Reflective practice – the leadership ‘superpower’ – Catherine Afolabi

Posted on Posted in Non-Clinical Leaders

Reflective practice – the leadership ‘superpower’

Catherine Afolabi

Catherine Afolabi

I take my seat, in a meeting room with thirty-odd clinical and non-clinical executives already arrayed around the table.  It’s a warm afternoon in a dark panelled room. I begin to present my report on a situation, which I believe represents a significant risk to staff and patient safety.  I am confident – after all, I know my stuff and I am used to presenting information people don’t want to hear. I have rehearsed and prepared a balanced and accurate evidence-based report.  I finish speaking and end, as usual, by taking questions and expect the discussion to open up. I am immediately challenged by one executive, followed by two others. Their accusations ranged from, deliberately withholding critical safety information (which had been raised in other forums). To including incorrect information (factual evidence supported the report). At this point, I have my first inkling that this is no ordinary day at the office.  The rest of the room is silent. There is no voice of support.

 

The meeting went downhill from there – the important issues I had highlighted were not properly discussed. The process employed in preparing the report was, repeatedly questioned.  I felt that the focus was on the messenger, not the message – and this messenger was being ‘shot’. I reeled from the room in shock and embarrassment with my own questions about my competence. Self-doubt and recriminations -from others, came later.

 

This experience happened some time ago.  It was not the first meeting where things did not go as planned and it wouldn’t be the last. However,  this one left an impression. It felt like more than the usual ‘tough’ conversation – it felt personal.  My core sense of self could have been damaged. Making it difficult to undertake essential functions of my job. Such as, raising difficult or contentious issues and presenting at meetings to very senior members of staff.  

 

Fortunately, it didn’t have that effect.  I was able to transform the experience into a learning point. The knowledge has bolstered my confidence and improved my ability to work through the “jolts” [1] of working life. I am now able to get through to the other side despite the challenges.  I put this transformation down to reflective practice. I was fortunate to understand the theory behind reflection and the different models. So I selected a model that enabled me to examine the experience without damaging my confidence.

 

Reflection has a somewhat dubious reputation in some quarters. I need only to listen to clinicians ringing colleagues and enquiring about whether their reflective journal will be introduced into court, to realise the anxiety it generates.  The tragic case in which Dr Bawa-Garba was involved, [2] has done much to amplify this worry. It is a wonder anyone chooses to commit reflection to paper.  There is no doubt that reflective practice, when undertaken in inappropriate conditions, for example by those with poor physical or mental health [3] or in a non-supportive, punitive culture [4] may harm the individual.  Reflection also requires time – a seemingly scarce commodity in already pressurised work environments.

 

Yet there is a significant body of literature supporting the finding that reflection, whether undertaken individually or in groups, provides insight.   Making use of learning from errors or other often negative events [5].  It is no wonder then that reflection remains a mandatory activity for many professions and specialties [6].

Through reflecting on my experience, I have learnt that:

  1. There were things I could have done (and now do) differently. For example, when laying the ground for difficult discussions
  2. I do not have to change who I am nor accept oppressive behaviours exhibited by others.  I speak out if I, or others, experience behaviours out of line with the espoused values.
  3. I held assumptions about power and authority.  My own power comes from expertise and experience within my field and it can feel daunting to others in positions of authority.

But why is reflection so important? How can one do it safely? And what is its relationship with leadership?

 

If you believe leadership is an inclusive process, not the preserve of the few, then reflective practice must surely be in your toolbox. It involves being curious, self–aware, continually learning and improving.  Reflection has improved my ability to gain new insights into my own actions. It also helps me to understand the perspectives of others, whilst not blaming myself. Helping to transform a negative experience into a learning one. From there I can move on from the experience and eventually achieve balance.

 

Professional bodies have their own requirements and guidance on reflective activity.  Reflection does not require identifiable details and if documented should be anonymised [6].  It can also take place in activities other than writing in a journal, for example, case-note reviews, clinical audit and discussing events with colleagues or within a team.  Reflection may also take place in relation to positive events. These situations all require an examination. Why did it happen and what can be done differently in the future.

 

Whether you undertake reflection as part of your professional requirements or for your own reasons, it becomes easier with practice.  For me, being reflective is part of my value system and I believe that my team and organisation are the better for it.

 

Catherine Afolabi is Head of Risk and Assurance at Guy’s and St Thomas NHS Foundation Trust. She is in the final stretch of an MSc in Governing, Managing and Leading in Healthcare at the University of Westminster. She believes people perform best in teams in which there is trust, purpose, choice, camaraderie and respect.

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