Managing and Leading

Discouraging Intuition and Deep Wisdom in Health and Care

Mike Chitty · June 16, 2024 · Leave a Comment

Time to enrich evidence based practice?

In the realm of health and care, organisations such as the National Health Service England (NHSE) and the Care Quality Commission (CQC) play pivotal roles in setting standards, monitoring performance, and ensuring quality of care. While their emphasis on evidence-based practice and rationalistic approaches is crucial for maintaining high standards and accountability, it can inadvertently discourage the use of intuition and deep wisdom among healthcare professionals. This essay explores this hypothesis, examining how current practices might inhibit holistic understanding and proposing strategies to mitigate these limitations.

The Dominance of Rationalistic Approaches

Evidence-Based Practice

Evidence-based practice (EBP) is a cornerstone of modern healthcare, emphasizing the use of the best available research evidence to guide clinical decision-making. While EBP has led to significant advancements in patient care, its stringent requirements can overshadow the nuanced, experiential knowledge that practitioners develop over years of practice. The emphasis on quantifiable data and standardised protocols can limit the flexibility and responsiveness required in complex, dynamic care environments.

Regulatory Oversight

The CQC’s role in inspecting and rating healthcare services ensures that standards are met and patients are protected. However, the focus on compliance with specific criteria can create a culture of box-ticking and risk aversion. This environment may stifle innovation and discourage healthcare professionals from relying on their intuition and experiential knowledge, which are often crucial in making quick, nuanced decisions in patient care.

Intuition and Deep Wisdom in Healthcare

The Value of Intuition

Intuition in healthcare refers to the ability of practitioners to make judgments and decisions based on tacit knowledge and subtle cues that may not be immediately evident through rational analysis. This skill, often honed through years of experience, allows for a more responsive and personalised approach to patient care. For example, a nurse might sense a patient’s deteriorating condition based on minor changes in behavior or appearance, prompting early intervention that might not be supported by immediate clinical data.

Deep Wisdom and Holistic Care

Deep wisdom in healthcare involves a profound understanding of the human condition, integrating emotional, psychological, and social dimensions of care. This wisdom often manifests in the ability to provide compassionate, empathetic care that addresses not just the physical but also the emotional and spiritual needs of patients. It requires the integration of both scientific knowledge and humanistic understanding, fostering a more holistic approach to health and well-being.

The Inhibitive Environment

Bureaucratic Constraints

The bureaucratic nature of organisations like NHSE and CQC can impose rigid structures that prioritise adherence to protocols over personalised care. Healthcare professionals might feel pressured to conform to standardised procedures at the expense of their intuitive insights, leading to a more mechanistic approach to patient care.

Fear of Litigation and Blame

The litigious environment in healthcare further exacerbates this issue. Fear of litigation and professional blame can drive practitioners to adhere strictly to guidelines and protocols, even when their intuition suggests an alternative approach might be more beneficial. This culture of fear undermines the confidence of healthcare professionals to trust and act on their deep wisdom.

Mitigating the Suppression of Intuition and Deep Wisdom

To create a more balanced approach that values both evidence-based practice and the intuitive, experiential knowledge of healthcare professionals, several strategies can be implemented:

1. Promote Reflective Practice

Encouraging reflective practice can help healthcare professionals integrate their experiences with evidence-based knowledge. Reflective practice involves regularly reviewing and analysing one’s experiences to gain insights and improve future practice. This can be facilitated through structured reflection sessions, journaling, and peer discussions.

2. Encourage Clinical Supervision and Mentorship

Clinical supervision and mentorship programs can provide a supportive environment for healthcare professionals to discuss and develop their intuitive skills. Experienced mentors can guide less experienced practitioners in recognizing and valuing their intuitive insights, fostering a culture that respects and integrates deep wisdom.

3. Integrate Holistic Assessment Tools

Incorporating holistic assessment tools that consider psychological, social, and spiritual factors alongside clinical indicators can support a more comprehensive approach to patient care. These tools can help practitioners capture and use subtle, non-quantifiable aspects of patient health, encouraging the use of intuition in clinical decision-making.

4. Foster a Culture of Open Dialogue

Creating an organisational culture that values open dialogue and diverse perspectives can help mitigate the suppression of intuition. Encouraging team discussions where all voices are heard, including those based on intuitive insights, can lead to more innovative and responsive care practices.

5. Develop Emotional Intelligence

Developing emotional intelligence can enhance healthcare professionals’ ability to recognise and respond to their own and others’ emotions. This training can help practitioners develop greater empathy and insight, which are essential components of deep wisdom and holistic care.

