Once upon a time in a Trust far, far away I met an aspiring leader called Sue.  Sue was trying very hard to affect change and do something good.  She was very focused on improving the quality of the service, making it safer, more efficient and improving the patient experience.  But Sue was facing a lot of obstacles and was being frustrated by the leaders and management in the hierarchy above.  She eventually started to doubt her own leadership abilities, so I did two things.  Firstly I gave her a copy of “Leadership Plain and Simple” by Steve Radcliffe so we had a common language and framework to discuss leadership.  Secondly, I did something I had wanted to do for a long time.  I did a quick survey of the staff on the ward to see if they could identify the “leaders” in the organisation.  I asked everyone from the FY1s to the porters, cleaners, nursing staff and registrars.

Only 3 people could name the Medical Director and only 3 could name the Chief Executive.  The same number said they would recognise either person if they walked into the ward right now.  In contrast the majority wrongly identified Sue as the “leader” of the ward/unit.  I explained to Sue that this illustrates the difference between those in “leadership positions” and those who show leadership.  Those in “leadership positions” are chosen by the hierarchy and may or may not show leadership, whereas those who show leadership are chosen by their peers and colleagues as “de facto leaders”.

In Sue’s case, she was the one driving change, and she was the one who would take it upon herself to act on the problems people brought to her.

“Leadership is solving problems. The day soldiers stop bringing you their problems is the day you have stopped leading them. They have either lost confidence that you can help or concluded you do not care. Either case is a  failure of leadership.” – Colin Powell

Just as Colin Powell explained, people turn away from those in “leadership positions” who fail to show leadership.  Equally people turn towards “de facto leaders”;  the people they bring their problems to, and who solve them (or at least try to).


if you want to see who the leaders are in an organisation, look to see who people are following.

Think about some great leaders from history such as Martin Luther King and Ghandi.  Nobody made them leaders.  They WERE leaders, chosen by the people who followed them, because they showed leadership.

I like Tom Peters’ term – “Boss-as-CHRO: Chief Hurdle Removal Officer”.  Tom talks about this in the following 2-minute video.

In his book “The Little BIG Things” Tom Peters also argues that, “the only source of innovation is pissed-off people!”  He recommends, ” bite your tongue and cherish such misfits”.  But is our public sector health service built to enable this?  With the current focus on how we can deliver sustainable, high quality healthcare within the financial constraints we hear much talk about the need for staff at all levels to show leadership.  However, if those emerging as “de facto” leaders in a Trust are disruptive and uncomfortable for those in “leadership positions” failing to show leadership, how will the “de facto” leaders get into “leadership positions” and gain the freedom and responsibility to fully realise their leadership potential?  My concern is that those in the hierarchy will see them as trouble makers and endeavour to suppress them.  How do we make sure this doesn’t happen when those already in the Trust hierarchy interview and appoint to “leadership positions” within the hierarchy?

Photo Credit: pedrosimoes7 via Compfight cc