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I’m Domhnall MacAuley and welcome to this BMJ Leader conversation. Today I’m talking to David Pendleton, who is Professor of Leadership at Henley Business School. But he has also recently taken on an advisory role with the Faculty of Medical Leadership and Management. David, let’s take it back way back to the very beginning, because you started off with a degree in psychology in Nottingham.

David Pendleton: I’m never entirely sure why I do anything. We all have theories about it but, I’m the extremely well educated only child of completely uneducated parents. They left school at 14, neither of them had the money to go any further in school. And so, the moment they could leave, they did. But they had this belief in the power of education to transform lives. I’ve no idea where this came from because they had not experienced it and no one in their family had. I was the first kid to go to university. I was living in Nottingham at the time and I was bored with every single subject at school so I thought, I want to do something different. And having been an only child, I spent an awful lot of my time observing and being on the outside of things and I think that predisposed me to psychology, to try and understand the subject that purported to help me understand what people are like and why they do things, and what their motivations are about, and how personality works. Those sorts of fundamental questions rather attracted me. So, psychology has always been my subject. I’ve always loved it. And, although I’m a Professor in Leadership now, I very much take a psychologist’s view of leadership.

DMacA: After your undergraduate degree, you took a break before you did your DPhil.

DP: I was heading off in a particular direction, which turned out to be a bit of a dead end. I was going to do a PhD at Brunel, and worked with a wonderful guy called Laurie Thomas. And, in some ways, the origins of the Pendleton Rules are in part to do with Laurie Thomas. He had this view about addressing the good points first- “Let’s understand what people do well” And that was his view right from the start. But in those five years, I explored, the subject of kids reading to learn and also, more broadly and slightly tautologically, learning to learn; how is it that we learn to learn? And that was Laurie’s specialty. Laurie was a great guy. Generous. Smart. He had been a production engineer, but quit production engineering the moment he realized that most of the issues he was dealing with were psychological issues and he took a different turn in his career and became a professor in psychology.

I spent five years, and during that time I did a little work with Laurie Thomas at Brunel at the centre for the Study of Human Learning, and also did some teaching and went up to, what was then, Leeds Poly to do some teaching in psychology to graduate students who were going to teach mentally handicapped kids. Having done that I bumped into the group that was training health education officers and suddenly my interest in health was awakened. I just thought, this is for me. So I took a detour and went to Oxford, did my doctorate with Michael Argyle, the doyen of social skills training.

And, I definitely took a deliberate view of this because Byrne and Long had just brought out their book on “Doctors talking to patients” , and they had been using audiotapes. And I thought, let’s see what we can do if we take a video camera into the surgery, and let’s see if we can find better ways of, not just understanding what goes on between doctors and patients, but maybe helping that communication be more efficient, more effective.

DMacA: Your work on the consultation was very much part of the education of a whole generation who trained in general practice. Let’s talk about the consultation.

DP: The credit, is not mine there was a team of us. It was Theo Scofield, Peter Havelock, Peter Tate and me, and the four of us got up to a lot of mischief together because we’d been told time and again- you can’t teach people to consult with patients; they’ve either got it or they haven’t. And our view was, that can’t be right. It’s a social skill. First, you’ve got to be able to understand it and describe what ‘good’ looks like. And once you’ve done that, you can do something to help people do it more effectively. And that was the kind of pig-headed attitude that we came at it with.

DMacA: You mentioned Pendleton’s Rules earlier and they were very current at that time, but they’re still current…

DP: Well, I’ll tell you a little bit about them to start with. I was thinking about this last night and I remembered Laurie Thomas, a lovely, generous, warm, bright psychologist, who was very influential in my life. And it was he insisted- let’s understand what’s done well, before we look at anything else. So, that was the origin of it. But the second thing, is that when talking with my three partners in crime, Schofield, Havelock and Tate, they were saying how an awful lot of medical education was education by humiliation; by getting people to feel bad about the things they’d done wrong.

And, you know, I remember Peter Tate telling me about medical teacher who had said to him, “If you had an IQ of one less, you’d be a plant” and all this sort of stuff. And, we all rebelled against this and thought, that can’t be a good environment for learning.

We thought about the preconditions for learning. And so I said, I’d been working with this guy on this. We start here, we start with, “what did you do well”, and so we fleshed out those rules. And, incidentally, they almost didn’t make it into the book because we thought they were so kind of obvious, why on earth would anyone do anything else? I wrote that bit of the first edition of the consultation book, and then I rewrote it again for the second edition. But, as I say, they almost didn’t make it into the book because we thought they were so obvious.