6. Balance Protocols with Professional Judgment

While protocols are necessary for ensuring standardisation and safety, it is important to balance them with professional judgment. Organisations can revise policies to allow more flexibility for clinical discretion, acknowledging that strict adherence to protocols may not always be in the best interest of individual patients.

7. Support Research on Intuitive Practice

Supporting research on the role and impact of intuition in healthcare can provide empirical evidence of its value. This research can help shift organisational attitudes towards recognizing and integrating intuitive knowledge as a legitimate and beneficial aspect of clinical practice.

Conclusion

Organisations like NHSE and CQC, through their emphasis on evidence-based practice and regulatory oversight, can inadvertently discourage the use of intuition and deep wisdom in healthcare. This inhibition limits the holistic understanding and responsiveness required for effective patient care. By promoting reflective practice, encouraging mentorship, integrating holistic assessment tools, fostering open dialogue, providing emotional intelligence training, balancing protocols with professional judgment, and supporting research on intuitive practice, healthcare organisations can create a more balanced and integrative approach. Such strategies can help reclaim the value of intuition and deep wisdom, enhancing the overall quality of care and supporting the well-being of both patients and healthcare professionals.

The Care Manifesto – A New Reading Group

Mike Chitty · March 5, 2021 · Leave a Comment

The Care Manifesto is a short book, less than 100 pages, written by the Care Collective.

It articulates a radical vision that puts care at the very heart of our lives and politics.

I plan to start a new reading group to explore the book and its relevance to management and leadership in health and care.

We will focus on just one section each week covering the whole book in just 6 weeks. It IS less than 100 pages after all!

The book is divided into 6 sections:

Caring Politics – 24 March
Caring Kinships – 31 March
Caring Communities – 7 April
Caring States – 14 April
Caring Economies – 21 April
Caring for the World – 28 April

All sessions will run from 5-6pm.

Fancy joining us? Book here – just 20 places available…

Plans for 2021 – I’d like YOUR help

Mike Chitty · December 22, 2020 · Leave a Comment

2020 started with me reflecting on the sorry state that our leadership (whatever that is) had got us in. Back in January 40% of NHS nurses had taken time of work because of stress in the previous 12 months, with similar figures for other clinical and non clinical staff. The NHS was in crisis.

And then covid seemed to erase history as well as make it, as newer and ‘bigger’ crises meant that historic problems got largely forgotten about as resources were concentrated on tackling this ‘new enemy’. Our leadership seems to always want an enemy for us to fight.

Some 10 years ago I was running three projects in Leeds.

The first, Progress School, provides free group based coaching to anyone that needs it. It provides time and space to think about who, and what, you are becoming and to find ways to manage your personal development.

Progress School will be back in 2021. You can help by coming to it yourself, or by suggesting it to anyone you meet that might benefit from a bit of free coaching.

The second was the Leeds Community Enterprise (Elsie for short). This is an enterprise accelerator. A source of wisdom, advice and practical support that can be used by anyone in Leeds who is undertaking any kind of enterprise. It may be a business, a campaign, community group or any other project. It is for anyone who is looking to make progress, but needs a bit of a hand from the Leeds community.

Elsie provides a service that is confidential, competent and caring.

With the boundaries between business, community and social impact becoming more blurred we need to put together new, low cost and sustainable ways of helping people in our community who are trying to make things happen. This is my best stab at what that could be like. Elsie is a group of trained volunteers drawn from all walks of Leeds life who meet for 2 hours every month to brainstorm advice, guidance and support for anyone in Leeds who is looking to advance a project. Elsie not only offers practical and technical advice, but will also act as point of contact into other Leeds support networks.

Elsie meetings are designed to be fun, fast moving, practically focussed and above all helpful – and not just for the people who are seeking support.

Elsie ran successfully in Leeds for a couple of years about 10 years ago. I plan to bring it back in 2021. You might want to help by joining Elsie as panel member, or by bringing a project to it. In order to become a panel member you will need to attend a short training session.

The third project that I want to bring back is Disrupting Poverty. This was a community of people who were disturbed by the extent of poverty in our city and wanted to do something about it. The way the city shaped itself into the ‘haves’, the ‘have lots’ and the ‘have nots’.

