Perspectives: Go quickly, start now: a personal leadership philosophy

Context is everything. I write this against a backdrop where leadership, its presence, its manifestation, its absence and its consequences are in the spotlight both in my home country and across the world. For me, leadership is political, situational, contextual and personal. On a personal level I have functioned as a leader working within the complexity of global health for many years. Irrespective of the technical specialty in which I work, my focus has always been on organisational change (improvement) and influencing the behaviour of others. Change in this context is predicated to a large part on managerial leadership and support, and these elements have been described as critical for successful organisational performance and the implementation of quality improvement (Roebuck, 2011; Ryan, 2004). Indeed, if I consider my current context, then accelerating progress towards the sustainable development goals (SDGs) and the ultimate health-related goal of universal health coverage (UHC) requires leadership – a key structural attribute of a functioning health system – ‘If the top is not interested, it will not happen’ (Koegler, 2011).

If I were to summarise my leadership story in a Tweet, it would be something like this: #graduatenurse #healthvisitor #infectionpreventionist #MBA #national #international #president #director #charitablework #author & #consultant. My own approach to leadership is influenced by my journey and by other factors including the academic literature, a library of leadership books and the individual leaders that have inspired me on the way. My story started with a nursing degree in the last century. That then progressed to my first ward, a novice nurse with a surprisingly bold voice, convincing those more senior to me to let me lead on the development of a nursing philosophy. Bringing colleagues on board, using a typewriter to print the co-developed philosophy (co-developed with staff and patients and their families), proudly framing and displaying it at the entrance to the ward. This is nothing special and I know that many colleagues will have executed similar things, particularly of my generation – but it’s my story and it’s the foundation for everything that happened next. I remember challenging colleagues on the rituals I saw all around (Elliott et al., 2015). I quite literally digested the book by Walsh and Ford (1989) and probably recited it in my sleep. All of this I’m certain I undertook with annoying zealousness, but I think it set me on a path, a journey, and was a little bit of leadership bursting to get out. I didn’t realise it but I was challenging injustices and championing patient-centered care and the true value of nursing. And I was doing so in a position of being an outsider, at that time, and on that ward in the north of England, I was ‘the only graduate nurse in the village’. It was a stigma of sorts and I think it affected how I developed. I learned a lot.

Jump forward a few years and I’m a specialist nurse, an infection preventionist, in a big tertiary referral centre in the UK, managing a team. Another fork in the road and I decide to study for a master’s in business administration (MBA) rather than pursue further studies related more closely to the technical aspects of microbiology and infection prevention and control (IPC). This was perceived as a strange decision by some of my peers, but I was excited to learn more about how organisations functioned and the role of leaders therein. I wanted to be an effective (nurse) leader. Another decade passes and I find myself working at the World Health Organization (WHO), one of very few nurses (still the case although there are slightly more now than then) and in a relatively senior position, working alongside medical doctors. I lost count of the number of times my name plate in a meeting stated ‘Dr Storr’. I learned not to apologise for not being a doctor. On numerous occasions I was on the receiving end of a look of horror when I corrected senior medical colleagues at big international meetings to explain I was in fact a nurse. Anyhow, none of this stopped me moving forward, and over time my work has evolved to its current focus on supporting low and middle-income countries in building stronger health systems. It has also included a quest to lobby for IPC to be taken seriously beyond its echo chamber – a work in progress – trying to influence policy makers, those working in disease silos. And ultimately trying to position IPC as a fundamental component of quality care, to build a case for IPC as something that’s relevant to the SDGs, particularly goal 3.8 on UHC and quality (Storr et al., 2016). All of these things have fed in to how I have developed in all aspects of my professional life and in particular as a leader. They have shaped my leadership philosophy.