But it’s turned out that they’re what the book has been most known for. People remember the tasks that that we wrote about. But, they really remember the rules. And, I’ve had them cited to me, not just in the context of medicine, but in the context of other professions as well. An accountant told me they used the Pendleton rules in accountancy, for example. So, it’s been fascinating the way in which those fairly simple principles have caught on. But the point of them is, and I had to write a corrective in the second edition of our book, “The New Consultation”, because people had, I think, believed that once they’d specified what had been done well and had made some recommendations on how things could be improved, that that was the feedback. But, no. For me, that was the menu. That wasn’t the meal, that was just setting out the agenda. So, what I had to write was that our task is to be as analytic and careful and forensic about understanding what’s done well as we are about what’s not done well. We need to understand in great detail how a particular good thing happened so that you can repeat it and maybe even improve upon it. And that’s the first thing I’d want to say- if anyone uses Pendleton’s Rules, please don’t think that once you’ve listed good things and listed bad things, that’s it. It isn’t. That’s just the start of the conversation. But this notion of being as forensic and analytical about the strengths as you are about things that have not been done so well, is the first corrective I had to write about.

The second was to make this a very dispassionate scientific teasing apart of what’s going on in the consultation, not to be insensitive to the way people are feeling about these things but rather to say, look, if we can stay in adult cerebral mode then, not only can we understand what’s been going on, but we can correct it without the kind of complications of feeling bad or guilty or foolish or whatever. Let’s just see it as a puzzle that we’ve got to solve. If we’ve specified what we think a good consultation looks like, how close did you get? Let’s look at the things you did well. Let’s understand them. What words did you use? Where were you at the time? How did you think of that? What was the response? What were you feeling? Let’s really understand that.

And then let’s look at the things that didn’t go so well. And when we’ve done that over several consultations, we’re then building up is a picture of what you do well. These are the sorts of things you do well, and these are the sorts of things that tend to go a bit pear shaped for you. If we can understand those pictures, then we can head off in a better direction.

DMacA: After this involvement with medicine, you went on to have a wide international career in every sector. I’m not going to ask you to go through each component, but I’d like to ask you you about a quotation which was, that you said, “ It’s a privilege, and I love it.” Tell me about that motivation.

DP: Having finished my DPhil, I got involved because of John Hasler, who is another great influence in my life. John is, and certainly was, one of the best leaders I’ve known. And I’ve known lots. I’ve known people knighted for services to this, that and the other, peers of the realm and all that. But, if I had to name the top five leaders I’ve ever encountered, John is on that list. He was terrific. And John got me involved with the RCGP, the RCGP exam, with Marshall Marinker and other people like this, people who were giants in their field. And he also got me involved in the Oxford Regional Vocational Training Scheme in general practice. That didn’t lead to a job. It led to activity and paid-for activity, but I had to cobble together a living from doing various small roles elsewhere. And then, I got married, and we had our first child and I thought, I’ve got to do something a bit more to make a decent living. So, I went to the King’s Fund College, which was a management school for the health service, and taught. I was a fellow in managerial psychology. And I got recruited out of that by a business psychology consultancy in Bristol. And that took me in a different direction. It was a pivotal role, that role at the King’s Fund, and I ended up working, effectively, as a management consultant, doing learning and development, management development, organization development, team development, executive development, all these various forms of trying to bring out the best in senior people in organizations. And what I was doing, and the way I was doing it, seemed to catch on. So, I got opportunities to go and live and work in Hong Kong for a couple of years, doing a project for Cathay Pacific Airways, meeting another great leader, a guy called Rod Eddington, who eventually came and ran British Airways and was knighted for services to transportation. I had a chance to work on four of the six continents. I haven’t worked in South America but I think I’ve worked just about everywhere else, and in just about every sphere of human endeavour, for charities, public sector, corporate sector and so on, worked in airlines and hospitals, the hospitality industry, retail, manufacturing, high tech, low tech, high touch, low touch, you name it. Because, of course, I’m completely agnostic as to the setting in which I do this. My subject is people and they’re remarkably similar wherever you go. What I love is the thought that we can make things better.

DMacA: We’ve talked about leadership. And you’ve met so many leaders. But you wrote a book entitled: “Leadership, no more heroes.” Tell us about that.

DP: Let me tell you why. When I started to look at the subject of leadership, it was about the year 2000. I’ve been in that field for about 25 years. I came across a chart that looked like a geological cross-section of a hillside with lots of strata. It had started out as a joke by a guy called Richard Pascal at Oxford, and it was a content analysis of the leadership research from 1950 to 2000. And what it shows is that, basically, the field is a mess. It’s all over the place. Things come and go. And he called this ‘Business Fads.” He thought that leadership didn’t feel like a scientific subject but like a series of fads and fashions. And so I thought, surely we can do better than that. I mean, I’m a psychologist. The notion of an evidence base and the work I’d done in medicine told me that finding the evidence base for what you’re doing is really important. So, I started to put together some ideas which culminated in a model called the ‘Primary Colours Model’ of leadership, which simply says that there are three domains in which leaders have to work. There’s the strategic domain, which is all about tomorrow. There’s the operational domain, which is all about today. And, there’s the interpersonal domain, which is all about the people that you’re going to take with you on the journey. I arrange that as a Venn diagram and, funnily enough, I ended up with seven zones similar to the seven consultation tasks, so I’ve seven leadership tasks. That wasn’t where I set out and I didn’t intend to do that, but it seemed to make good sense about what leaders have to do.

