions.
*Seize opportunities to develop.
*Listen to what patients, their carers and front line staff are saying.

Trevor: Are you optimistic about the future of healthcare management here in the UK?

Ken: I am a natural optimist. I am confident that the NHS has a future and there will therefore always be a need for good management. The top guys though will need a much tougher skin, have to be more politically and publicly astute and find a way of imposing that public service ethic on an increasingly strident audience.

Trevor: Brilliant - thanks Ken – keep taking the pills my friend!

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Simplicity Blog - Happy 1000th Post

This one is a very special posting for me.

This is the 1000th posting I have written on Simplicity Blog and I have responded personally to every comment. We have created a bit of a community.

Simplicity Blog has become an important part of my life.

I would be fascinated to hear your reflections regarding Simplicity Blog – does it still hit the right spots for, at least, some folks?

As for me, I still love writing the Blog and find it a great way to get my views and feelings ‘out there’ about leadership and management.

Thanks to all readers and commenters for your terrific support over the last 999 postings – you are my teachers - and here’s to the next 1000!!!

Best wishes – always keep it simple.

Below is what I wrote in the very early days and I don’t think my views have changed at all in the (almost) five years since I started my Blog.

------------------------------------------------

Post Number 1 on 22 January 2005

I love communicating and blogging is the latest way of doing it.

Isn't it wonderful how we can now share thoughts instantly with like minded people from all over the world about how organisations are led and how things need to change?

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Post Number 3 on 24 January

My passion is to dispel the myth of complexity in management and leadership.

After all, complexity is merely the sum of simple parts. Management is not complicated at all ….we just love to make it complicated.

I also love lists.

This is a list of 17 things I believe. Yes 17 is a strange number. There is no mystery or significance in 17 - that is as far as I got!

So here goes .....things I believe with a passion - not in priority order
1. Staff at the front line know all the answers all the time
2. The words “managing people” should be exorcised from the workplace. Nobody “manages” people any more - people manage themselves.
3. If a manager has any job at all in 2005 it is to move heaven and earth to make it easier for front line staff to do neat work
4. Get other people to do bits of your job - they usually do it better than you
5. Management is simple
6. Leadership is not - it is an art form
7. The basics are the new cutting edge
8. I’m not convinced leadership can be taught
9. Give all the budget to front line staff ….yes I did say all the budget
10. Complexity is merely the sum of simple parts
11. Forget MBA think MST (Masters in Story Telling)
12. We are all Chief Executives of our own future
13. “Powerlessness is a state of mind - not a state of reality” Tom Peters
14. I don’t know what “a big organisation” means in 2004
15. I would take a pay cut for some leaders ….I would not follow some leaders if they doubled my wages
16. Our greatest motivation is always from within
17. The older I get the more I like words like “difference” and “diversity” …and the less I like words like “right” and “wrong

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Some light relief

I realise I run the risk of losing all credibility and friendship with my many US friends in publishing the following. It was a letter written by comedy actor John Cleese in his character Basil Fawlty from the classic British TV Sitcom "Fawlty Towers." It was first published at the time of the election for the second time of George W Bush - hence the reference to Tony Blair.

I promise my friends on the left hand side of the pond this is meant to be funny - hope the Brit humour travels.

JOHN CLEESE LETTER TO THE USA

To the citizens of the United States of America:

In light of your failure to elect a competent President of the USA and thus to govern yourselves, we hereby give notice of the revocation of your independence, effective today.

Her Sovereign Majesty Queen Elizabeth II resumes monarchical duties over all states, commonwealths and other territories. Except Utah, which she does not fancy.

Your new prime minister (The Right Honourable Tony Blair, MP for the 97.8% of you who have, until now, been unaware there's a world outside your borders) will appoint a Minister for America. Congress and the Senate are disbanded. A questionnaire circulated next year will determine whether any of you noticed.

To aid your transition to a British Crown Dependency, the following rules are introduced with immediate effect:

1. Look up "revocation" in the Oxford English Dictionary. Check "aluminium" in the pronunciation guide. You will be amazed at just how wrongly you pronounce it. The letter 'U' will be reinstated in words such as 'favour' and 'neighbour'. Likewise you will learn to spell 'doughnut' without skipping half the letters. Generally, you should raise your vocabulary to acceptable levels. Look up "vocabulary."