My leadership philosophy is therefore underpinned by what I consider to be my purpose in the world of work. It may sound grand, but as I’ve developed I seek to be a powerful force for good in global health, to influence others to make healthcare safer, more equitable, and of a higher quality for all people with no one left behind. In particular it’s influenced by the work of Heifitz (Heifitz 1994; Heifitz et al., 2009) and the notion of ‘adaptive leadership’. I became familiar with this work from personal interactions with Peter Pronovost – a ‘thought leader’ in the field of healthcare quality and safety. Intrigued to learn more I bought the books and set about reflecting on how this translated into my day-to-day reality. Heifitz and colleagues explain that adaptive leadership is concerned with mobilising people to tackle tough challenges and to thrive. My approach is also based around the central idea of a leader as a principled, authentic visionary – one who inspires others by acting as an exemplar. At its core are integrity, humility and empathy. It also draws on a number of theories including transformational leadership (Boal et al., 1988; Boerner et al., 2007), performance-oriented or charismatic/value-based leadership (House et al., 2004) and more recently authentic leadership that has attempted to overcome some of the criticisms of the former (Michie and Gooty, 2005). Boal et al. (1988) describe the impact that transformational leaders have on the behaviour of others ‘lift(ing) ordinary people to extraordinary heights’. Transformational leaders act as role models, are respected and trusted, promote self-efficacy and provide meaning and challenge to the work of their followers (Boerner et al., 2007). They galvanise followers around a vision of a better future (House et al., 2004). It’s the vision part of this style of leadership that I like – transformational leadership per se coming in and out of fashion (and not without its critics). Lilley (2017) got it spot on when he said that leaders are ‘visible, have a vision and share it often’. So if I had to write my own vision statement it would be something like this. My vision is to inspire others through my actions and beliefs as an ethical humanitarian, in particular to empower others to believe in their capability to surpass their wildest expectations and to see their power as agents of change and improvement in a healthcare context, to improve the quality and safety of healthcare. My overriding purpose is to continue to be abundant, to engage others in realising dreams through inclusivity, togetherness and always with an eye on pursuing equity and social justice.

As well as having a personal vision, in recent years I have been stimulated by some studies of leadership, sat down and considered my own core leadership values, and these also inform my approach to leadership. My values in particular are influenced by recent literature on the cultural elements necessary for sustaining high quality compassionate healthcare (Dixon-Woods et al., 2014) and the criticality of understanding one’s own values and emotions (Michie and Gooty, 2005). My five core values are as follows: (a) I believe in social justice and that a single individual can shake the world gently (quote adapted from Mahatma Ghandi); (b) I believe in tolerance and respect for others in the pursuit of equity in healthcare – everyone is worthy of being cared for with compassion as a human right – no one left behind; (c) I believe in the power of collective action and teamwork, grounded in trust, in the pursuit of effective, safe high-quality healthcare; (d) I believe in ethical humanitarianism (actively engaging in the promotion of human welfare and social reform); finally, (e) I believe in humility, the power of listening and the capability continuously to reflect on one's actions (Quinn, 2004), balanced with inner strength and belief, as a prerequisite for self-improvement.

