What does this tell me
about my leadership?

Much of my leadership thinking has begun with a question: why is this happening?

Why is a proposal not progressing? Why has a conversation not led to action? Why do people agree that change is needed, yet seem reluctant to commit to the next step?

Working within general practice, the PCN and the emerging neighbourhood system provides plenty of opportunities to ask these questions. Responsibilities overlap, organisations work to different priorities, and decisions can depend on relationships and conversations that are not immediately visible.

When I care about an improvement, particularly one that could make care more connected for patients, a lack of progress can feel frustrating. I want to understand the obstacle so that I can address it.

However, through my leadership development, I am beginning to recognise that there is another question worth asking:

What does this interaction tell me about myself and my leadership?

That question changes where I place my attention. It invites me to examine how I enter a conversation, what I assume about others and what happens to the relationship after I have spoken.

Moving from explanation to observation

As a clinician, I am accustomed to identifying problems and working towards a response. That approach is useful in leadership, but it can also make me quick to interpret what I see.

An unanswered email becomes a sign of disengagement. A delayed decision becomes evidence of resistance. A cautious response suggests that someone does not share the urgency.

Those interpretations may sometimes be accurate. They may also be incomplete.

Another person may be managing responsibilities I cannot see. They may support the purpose but remain uncertain about the proposal. They may lack the authority to act, or need time to discuss its implications with colleagues.

They may also have experienced my approach differently from how I intended it.

Being more observant means allowing some space between the interaction and my explanation of it. Before deciding what a response means, I need to notice what actually happened, what remains unknown and what I have added through interpretation.

This is particularly important when there has already been tension in a relationship. Previous experiences can make us alert to signs that confirm what we expect. We can begin responding to the history rather than the conversation in front of us.

My intention is only part of the interaction

I want to bring energy, clinical purpose and ambition to neighbourhood working. I want to help move discussions towards improvements that patients and professionals can experience.

Yet a clear purpose does not guarantee that my contribution will be received as I intend.

What I experience as enthusiasm may feel like pressure to someone else. A detailed proposal may demonstrate preparation, but it may also leave colleagues wondering whether there is still room for them to shape it. A challenge intended to clarify accountability may be heard as a judgement about someone’s competence or commitment.

These possibilities do not mean that I should become hesitant or stop asking difficult questions. They mean that I need to remain interested in the effect of my behaviour.

Have I helped people understand the problem, or moved too quickly towards my preferred answer? Have I asked for their perspective early enough? Have I made disagreement possible, or presented my reasoning so firmly that challenging it feels uncomfortable?

The answer cannot come entirely from my own reflection. I also need feedback from people who experience my leadership, including those whose response is less affirming than I might hope.

Relationships reveal what a proposal cannot

A proposal can explain a service model, its clinical rationale and its intended benefits. It cannot, by itself, reveal whether people trust one another enough to deliver it.

Within the PCN and neighbourhood system, relationships influence how ideas are discussed, whose concerns receive attention and whether an agreement becomes action. People bring professional identities, organisational responsibilities and previous experiences into each exchange.

I bring these things too.

My commitment to a particular approach can make it harder to hear reservations without interpreting them as obstacles. My desire for progress can make me impatient with the conversations through which others develop confidence and ownership.

There is also a more personal question. When a proposal receives little response, am I concerned only about the work, or am I also feeling that my contribution has not been recognised?

Both reactions are understandable, but they require different responses. The clinical case may need further discussion. My need for recognition requires honest reflection. If I confuse the two, I may pursue the conversation with more intensity than the situation warrants.

Observing relationships helps me distinguish between these different needs.

Understanding the power I bring

It is easy to notice the power held by other people: the authority to make decisions, control resources or determine priorities.

It takes more deliberate attention to recognise my own influence.

Clinical experience, professional standing, confidence and the ability to develop a persuasive argument all carry weight. Even without final decision-making authority, I can shape how a problem is framed and which solutions appear credible.

That influence brings responsibility.

If I arrive with a strongly developed position, others may feel that they are being asked to endorse it. If I speak early and at length, I may unintentionally narrow the discussion. If I repeatedly return to the same concern, colleagues may become less willing to engage openly, even when the concern itself is legitimate.

I need to consider whether I am creating the conditions for shared leadership or simply inviting others into an approach I have already constructed.

Sometimes the more useful contribution will be to ask a question, listen carefully and allow someone else to develop the next step.

Silence is information, but its meaning is uncertain

One of the more difficult leadership experiences is waiting for a response that may or may not arrive.

Silence leaves space for interpretation. It can feel dismissive, particularly when considerable thought and effort have gone into the work.

But silence alone cannot tell me why someone has not responded.

It may reflect competing demands, uncertainty, disagreement or avoidance. It may reveal that my request was unclear, that the timing was poor or that I approached the wrong person. Several explanations may be true at once.

The useful response is neither to assume rejection nor to explain away every delay. It is to seek enough clarity to decide what to do next.

Have I made a specific request? Is there an agreed next step? Would a brief conversation be more helpful than another detailed email? Is further engagement likely to move the work forward, or am I seeking reassurance that my contribution matters?

These questions help me choose a proportionate response. They also help me tolerate the fact that some uncertainty will remain.

Reflection does not mean taking all the blame

There is a danger in turning every difficult interaction into a judgement about my leadership.

NHS systems contain genuine structural constraints. Unclear authority, competing incentives, limited capacity and poor governance cannot all be resolved through better communication from one individual.

Other people remain responsible for their decisions and behaviour.

The purpose of looking inward is to understand my contribution more accurately. It is not to make myself responsible for the whole system.

I can recognise that a concern is justified while also deciding that my way of expressing it needs to change. I can improve my approach while continuing to ask for clear accountability. I can acknowledge another person’s pressures without accepting indefinite uncertainty as a satisfactory way of working.

That balance matters. Reflection should strengthen judgement and action.

Observing myself in practice

I am beginning to see everyday interactions as opportunities to learn about my leadership.

After a meeting, I can consider when people became more engaged and when the conversation narrowed. I can notice whether I listened differently to someone who supported my view than to someone who questioned it.

I can pay attention to my own response to delay: whether I become more forceful, withdraw or start making assumptions about motives.

Over time, the most useful evidence will be patterns rather than isolated reactions. If similar difficulties arise across different relationships, I need to examine what I may be contributing. If they occur in one setting, I need to understand what is distinctive about that setting.

The reflection becomes meaningful when I test a different approach and observe what follows. I might offer an earlier invitation to shape a proposal, make a shorter and clearer request, ask directly for feedback or leave more space before responding.

I then need to ask whether that change improved the conversation, clarified the disagreement or helped others take ownership.

A developing leadership discipline

My ambition to improve care remains. So does my willingness to challenge arrangements that appear to hinder it.

What is changing is my understanding of how that ambition needs to be exercised.

I am learning to pay closer attention to the relationship as well as the task, to my impact as well as my intention, and to the assumptions I make when progress feels slow.

“Why is this happening?” remains a necessary question. It helps me understand the system.

“What does this tell me about myself and my leadership?” helps me understand how I am working within it.

Holding both questions together may help me become a more effective leader: clearer about what needs to change, more thoughtful about my contribution and better able to choose when to speak, listen, act or wait.

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.