This is the fourth part of the BMJ Leader blog series written anonymously by “Magical Meander”, a medical manager working in the NHS, to help align perspectives and build understanding of medical management across these two professions.

One of the hardest aspects of managing colleagues is understanding the nuanced balance between factors that contribute to poor or challenging performance, supporting clinicians and the need to keep patients and colleagues safe. In part this is made harder because we all have our own emotional reactions: disappointment, concern, frustration to name but a few. COVID-19 has reminded me that at the core of doing this well is the need to find the sweet spot between looking for the real reasons for behavioural change in colleagues and then dealing with them empathetically and equitably. It has also made me aware that part of the skill to this is really looking at issues and observing things, and being curious and asking questions about people’s lives not just making assumptions. Perhaps though at its core COVID-19 has made me find time to actually do both of these.

COVID-19 has led to all sorts of new habits. The healthiest of mine is running regularly. Almost every day at the same time I go for a short painfully slow run. It’s my time to think and watch the seasons pass: blackberry picking has shifted to conker collection. The run has taught me how rarely I actually look at things properly. To misquote Sherlock Holmes: “I see but I do not observe”. It was about a month ago I realised that a number of the small roads I run past, in an area I grew up in, where I have lived most of my life, were named for famous English artists. How could I not have seen this before?

Whilst on a run I reflected on how this spills over into my hospital work: when confronted with a colleague who has shouted at colleagues or refused to support their team the first reaction I usually have is how to pick up the pieces and then identify how to move forwards. I have to remind myself to start to notice the subtle cues that might lead me to the answers around why this has occurred, whilst supporting solutions to mitigate the impact.

So I reflect I need to look better. But I also need to emote better. To be curious. Whilst running again: a few months back I began to be imperceptibly aware that I was exercising at the same time as other regulars. In particular an older man who cycles the route I run. Gradually we have started acknowledging each other, a wave or a shouted hello. If I don’t see him now I wonder why not. For some reason these gestures are connecting. Others I come across are out walking dogs, or a few seem to emerge from their cars daily and give me a sense (maybe untrue) that they are living in their cars. All of these collisions of worlds and lives made me start to want to understand the individual’s stories, something I am unlikely to ever achieve.

Another habit that I have started (and am sure will end soon) is driving to work. Apart from learning how truly dangerous and annoying so many drivers are. I have again found myself observing things more closely. One day on my drive through a city centre I noticed small tanker truck driving at a snail’s pace hugging the pavement. Stuck behind the vehicle I had time to notice that the tanker had a hose coming from it and holding the hose a man in uniform who was reaching up to water the beautiful if formulaic flower boxes that were hanging from lights or poles. As I finally managed to overtake I found myself irritated. Not because I was running late, but because I found the juxtaposition I had seen so galling. How could a city council choose to spend precious money on flower boxes and daily watering, when every day I had walked past banks of homeless people, huddled near stations.

All of these seemingly unconnected thoughts percolated through my brain. Then one day I mentioned the hanging basket watering to my director of nursing. Her response surprised me: it shook the scales from my eyes. She talked about the role of the flower baskets in job creation. As she spoke my thoughts jumped even further to the benefit of beautiful streets on the tourist trade and the indirect benefits. Or the effect on wellbeing of well-groomed streets. I started to question how limited the depth of my thinking had been, when I allowed my irritation to be the only thought.

So I need to look better and really see things clearly to be an effective rounded manager. But I also need to be curious and ask questions about the why, but also to accept that all I may ever get from colleagues is a glimpse at their worlds. Maybe more importantly than all of this, I need to learn to use the logical bit of my brain to dig deeper into the emotional responses I feel in response to situations at work, if I am truly to unpack complicated situations and support colleagues to do the best they can do for patients and families.

Magical Meander

Magical meander is an anonymous blog written by a medical manager working in the NHS and published every six weeks on BMJ Leader Blog.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.