Disrupting Poverty used large group meetings called “Innovation Labs” or “Results Factories” to bring people together to explore ideas and organise to make the best of them happen. Back then we calculated that the number of children in Leeds who officially lived in ‘poverty’ would more than fill Elland Rd. In the decade since them things seem to have got worse. I stopped Disrupting Poverty when the council set up the Poverty Truth Commission. I wish I hadn’t. I intend to start it up again in 2021.

How Can You Help?

Get in touch to have a natter is probably the best way. You can book a bit of time in with me here

Or sign up for the Elsie Training here…

Progress School dates for 2021 will be published soon.

33 Ways (and counting) that ‘Whiteness’ Works

Mike Chitty · October 23, 2020 · Leave a Comment

I started in anti racism when some of my favourite musicians starting playing gigs in the late 70s for the Anti Nazi League and Rock against Racism and I was ‘just seventeen’, if you know what I mean. It was not long after Bowie had declared that ‘Britain is ready for a Fascist leader’.

In the 80s I trained as a Teacher when the impacts of race, class and gender on educational attainment and child development were taught rather than the mechanics of the national curriculum. It was the time of the miners’ strike and the North/South divide in the UK was wide.

In the 90s I worked in black, village schools in rural West Africa in an old British colony before coming back to Leeds to raise a family and build a career. I had some theory as well as a little practice and experience under my belt.

But no-one had re-framed the challenges of anti-racist practice with the study of ‘whiteness’ and how it operates until Tracie Jolliff introduced it to me at the NHS Leadership Academy perhaps 5 years ago. It has shaped my practice and my observations and reflections ever since.

Now I will ask leadership teams and boards to have a good look at how ‘whiteness’ operates in their culture. Because until we can start to see ‘whiteness’ as an ‘operating system’ and start to re-write some of its code, it will keep being extractive. It will keep producing inequities.

More recently working with Pauline Mayers on ‘Lessons From Henrietta Lacks’ has helped me to see a bit more of how my own whiteness operates as part of the wider system. Heather Nelson at the Black Health Initiative in Leeds too has helped me to look in the mirror. And Whiteness has also had me in its sights. “If you are going to do ant-racist work you will have your baptism of fire”. You will have many baptisms…

By ‘whiteness’ I don’t mean all white people. As Professor Kehinde Andrews has said ‘whiteness is not just for whites’. I mean a system of cultural and historical assumptions about hierarchy, power, objectivity, logical positivism, duality (whiteness is happier with black and white rules not shades of grey, nuance, wisdom and judgement) and patriarchy that are so deeply enmeshed in many ‘white’ cultures that they pass invisibly as ‘how things are’.

I have started to look for clues about how whiteness works. Signs of whiteness at work. In myself. In the organisations I work with, and for. In the communities and societies that I am a part of. That are a part of me. They are clues, not laws, or rules or truths.

Whiteness looks for and at what is wrong with colour
Whiteness commissions or supports people of colour to sort out ‘what is wrong’ (provide special course for people of colour, set up networks, write reports)
When Whiteness experiences dissent or challenge it frames it as a threat and defaults to power and hierarchy over compassion and listening
Whiteness likes to be taught by colour (What should we do?)
Whiteness finds reflecting on itself difficult – it often triggers guilt and shame rather than hope and opportunities to change
Whiteness often blames victims (if we feed the children they will become dependent)
Whiteness polices tone – ‘calm down…’
Whiteness when it feels threatened punishes
Whiteness invites people to learn and when the learning becomes powerful, painful and the Zone of Uncomfortable Debate is entered with accompanying emotion, they close it down or punish the ones expressing their pain
Whiteness values compliance over dissent
Whiteness ‘does to’ rather than stands alongside
Whiteness rarely looks hard at itself
Whiteness learns slowly because it already knows how to look after itself
Whiteness values self development over self sacrifice
Whiteness exercises ‘power over’ in preference to ‘power with’ or ‘power to’
Whiteness holds on to its power
Whiteness sees itself apart from the system rather than as a part of the system
Whiteness prefers domination to collaboration; competition to cooperation
Whiteness is used to ‘winning’; getting its way
Whiteness is trapped in its own miserable, extractive, consumerist nightmare of progress
Whiteness finds it hard to see its paradigm of privilege
Whiteness manipulates through psychological safety and self supporting cliques
Whiteness recognises as intelligence/wisdom the products of white normative educational and developmental processes. It tends not to recognise the product of other non-white developmental norms.
Whiteness claims inclusion and compassion – while presiding over enormous inequalities and violence
Whiteness shies away from complexity and nuance in favour of evidence
Whiteness tends to divide the mind from the body
Whiteness encourages us to privilege certain world views and to dismiss others as unscientific, or not evidenced
whiteness upon learning of the pain/trauma of others will become the emotional ‘victim’ needing comfort thus derailing the conversation and focus back to themselves
Whiteness upon learning of the pain/trauma it causes others will become the emotional ‘victim’ needing comfort and thus derailing the conversation and putting the focus back to themselves
Whiteness starts with white as the default. It then uses categorisation and tick boxes to fragment people, shift them away from default and identify them in more and more ways as Not Normal. To hide intersectionality by counting variables that it can then treat as ‘independent’.
Whiteness prizes ‘knowledge’, but is very clear about the forms that it finds acceptable – fetishising a narrow field of science and turning away from epistemological positions that doesn’t privilege it.
Whiteness sees ‘BAME’ as a ‘background’. In the foreground it sees opportunity.
Whiteness prefers to see racism as an individual, personal act, an event that can be condemned – rather than as a structure of its making for its own convenience and power.