Then my colleagues and I assessed leaders all over the world against these seven criteria and what we discovered is that wasn’t one leader we ever found who was world class in all aspects of leadership. If you think you’re going to be a leadership hero, stop now. In fact, I’ve often said the fact that we didn’t find one, and I’ve personally assessed hundreds of leaders and my colleagues and I have assessed thousands, and if we didn’t find one who was world class in all aspects of leadership, it was either the world’s worst sampling error or there is something there that you have to take seriously. The first proposition I’ve got is that this Venn diagram is a map of the territory of leadership. It’s not saying what you should do. It’s saying what you have to do in leadership. But the second proposition is that it’s really hard to be good at all of it. So, what I’ve been trying to say is if you want complete leadership, you won’t get it from an individual, you’ll get complete leadership from incomplete leaders working in teams of complementary differences. Hence, no more heroes.

DMacA: When you talk about complete leadership, let’s move on to talk about Work-Life matters…

DP: When people talk about work life balance, they talk about this kind of balance between work and life. But, work is part of life. You end up with work-home balance, and work-nonwork balance. But I find that is not a very helpful analysis. I’m much more interested in the balance within your work life. That is, when people are at work, what is the balance between those things that take energy and those things that give you energy? And if you get people to audit that, they can do it. I just say to write down every element of your job and they’ll say, what’s an element? Traveling, writing reports, seeing patients, whatever it might be, each of these is an element of work and then simply decide, on balance, what’s giving you energy or taking it away. Give a score out of ten. How much does it give or take away? And you can do a rough and ready calculation to see if you are living in a world of positivity or negativity on balance. Then you can start to tweak things and make changes and make your life at work better for you, more complete and so on. And that led to a field called job crafting. So instead of fitting people to jobs, you can actually fit jobs to people and maybe get a better work contribution from people who are happier doing what they’re doing. The idea of balance at work came from a motivation that I had, just reflecting on my own life, that we give the best hours of each day and the best years of our lives to our employers. So, no wonder we’re given what’s called ‘compensation’. We are compensating for giving these chunks of our life away. So work matters.

The second chapter in Work Life Matters is ‘Work Matters’- let’s understand how and why it matters. Freud said people have two fundamental motives; one was to work and the other was to love. If it’s that important, we better make the most of what we can. My motivation has always been to try to create work environments where people thrive. With my wife, Jenny King, we created the Edgecumbe Consulting Group, and our theme was that we want to do work that helps people and organizations to thrive, not just survive. Not just to get by, but to thrive. And we also wanted to create Edgecumbe as an environment in which people could work, where we could send them away at the end of the day with a smile on their face, not careworn, not knackered. I wanted people to feel that work can be a joy. I fully understand that much of work doesn’t feel like that but, on balance, can we not make it like that? And if we thinking about leadership isn’t one of our responsibilities as leaders to create the conditions for people to do well, for people to succeed? One of them must be the conditions in which the morale and motivation stays strong.

DMacA: You’ve written so much on these themes of leadership, and you’ve had all this experience around the world, but now you find yourself back at the beginning. Because you are once again advising on health care. What are the key messages that you would bring to the Faculty of Medical Leadership and Management, based on your experience.

DP: The first one, in a sense, is obvious, but it’s really important to stress. Leadership does make a difference. The evidence suggests that it’s not so powerful that it can transform organizations on its own. But for many people, that’s exactly what it does. People work for people. People join an organization, and if they leave, its usually because of a boss that it just doesn’t work with.

Whenever I run a session on leadership, I always start by asking what are the other words that come to your mind when talking about leadership? And when I start to write them all down, they are nearly always to do with the interpersonal aspects of leadership. Occasionally you get words like strategy or plan or whatever it might be, but often it’s to do with things like inspiration, aspiration, motivation. These are the sorts of words come to people’s minds. So, leadership does make a difference. And in the current state of the health service, there are puzzles to solve, and there are problems to solve. The difference is that a puzzle is technical and can be solved. For example, how to make the health service more efficient, that’s a puzzle.