I end this reflection with a more recent leadership experience that solidified all of the theory I had been carrying around within me. I have always wanted to challenge and change things in a positive way; especially the status quo. As a younger, more novice nurse perhaps looking back I was too zealous but I don’t regret a thing. Shake it up. Make people think. We should never stop doing that. More recently I was president of a 2000 member-strong charity – the Infection Prevention Society (IPS) of the UK and Ireland. I headed up its board of directors and this role for me was all about the realisation of the power and influence of leaders as agents of positive change. I realised I could work with the board and the members to help transform the organisation and I did this for a short time. In this time, I tried to support the society to become, and be perceived as, a force for good. It was a wonderful experience of putting into practice some of my leadership principles. In particular, this experience was about moving quickly, and drawing on all of those academic change management principles I’d digested over the years. The presidential role lasts 2 years (with 2 years as vice president). Time was limited and acting slowly was not an option – we had to create that sense of urgency (Dixon Woods et al., 2014; Kotter, 2007). We had to convince the members that change was vital for survival. First, we asked a series of questions: what was the overriding vision and mission of the society, what had it achieved in the last year and where was it heading in the next 5 years? The answer to this was simple – no formal vision and no formal plan. Under my influence the board simultaneously invested time listening to all members – what did they want? They told us, and over the coming years we listened. It was that simple, but it took a certain kind of leadership. The approach has been written up and makes interesting reading (Storr et al., 2012). Here are some snippets. To win over the unconvinced a number of things took place – the survey acted as a catalyst to generate the evidence for change. It helped to craft a manifesto, a mantra, a script to sell the need for change. I convinced the board and the members that we had to ‘reinvent’ the society starting with co-developing a fresh new brand starting with a new logo. I implemented a weekly communication with all members, directly from me, that is, a personal touch. I started monthly drop-in sessions for members to connect directly with myself and the board. For me, success hinged on making the president role come to life – to be a visible, listening leader. We co-developed core values for the board to act on, as the standards that would drive all of our actions and nurture a previously absent (in my mind) sense of accountability to the members. I personally tried to lead by example. To engender in all members the unique influence they had over the million and a half people who worked in health and social care in the UK and Ireland, and therefore ultimately over the people who accessed healthcare – to make it focused on the impact we had on patient’s/people’s lives. I knew that success would be the execution of the strategy and its sustainability beyond my 2-year tenure – setting the stage for the next president and the next and so on, to give a solid long-term purpose to the board’s work.

What I learned from this experience were three things. First, that respect and reputation go a long way in convincing others of the need for change. Part of my success was that the board believed in me and they believed in me because I had a track record. Second, that the belief of the board (and ordinary members) gave me the courage to grasp the opportunity to transform the organisation – they made me feel that anything was possible. Third, that a mandate for change is critical – gathering evidence and listening to people made the difference between success and failure. To the virgin leader, what I have to teach is simple – it’s all about the planning. But paradoxically, I would also emphasise that it’s equally important not to be too rigid and ‘over plan’. Hold on to a small number of what you consider critical things you want to achieve and be prepared to listen and change direction. I did come across a number of organisational constipators who resisted change at all cost. I listened, but I let those around me drive the change forward using the momentum that had been generated through the manifesto/mantra and the member feedback.

The belief of others was ultimately what made the change possible and successful. If someone else believes you can do something, even though you may doubt yourself – that can make all the difference between stopping and carrying on. The belief of others coupled with your own inner passion for change is a perfect combination for success. And my own belief and how I sold this was critical. I built a compelling case for change and articulated that case in a calm and systematic manner – I developed a script and stuck to it. I made it clear that the benefits of the change were that as a successful society we could change people’s lives. Indeed, this emerged from the vision that was co-developed across the organisation.

Ultimately, what I’ve learned over the years is that to make an IPC programme work, in the largest, most highly specialised hospital or in a small remote rural health post, requires leadership. In particular it’s about making sure that we can influence the right people to make the right things happen. Communication is key to this. To make an impact and to change people’s lives, whatever model of leadership we aspire to, must be translated into leadership actions – ‘the messages that leaders send about their priorities are communicated more powerfully through their actions than their words’ (Dixon-Woods et al., 2014). Informed by Covey (2004) and Bradberry and Greaves (2009) I reflect on my leadership approach at least each year, and even have a structured action plan to help me develop further as a leader with strong emotional intelligence. A clear, time-bound plan has helped instill a sense of urgency that guides and supports how I live out my leadership philosophy in the real world. As Berwick (2004) articulates perfectly ‘go quickly, start now – delay is waste’.

Biography

Julie Storr originally studied for a degree in nursing at the University of Manchester before specialising in infection prevention and control (IPC). She is co-founder and director of S3 Global and currently supports a number of WHO teams (e.g. quality, water, sanitation and hygiene and antimicrobial resistance). She is on the steering group of Healthcare Information for All (HIFA), a trustee of Peoples-Uni and an honorary adviser to the Tropical Health Education Trust.