Finding your strategic space

Diabetes - sEaster is usually a quiet time here at Drake Towers, partly because I try and keep it that way to spend time with the kids, but also because half of my clients are usually doing the same. Instead, I try to make time to switch into a different mindset; to step back from day-to-day work, and think more strategically, about my clients, my own business, and my desires for the future.

This year though, things were different – two weeks before Easter, child 2 was diagnosed with type 1 diabetes. Thus, followed four days in hospital, with frequent follow-up visits, daily calls with dieticians and the diabetes team, and a learning curve as steep as anything I’ve experienced since my student days. For the uninitiated, diabetes is where your body no longer produces enough insulin to keep the right level of sugar in your blood. Too much blood sugar brings long-term health problems, as well as toxic ketones which make you very ill, very fast – that’s usually how people first get diagnosed. Too little blood sugar, and you slip into a coma.

And so, each day becomes a sequence of small needle-pricks and big decisions: how do we correct, now that he’s gone high, or low? How much insulin with his next meal? What do we tell school to give him before his PE lesson tomorrow? Decisions complicated by the fact that all newly-diagnosed diabetics react differently to insulin and to the carbohydrates that turn into blood sugar; their response can vary by time of day; by emotional state; with different food combinations; and from week to week as their pancreas stutters back in to life, only to stop again.

In the early weeks, friends asked us about the implications: “will you be able to get his needles on the plane when you fly?”; “can’t you get sensors that read his blood automatically?”; “will he be able to take care of himself if both of you are out?” We explained that we’d not had any time to think about that, because each day, all we were focusing on was keeping him out of hospital.

We were entirely in the ‘operational decisions’ mindset – what to do in the immediate future. The home-life equivalent of deciding how many staff you’ll need to rota for the beer garden next weekend, when there’s a match on Sky, a low-pressure above the Atlantic, and two of the team seem to be coming down with a cold. Pragmatism and experience make us faster and more confident with those day-to-day decisions over time, but there’s always another level of decision to be made. For us, it’s questions like: do we need to make some lifestyle choices as a family; in which of the smart technologies, for blood testing and insulin, should we invest; and how quickly do we trust an 11-year-old to manage the ‘operational’ decisions himself, knowing a wrong move means a 999 call? These are our strategic decisions – direction, change, investment, empowerment – and our challenge is the same as for any business leader: how do you create the time to define, talk about, and take, those bigger strategic decisions, when urgent imperatives consume all your attention?

I discovered relatively early on, that when your wife walks out of your child’s bedroom at midnight, with a worryingly low result, and the prospect of a 3am alarm to check he’s still OK, apparently, it’s “not a good time” to talk about the relative merits of different CGM systems. Who knew?

So, this week, we ring-fenced two hours to define all the big decisions we need to make. Next week we’ve carved out the same again to make a decision on the first. Strategy, as I’ve said many times here, isn’t something you can leave to a once-in-a-blue-moon review, it’s a series of decisions you can, and should, talk about on a regular basis. Weekly at most, monthly at least, but scheduled and adhered to religiously, because there will always be more urgent things to talk about.

As for the diabetes, thanks to everyone who’s written or spoken to me over recent weeks, and apologies for the scarcity of recent articles. Suffice it to say, child 2 has taken it all in his stride; he’s in better health than ever and is handling it all extraordinarily well. If leadership is largely about resilience, he has a fabulous future ahead of him.

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