Do you know what game are you playing?

We have all received those emails. “Urgent reply required“. Some report, return or response is being demanded at short notice with even faster delivery expectations. It is likely that most managers’ inboxes are littered with such emails demanding attention. This creates an environment of reactivity – always dealing with the urgent issue in favour of the important ones. Don’t worry, those important ones will have their moment, they too will become urgent at some point. This is the opposite of the “stitch in time saves nine” aphorism.

The reactive workload resulting from urgent tasks dominating the important ones is a vicious cycle. It is incredibly difficult to break out of this cycle – to escape the orbit of reactivity. This orbit of reactivity creates decisions that appear inconsistent, without wider context, without coherence with wider strategy. This is the pragmatist – “getting stuff done” and is an easy trap to fall in – we all have done. Such a reactive day will start with the email inbox and probably not escape it barring those meetings where further urgent actions are handed out – and followed up with confirmatory emails.

How is that working for you?

Do you feel this reactivity permits an organisation to own its own agenda, to pursue that agenda and achieve long term goals? That would appear to be an unlikely outcome. It is time to take back an element of our own decision making cycles.

In healthcare, the opponent in our game is the constant and ever growing demand signal. There is always more work, it is never ending. Constantly reacting to this demand rather than getting out in front of it has us all on our back feet.

There is an alternative. This alternative approach can be described in the vernacular of “Game Theory”. This is a Nobel Prize winning area of work that describes a game as any interaction between to people/organisations. Within the theory there is one particular concept of note: the infinite vs finite axis of viewing interactions.

Finite games are known: they have identified players, rules and agreed outcomes. Organised sports are a wonderful example of finite games. In many instances, there is even a whistle to clearly signal the end of the game. There are clearly defined conditions for winning. Infinite games, by contrast, have players that may be know or unknown, rules that change or are hidden and the outcome is to stay in the game, there are no winning conditions.

Demand for healthcare is an infinite game. There is nothing in any examination of the data that shows it will do anything other than grow. The type of services under demand, the amount of the demand have all shown net growth in recent decades.

How can success be achieved be defined in an infinite game? Infinite games’ success is defined by staying in the game – surviving – rather than some winning condition or state. To survive, to remain sustainable, the important must be addressed, not just the urgent. Systems must be agile, have long term goals and work to generate non-dependency, to have succession plans and adapt to the inevitable change in circumstances.

To be sustainable, an organisation must have authentic leadership. Authentic leadership is the genuine alignment of knowledge, skills and behaviours backed up by core values. Those core values must inform a morally compelling vision for the organisation. An example of this has been the original (& extant) vision from one of the most interesting social experiments of the last few hundred years: The United States of America. This vision was initially set out by the Declaration of Independence, and equality sits at its heart – at its morally compelling core. This equality was not universally applied from the outset, and remains a work in progress. The progress towards this goal can be tracked in their legislative history: The Constitution, the abolition of slavery, women’s suffrage, the Civil Rights Act, the establishment of gay rights. The progress towards equality has been an (ongoing) incremental process of seeking to meet the morally compelling vision of all people being equal. Each of these legislative steps were arguably finite gains in an infinite game, and the game continues.

How is it to be in an organisation with a morally compelling vision, with teams that manifest that vision with their thoughts, feelings and actions? It feels great! Everyone understands their role, they understand their part in progressing the organisation’s direction of travel. They know that their short term, finite goals sit in the context of an infinite effort to grow the organisation. These organisations are places of vision, leadership, and trust, where obstacles to progress are openly navigated and the organisation remains adaptable.

How might such an organisation evolve from the ones we commonly experience? Firstly, there must be the goal to be that kind of an organisation, then the focussed effort to identify core values, create a compelling vision and then empower a culture of manifesting that vision.

This is no small feat. Recognising the need to change is as challenging as realising that changes may need a helping hand. The first step: prioritising the work. And by prioritising, I mean de-prioritising and saying no to some of that urgent workload that is preventing the important work from getting done.

What are you going to say no to today?

Drew “Rusty” Carroll is a former Primary Care Network Clinical Director. He is an Advanced Clinical Practitioner working in primary care and Managing Director of An Turas – a leadership consultancy. He has leadership experience in healthcare, the British military and industry. Claiming to have learnt most leadership lessons “the hard way”, he works to have impact at system level and is passionate about working with staff to strengthen organisations. He can be contacted via