But, how do we look after the morale and motivation of people who are absolutely on the chinstrap and they’re knackered, they’re working far too many hours with far too many demands, and it’s thankless. That’s a problem. That’s a problem because people’s feelings and values are involved. There are puzzles and problems, and leadership can make a difference to both. However complex the puzzles are, that’s not where the agony is, it’s in the area of the problems. So, I want people to understand that leadership can make a difference to both.

But the second thing is, and I’ve just written a piece on accountability with Sir David Haslam in the BMJ Leader, where I’m saying that one of the problems with the health service at the moment is that it is way too bureaucratic. I want to know- what is the question to which a committee is the answer- because its probably the wrong question. What we need is people to take responsibility. With 7.5 million people waiting for diagnosis and treatment, whose job is it to sort that out? If you say everybody, that means nobody. If you say the Prime Minister, that also means nobody, because he or she can’t do a thing about it. If you say the Secretary of State for Health, that also means nobody, because he or she can’t do anything about it either. How are we going to break up the health service into smaller and more manageable pieces? And whose job is it to make a difference to that component? The problem with a committee is that it obfuscates responsibility- no one feels that it’s really their issue. If they fail, it doesn’t really matter because there are 15 other people on this committee, and it won’t be me. When you’ve got a bureaucracy, you’ve created a situation where many people can say no to a suggestion, but no one can say yes and make it happen. In any other walk of life, that wouldn’t be the case.

Who has 7.5 million people waiting on their job description? If its nobody then it’s not going to happen. What we monitor and measure tends to get done, and if we don’t, it doesn’t tend to get done. What would the components of the health sector be? Let’s say, we break it down to integrated care boards and we said to the chief executive of the integrated care board, this is your job. These are the numbers, this is where you are now, and, if you feel that you haven’t got the opportunity to make a difference, what are the obstacles that we need to get out of your way? That might be the Secretary of State’s job but, if they can identify who they’re going to make accountable for these things, and if they can give them the information, and if they can give them the tools to make a difference, they can then be held accountable.

My feeling is if we really mean it, we’ve got to set about this with a will. And that is about leadership. It’s about management, of course, but it’s about leadership primarily because it’s about saying- this is not an impossible task and we’ve got to solve it. Stepping into that leadership space is where leadership starts.

DMacA: My final question is about our shared interest, because you have a rather eclectic interest in sport…

DP: For many years, I’ve had to talk about the triumph of hope over experience while supporting Nottingham Forest. In fact, they are doing rather better at the moment but that’s where I grew up. But I’m in Bristol now and I’m really a rugby fan. Ah, the triumph of hope over experience…

But, my other interest is that I’m really interested in music. Tonight, I’m singing a gig at a local restaurant, singing some jazz for Valentine’s night. And I have to say that I think I’ve learned more about team working through playing with musicians than any other means.

And team working, is of course, key to the sporting world as well. But the thing that I’ve learned from a number of different influences, is that people do things for each other. I play with a jazz pianist called Ruth Hammond. She sings, she plays the sax, she plays the flute, she’s a wonderful musician. She’s the only person I know who can play the piano and make me weep.

I’m quite confident about most of the things I do, except singing. That’s where I feel challenged. But she’s taught me to trust her, to relax, the other musicians are on my side, they want me to do a good job. And these are world class people. And, teamwork is a joy for lots of reasons. When teams work, they really are greater than the sum of the parts. And, whenever I do any session on leadership or the consultation or anything, I always start it with the notion that- if we can get the chemistry right between us today, we can make today a day that you’ll never forget for the best reasons. Every day is a chance to make a difference. And that’s what I’ve loved about my career. And of course, I’m well past my sell by date now, but I’m still banging on. Why? Because I love it.

DMacA: Thank you very much for sharing so much of your life, your career, but most of all your enthusiasm and your energy. Its just been a pleasure.

David Pendleton

David is a psychologist, organisation and management development consultant, author and professor. In the field of healthcare he completed a DPhil at Oxford on Doctor-Patient Communication in General Practice, was Stuart Fellow at the RCGP, consultant to their membership exam and was a Trustee of the College for 6 years. In the corporate field, he was Director of People and Organisation Development from 2001-3 at Innogy (now npower) a FTSE100 company, and an in-house consultant at Cathay Pacific Airways from 1993-5 based in Hong Kong. He co-founded the Edgecumbe Consulting Group with his wife Dr Jenny King and they co-led the company from 1995-2015. In the academic field, he was an Associate Fellow at the Said Business School at Oxford from 2005-2022 and has been an Associate Fellow at Green Templeton College Oxford since 2007. He has been Professor in Leadership at Henley Business School since 2017 and has been appointed Advisor in Leadership at the FMLM in 2025.

Professor Domhnall MacAuley

Domhnall MacAuley currently serves on the International Editorial Board for BMJ Leader.

Declaration of interests

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