Using the same twenty seven words interspersed with filler noises such as "like" and "you know" is an unacceptable and inefficient form of communication. Look up "interspersed." There will be no more 'bleeps' in the Jerry Springer show. If you're not old enough to cope with bad language then you should not have chat shows.

2. There is no such thing as "U.S. English." We'll let Microsoft know on your behalf. The Microsoft spell-checker will be adjusted to take account of the reinstated letter 'u'.

3. You should learn to distinguish English and Australian accents. It really isn't that hard. English accents are not limited to cockney, upper-class twit or Mancunian (Daphne in Frasier). Scottish dramas such as 'Taggart' will no longer be broadcast with subtitles.You must learn that there is no such place as Devonshire in England. The name of the county is "Devon." If you persist in calling it Devonshire, all American States will become "shires" e.g. Texasshire Floridashire, Louisianashire.

4. You should relearn your original national anthem, "God Save The Queen", but only after fully carrying out task 1.

5. You should stop playing American "football." There's only one kind of football. What you call American "football" is not a very good game. The 2.1% of you aware there is a world outside your borders may have noticed no one else plays "American" football. You should instead play proper football. Initially, it would be best if you played with the girls.

Those of you brave enough will, in time, be allowed to play rugby (which is similar to American "football", but does not involve stopping for a rest every twenty seconds or wearing full kevlar body armour like nancies).

You should stop playing baseball. It's not reasonable to host an event called the 'World Series' for a game which is not played outside of America. Instead of baseball, you will be allowed to play a girls' game called "rounders," which is baseball without fancy team stripe, oversized gloves, collector cards or hotdogs.

6. You will no longer be allowed to own or carry guns, or anything more dangerous in public than a vegetable peeler. Because you are not sensible enough to handle potentially dangerous items, you need a permit to carry a vegetable peeler.

7. July 4th is no longer a public holiday. November 2nd will be a new national holiday. It will be called "Indecisive Day."

8. All American cars are hereby banned. They are crap and it is for your own good. When we show you German cars, you will understand what we mean. All road intersections will be replaced with roundabouts, and you will start driving on the left. At the same time, you will go metric without the benefit of conversion tables. Roundabouts and metrication will help you understand the British sense of humour.

9. Learn to make real chips. Those things you call French fries are not real chips. Fries aren't French, they're Belgian though 97.8% of you (including the guy who discovered fries while in Europe) are not aware of a country called Belgium. Potato chips are properly called "crisps." Real chips are thick cut and fried in animal fat. The traditional accompaniment to chips is beer which should be served warm and flat.

10. The cold tasteless stuff you call beer is actually lager. Only proper British Bitter will be referred to as "beer." Substances once known as "American Beer" will henceforth be referred to as "Near-Frozen Gnat's Urine," except for the product of the American Budweiser company which will be called "Weak Near-Frozen Gnat's Urine." This will allow true Budweiser (as manufactured for the last 1000 years in Pilsen, Czech Republic) to be sold without risk of confusion.

11. The UK will harmonise petrol prices (or "Gasoline," as you will be permitted to keep calling it) for those of the former USA, adopting UK petrol prices (roughly $6/US gallon, get used to it).

12. Learn to resolve personal issues without guns, lawyers or therapists. That you need many lawyers and therapists shows you're not adult enough to be independent. If you're not adult enough to sort things out without suing someone or speaking to a therapist, you're not grown up enough to handle a gun.

13. Please tell us who killed JFK. It's been driving us crazy.

14. Tax collectors from Her Majesty's Government will be with you shortly to ensure the acquisition of all revenues due (backdated to 1776).

Thank you for your co-operation.

* John Cleese [Basil Fawlty, Fawlty Towers, Torquay, Devon, England]

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(Enough) Work is good for you

How important is your work to you?

For me its really important – always has been – always will be. I think it's partly to do with my late beloved Dad’s strong work ethic and the example he set. It was drummed into me from my earliest days. Dad always said “you get nothing for nothing.” He always told me to work hard in whatever I did.

