In Memory of Ian Bradshaw – Leadership Lessons From the Chemotherapy Ward
Ian Bradshaw was a deeply reflective friend, former colleague and client with an authentic commitment to nurture and bring out the best in everyone around him. Nothing demonstrated this more than our regular conversations whilst he was undergoing chemotherapy and whilst in palliative care. His peace came from knowing that his family and everyone else around him would be OK when he was gone.
One of the things that struck Ian, was the leadership demonstrated by the people taking care of him in the chemotherapy ward. This moved him to write the below piece and send to me. Shortly afterwards he passed away peacefully with his loving family by his side.
“On the 1st April 2019 a young doctor at Epsom General Hospital took me into a small cubbyhole of a side room to enact the most spectacular of April’s Fool day japes. I was still a little drowsy, recovering from the sedation of the just completed endoscopy; he recognised this and took things slow. This was the moment, at approximately 2:30pm, long after all foolish activities should have finished for the day, that I was subject to the cruelest joke ever, and learnt I had cancer.
I remember the room being very quiet and peaceful, and on reflection was surprised by how calm I remained. I guess I knew something was wrong, but nothing quite prepares you to hear that news.
My youngest son had driven me to the appointment and was outside waiting to take me home. When he asked if everything was OK, I lied; not to keep him from the truth, but to enable me to tell all three of my sons the news at the same time. That was the most difficult conversation I have ever had to hold in my life. It happened two weeks later on 15th April after biopsies had fully confirmed the diagnosis of April Fool’s day and specifically identified the exact form of cancer in my oesophagus.
That was 9 months ago, and since that date I have undergone four rounds of pre-surgery chemotherapy coupled with immunotherapy under a clinical trial offered by the Royal Marsden Hospital. Late in August the superb Marsden surgeons in Chelsea removed my oesophagus, and after a number of weeks of intense nursing to some semblance of physical recovery I have just completed my four cycles of post-operative chemo/immunotherapy.
You might think this leads to tales of pessimism and doubt, but far from it. What I want to focus on here are the positive lessons I have been able to apply on this journey of a lifetime.
Ten leadership lessons applied to the chemotherapy ward:
1. Have a crystal-clear vision
The simpler the better. Mine was – “we are going to beat this”. That vision, and that vision alone, has driven every single decision I have taken in the last eight months. Literally what I ate, when I slept, when I worked, and when I was strong enough to socialise, travel, and exercise and generally enjoy life. I cannot stress enough how important having a clear vision is. Without it, as a leader I am broke, literally I have no currency, and there is no reason whatsoever that anyone should follow me.
2. Positively communicate the vision to your team
Having a clear vision is the first step, but then I had to communicate that vision to all that matter – my team! I needed to ensure they understood it, and were onboard with it. That means they are able to explain the vision to me, better than I had explained it to them. Team family and the medical teams were instantly onboard; and a key element in my relationship with these teams was positivity. Others will tell you of an increasing belief that those with a positive outlook fair better in the receipt of cancer treatment and it is claimed they have better overall outcomes. Hence, I learned to communicate my vision with positive energy, happiness and commitment.
3. Surround yourself with Excellence
I needed a wider team who are fully aligned with the vision, and very specifically have skills and competences I did not possess. I had to learn to depend upon and delegate fearlessly to this excellent team. Royal Marsden Hospital (in Sutton & Chelsea) and Epsom General Hospital have formed a very strong pro-active blanket of excellence for me, for which I am eternally grateful. They administered chemo, carried out surgery, and picked me up when I was stupid enough to ignore the advice of my nurses, causing my immune system to crash. I learnt that nothing can be achieved alone. To deliver any strategy in business (no matter how simple or complex) needs a wider team, alliances, coalitions, collaboration and simple help. When the chips are down, it is obvious that everything that is important is delivered not by the leader but by “the team”.
4. Feed the team
Business experts call this “motivate and inspire” – words that can strike fear into all but the most charismatic leaders (and believe me they are few and far between, and I am not in their number). For us mere mortals, the simplest form of motivation is to listen. And by that, I mean I had to learn to actively and genuinely listen. Not only is it informative in terms of what you will learn about your business, but it will be invaluable in terms of what you can learn about yourself, and your ability to lead. If you are like me, and are a bad listener, then take someone else with you to key meetings, so they can listen for you. My wife, or one of my sons, played this role excellently in all my meetings with the senior consultants and senior clinical staff, and often picked up key nuggets of information I had missed, that were vital to my treatment or recovery. The second simple motivation tool is communication. I learnt quickly to tell the team simply and often what is happening and what is pleasing me, and what is worrying me. I found repeatedly that someone in the team was able to eradicate every worry that I could possibly imagine. This worked absolute wonders for my mental strength and enabled me to continue to focus on the vision and very greedily (for me) – what was pleasing me. If you want to know the next simple step to motivate and inspire, please see lesson 10 below.
