How to Lead

A dick? You mean a nasty person?

Oh, no. No. I don't think so — not at all. You can be a nice person, and you shouldn't be a dick, at least the way the connotation reads for me. You have to be one who is willing to challenge dogma and to be respectfully standing out in terms of your beliefs, but you shouldn't be nasty about it. So there's a fine line here. You want to be aggressive in pursuing your interest and your proof, telling the truth, telling it like it is, standing up for what you believe — but you don't want to be doing things that are seen as hostile, or showing animus. That won't help you at all.

There is a fine line, because you can't just lay down and not pursue your mission. But if you are perceived as a nasty person, that'll be ruining. That kind of image doesn't go away. If you do things that make you seem to have no respect for others, and you do it on a repetitive basis, you'll be branded as a bad person. So you don't want to go there. I've had times when I've been sleep-deprived and stressed out and I'm ready to really lose it, and I have to bite my tongue — you are not sending the email, or whatever it is — because you just don't want to project that image. It's a bad image.

I would absolutely say no. To be a good leader in healthcare now, you do need to be disruptive — not a dick, but disruptive. You need to think of new ways of working, because the traditional ways of running health systems, even of practising medicine, just don't work anymore. Many parts of healthcare are at an inflection point where they're radically changing. Healthcare leaders have to embrace that change. They have to be willing to rattle the cage, to challenge their teams. Otherwise, some of these organizations, unfortunately, may not be around — definitely not in the same way they are today — in five or ten years' time.

We're going through the same shift retail went through ten years ago, when it became heavily digitalized. There were many companies at that point that missed the boat. Even in the early 2000s, Walmart looked very closely at Amazon and missed the boat on that. Look at where those companies are respectively now. Some companies have managed to keep up with the times, but many have not. Look at where Motorola is, where Nokia is — disrupted completely out of the market by smartphone companies. And those were technology-oriented companies that got pushed out, let alone very traditional ones like Kodak, which now barely exists. Blockbuster thought Netflix was a joke that would get nowhere. Look at where those respective companies are now.

Healthcare is going through that change at this moment, and in ten years' time the players in the health and care space will look very different. Leaders have to be willing to embrace that change, or they risk getting left behind. So I wouldn't say leaders need to be a dick to be successful. But in this environment, it's important to be disruptive and to embrace disruption — while at the same time building a culture that actually embraces it, that is creative and innovative, rather than doing more of the same and the traditional ways of working that many parts of healthcare have become used to over the past decades.

Firstly, it depends on your personality type, and different types of leadership are useful in different circumstances. The dick style is useful for very specific short-term situations where you need people to do something for a particular task — which is often why you see it coming from other industries where there's a focus on a particular task. But it's an extremely bad style for developing trust and for the long term.

That's why there's this split between management and leadership. Management is getting a group of resources — and often those resources are people — to deliver a thing. You have no interest in the relationship between you and them, and no interest in the long term. That's what management is designed for. The leadership concept is that if you were to run off and say, "Come on, let's go and do this," all these people would follow you — not because you said "if you don't follow me, this will happen," but just because they wouldn't even think about it. If people wouldn't follow you without you asking, you're not leading them. You're managing them. And the two things are not necessarily the same.

So where there's a short-term problem, the dick style can work quite well to get people to do stuff quickly, but it often has long-term consequences. Whereas the organizations where it's genuinely much more of a slower burn — where you build trust — those are the ones that do much better over the longer term. If you're trying to build a team around you, for your research or your clinical work, then being a dick won't help. What you're talking about here is you as a senior doctor building a team around you — and almost by definition, that's a network, and it's a longer-term thing. People get obsessed with the short term. Don't be bothered about the short term. Be bothered about what's going to happen in a year, and then two years, and then five years. There's no rush for this.

A bit of advice I'd always give people is that life is too short to work with assholes, basically — if I can say that. You may find yourself contemplating working with somebody who has a reputation for Nature papers or Lancet papers, but also a reputation for not being very nice, or being a bully. I would say just don't do it. Work with people who are cool, and you'll enjoy yourself and you'll be more productive. That's the way to pursue things.