What have I missed?

Love’s Leadership; Lost or Found?

Mike Chitty · August 21, 2020 · Leave a Comment

Leadership is a toxic word for many.

While for others it seems like the holy grail. The missing ingredient in failure. The magic that leads to success. A thing worth obsessing about and building a multi billion pound industry, and healthy livelihoods in.

What is Leadership?

Leadership has no widely agreed definition. It is a word that is used to describe and explain a wide range of phenomena in:

politics, culture, work and leisure from the global to local,
organisations of all sorts,
networks, communities, associations and ‘social movements’

Leadership is found in just about every aspect of human endeavour. But only because we look for it. Or its magical explanatory powers.

It comes in a bewildering choice of varieties:

Transactional
Transformational
Digital
Directive
Affiliative
Participative
Clinical
Patient
Citizen
Distributed
Distributive
Collective
Charismatic
Dictatorial
Evil
Benevolent
Adaptive…
I could go on, probably for ever

But perhaps, like Phlogiston, it doesn’t really exist?

Doers Leadership even Exist?

After all it is a word that allows us to label something that we can’t actually describe. A bit like love. And for me, leadership is an expression of togetherness and love. And no matter how hard we try our expression is imperfect. But we can reflect. Learn, change and get better.

Leadership, like love, is a gift that has to be given and received. Neither are straightforward. Plenty can go wrong. It probably will. But this is part of the process. It allows it to deepen and mature.

For me, leadership is a collective process that creates a future that is different to the present. Good leadership creates more sustainability and fairness. Not so good leadership leads to an insecure future and grave inequalities. It is heart-breaking that in our current narrative Leadership is too often judged in much narrower terms, and in fact inequality and environmental harm are things that can be created as long as the price is right.

Leadership and Leaders

We have a generation of gifted leaders working hard, being heroic, making great progress. Providing us with GOLD command. But it would seem we also have a generation of evil and malevolent leaders spreading division and oppression, shirking and profiteering.

See what I did there?

I shifted from LEADERSHIP – that social process that we are all engaged in to some extent, to LEADERS. The anointed few, with special powers of high office, high skill, high imagination or high finance who we can choose to love or loathe. This lets us escape from thinking about our role in this. It supplies us with heroes and villains and allows us to play the victim. The age old drama triangle plays out and nothing changes.

We must resist the temptation to act as if Leadership is a special set of behaviours that Leaders, those other people, do.

Leadership is not power. It is not authority. It is not what ‘the bosses’ do. It is the ultimate inclusive process. We are ALL more or less complicit in it. It is a social process that we all contribute to. Sometimes through our silence and compliance.

Human civilisation is fragile, brutal, powerful and hate filled. It is also beautiful and loving. In my home city of Leeds, in spite of a strong economy, inequalities have worsened. Life expectancies have stalled or are going backwards. Even before Covid hit. And if look at the global level thinks look even worse.

Has it all gone wrong?

Leadership has not been getting most of us to a better future. Even those that have made a lot of money from it aren’t any happier. And aren’t living any longer. And even if they were living longer and more happily, while the rest get left way behind, how long could that be sustained? Socially? Environmentally?

So perhaps we still have a lot to learn about the thing that we label ‘leadership’.

Where do I start?

We can start with a more committed, generous, imaginative and thorough attempt to describe what we think we are putting the label on, and what we think that thing is for. And a reaffirmation that we intend this thing called ‘leadership’ to take all of us to a more secure and fairer future.

And a recognition that we all have a part to play. Gifts to contribute and gifts to receive.

Are you ready to start your leadership journey?