I’ve always taken work seriously and I have to say a few years ago, far too seriously and at the expense of my health.

That brings me to a really tricky discussion and I would be fascinated to hear from you about this topic.

I began thinking about this last night when I was listening (yet again) to some of my favourite Eagles tracks and came across the Don Henley classic “New York Minute.”

The lyrics of this song always send shivers down my spine:

“Harry got up
Dressed all in black
Went down to the station
And he never came back
They found his clothing
Scattered somewhere down the track
And he won’t be down on wall street
In the morning

In a New York minute
Everything can change
In a New York minute
Things can get pretty strange
In a New York minute
Everything can change”

The song is a story of a New York City Wall Street worker who lost his way somehow and decided to end it all in front of a train.

Now I’m older I can say I agree 100% with my Dad’s philosophy. Work is good for our physical and mental health. The problem starts when work becomes too important, relative to other parts of our life.

Work gives us a sense of belonging; a sense of achievement; and it boosts our self esteem. Never under-estimate the importance of work in our total make up.

Having said all that, work should not be allowed to become such a controlling factor that it drives us to the edge of despair and sadly in some cases such as 'Harry' - over that edge.

It’s a fragile line and as Don sings those haunting words .... “In a New York minute, everything can change”

In my career I've had to re-assess my position regarding career choices on a number of occasions - we all do that. I am not for a nanosecond suggesting we shouldn’t worry about work – worrying about it keeps us performing to some degree. When worries about work turn into clinical depression we need to look for help and talk about how we feel. My great guru and life supervisor Professor George Giarchi often uses the expression “This too will pass”

Speaking from personal experience I would say George is right.

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Manager/Front-line Disconnect?

I can't help thinking managers don’t spend enough time getting alongside their front line staff.

The more front liners I meet – around 1000 in the last year - the more ‘disconnect’ I find between managers and front line employees.

Front line folks who REALLY rate their managers tell me their manager spends time with them. The front line employees who are critical of their manager invariably see one of the biggest problems that their manager spends far too much time behind their office door away from front line action.

This is not a surprise to me – it’s what I’ve been saying for more than 30 years.

When I started one of my healthcare jobs in 1989 I spent the first month of the job doing nothing but meeting people who worked on the front line interacting with patients. This was brilliant education for me and it felt like the employees enjoyed the experience of showing this ‘new guy’ the ropes about what they actually do.

I wrote up my feelings about that month and submitted it to my bosses in the form of a report called ‘I’m Pleased I Asked the Questions.” One of the bosses I respected most –sadly now deceased - wrote me a letter in reply that I wish I had kept.

He said this:

‘Trevor – As a manager you have undoubtedly chosen the most difficult route to lead and manage. The most difficult, but the most rewarding. Too many managers take the simple option – they sit behind the comfort of the office door and let the system take the strain. Good luck in your career.’

So here we are in 2009 – 20 years later - nothing changes it seems to me.

Why do some managers not get themselves off their backside – out of the office and talk to their front line folks? They are your greatest teachers.

Maybe it’s just me but this stuff is really simple.

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"MANAGING ACROSS CULTURES - The Seven Keys to Doing Business with a Global Mindset"

Without a doubt one of the greatest joys of my professional life is that I now meet ‘virtually’ many people from all over the world. I would not have had the opportunity to ‘meet’ these people without the aid of the internet, email, blogging and the myriad of other modern communication methods at the fingertips of all of us.

In addition I've spent all my working life meeting and working with thousands of wonderful colleagues from all over the world in my healthcare management career.

Some of the challenges this brings include creating a common language and understanding the subtle (and often not so subtle) differences we have, depending on our nationality, our upbringing and our work experiences – in other words, the culture we live and work in.

It has become clear to me – often through mistakes I’ve made - that we are all different; generalisations are not helpful; and what make us tick is as different sometimes as chalk and cheese. Failure to recognise and respect those differences is a huge deficit. Like most managers, I imagine, I’ve learned mainly through experience about these things. I have delivered training workshops on the joys of diversity and I’ve read a few articles on the subject. But I've not found an easy to read guide about all this … until now.

