An advertising friend of mine (Andy Cridland) and I, were having dinner the other day. We got talking about my post on the Eurostar and Giselle. I was talking about how advertising theories and behavioural economics can be related to medicine. He said “you need to watch Simon Sinek’s TED talk!…” So I did, and it changed my outlook on leadership.

Leadership is a term we use commonly in medicine. It gets banded around on the shop floor, in teaching sessions, in simulation and in interviews. There are whole faculties devoted to it. I found that when you go onto their websites, there’s so much information, I was getting confused. I want to talk about leadership in a different way. I want to relate Simon Sinek’s talk to how we behave in the NHS and more specifically the ED.

If I ask you: “Why would this ED want to employ you?” or turning it on its head, “Why should this Registrar come and work in your ED?” How would you answer them?

I bet most of you would say something like: “I’m a competent and caring doctor because i’ve done such and such. Here’s my portfolio of evidence and I would be a great asset to the team….” Its a stock answer and its a bit “meh”.

Sinek says:

“all the great inspiring leaders and organizations in the world, whether it’s Apple or Martin Luther King or the Wright brothers, they all think, act and communicate the exact same way. And it’s the complete opposite to everyone else.”

WHY, HOW, WHAT.

That is why some leaders can inspire and others can’t. Everybody in the NHS or any organisation knows WHAT they do. Most people know HOW they do it. Usually through systems and processes in the Trust/ED etc. Not many people know WHY they do what they do. Sinek isn’t talking about “getting results” like making patients better. He means, “what is your cause, your belief?”.

Why do you get up in the morning to go and work as an Emergency Physician? I see more than a few junior doctors and EM Consultants burning out and stressed. They’ve lost their “why” or perhaps never knew it in the first place.

People/ organisations usually say what they do, how they do it and then why they do what they do. “Hi, we are a great ED with amazing doctors…come work for us…” Its uninspiring. Think about this. Apple and Dell both are equally equipped to make great computers. Why, then, do Apple sell more products? Why do people buy iPods, iPhones and iPads and why did no-one buy Dell’s MP3 players? Yet Dell make perfectly good, high quality products.

“People don’t buy what you do; they buy why you do it…”

This is how Apple get you to buy their product:

“Everything we do, we believe in challenging the status quo.We believe in thinking differently. The way we challenge the status quo is by making our products beautifully designed, simple to use and user friendly. We just happen to make great computers. Want to buy one?”

WHY, HOW & WHAT. Not what, how and why.

If you don’t know why you are an Emergency Physician, you can not expect others to follow you and be part of what you do. If you want to hire people just because they need a job, they will work for you because of the money. However if you want to hire them because they believe what you believe, “they will work for you through blood, sweat and tears”. They will stay beyond the end of their shift. They will go above and beyond to help you achieve your vision for the department. They will come in on their days off and they will for example support the junior doctors strike, by staffing the ED to ensure patient safety is maintained.

Perhaps one of the greatest examples of believing in someone’s cause is that of Dr Martin Luther King. Sinek explains how Dr King managed to get 250,000 people to attend his speech in Washington in 1963. How? There were no websites to check or any invitations sent out.

He didn’t tell people WHAT needed to be changed. He told them WHY things need to change. He told people what he believed in.

“I believe, I believe, believe…”

Those people then believed what he believed. Word spread.

“And people who believed what he believed took his cause, and they made it their own, and they told people. And some of those people created structures to get the word out to even more people. And lo and behold, 250,000 people showed up on the right day at the right time to hear him speak.”

Remember it was “I have a dream….” not “I have a plan…”

Politicians, like the Secretary of State for health in the UK, have a 23 point plan. Its not inspiring. There are two types of mentors in medicine. Leaders and those that lead. Leaders are people in authority and hold powerful positions. Those who lead, however, are people who inspire us. They can be organisations as well as people. We follow them because we want to follow them.

“We follow those who lead, not for them, but for ourselves. And it’s those who start with “why” that have the ability to inspire those around them or find others who inspire them”.

If you get the environment right, like your ED or ward, the team members will have the capacity to do incredible things. We’ve all asked people “Why did you stay 3 hrs beyond the end of your shift?”. One of the most common answers is “They would have done the same for me…” I remember starting a shift at 7am and finishing at 1am instead of 7pm. It comes down to having an immense sense of trust and togetherness with others you work with. Just as the recent Paris attacks demonstrated. Read the sobering Lancet article on how the medical services did an incredible job in handling it.

But trust is a feeling not an instruction. Telling someone “trust me…” doesn’t mean anything unless that person believes in what you are doing. You need to create and harvest that. Its coming up for the new F2s to start working in the ED next week. Make a special effort to tell them WHY you have become an Emergency Physician and WHY you work in your particular ED.

I’m Neel. I became an ED doctor because I get to give life saving treatment everyday to patients that need it. I do this by working in a department with fantastic colleagues (consultants and juniors) who I believe and trust in. They give excellent and high quality care to their patients. They and I do this 24hrs a day, 7 days a week and 365 days a year. #notsafenotfair #iminworkjeremy #juniorcontract

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