Weeknote: 20 to 23 September 2022

Stone relief sculpture above the doorway of a 19th Century building. The carving depicts a winged human figure plunging a spear into the jaws of a scaley dragon that looks a bit like a winged lion
Archangel Michael slaying the Dragon above a doorway in Headingley, Leeds

What did I enjoy?

I’m enjoying seeing the long-awaited work on urgent and emergency care (UEC) strategy coming together. It’s taken a long time to get to this point, and I’m especially proud that my team’s input is threaded through the whole document, not confined to the “digital enablers” section. Some work we were already doing to understand patients’ experiences of UEC has proven particularly timely. As ever, the draft grew unwieldy because we had so much that we wanted to share, but ultimately it needs to be simple and focused to make an impact. On Friday afternoon, I put on my headphones, printed out the draft of the digital chapter, and gave it quite a drastic prune. I hope the colleagues whose important words I had to cut will forgive me. The long version won’t be wasted. We’ll find other ways to make use of it.

I took Wednesday morning off from my NHS work for the annual general meeting and board meeting of Leeds & Yorkshire Housing Association, where I’m a non-executive board member. The discussion covered a wide range of topics, but never far from board members’ minds were the pressures looming for our customers, who include some of the poorest and most vulnerable people in society. A couple of board members who have been most impressive in bringing the customer’s voice into our conversations are leaving the board, and we need to make sure we keep people at the heart of our decision-making now more than ever.

What was hard?

Around midweek, I had to move quickly to raise my concerns about a change that had apparently been discussed for quite some time at a senior level, but not with the people most directly affected – including me. It seemed like a classic case of trying to optimise one part of a complex system, but in the process undermining work that was already in progress elsewhere. The fact that I know and trust the people involved made it all the more disappointing that they had not thought this through. Some of the other people who I would have wanted to involve in my response were on leave, so I have had to trust my instincts and propose something that I think will work better for us all.

There was also a meeting of the informal group of digital profession leads that I have been convening across our soon-to-merge NHS national organisations. Colleagues shared some progress but also some common frustrations about things that might be leading them further away from the conditions we know are essential for modern digital delivery. We agreed to revisit the “hopes and fears” board we made in our first meeting late last year, and see which of them have and have not transpired.

What did I learn?

The next morning, I was reminded that sometimes it pays to channel frustration into making good trouble. After reflecting on why these difficulties were recurring, I emailed some important people and asked them to make a specific change in the way they’re approaching things. I got a quick response from one of them, and a lovely call from another offering to work together to fix it.

What do I need to take care of?

In retrospect, it’s a red flag that a couple of people told me I had been “brave” to send a message to some national directors. It didn’t feel especially brave to me. I’ve hesitated longer over some takeaway choices than I did on hitting the send button. But if it’s considered brave for me – an executive senior manager in the organisation – to contact people a couple of pay grades higher than me, what must it feel like to more junior colleagues, or people from minorities who don’t start every working day with the invisible knapsack of white, male, middle-class privilege that I was born to? Surely it’s a precondition for psychological safety that no one thinks it’s brave to call out what’s wrong.

This week was hard – partly because the challenges I’ve described above landed in a week when my work was compressed into only 3.5 days. I was grateful to a colleague who directly asked me on a one-to-one if I was OK as I raged about the situation. I hope I would do the same for someone else.

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