For anyone whose work involves understanding cultural diversity and the nuances of different cultures (by the way - that means ALL of us) I recommend with great enthusiasm a book I’ve just finished reading;

“Managing Across Cultures - The Seven Keys to Doing Business with a Global Mindset”

This book by Charlene M Solomon and Michael S Schell is crammed with practical ideas and suggestions of how to work in a multi-cultural business world. It gives the reader an opportunity to assess one’s own cultural position on each of the seven dimensions considered by the authors as the key planks in recognising and working in a multi-cultural business world.

The book includes real world scenarios where ‘missing the trick’ of recognising, and more importantly, respecting cultural differences is not just an unfortunate oversight that can cause offence. It can also mean failure on the bottom line financially in a big way and result in missed business expansion opportunities.

As I read the book I found myself saying that this stuff is actually more than about how to manage across cultures. It is in fact about managing - full stop. I suggest the kind of respect and awareness called for in this book is as applicable working within a single culture population.

I congratulate the authors for such an insightful and brilliant reference book that will be regularly used by this trainer/consultant in my work.

The world is becoming a very small place. I often say that I now have more friends that I don’t know and may never meet than those I have met. “Managing Across Cultures” is a book I highly recommend.

It is written in an 'easy to read' style that I suggest ‘travels’ across cultures which of course means the authors are also 'walking their own talk.'

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Friend of Simplicity - Dr Phil Shute

I am delighted and indeed honoured to have as my 'Friend of Simplicity' Dr Phil Shute. Phil is a General Practitioner (Family Doctor) in Torbay, Devon, here in England.

I've known Phil for about 20 years, initially as my own Family Doctor and then as a professional colleague in the National Health Service (NHS). When I was a healthcare manager in the NHS Phil and I worked together as a team on ground breaking community health development in a very deprived part of Devon. I have to say (because Phil is far too modest to say this) that Phil was the leader, the inspiration and the driver for the project.

As a professional colleague Phil is simply a pleasure to work with and speaking as a patient I can truly say my life is richer and better thanks to his skills, support and understanding.

Good men are few - Phil is a VERY good man.

I know Simplicity readers will enjoy Phil's straightforward no-nonsense views and I look forward to receiving many comments. It is brilliant to get a medical perspective on some of the issues we regularly debate on this Blog from such a highly regarded doctor.

Trevor - Phil – thanks so much for agreeing to take part in my series of ‘Friend of Simplicity’ interviews. Can you briefly outline your career to date?

Phil - Hi, Trevor - My career to date: State Primary, State Grammar, both in Plymouth. Academically diligent and not brilliant. Older than my years, was always seen as the responsible one who could be relied upon to do an honest job, equitably and without disadvantaging anyone else. Captain of sports teams, glittering schoolboy rugby career......... got me into St Mary's Hospital. London (my academic record would not have stood out). Career at medical school above average, never considered anything other than a career in General Practice, though was offered many more "glittering open doors" when in hospital posts.

Did "Publish" whilst still a student (only one in the year so to do..... BMJ - British Medical Journal too!) Always felt that in whatever speciality I spent time as a student or qualified doctor that I was restricted by specialities; I was always holistic in my outlook, still am, probably more-so. Both house jobs at my teaching hospital..... Sounds prestigious but the first post I landed through rugby connections, the second by my reputation as an honest workhorse. Proud of that, still am.

GP training scheme in Barnstaple (back in Glorious Devon) wonderful place to have worked. Teaching Hospital jobs can be a bit self-serving, chasing small print and not enough substance... look great on CV's but less learning experience. Absolutely adored my time in Barnstaple and as a trainee in Bideford. Won the GP research prize locally and then awarded the Royal College of General Practitioner National Trainee research prize for 1985, Published again, JRSM - Journal of the Royal Society of Medicine this time.

Settled in General Practice in Torquay; still there; avidly "into" research in the early days, gave highly regarded paper but realized that chasing publications really wasn't the path for me; just a work horse. I now teach students at the Peninsula Medical School, not because I'm an academic but I'm in a great practice for teaching with a wonderful body of honest patients whom students ought to see.

