Paradigms and why they matter

Paradigms are tricky things, sometimes almost invisible, certainly not often directly observable. But they are well worth thinking about, and learning to work with for those who want to try to improve things a bit.
If we can recognise our paradigm and change it a bit, then all sorts of new possibilities can emerge.
They are a bit like ‘the system’ that we live in. The system of widely accepted and normalised beliefs, methods, values, customs and practices that we usually just take for granted.
And just like fish don’t recognise that water exists, until that moment they are removed from it, most of us don’t recognise the paradigm that we live in. It is an almost invisible context or medium that we operate in.
Paradigms matter because they give us a context and ways of working, but they also bring with them limitations. They rule certain things out, or at least relegate them to the ‘unusual’.

The Horse Paradigm

For a long time the main paradigm that shaped transport policy, planning and practice was the paradigm of the horse. Horses were the most cost effective way of providing power to our transport systems. The paradigm was so powerful that at one time it was thought that the limits to growth of major cities was the capacity to remove horse shit, urine and carcasses from the streets. By the late 1800s most major cities were drowning in horse manure and urine. With more than 50 000 horses on London’s streets each producing 7-16kg of manure and a litre or more of urine it wasn’t just the smell and the mess that was the problem, but also the flies. But this is what ended the horse as the dominant paradigm. But it didn’t start that way. To begin with only the rich could afford to travel by horse. The rest of us had to walk. The horse was not the dominant paradigm to begin with. It was walking.

And this tells us something about paradigms that seems generalisable. They first appear in our world as a minority activity that gains in popularity before fading away. Sometimes this happens in the course of a few years and sometimes it take decades or even centuries.

Back to the horse paradigm.

Most of the experts of the late 1800s were seriously consumed by the challenges of the waste products of the horse paradigm and how to remove them from our cities – preferably without using more horses! Most were really not focussed on alternatives to the horse which all appeared outlandish, dangerous and rife with problems of their own. When the first steam engines were being turned into locomotives hardly anyone thought they were going to be the next big thing in transport. Canals were seen to be much more viable propositions than railways. When Henry Ford was messing about with the first motor car his customer research didn’t go well. People didn’t want his dirty, expensive, unreliable cars, they wanted ‘faster horses’.
And this tells us something else about paradigms that seems to be generalisable.

The clues to the paradigms of the future are to be found co-existing alongside the current dominant paradigm. Often ridiculed or feared, as the dominant paradigm outlives it usefulness or creates more problems than it solves, they gradually become more popular until perhaps they become the dominant paradigm.

And as one paradigm declines to be replaced by another there can be conflict. The dominant transport paradigm in most of our cities at the moment is of course that of the motor car, still largely petrol driven, already taking up too much space for our road system and still getting bigger, using a ton of metal and plastic to transport usually one <100kg passenger, killing and maiming people every day at a disconcerting rate and endangering our very existence through pollution and climate change while spending most of the time parked up consuming valuable land space.

Contenders for an emerging paradigm?

More but different cars, clean power systems, driverless cars and shared car fleets? Or public mass transit systems? Or bicycles, scooters and e-bikes? But we can be sure that the current dominant paradigm of the car won’t go without a fight. Often literally. And it will probably take a very long time to go completely. I mean we still love our horses.

Why does this stuff matter? Why should you think about it?

I suppose to some extent this depends on how you characterise the current dominant paradigm and whether you want to see it develop and grow, or whether you want to see it replaced by a new paradigm.
If you think that the current dominant paradigm is working well and has room to create more value then your focus should be on resourcing and supporting this work and perhaps ensuring that you don’t invest in emerging paradigms that might threaten this one. I mean if it ain’t broke, why fix it?
If on the other hand you think that current paradigm has become toxic, creating more problems than it solves then you might choose to invest your energy in supporting emerging paradigms and potentially undermining the dominant one, or at least trying to limit its growth.
Unless you think carefully about this stuff you may find that, while you would love to see a new and different paradigm emerge, you have been effectively captured by the current dominant paradigm and compelled to work in ways that support it, either directly, or by earning a living clearing up the mess that it makes. Our cities used to be full of people whose job it was to carry away the shit and the dead horses so that the dominant paradigm of the horse could continue unaffected. These days perhaps our cities are full of people clearing up the mess created by our own dominant paradigm; global warming, homelessness, mental health crises, plastics, crime…

Paradigm Shifting…

So can we shift a paradigm? Can we consciously act to accelerate the demise of one paradigm and the emergence of the next? Can we manage a transition from one paradigm to the next without a full blown crisis. And if a crisis does hit, is the new paradigm waiting in the wings, oven ready, to step up? Or do we have no alternative but to put the defibrillator on the old paradigm and spark it back into life? Like the banking crisis in 2008 for example.
Some people might focus their energy on bringing about the demise of the dominant paradigm while others fight to maintain and develop it. Some might focus on developing ideas and technologies that might lead to possible new paradigms while other innovate strictly within the dominant paradigm, reinforcing it further still. And often these players all co-exist side by side in the same place, at the same time. And learning how to work together to ensure that the dominant paradigm creates as much value as it can, while allowing new and perhaps better paradigms to emerge seems like a worthwhile leadership challenge. And at the heart of it is

  • paradigm awareness,
  • the effective management of power and resource imbalances and
  • the building of trusting relationships between those that could otherwise easily come in to conflict.