There are probably a couple of things. One is: don't lead people on — make decisions early. There's nothing worse than projects drifting and resources being slowly cut because people aren't prepared to say we should stop this. So there's something about being decisive early when you see something isn't working. And then honesty is the other thing. Don't try to flim-flam around the reasons. If this hasn't worked for this set of reasons, this is why we're doing this, here's the impact on you, and here's how we're going to make things work for you going forwards, even though this thing hasn't worked out. Those would be the two things: be decisive, and don't beat around the bush and lead people on.

Personally, one of the most important but also most powerful principles is that of generosity. I love the writing around givers and takers and who ultimately wins. If you can be generous when people aren't expecting you to be generous, you can work yourself into the middle of a network and become a super-connector. I think it drives my team mad, me banging on about this — but the point is, we spend most of our time saying no to amazing entrepreneurs. It's sad, but unfortunately that's just part of the beast. So we've tried to build in processes to make sure we continue to be generous. That means not just saying no, but giving very unfiltered feedback — often feedback entrepreneurs don't want to hear, but that comes under the banner of generosity. Or equally, offering to connect people to angels, going above and beyond.

There are so many instances when folks come back to me — I love having conversations with entrepreneurs or investors where they're not quite sure where it'll lead, but someone has said, "Oh, you should have a chat with Will. I'm not sure where it'll go, but he'll probably figure out some way he can be helpful to you." So generosity can be a real power play. For me, it's probably one of the most satisfying parts of the job.

The most effective leaders are those who can be authentic and be themselves, rather than having to take on a special persona that isn't true to them. And that's true for doctors too — when you're in clinic with patients, you obviously have to be the doctor, you have to play that role, but you have to do it in your own way, because people will very quickly see through you otherwise. For myself, it was an enormous relief when I realized I didn't have to be the same as the people I admire in how I lead — that I could be myself. You still have to put on the leadership role, take responsibility for it, and be aware of the people around you and what they need from you. But not to have to put on an act — because that's exhausting, apart from anything else, and it won't ring true.

That was something that came over time, and it brought real additional confidence, because it meant I could relax into the role rather than being constantly under tension that I wasn't delivering enough. My leadership style, I think, is in some ways quite hands-off. I expect a lot from people, and they give a lot. I find that the more you let people get on with it, the better. Knowing when to get involved is a skill you learn over time — knowing when to give support, but also trusting people to do the right thing.

I think many different personalities and people can be good leaders. There's no single way to lead effectively. I'm a very different leader to many of my colleagues in terms of my style and how I interact with people, and different approaches can work. For me, what really works is hiring people who are just way better than me at what I'm hiring them to do. They're the expert, and then I place a lot of trust in them. I'm there to strategize, to brainstorm, to align, and to provide support — but they're very much in the lead on the things they're responsible for, driving and building their team and pushing that forward. It's all about hiring really great people, putting them in the roles, trusting them, and being there to drive the alignment.

It does favor being an extrovert. In the earlier days especially, I spent a lot of time out building relationships, networking, and on stage. Once we started to scale, there were a lot of requests to do interviews and speak at events. I still get a lot, but I do fewer of them now than I did, because I realized it takes me quite a bit of energy and thinking in a way it doesn't for my co-founder, for example, and many others who really love it. In certain circumstances I enjoy it too, but in others I have to be more selective. That can be challenging when it's expected of you. In the business itself, I also favor writing things down rather than speaking to the whole company, and smaller meetings and one-to-ones rather than talking at a large number of people.

So you can still be a really good leader and have a real impact — but you have to learn to know yourself well, adapt, work out where you're strongest and how you can have the most impact, and be okay with saying, "I do less of those things, because that's not where I'm at my best."

If you start a company, you're basically inviting the whole world to comment on whether they think what you're doing is a good idea or not. People are very liberal with their opinions. That's great, but a lot of the time the people talking to you either haven't thought heavily through the problem, or they're not qualified to give you an opinion that could be considered expert. So I'd really scrutinize whether you should take an opinion on board. When I first started my company, I had much lower confidence, and I think you generally look at anybody who's older than you, or anyone in a senior position at a bank or McKinsey or wherever, and automatically assume their advice is good and go ahead and implement it. I'd really caution against that.

