Knowing yourself:
the uncomfortable beginning of leadership

One week has passed since the opening four days of the Nye Bevan Programme.

The theme was knowing yourself. At first sight, that can sound like the gentler part of leadership development. Before strategy, transformation and system change, we pause to consider who we are.

My experience was rather different.

Knowing yourself is not simply an exercise in identifying strengths, preferences or a reassuring description of your leadership style. If taken seriously, it means examining where your leadership comes from, what happens to it under pressure and how your presence affects other people. It means considering not only the contribution you make, but also the space you occupy, the power you hold and the behaviours that may emerge when events do not unfold as you hoped.

I left the opening module with fewer certainties than I brought into it. I think that may be the point.

A mirror rather than a map

I had expected leadership development to give me additional frameworks through which to understand organisations and change. Instead, the opening days repeatedly turned the lens back towards me.

Through our lifeline work, leadership mapping, psychometric assessment and conversations with colleagues, I found myself returning to a more difficult question. What has made me lead in the way that I do?

The easy answer would be to describe my roles. I am a GP partner, a clinical governance and transformation lead, and now a neighbourhood Clinical Lead. I have developed multidisciplinary approaches within Carlton Group Practice and become increasingly involved in wider transformation across East Staffordshire.

Those roles describe where I lead. They do not fully explain why I lead as I do.

My lifeline suggested that the origins lie much earlier. Growing up, I saw illness, vulnerability and inequality at close quarters. My mother lived with significant heart disease and could not read or write. My younger brother lived with cystic fibrosis and died aged twenty-eight. Being alongside him during his final week in hospital changed how I understood illness, dependence and healthcare from the other side of the professional relationship.

These experiences helped form a strong instinct towards advocacy. When something matters, I find it difficult simply to observe. When somebody appears unheard, I want to speak. When a system seems capable of doing better, I want to become involved and try to change it.

That instinct has become an important part of my leadership. It has given me courage, persistence and a willingness to accept responsibility. But the opening module made me confront a less comfortable possibility: the origins of a strength may also help explain its shadow.

Advocacy can become an assumption that I should intervene. Responsibility can become over-responsibility. Persistence can become impatience. A willingness to step forward can unintentionally reduce the space available for somebody else to do so.

When strengths cast shadows

The idea that our strengths can become risks under pressure was not entirely new to me. What was different was seeing how clearly it connected with my recent experience.

I bring considerable energy to work that I believe matters. I am diligent, analytical and inclined to translate complex problems into practical action. Within Carlton Group Practice, these qualities have often helped ideas move from discussion into delivery. I have longstanding relationships, clinical credibility and sufficient authority to bring people together and establish new ways of working.

The wider system is different.

Across a PCN, neighbourhood or integrated care system, authority is dispersed. Organisations carry different accountabilities. People understand the same problem through different histories, interests and professional identities. A clinically persuasive argument does not automatically create a shared interpretation of what should happen next.

This has sometimes frustrated me. My response has often been to clarify the argument, prepare another paper, initiate another conversation or create further momentum. At times, that persistence has been useful. At other times, it may have reflected my own discomfort with slow progress, uncertainty or responsibility without control.

The question is therefore not whether energy, diligence and challenge are desirable qualities. They are. The more important question is what happens to those qualities when I feel unheard, when other people disagree or when the pace of change is slower than I believe patients need.

What I experience as clarity may be experienced by someone else as certainty. What I intend as urgency may be experienced as pressure. What I see as persistence may begin to feel like an unwillingness to let others find their own way.

Intentions matter, but impact matters too.

The system as a mirror

Over recent months, I have spent considerable time trying to understand and influence neighbourhood development in East Staffordshire. There have been questions about population need, geography, governance, representation and how clinical leadership should be distributed.

I believed, and continue to believe, that important issues were at stake. However, the most useful reflection is no longer simply whether my analysis was correct.

The wider system has acted as a mirror.

It has shown me how I respond when I believe an issue carries moral importance. It has revealed how strongly I associate leadership with accepting responsibility. It has made me examine what happens when I can influence a situation but cannot control it. It has also forced me to consider when legitimate challenge may begin to look oppositional to others.

This does not mean that challenge should be abandoned. Leadership that avoids disagreement is unlikely to transform anything. It does mean that moral conviction requires humility. If I become too certain that my position is the ethically correct one, I may become less curious about the values, pressures and responsibilities shaping somebody else's view.

Remaining values-led without becoming morally certain may be one of my most important developmental tasks.

Power is not removed by good intentions

The leadership mapping work also made power more visible.

Within Carlton, I hold positional, professional and relational power. In the wider system, much of my influence has historically been informal, arising from clinical credibility, relationships, knowledge and a willingness to convene people around a problem.

During the week following the opening module, I was elected as a neighbourhood Clinical Lead. That gives me a form of positional legitimacy that I did not previously possess.

It would be easy to interpret that appointment simply as recognition of the work I have undertaken or as validation of arguments I have made. That would be incomplete. The appointment also changes the power I carry into a room and therefore changes my responsibilities.

