Raindrops. Lightening. Population health. Porch and puddles.
Despite the tropical downpour, we had made it to the outlying health centre and looked out from the cover of the porch on to a wet and muddy landscape. The working day here starts early in the morning; we had arrived close to midday and so I thought we were very late.
The rain began to subside. Other recent arrivals included the consultant to open clinic, the dispenser to unlock the pharmacy, and the patients to receive their health care. All seemingly unperturbed by the delay and carefully avoiding the puddles – adaptable, flexible, resilient.
I spent six months in the Central African Republic (CAR) as a project pharmacy manager with a humanitarian organisation. Within my team, I introduced the concept of ‘leadership triad’,(1) where each team member could identify their role in leadership, management, and followership. This blog shares my experiences and the lessons learnt.
‘Do we complete these medical orders now, or organise our warehouse stock? Should we dispatch the remaining limited supply to the hospital, or to the clinic 12 km away?’
Some days, conflicting priorities threaten to overburden the team, calling for a more autocratic leadership approach to respond to demand and maintain efficiency. Other days, pressing activities are under control, allowing space for creativity and transformational leadership.
Leadership is contextual. I discovered it was worth identifying the times, adapting to the situational reality, and allowing my leadership to adjust to the context – of the country, the project, the team, the times.
Who am I as a leader?
In the humanitarian setting, internationally mobile staff turnaround can be high, as projects vary in duration and required skill sets. We work alongside locally recruited staff, and the least I could do in my short stint with my central African team was to leave them stronger than how I found them. The challenge was to establish trust swiftly to improve individual and team performance.
In the formal position of leadership, I could either remain a stranger or let the team get to know me – my values, priorities, and ambitions. A level of transparency in my leadership style created shared purpose and cohesiveness. In practice, we set team objectives and based team training and strategy around these objectives. They wanted to know where we were heading and what we were prioritising – I wanted to know how they were following and understanding the organisational vision. Their feedback came more readily when they received feedback on their feedback! I had set up a transparency loop, their ideas became forthcoming and fearless, readied for discussion and decision, and my feedback explained if certain ideas were shelved (not simply ignored) or implemented.
What to say, or not say?
Information can sometimes stampede, trickle, metamorphose into something else or get completely lost through the delicate art of communication; especially with the complexity of a multilingual, multicultural, cross-cultural setting.
Towards the end of a meeting conducted in French, I was expectantly waiting for the concluding summary to help clarify what the next steps were. Instead, a ‘et voilà!’ accompanied by a hand clap from the speaker marked the end of the meeting. I left the meeting mildly confused and blissfully unaware of the expectations placed on me.
In this situation, information between speaker and intended receiver had been lost. Admittedly, this could have been due to my far-from-perfect grasp of French, or due to the much more interesting and exciting topic of communicating in high-context versus low-context cultures. In this higher-context culture, I may have been expected to imbibe a ‘to do’ list that was not explicitly outlined, which to my lower-context British culture was overly cryptic. A similar example is recounted in Erin Meyer’s book The Culture Map.(2)
During my time in CAR, the above is one of many situations where culture affected communication. Through mishaps, I became more adept at asking for clarification in meetings; so much so that I became the meeting minute-taker!
Ways of management
The leadership triad emphasises the dynamic interplay between leadership, management, and followership. This interplay can be liberating, as one can shift between roles and empower individual team members to do the same within their scope of practice.
On starting a previous job, a year and a half ago, my then-manager asked me: ‘How do you like being managed?’. And so, overseas, as manager of a new team, I asked them: ‘How do you like being managed?’. I received the same answer I had provided my manager a year and a half before: a blank stare.
They, like me previously, did not fully understand the reasoning behind the question. I became aware that I managed based on how I like being managed, but discovered that some in the team responded well to me checking in on them more regularly than I would have liked to have been. I realised that one style may not suit all. I learned to move between parts of the leadership triad and through different styles of leadership and management. Together with the team, we became aware of what worked well and found the balance between undeviating orders and open suggestions, between managing activity-by-activity and fostering higher levels of autonomy.
Who follows whom?
I learned the value of followership, taking on direction from others to know how best to share my perspective or to respectfully disagree with my superiors. Likewise, within my team, there were times when I would slot into a followership role as my colleague would handle a situation in the locally-spoken language, or deal with a situation familiar to them.
Team members had weathered storms before my arrival, and as they learnt new aspects of followership – like improved work ethic or courage to put suggestions forward,(3) I too realised the need to step into that role to learn from their experiences and in circumstances follow their lead. It took humility and appreciation for what just is in that different context. It was tricky at first, but it soon became a privilege to be the one to ‘watch and learn’.
Inspiration for this blog originated from a place 3,500 miles away from the UK, and yet in the UK too, one never knows when or for how long the rain will fall. Within all leadership challenges are lessons: on adaptability – to act in accordance with the times; on flexibility – to move plans around the puddles; and on resilience – to weather this storm, and the next.
I continue to learn, in a different country and humanitarian context, and am keen to hear if any of the above resonates with your leadership experiences – humanitarian or other.
- McKimm J and O’Sullivan H. When I say… leadership. Medical Education. 2016; 50: 896-897.
- Meyer E. The Culture Map. PublicAffairs, 2015.
- McCallum JS. Followership: The other side of leadership. 2013. Available from: https://iveybusinessjournal.com/publication/followership-the-other-side-of-leadership/ accessed 14 August 2023.
Eleanor Harvey is a humanitarian pharmacist. She graduated from the University of Nottingham and gained NHS hospital experience at Bath (Pre-Registration year), Bournemouth (Rotational and Specialist Cancer and Nutrition, becoming an Independent Prescriber) and Southampton (Critical Care). Subsequently, she worked for the UK Health Security Agency as Chief Pharmaceutical Officer’s Clinical Fellow – part of the FMLM leadership scheme; she led projects, co-led workstreams and published research on antimicrobial stewardship and infectious disease outbreaks. Now she is an Editorial Fellow for BMJ Leader and works overseas as a healthcare professional in the humanitarian field. She has a keen interest in leadership and management, and in emergency preparedness and response.
Declaration of interests
I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: None