Go back to first principles and understand what's right for you, what's right for your customers, what's right for your business. Otherwise you can end up going down the wrong path. Really try to evaluate the advice you're getting: are they actually an expert in this particular thing they're telling you about? If they're not, you should really consider whether it's valuable advice. So with all advice in general, I'd just really think hard about whether it makes sense for you or not.

In the academic world, there are always challenges over credit, recognition and attribution of scientific work — people squabble over that. In management, commerce and industry, there are challenges over personal recognition in a competitive corporate ladder, or even personal financial gain; you see it in private practice. Harry Truman once said something along the lines of: you can achieve whatever you want, provided you don't mind who gets the credit. When I think of the people who brought me on and helped me in my career, they always gave me free rein and never claimed credit for it. So many things go wrong in medicine when people want the credit. Ultimately, if you're a collaborator, if you treat other people the way you want to be treated and you're not trying to get credit for their efforts, then people will treat you very differently. It's a real key attribute of leaders.

When I was a very senior trainee in heart surgery, about to take up a consultant job, I was working for a pretty scary and impressive senior consultant. I went to see him and said, "Mr. Parker, when I become a consultant in three weeks' time, what's going to be different? I see the patients in clinic now, I assess them for surgery, I see them on the ward before their operation, I do their operation, I look after the cardiac intensive care unit, I take patients back to theatre in the middle of the night if they have a complication, and I see them in follow-up. So what's different about being a consultant?" He just looked at me and said: "Taking responsibility for other people's mistakes." As I've gone up the leadership ladder, that has become more and more prescient. As a consultant, if your senior house officer or your registrar makes a mistake, you look after them, you help them through it — but you take responsibility. It's a different level of responsibility, for a different level of mistake, often for things over which you have no control when you're in a very senior leadership role like medical director of the health service.

I'd like to simultaneously, respectfully agree and disagree — let me explain why. Firstly, there are two different types of leaders: those who want to change things for the better, and those who don't want any change because they're quite happy as they are, and who try to obstruct the former. And then there are another two types: those who quietly go about their business using the sorts of values and principles I described, versus those who think they can get change by being very vociferous. That's always a short-term game.

One of the things I learned as medical director was that I had to take the consequences, or the criticism, quite often for things that were both thought up and done by other people. I had two choices: to say "not me, Gov," or to say nothing and try to change it behind the scenes. I learned that the latter is a much better strategy. Particularly in a political arena, if you're very critical of people who've made decisions you don't agree with, you soon get cut out of the sphere of influence. If, on the other hand, you're quiet, you're discreet, you use rational argument, your views are quite often welcomed. Megaphone diplomacy doesn't work in the long term. You win your arguments in private, and you lose them in public.

Habits? Oh, God. Yeah — I don't really have any, to be honest. I probably should. I tend not to make too many plans, at the weekends or in the evenings, just because I like to have the ability to work if I want to. I don't have any hobbies as such. I just don't really want to do anything that consumes my time, because there's one really important thing that needs to consume my time, and it's this. So I guess that's probably the only one. The only thing I do make time for is exercise. I do need to exercise, and I think that helps manage some of the stress you talked about before. But no, I don't really have — I feel bad now, I feel like I should have some. Maybe next time I talk to you I'll have some rituals.

It's a really good question, and it's not morbid, and there's no need to apologize. I think the answer is yes — and it has to be, because you can't change things. But in terms of the sacrifices: if I were giving advice to the 20-year-old Bruce in the pub as a student, I might say that when you make some of your choices, perhaps pay more attention to the impact those choices might have on those nearest and dearest to you.

As a cardiac surgeon in those days, the rotas and things were very different. You were at work before the kids got up, and you came back when they'd gone to bed. That was the norm, and it couldn't be changed. But when I decided to take on a role at UCL and then medical director of the health service, I stayed living in Birmingham because my wife had a job here — there were schooling issues — and I went to live in London during the week. I'd go to London at six o'clock on a Monday morning and come back late on a Friday night or early Saturday morning. I did that for 14 years, and I got to a place where I felt that was normal. It wasn't until I stopped and came back to live at home that I really realized the sacrifices my family had made in order for me to do what I wanted. When I embarked on it, I probably didn't realize what it meant for them. So in answer to your question, it leaves me with that really difficult question that so many families grapple with: how do you get your work, ambition, and family life balance right?