I work in a wide range of settings, from cultural education partnerships, local authorities, the NHS, the private and third sectors. In every setting I have found that an exploration of new and emerging paradigms and the implications this has for leadership, decision-making and partnership working has had profound and very practical implications. If you would like to explore whether some considerations of paradigm shifts might be helpful to you and your work please do get in touch.

Board Development

I have been involved in quite a bit of ‘board development’ work. I started working with boards when I was at the Business Link University in the 1990s, and cut my teeth working in a range of ‘for profit’ businesses as well as social enterprises.

More recently I have worked on board development in NHS Hospital Trusts and a number of ‘system boards’. More on these later.

Why Have a Board at All?

It is dangerous to have too much power concentrated in a single individual at the ‘top’ of an organisation. This can work for a start up or a micro enterprise, but as the organisation grows it becomes difficult. A

‘Boards’ developed as a way of bringing more diversity to the leadership of the organisation. To bring in different perspectives, knowledge and experience. This is critical in the volatile, uncertain complex and ambiguous world that most organisations have to operate in today.

A Typical Board Meeting

Boards also provide control over the power of individual leaders and their executive teams. They ensure that the organisation operates on behalf of its owners, the environment and the communities in which it operates.

In theory at least…

Sometimes Boards lack sufficient diversity and become too focussed on their own self-interest rather than that of the organisation that they direct.

Remembering that the board provides a place where many voices can be heard and woven together to provide the organisation with practical direction and momentum can significantly help with board development. It is always worth thinking about whose voices are not being heard, or are being marginalised as one aspect of board development.

Functions of the Board

The main job of the board is to provide an organisation with a sense of direction and momentum. But it also has to maintain control. The tensions of movement and control need careful balancing.

If everything seems under control – you are just not going fast enough

Mario Andretti

In order to manage this tension the board acts as a pivot point.

The Board as Pivot Point

On one side of the pivot it has to look ‘down and in’ to understand enough about the workings of the organisation to provide assurance that it is effective, efficient and compliant with policies and legal requirements. And those working in the organisation have to feel completely safe to be open and honest at the board. Trust is critical.

On the other side of the pivot it has to look ‘up, out and to the future’ scanning the environment for opportunities and threats and ensuring that the organisation is ‘future fit’. It brings in experience and insight from outside of its own system.

The board has both operational and strategic functions which are carefully balanced in a well developed board.


Every board member is, or should be, a director of the organisation. This is a specific role recognised in company law and attracting some quite onerous risks and responsibilities. If directors are found to be incompetent or negligent the penalties can be punitive.

Executive Directors

In practice, though not in law, we recognise two different types of ‘director’. The first is employed to work in the organisation, usually full-time, and usually, though not always, at executive level. Hence the name Executive Director. Usually they will work between 3 and 5 days a month as a director of the organisation – working as a part of the Board to provide ‘momentum and direction’. The rest of the time they work as a ‘servant’ of the board ensuring that the organisation is efficiently and effectively run and that the ‘direction’ offered by the board is followed. Executive directors provide the board with one channel of information about the performance of the organisation. It is important that it is not the only channel!

The Chief Executive is usually just that. They are a board member who is responsible for the running of the organisation as a whole and usually line manages the other executives.

Non-Executive Directors – NEDs

Non-executive directors are usually employed to work as board member for 3-5 days a month, but are not employed to work in the organisation. Usually they are chosen because they bring skills and experience that build on those of the executives and bring an independent perspective that is vital.

The chair of the board is usually a non-executive director who is responsible for the running of the board. As such the Chief Executive is accountable to the Chair.

In law there are only directors. No distinction is made between non-executive and executive directors who share the same responsibilities and legal duties.

Why Do Boards Need Development?


This formula, developed by Reg Revans, states that the rate of learning has to be greater than the rate of the change in the operating environment. Unless the board is learning more quickly than its environment is changing, it will fall behind. The board as a whole needs to be a ‘learning board’ and every director has to be learning as well, working at their ‘development edge’.

In theory the Chair is responsible for appraising each director at least annually and ensuring that they have adequate development plans for their role as a member of the board. This is a significant responsibility and one that is sometimes overlooked.

I also believe that Boards should be highly skilled at collective reflection, with regular use of tools such as After Action Reviews used to improve effectiveness and efficiency. Ideally there would be some sort of meaningful reflection at the end of every board meeting – but often this gets squeezed out entirely or rushed through as busy directors start packing away their papers and tablets.

Reg Revans offered a useful maxim through which the development of the board might be considered…

No action without learning. No learning without action.

Reg Revans

Directors learn to ‘keep quiet’…

Boards are complex, organic, rational and emotional crucibles for debate and discussion where the future direction of an organisation is decided. Usually they have a number of big brains, big hearts and big egos all of which have something to offer. Ensuring that all voices are heard can be a challenge especially in a long board meeting with a packed agenda.