Have been involved in many schemes and initiatives, proud of many of them. Not least the Gym we have within the practice.... first in the UK and "state of the art". The way we funded it was seminal and inspiring..... Just shows that when you have a body of good ideas someone, sometimes, listens and really splendid things can happen. Our area - Torbay (population 110, 000) is a fitter place as a result.

Similar things happened a few years back when we kick-started a local "Health Gain Initiative" looking right outside "Health" for a change into the broader field of "Welfare" (not the benefits system, but what patients really needed)

Very proud of my work in sport to this day. I'm a medical advisor to the Amateur Swimming Association, and as a medic and technical official and club manager. I facilitate sport from grass roots level up to World and European Cup levels and World Championships; from the youngest kids up to veterans.

I have a regular column or two in local papers where I exercise my skills as a sports journalist.

Trevor - I’m very interested in how Doctors view management. As a Doctor what do you look for in a manager in healthcare?

Phil - I look to management in health care to free up my time to work the coal face, to facilitate patient care and to make up for my own inadequacies in management, I frankly don't expect to manage in any other way than "Policy".

My 360 degree appraisal flagged that management was not my forte, a view with which I'd concur.

My own approach to management is the same as it was when I was captaining sports teams.... I led and hopefully still lead by example, not dictat. I have always gone the extra mile for colleagues and patients; will always put my body on the line. I expect managers with whom I work to do the same.

The managers within our Practice do just that, and I'm very proud of how we all get by in the face of a quite dizzying workload. If I've been influential by my example it would, I hope, be honesty, integrity, compassion and hard work. I'd love that to be said about our practice; all aspects, management, reception, patient experience, clinical expertise. I don't manage, but in a quiet way I'd like to think I lead in some ways.

Trevor - As you know Phil I am very interested in the study of leadership. Can you identify someone you would describe as a leader that has inspired you in your career and what qualities did that person have that made them stand out from the crowd?

Phil - Leadership is a true gift, and believe it or not, it's seldom evident in day to day medicine. It's probably far more in evidence in day to day management, where leaders can set an agenda. In clinical practice our patients set agendas.

I was first inspired by a teacher in my primary school, year 6, a fine man, towards the end of his career in teaching who always put his pupils first, was authoritative, firm and directive and unflinchingly fair.

I was next impressed by my captain when I first played rugby for Devon aged 17, the captain was 18, full of testosterone and adrenaline, a bit feckless, but who was so totally superior to everyone else on the field. You couldn't help but follow him, he was "everywhere". He went on to captain England and even the British Lions. Clearly others were similarly impressed.

The professor of medicine at St Mary's Hospital, London was the best and most gifted physician I've ever seen to this day. He weekly conducted his "Open Round" in the biggest lecture theatre at St Mary's and it was always packed. One or two of the registrars or senior registrars would select a patient unknown to the Prof and the consented patient would be wheeled into the theatre. Without taking a history, and without access to any "imaging" and investigations, solely by examining the patient meticulously (and talking us students through the process) he would seek a diagnosis and teach us all his clinical method in the process. It's the most impressive thing I've ever seen. Skills like this are not so valued these days as imaging and diagnostics has largely taken over; good, as that means diagnosis is available to everyone irrespective of which doctor is looking after you, BUT there is no substitute for genius.

Trevor - There has been a lot of publicity recently about radical reform of the US healthcare system. I would love to hear your views about that and in particular the publicity that has come from some parts of the US media and US politicians who openly and heavily criticise the UK National Health Service.

Phil - I don't know a lot about the Health Service in America other than they pay more than twice as much as we do and as result there is much more provision than we have.

Much of the NHS bashing coming out of USA is ill-informed. Much of the NHS bashing is engendered by lobbyists in the pay of astronomic profit-takers in the USA. They should re-examine their service if it has the inequality of access that I'm led to believe.

We have a service that has evolved around our patients and has probably had more thought put into it. We undoubtedly provide better value for money, our productivity is astonishingly high, we are ethically driven and our system, whilst far from perfect, is worth looking at if not worth adopting (well.... no-one else has adopted our system)

Trevor - What are your views about the development of electronic health records and patients having greater access to their own electronic records?