5. Create more leaders
The captain cannot be on the bridge 365-24/7. And I may not have noticed quickly enough, but leaders exist at all levels in our organisations. A junior member of the team might lead on organising a social event. Someone in the centre of the team might coordinate efforts to ensure no two parts of the team are pulling in opposite directions. My youngest son led my fitness and dietary regime without which I might not have survived the chemo or the surgery. My middle son kept me grounded, refusing to treat me any differently despite all the crazy treatments and the never-ending visits to hospitals for check-ups. My eldest taught me how to motivation and inspire myself on the tough days and endlessly encouraged me to pamper myself on the good days. Our job, as leaders, is to encourage all these new leaders to blossom.
6. Don’t sweat the small stuff
There is Important, and there is Urgent, and then The Rest. I learnt to focus on the Important only (some of which will also be urgent). Someone else always picked up the slack on the (non-important) urgent, and the rest either get done, or didn’t; and believe me it did matter which. I believe massive efficiency improvements are available for most businesses that can stop their staff needlessly processing “the rest”. Just like cancer – we need to cut out pointless activities and initiatives from our organisations and focus only on what is truly important for the business bottom line. If you need a practical lesson in this, spend a day on a chemo ward, you will see nurses have totally adopted this lesson (together with lesson one) in their obsessive focus on patient care and patient outcomes.
7. Learn, …never stop learning
I had to force myself to keep my mind open and occupied, but avoid becoming obsessive on any one topic. I tried to improve my skills of engagement with my audience on what matters to them; and constantly have a sense of enquiry about their concerns. Once my surgeon knew I was an engineer by background, he was able to describe his work much more effectively to me. Learning that the leak test on the new joint between my upper stomach and windpipe, is pretty much the same as we would use to test a pipeline joint in the oil & gas industry, built confidence and trust between us. Issues often emerge from the learning that follows such enquiry, the investigation of which enabled me to better understand this surreal environment of the chemotherapy ward.
8. Stay optimistic
No matter what feedback you receive, please remain optimistic. My personal advice is do not over-consult the internet, especially on medical issues. For all sorts of reasons (you can easily figure) the internet thrives on giving you the worst-case outcomes, especially in respect of medical issues. So, let’s suppose there are a 1000 people with your symptoms; they will all get a range of outcomes that a statistician will plot on a bell curve. Remember the internet will describe the worst possible outcome, and by definition that will likely only impact five to ten in those thousand patients, the outcome for the other 990 will be something better, or much better, and the strong probability is you are somewhere in that 990.
9. Diversity every time
Apart from the most senior consultant oncologist, and a couple of the chemo nurses, almost every other member of my highly professional and experienced medical, clinical and surgical teams were of non-British descent. I get hung up on external identifiers of diversity (I have just done so above); we use: gender, ethnic origin, sexual orientation, skin colour, hair colour, dress sense (or lack of it in my case), and just about any other visible differentiation to claim we have got diversity in our teams. Quite frankly I find these are all equally useless (or useful); as what I am truly trying to achieve is diversity of thought. I have come to learn those easily identifiable external markers are at best a weak proxy for discovering who thinks differently from you. But I discovered I don’t need those useless markers – when I meet someone who thinks differently from me, I know. They can make me feel uncomfortable, or exceptionally at ease, they will likely irritate, they can entertain, they will grab my attention or I will find them unusually quiet. In the absence of any obvious de-railers (really poor social/team skills, or clear signs of being a mad axe-murderer) then I would always give preference to the diversity candidate. They will automatically add value to the team by bringing their different thinking into the debate.
10. Say Thanks
As a leader, I could simply not do this enough. I tried to include everyone in my thanks from the highly skilled consultants and surgeons (or maybe project directors in your case) across to the exceptionally dedicated nurses (field engineers), and including the gentleman who cleaned my hospital room twice a day (your critical support staff) to ensure I didn’t get attacked by germs when my immune system was at its very lowest. All these people were there for me, and all gave their very best without being asked. But when you thank them it is more that simple gratitude. You are saying I have noticed you, I appreciate your contribution to my good health (or your project or business) and I am sending a signal to you that you matter to me.
I don’t yet know the final outcome of my personal journey, but I have had great feedback on the way. The surgeon confirmed he had removed all of the tumour with safe margins when he removed my oesophagus, and the mop-up chemotherapy appears to have worked for now as there are no tumour markers in my blood results, and all my recent scans were clear.
I review with the doctors in three months to see how things have progressed; in the meantime I need to build strength, energy and muscle mass; and thank a lot of people who have supported me these last nine months.
The lessons are free for you to use, or abuse, as you see fit.
If you do find these lessons of any value, then please do consider making a small contribution to: Cancer Research UK, The Royal Marsden, or Epsom General Hospital.”