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LONDON CLINICAL LEADERS NETWORK LEADING FOR HEALTH MASTERCLASSES SPEAKER: PROFESSOR ADRIAN FURNHAM 27 February 2009 Presenter: The Leading for Health Masterclasses are part of NHS London's vision of world-class healthcare for Londoners. Anyone working within the NHS in London with an interest in leadership has been invited to learn from inspirational speakers. Each podcast in this series focuses on one of these speakers. Today, Professor Adrian Furnham. Professor Adrian Furnham: 'Change' is a word which brings up two emotions: boredom and anxiety. Anxiety because most of us don't like being changed. Change hurts; change is difficult; and the older you are, the more you resist it. And it's boring because people talk about it all the time. But we are living in a changed world – a dramatically changed world, a world changed by technology and by people and so forth. And we live in a wireless world – in a 24/7 world where you don't have company headquarters; we have flatter companies; where you don't have local and global markets – you have web-based everything. You have e-excitement or you don't have e-excitement – you now have e-fatigue and, we are told, instead (in this country) of having a surplus of youth, we have a surplus of wrinklies. I think, however, we do believe (most of us) that the world is very different from what it was ten years ago and much faster and much more complex. Of course, ten years ago they thought exactly the same thing about the previous ten years, and even in the 1950s they thought that about the 1940s – so, I don't think we must go overboard on this. Yes, I think the world is becoming more technologically

interconnected; I think people have different expectations; I think they have a different attitude to work and to leisure – and that these changes do happen gradually, but it does seem, I think, at least for managers, that things are changing quite rapidly.

2 There are those who quite like change and there are those who quite like people changed. They believe that you change organisations by changing people. Well, as a psychologist, I don't know how easy that is to do. If you think people change much, or change easily, I recommend you go to a school reunion. [Laughter.] You will notice that they are wider, wrinklier, and greyer – but much the same. The bully is the bully; the joker is the joker – whatever. Of course people change. They change with trauma – and many of you in medicine will know that – that, if you have had a brush with death, this can have a very powerful effect. Sometimes they change with therapy. The question is, what things lead to change; when is it easier to do; or when does it often occur? Political forces have a very powerful influence on how organisations exist. If the law changes, things change very dramatically. The world is a small place; there's

international competition; people are able to travel more; their expectations are different, and organisations have to respond to this if they are to survive, even if they are organisations which are government-sponsored organisations. They know that people now have much more choice than they ever had and, of course, they can vote to influence the political decisions that will ultimately affect the organisation. Some situations (some business situations) are reasonably easy to change: smaller scale, internally originate, less serious in their implication, quantifiable objectives, technically oriented, generally involve relatively few people – all these things can be done. These situations are hard as opposed to soft – not as opposed to easy. In fact, easier to change. But alas – and you can't think of a more complicated … I don't think there is any complicated organisation in the world as complicated as the NHS. I'm sure many people say there is no such thing as the NHS. There are multiple organisations; there are multiple cultures – and I'm sure that is true. How you change an organisation that big, I think, would never happen at the top. It happens lower down. People will change parts of the organisation and therefore the organisation will change up, rather than down. Freud had this wonderful analogy of somebody in the bath grasping the soap – trying to grasp it – and the more you try and grab the soap, the more you cause the water to become cloudy and in doing so, therefore, don't see the soap. It is one of those sort of

3 analogies. I think change in big complex organisations is much harder and, therefore, from leaders requires much more. Different strategies that leaders will try: their preferred strategy is a function of their personality; a function of their values; and a function of the organisational culture. The idea here is that we are having to go through this stuff, so we need to talk about it; we need to get together and have a seminar and a meeting and an away-day; and stuff! But it tends to be conflict-averse; led in a sort of human-relations school. You can express your anxieties, but not your anger, and you're not here to talk about why we've got to do this bloody stuff, but rather how I feel about doing this stuff and it tends also, for some people, to be time-wasting. You know, it is very easy to have meetings about worrying, about the future and worrying about change, but there comes a time you've got to stop having this stuff! You've got to do the emotional palaver and then get on with it. The political strategy is commonly used. The idea is this: you know, as a leader, that, in a group such as this, there will be three or four people who will have influence – they will have positions of power – and there is probably no correlation, by the way, between the official structural power whether you are director of this or head of that, and whether you are powerful – and I get hold of you and I flatter and I charm and I cajole and I give you a knighthood – and 'stuff' – and then you deliver the change because, in a sense, you become my henchmen or women. Now, I'm expressing it rather too strongly, but this is the game. The game says, "This is the political strategy." The political strategy says, "We need to charm those with influence because they will carry the message further." It can destabilise the organisation. But the worst thing of all, you notice, is that the leaders for change are saying, "Now, what we need in the organisation is, we need 'transparency'. We need it all to be open." And then what do they do? They do this, which is exactly the opposite of transparency. It is deviously political. However, of course, what leaders need to know is that they do have, in their followers, those with more influence and so that would be, I think, quite a good strategy with caveats.

