Mr Henry Marsh: Philosophy, Plumbing and Humility


I’m listening to the neurosurgeon, Mr Henry Marsh, talk to a large group of the public, this includes teenagers with an expectation of insights into a life of glamour as a neurosurgeon. Mr Marsh’s leaves us feeling inspired, thoughtful, and most of all sober to the inevitable fact, that with life comes death.

He calls neurosurgery plumbing because he’s no neuroscientist; nevertheless, neurosurgery is a career for educated plumbers with nerves of steel (one must achieve three A graded A Level’s, to be shortlisted for medical school). He describes the stress of emergency life-saving surgery as verging on terror, yet, this doesn’t get in the way of fast plumbing.

An ability to act in spite of fear has been suggested as a hallmark of success. It points to a well documented core leadership trait – courage. Being a doctor isn’t for everyone, but the principle of courage stands, whatever your profession or your status therein.

Failure for Mr Marsh was core to the learning process, an uncomfortable truth perhaps. He described over delegation and misplaced trust, yet in essence, the ability to deal with failure was necessary even when the stakes were life or death. Mr Marsh was notably humble and authentic in the presence of his starry-eyed audience.

In a nutshell, the art of being a ‘consultant neurosurgeon’ appeared more about decision making than it did surgical skills; that is, to operate or not to operate? One could be forgiven for thinking Mr Marsh a philosopher not a plumber. But undoubtedly, there were no shortcuts to plumbing or philosophy.

As a true master, he glided effortlessly through two hours of crafted teaching, leaving the attendees with discreet golden insights into the world of transformation. We expected glamour, we received philosophy, plumbing and a humble version Mr Marsh. Encore!

What can we learn from Mr Henry Marsh?

  • In the presence of fear we can still do what’s necessary.
  • We don’t always get it right, this is a part of our growth and learning.
  • As we accept our fallibility, we learn humility, this creates clarity of decision making as we gain experience in our field.
  • We work as part of a team, as a leader we must own our team’s mistakes.
  • If you don’t know the answer tell the truth, we’re not all neuroscientists or…fill in the blank.
  • It takes courage to do what you love – do it anyway.

Books by Henry Marsh:

Marsh H (2014) – Do No Harm.
Marsh H (2017) – Admissions.


Is The NHS a Burning Platform?


Did someone mention a burning platform? As operational managers, many burning platforms distract us from planning and effectively running our clinical services on a daily basis. Some would say that putting out fires is the job of an operational manager; this is undoubtedly true. However, in our blindspot there is an uncomfortable truth. Allowing a fire to take hold is also a sign of failure, our failure. This could be due to an act, or omission, on the part of the manager and clinical team. It can often be the result of system failure, as the corporate wheel spins in the opposite direction, preventing managers from managing effectively (pyromania is for another article and will not be debated here).

A burning platform is a description often used in the NHS to describe an impending service catastrophe, one which we may or may not be able to fix (rather than prevent). The best operational managers have developed fire-fighting as a selling point or winning strategy and this has become an essential part of our roles. If we scale this up it would reflect our evolving healthcare ethos, closing the stable door after the horse has bolted (remember Sir Derek Wanless?).

Undoubtedly we have the best emergency care services in the world – another example of our flare for fire fighting. Our A & E services are so efficient (unless an inpatient bed is required) that patients flock to our doors. As victims of our success, the patients keep coming, the majority of whom we treat within four hours.

But there’s a good reason to be talking about burning platforms. Some years ago, I was in conversation with an oil industry health and safety manager, talking about training off-shore workers in light of the Piper Alpha disaster (a North Sea oil rig that caught fire). The fire was responsible for the death of 167 men. Lord Cullan reported inadequate maintenance and safety procedures as responsible and made 100 recommendations.

I learned that as part of the fire safety procedures, personnel were required to move to the designated fire point and wait for instruction. Personnel were advised not to jump off the rig into the sea as this would result in certain death. As the fire worsened, men continued to stand at the designated point waiting for instruction; however they were unaware that the fire marshals had already been killed in the fire. A number of men, in the face of certain death, jumped overboard; others stayed waiting to be told what to do. In this instance, those who jumped had a greater chance of survival because it was the worst oil platform fire in history.

The fire took thirty-six days to be extinguished by wild well controller Red Adair (The Guardian 2103). Red Adair, as you can guess, wasn’t famous for fire-prevention, he was famous for dealing with burning platforms. To be an expert at this, you would need to spend at least 10,000 hours practising, and the same is true for fire prevention.