This can result in directors keeping quiet until ‘their issues’ are being discussed as a way of helping to manage time. However it is a waste of potential and a dereliction of duty as every decision made by the board is a decision of the whole board.

The Executives Can Capture the Board

Sometimes executive directors have a language of their own. A kind of techno-babble derived from their own technical specialism and sector. Sometimes policy and regulation brings in a new lexicon and it takes a brave non-executive in a busy board meeting to put their hand up and say “I have no idea what you are saying”. Instead they nod wisely and hope that everything will work itself out.

The Non-Executives Can Capture the Organisation

Sometimes the non-executives in their enthusiasm to fulfil their obligations to ensure that the organisation is being well run can start diving down into the operational aspects of the organisation, which are rightly the domain of the of the executives. They start to demand more and more data as a way of finding ‘assurance’ and ask for more and more meetings to discuss the data. Before we know it the entire board is involved in the operational aspects of the business and momentum and direction are lost while we assure ourselves that all is well enough.

A Preference for Maintenance over Direction

Sometimes the executives can collude in this ‘operational takeover’ as talking about the operational aspects of the business is something of a ‘home fixture’ for them and less challenging than the creative, imaginative and somewhat risky work of setting direction for the organisation.

Also the urgent work of sorting out performance today, results for this quarter, turning the rag ratings green before the next board meeting can displace the urgent decisions about what should we be investing in for the future? What should we stop investing in? Operational urgency starves important strategy.

The Silo Mentality

As non-executives, if we grill the finance director over the finances, the chief operating officer over the operations, the marketing director over sales and our job is done.


As an executive as long as I make sure my part of the business is doing OK and well resourced my work is done.

As Henry Mintzberg suggest this approach to looking after our part of the cow usually ends up killing the cow! A board of directors has to direct the whole cow! It has to think about the organisation as system – not as a series of parts.

The Board becomes Detached from the Organisation

Sometimes boards become so strategic and visionary that the direction they offer bears no reality to the lived experience of the organisation. I worked for a telecoms company a good few years back now where the board decided to invest massively in fibre optic cables. However the every day work of engineers still involved copper cablers and pleas to train the workforce on fibre optic cabling skills fell on deaf ears because it just wasn’t part of the every day experience. The board had run ahead of the organisation.

And many, many more…

These some of the ways that boards can get out of whack if they are not kept subject to regular review and development. There are many more…

If you think that your board could do with development and would like a conversation about it please do get in touch, in confidence, here…

Reflections on Leadership Development in Primary Care…

For the last decade or so I have been working mainly on leadership development in the NHS.

Much of that work has been done in NHS Trusts and organisations like NHS England, and Clinical Commissioning Groups.  Recently I have been working more with GPs, GP Federations, Primary Care Networks and other community health and development workers.

Working in secondary care

  • Primary care and care in the community are sometimes looked down upon. They are treated, by some, as a ‘second class’ part of the health service. It’s not ‘proper nursing/doctoring’ unless it is in a hospital, apparently. This is occasionally stated explicitly. But more usually it is implicit in what gets discussed, invested in and shown on the TV.
  • The way that secondary and acute care attract the lions share of investment. Even when that runs counter to national strategy which is to strengthen prevention and care closer to home.  This is particularly clear at the moment as politicians are queuing up to promise us new hospitals!
  • When I work in secondary care I get to work with perhaps a director of  Workforce and Transformation or Strategy.  Often a Chief Operating Officer as well and other executive and non executive directors. There is a board and a sub-committee structure looking after issues like quality, finance and workforce.  There will usually be an Organisation Development Team. Sometimes a training and development team. Often there will be a Leadership Development specialist or two.
  • And there may even be some budgets available.

Working in primary care

Contrast this when working in primary care at general practice level.

  • There is often precious little specialist experience in leadership development or organisational development and even less resource.  
  • Instead there are partners, GPs and other health professionals and practice managers trying to run a sustainable business providing excellent health care in a challenging clinical and financial environment. At the same time they are trying to find a pattern of working that is financially and psychologically sustainable.
  • And the financial vulnerability, the precariousness, of small or medium sized business often shows up.
  • The idea of Leadership Development often seems like a luxury rather than a necessity.

No wonder the workforce data in primary care is so shaky.  And while politicians promise thousands of new doctors and shiny kit the challenge lies in retaining the current workforce.  This is a leadership challenge. Helping them to find pride and joy in their work. To believe that it offers them a rewarding future.

For 30 years I have been married to Anne. In that time she was a nurse, midwife, health visitor and infant mental health specialist.  She told me about her work, often with partner agencies to keep families together and getting by. This too is the work of the NHS and it’s partners. This IS integrated care.  Care in the home and the community focussing on people in their life context – not just in a hospital bed or waiting room.

I am excited to work with the GenX GP network in Leeds.  It gives us a chance to find hope, pride, sustainability and joy in this very beautiful part of the NHS.

Close to people and their communities.

Increasing access to and effectiveness of leadership development here will help to realise the aspirations of the NHS constitution.