4 The economic strategy: 'homo-economicus'. You change people's behaviour by

incentivising them – or de-incentivising them. It can, at the moment, become rather interesting. We read about it all the time. How can you use money? It's 'homoeconomicus'. What we know, I think, in psychology, without any doubt (I've written two books on the psychology of money – I'm very interested in it), that money is not a motivator but, my God, is it a powerful de-motivator! If you get it wrong, you hack people off viciously! If you get it right, it doesn't have that much power. Do you remember we used to have this thing called 'bonus time'? The more furious you ever see people is when they've only got 1.2 million and some other character has got 1.3 million – very, very cross-making indeed. We also know that this approach doesn't do emotions. 'Homo-economicus' sees us as motivated entirely by money – and you know that's not true. Like job titles … I don't know – you must have been restructured and had your job title changed. Job titles are very important. Who you are is what you do. There's a joke that if an extrovert comes to you with a good idea and you want to put them off their good idea, you say to them, "Go and write me a report." If an introvert comes to you with a good idea, you say, "Come and do a presentation." All reports that land on your desk are out of date. Baboom! And so some academics say, "Well, let's update it." So you never have to make any sort of decision. You can change things by engineering. You re-engineer the process and, of course, in medicine you watch how the patient goes from here to here – there is a process – and what one re-engineers is how he or she goes to these various places. Now, you can re-engineer through technology, you can re-engineer through architecture. I mean, people have said, "Why have we got a two-party system in this country?" The answer is, because of the way the House of Commons is built! It's called 'antiphonal'. We have an Hegelian model: thesis and antithesis; an inch of synthesis. So we have Blue Team and Red Team set up in the House of Commons, antiphonally. It's architectural determinism.

5 Well, some people say, "You change a building, you change how …" Not whether they've got cubicles, but you physically change the environment and you physically change the culture – and it's true! And then, of course, finally, there's the sort of military confrontational strategy. You do brute force; you mobilise anger; you make people confront – and that, sometimes, is done. I think what people tend to do is they tend to have one strategy. People said if the only instrument you have is a hammer, you'd treat everything as if it were a nail. I think one needs a variety of techniques and approaches and, by using them at the right times, then you can move the individuals around you and, ultimately, the culture of the organisation. I'm going to say a little bit about individuals. What we know about great leaders is they have certain personality characteristics. The first one is stability. The opposite of stability is neuroticism – and the issue is around stress. What we're told about stress is that stress comes from the outside. You are stressed by your nasty boss; your demanding patients; and all the rest of it. Well, that's half true. Stress also comes from the inside. We all have stress at work – that's not very interesting. The question is, why some people are more stress-prone than others – and, of course, how you learn to cope with that stress. We know that leadership roles are extraordinarily stressful. We know that leaders suffer from a whole range of psychosomatic illnesses like irritable bowl and migraine and stuff. The question is how vulnerable they are, and that's what that measures. Also, people don't have to be extroverted, but they have to look like extroverts. You've got to become a socialised extrovert. Why? Management and leadership is a contact sport. You don't sit in your office as you used to, fiddling around with that which you learnt to do at university. You go out there and do it! Now, if you're an introvert it is not as easy, but you've got to learn to look extrovert and do the things that come easily to extroverts.

6 You need to be hard-working and conscientious, and you need to be open to new experiences. Some of the managers I know – some of the leaders I know – have one very powerful characteristic we haven't mentioned. It's courage – because, when you are in the business of change, the probability of failure is very high. I think there are different types of failure. There's the courage to fail; there's

interpersonal courage – the courage of telling people the truth is the courage of confronting poor performance. The leaders that I have met – I have met very talented and clever and warm people – but they have never confronted poor performance and that lets everybody down. The number of organisations, the number of … And it is always big strong chaps, I might add. The more big and strong and chap-like they are, the worst they do this stuff. They don't have that courage, partly because they don't have the skill. There is moral and there is ethical courage. There is courage about, there is right and there is wrong – and, yes, there is a line in the sand – and Enron never got that right. It's very easy to slip at certain points – particularly when there is change, particularly where there is a lot of money involved, particularly where there are political careers involved. All leaders have to grasp change. They have to be pro-active and they have to be reactive. If I leave you with one message, I think it's this: there are strategies. There are strategies that are culturally acceptable strategies and that there are personal preference strategies – and I have gone through a few of these. The leaders who deal with change best use a mix of these strategies and they know when to use them and they know when not to overuse these strategies because, from a variety of use of these techniques, then, I think, one can push and continually push ahead and reinforce and keep constant people's changing behaviours to fit the situations they find themselves in. Thank you. [Applause.]

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