In light of the above, do we really believe that the NHS is a burning platform? As much as I jump at the chance of putting out fires, fires are a sign of system failure and should not become the norm. But like a turkey fattening itself up for Christmas, it’s a big ask for those of us who have developed a career out of fire-fighting. The first stage is to recognise the number of burning platforms we own. What we allow persists.

I’m uncomfortable thinking that I may contribute to this Red Adair culture. However, to transform we must feel uncomfortable with the status quo. We must feel the heat of the flames licking at our feet in order to shift positions or jump; either that or die complaining. The Kings Fund leadership team teach that we are all part of the solution regardless of the problem and I believe this too. But it’s a scary environment: we’re programmed to respond to fear and as Florence Nightingale once said, ‘How very little can be done under the spirit of fear.’

But the news is good: we don’t work on an oil rig or a burning platform, we work in the NHS. Although somedays it can feel as if we are on fire, we are not. The burning platform is a powerful illusion but we must decide whether we are going to stand around waiting for instructions or whether we feel uncomfortable enough to shift our position. We don’t need to jump into the cold North Sea, we’re on solid ground. Once we can see this, our vision of what is possible will change and we can find new ways to work that take the heat out of our experience.

A Life in 5 Chapters by Portia Nelson

Poem shared by Dr Wayne Dyer:
Chapter 1
I walk down the street.
There is a deep hole in the sidewalk.
I fall in.
I am lost… I am helpless.
It isn’t my fault.
It takes forever to find a way out.
Chapter 2.
I walk down the same street.
There is a deep hole in the sidewalk.
I pretend I don’t see it.
I fall in again.
I can’t believe I am in the same place.
But, it isn’t my fault.
It still takes me a long time to get out.
Chapter 3
I walk down the same street.
There is a deep hole in the sidewalk.
I see it is there.
I still fall in. It’s a habit.
My eyes are open.
I know where I am.
It is my fault. I get out immediately.
Chapter 4
I walk down the same street.
There is a deep hole in the sidewalk.
I walk around it.
Chapter 5
I walk down another street.

Listen – It’s Not All About Us.


The subject of active listening keeps cropping up in conversation, mostly with doctors. They keep talking but remain convinced they’re not being heard.

Recently, a colleague and I delivered training for the NHS London Leadership Academy, part of this involved a session called ‘Listening with nothing on your mind.’ The feedback suggested that it was the most popular part of the programme. The exercises we used were insightful.

The challenge for all of us is to listen without interruptions from self-talk and a pre-occupation with the outside world. We are often deeply distracted by our own state of mind. If over thinking is a perfectly normal part of the human condition, how do we improve our listening skills? How do we know when we’re distracted and off track? How do we know that we’re not missing something vital to the future of our business? In healthcare the ability to actively listen is necessary for safe clinical care.

It’s not always as simple as it sounds. Coaches like myself have supervision and many years of training to hone this skill….the art of coaching essentially depends upon deep active listening; this requires awareness. We must manage our tendency to be distracted by ourselves or by others.

Notice when you’re being distracted – try it, today. Notice the difference it makes to your relationships with the people around you and also the quality of your experience.  We may also find that your jobs become much easier, as we learn, that it’s not all about us.

Beyond Healthcare’s Burning Platform


I’ve written recently about the above, and the tendency for NHS managers to refer to the NHS as a burning platform. But there are those who’ve made a career or winning strategy out of fire-fighting, the Red Adair’s of healthcare ( Red was the famous wild well extinguisher).

But fighting fires, whether in work or at home, indicates a habit of reacting to what’s thrown our way, as opposed to the planning of a more satisfying alternative. Individually, this can be difficult to see, we’ve become experts at reacting to what goes on around us, we can’t see any crazy alternatives.

A coach mentor of mine, Steve Chandler talks about creating a Crazy Good future. Most of us dare not plan for good, let alone crazy good; but until we do, we’ll be stuck right where we are — feeling as though we’re on fire with our hand on the water bucket.

What’s your crazy good alternative?


Is Fear the Death of Creativity?

Editing A Blank Page

I haven’t blogged for a while because I’ve been learning to write fiction. Who’d have thought learning to write fiction could be as difficult as learning any other new skill? On some days it’s been rather a slog, and it feels more difficult than it should. As Gene Fowler once said:

    ‘Writing is easy: All you do is sit staring at a blank sheet of paper until drops of blood form on your forehead.’

It occurred to me more than once, as with any other endeavour, it is the fear of failure that is more likely to grind us to a halt. I learned from the masters, that it is better to write poorly than not write at all.  After all, as Jodi Picoult once said, ‘you can’t edit a blank page.’