Phil - Patient-held electronic records would be splendid but I suspect would be as accessible when needed as their NHS card or NHS number (i.e. almost universally mislaid or filed under "lost") forget it.

Universally available health records would be splendid but the truth would upset a lot of information holders. Bureaucratically it would be a nightmare.......... I'd spend all day and every day talking people down from their anxieties and clinical work would be totally paralysed. Political correctness gone insane.

People only want to know what's in their notes when something goes wrong, OK they can have them if that's the case when it becomes appropriate for the patient.

We've already got that system. I think it would be an even bigger waste of money than ID cards (I'm not anti-ID cards). Just because we can do it, even if it's a good idea, doesn't mean we should. I'd rather spend the money on clinical care.

I'm reminded of a report on our local in-patient psychiatric unit where the quality of care for detained psychiatric patients was not even mentioned; but of course there had to be universal access to legal representation for all detained patients. It was, of course, written by lawyers.

Whose idea was the electronic record with universal access to data? What a security nightmare? I know the intentions are noble but if this isn't "1984" what is?

Trevor - I know that you and I agree we must look way beyond healthcare professionals such as doctors and nurses to improve the health of the population. It is everyone’s business. What would your vision of a healthcare system that promoted health look like?

Phil - This is like "Life, The Universe and Everything" There is no doubt that health equates to wealth in many societies. So much research relates poverty to ill-health and in this respect it's the poverty and life-style link that results in increasing morbidity. We can't rule out poverty but we can start to address equity of access to health care, at least we can in the NHS (Not in the American system).

If we're talking life-style then education/example and opportunity/provision is the way forward. There are more 50metre swimming pools in Paris than in the whole of Great Britain. We're better at swimming than the French, that's because they're French; but more Frenchmen swim than Britons and their rates of heart disease are way better than ours.

It's no good the government telling people to take more exercise if they've grown up not doing it, don't know how to do it and there's no where to do it. If there was a single measure we should consider, it's what the Scots are doing with alcohol, and which I've been advocating ever since it was proven beyond doubt 50 years ago that the only 2 factors which reduce alcohol related problems and morbidity is price and availability. We should charge according to alcoholic content and not discount, and reduce the number of licensed premises or restrict access to them.

Trevor - Are there major differences in the patients expectation in 2009 than when you started work as a Family Doctor and if so what are they?

Phil - There's far less demand for home visits than when I started.... more people have cars (though not that many more), education is working, patients are actually more realistic in their demands.

But the main reason is we make ourselves far more available in many different ways. 30% of my consultations are now over the 'phone. In many instances this is far more appropriate. A whole new set of consultation dynamics has become apparent. We used to be looking for body language as a diagnostic tool, but patients are inhibited in our consulting rooms and have had to drag all the way to get to you and then get coughed-over in the waiting room; how valid is their body language going to be? Patients often give far more relaxed and less inhibited consultations in the comforts of their own homes and favourite arm chairs over the phone.

We are all offering "advanced access" and it's MUCH easier to offer "same day appointments" negating the need for home visits.

People are a little more pro-active and advice-seeking, but still not as much as we'd like (the 'phone is particularly good for this).

The government is much more demanding than our patients.

Trevor - Finally and based on your experience what are three key pieces of advice you would give to a young Doctor now starting their career in medicine?

Phil – Yep – here we go

1. If you don't like hard work get out now

2. Work is what you are. It's no good having your ego first and the work as an unfortunate if necessary poor second place. Medicine isn't a job, it's not a vocation, it's a way of life. You eat and sleep and breathe and drink it; you can't deny this. It defines you, regulates you, establishes your value-bases, controls you. This is not scary at all. You have a valuable knowledge base, a good income (but it's not easy money), respect and respect for others. It is a privilege to practice medicine and to be invited and welcomed into other people's lives; value their lives and hence your own.

3. Take yourself seriously.......... but not too seriously; surely you are an important person in the lives of many patients........ But you're not family and you're not God.

Trevor - Many thanks Phil – I appreciate your words it is always a pleasure and an education to listen to you.

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