Distributed leadership cannot mean asking other people to undertake more work while meaningful authority remains concentrated. Nor can inclusion mean inviting a wider range of people into meetings after the important decisions have already been framed.

I have spoken consistently about supporting women and a broader range of colleagues to take leadership roles within our PCN. The real test is not whether I encourage them while retaining my own centrality. It is whether I share information, opportunity, decision-making, recognition and space. Diversity without influence risks becoming representation without power.

The same principle applies beyond professional leadership. If neighbourhood working is intended to respond to inequality and population need, then patients, communities and colleagues closest to those realities must be able to shape decisions, not simply comment on plans developed elsewhere.

Ambition without self-deception

The opening days also made it harder to avoid the subject of ambition.

I am ambitious. I want to develop beyond practice and neighbourhood leadership into broader clinical and system leadership. I want to contribute to work on complexity, inequalities, integrated care and clinical transformation at a wider level.

I do not think ambition is something a leader must deny. Leadership needs people who are willing to accept greater responsibility and attempt difficult things. However, ambition needs examination because service, identity, recognition and power can become intertwined.

I may genuinely want greater influence in order to improve care. I may also value being recognised, invited into important conversations or associated with successful work. Both can be true at the same time.

The danger lies less in receiving recognition than in pretending it has no effect on me.

My ambition therefore needs tests. Does my leadership create greater capacity in other people? Can the work continue without my constant involvement? Do colleagues feel able to challenge me? Am I prepared for somebody else to receive recognition for work I helped to begin? Does my growing influence widen participation or merely make me more central?

If progression simply means accumulating larger roles, I may reproduce the concentrated model of leadership that I have often questioned. Development should mean learning to lead differently, not merely being given more to lead.

Instruction, context and creating space

One practical insight has stayed with me. Leadership requires judgement about the balance between instruction and context.

Instruction tells people what needs to be done. Context helps them understand why it matters, what constraints exist and where they have freedom to exercise judgement. Each can evoke a different response.

There are moments when clear instruction is necessary. Patient safety, professional standards or an immediate operational risk may require a leader to step forward and provide direction.

Complex transformation often requires something different. People need a shared purpose, access to relevant information and permission to contribute their own expertise. If the leader provides every answer, the team may comply, but it is less likely to develop genuine ownership.

Practical distributed leadership therefore involves more than delegating tasks. It means creating sufficient context for leadership to emerge from elsewhere. It also means tolerating the possibility that another person's response may differ from the one I would have designed.

The question I need to ask more often is:

Does this situation require my instruction, or does the team need context, confidence and space to lead?

Learning when to step forward and when to step back

Much of my life has taught me how to step forward.

I have learned to advocate, challenge, accept responsibility and speak when something matters. I needed to learn those things, and I do not want leadership development to make me quieter, less ambitious or less willing to challenge.

The next stage is more subtle. It is learning when stepping forward serves the purpose and when it primarily satisfies my own need to act. It is learning when to remain present without becoming central, and when to step back without withdrawing.

Stepping back can be an active leadership decision. It may allow others to experience responsibility, expose whether a partnership has genuine ownership and reveal what the system does when one person stops creating all the momentum.

It may also generate uncomfortable information. Work may slow. Other people may choose a different direction. A proposal may not be taken forward at all. Knowing yourself means recognising the emotions these outcomes evoke and resisting the instinct to intervene merely to relieve your own discomfort.

One week later

One week is not long enough to claim transformation.

I have not returned from four days of reflection as a fundamentally different leader. My instincts remain. I will still feel urgency when patients appear to be poorly served. I will still want to organise complexity, challenge unclear governance and move good ideas towards delivery.

What may be changing are the questions I ask before acting.

Am I creating clarity or imposing certainty? Am I carrying a responsibility that properly belongs to the wider system? Whose voice is absent? What might resistance be telling me about the proposal, the relationships or my own leadership? Does my intervention create capacity in others, or greater dependence upon me? Can I remain constructively connected to people whose views I fundamentally disagree with?

These are not questions that can be answered once. Knowing yourself is not a stage completed at the beginning of a leadership programme. It is a continuing discipline, particularly as responsibility, visibility and power increase.

The timing feels significant. I begin Nye Bevan at the same moment that I assume a new formal leadership role and become more involved in work across organisational boundaries. It would be tempting to see this as evidence that I am progressing towards the leader I want to become.

A more honest interpretation is that the real test is only beginning.

Knowing myself will not mean becoming preoccupied with myself. It should make me more attentive to what my leadership enables in others, what it unintentionally suppresses and whether the people and systems around me become more capable because of my presence.

Perhaps that is the uncomfortable beginning of leadership. Not asking only what I can achieve, but what happens to other people when I try to achieve it.

This essay forms part of my reflective leadership journey during the Nye Bevan Programme. Views are personal and do not represent any employing, commissioning or partner organisation.