Leaders, have we lost sight of the game we are in?

Today is the 70th Anniversary of the NHS. It represents a cultural ideal. It is hailed by many as a fantastic achievement, but are we doing it a disservice?

Let me ask you a candid question, do you trust your leaders? When the healthcare team looks to those in charge, do they see a leader or do they see a manager of people? Some may feel they are leaders, but do they understand the fundamental role of being a leader?

What is a leader?

If you ask Simon Sinek he will tell you that leaders are not there to ‘be in charge’, they are there to take care of those ‘in their charge’. A leader’s role is to provide an environment that cultures safety, freedom, support and a place to be creative. A leader’s role is not to chastise or punish when things aren’t ‘meeting targets’.

Much like a parent, a leader should try to understand why those in their charge are struggling, rather than berate, belittle or discipline them. A culture of openness and honesty, of learning from mistakes is the heart of this and is possibly one of the fundamental reasons that the GMC’s recent involvement with overturning its own tribunal decisions was such a mistake.

If you don’t feel safe to admit you made a mistake, admit that you cannot do something, that you are having a hard time, that things aren’t working how you expect them to, how does that make you feel? Do you give the job your best, or do you retreat, hide away, lower you head and toe-the-line, disgruntled and unappreciated.

Simon makes another fantastic point, and that is that being a leader is hard and comes at great personal sacrifice. What he describes feels at complete odds with current leadership culture:

  • When things go right, the leader does not take the praise, that should go to everyone in the team
  • When things go wrong, the leader takes full responsibility

Just reflecting on that for a moment, don’t take the praise, accept all the responsibility. Are those the leaders we have at the moment? Are those the leaders we deserve?

The most important take away message regarding leadership and the NHS. The message from NHS leaders and the government is about ‘putting patients first’, they put patients first, above all else. But is this what they should be doing? I would argue that the people in their charge, their staff, are the most important people to them. And the staff, feeling well supported and nourished by their leaders, will put the patient first.

Game theory and the game we are in

Thinking about game theory in economics we can consider finite and infinite games, and Simon again helps with the explanation:

A finite game has known players, fixed rules and objectives that have been agreed upon.

An infinite game has known and unknown players, changeable rules and boundaries and serves only to perpetuate the game.

In a finite game, you play to win, but in an infinite game there are no winners and losers. So what game are we in. The current government appears to be playing a finite game, they play for short-term wins, votes, financial savings. The NHS has always played a infinite game, it has played to last, but something has changed, we have become threatened with the introduction of privatisation and our leaders have been shaken. The NHS now focuses on the short-term winning and losing and has forgotten about its long-sighted vision.

So how do we, as the NHS, win?

We don’t play to win. We don’t focus on the competition, we focus on the future, the long-game, we focus on competing with ourselves, of improving the service we provide day in, day out.

Privatisation will come and go, as finite businesses do, governments will come and go on their 5 year cycles. By focusing on the future, on what we do and ignoring the competition we take back what is truly great about the NHS.


So the NHS needs a cultural change, we need the leaders we deserve, who play the game the NHS needs.

This 35 minute video below of Simon Sinek and I strongly recommend you watch it, it really is worth the time invested in it.