For our medical leadership interview series, we spoke to Dr John Byrne, former Executive Medical Director at Humber NHS Foundation Trust. Having recently stepped into a new role at Executive Medical Director at South West London Integrated Care Board, John reflected on his experiences at Humber, sharing his formative experiences as a leader, how his team supported the trust’s digital programmes, and advice for the medical leaders of tomorrow.
His previous role at the Humber NHS Foundation Trust
In John’s role as Executive Medical Director, he was responsible for a number of areas, from patient care to research, pharmacy, medical education and mental health legislation.
He said: “Those are the key operational areas I led on, but internally I also led on strategic things such as health inequalities and mortality. Externally, I was the SRO (Senior Responsible Officer) for the Yorkshire and Humber Care Record, which was one of the original five national exemplars to develop the idea of a shared care record.
“We managed to do that across three ICSs through developing our own technology, and we also worked on rolling out that technology to three other ICSs. That was part of my day job, but I did it on behalf of the system, not on behalf of the trust.”
Experiences and challenges
“Life is full of challenges, isn’t it? They can be short-term, long-term. They can be about people, money, systems. I think one of the key learnings for me was understanding about what is in your power to fix. What’s in your power to influence? There is no point wailing against the moon, because you can’t change it. Fix the things you can fix, influence the things you can influence.”
On challenges he himself faced, John commented, “I think it was very interesting to come into an organisation that had been challenged for a period of time on the basis of CQC inspections. That was about trying to understand what the issues were and which issues related to operations, which to culture, and so on,” he explained.
John added that some issues can have a simple fix, but by having a standard approach to fixing governance challenges, you can gain a greater understanding of where your organisation stands from a data perspective.
“You can put in processes, but it takes time to get the metrics and data required to improve those processes.”
John also highlighted the importance of culture: “You want colleagues, clinical or corporate, to be engaged and aligned around the organisation’s objective of delivering great care. That’s about having conversation after conversation over a prolonged period of time.”
Finally, he touched upon leadership: “The difference between leading and management is that you can lead an organisation to good, and if an organisation is already good, you can manage it.”
Supporting digital programmes
John took the stance that everyone needs to be invested in digital, just like everyone is involved with health inequalities and patient safety. He commented: “I’m wary of the notion of digital champions only coming from one group, because I think everyone needs to be invested in it.
“What we tried to do when it came to digital is to be clear that it’s complex and messy. It’s only an enabler and it’s never going to fix the world. But it can make your life easier, and perhaps that outcome improves quality of care for patients. But it’s very important that we steer away from the idea that it’s a Nirvana, because there’s no such thing, in digital or in anything else.
“One of the things that we tried to do is to listen to our colleagues and absorb the feedback around our electronic patient records,” John said, noting that feedback indicates that staff struggled with the EPR and didn’t feel that it made their job easier.
“That emboldened us to take on a challenge of trying to become a Digital Aspirant Plus trust, and we achieved it – I think it’s because we listened and engaged with our colleagues. We understood that we had a challenge that we need to fix – improving the EPR from our colleagues’ perspectives. Then it’s about finding the time and space to encourage them and understand a bit more about what they do.”
Projects and learnings
Becoming a Digital Aspirant Plus trust was one of the trust’s biggest projects in the summer, with work in its early stages.
“Other things that we have led on have been pharmacy based. We managed to transform our approach to pharmacy by introducing e-prescribing right across inpatient units, which was a real benefit for us in terms of quality, safety and efficiency. It made it much easier for our colleagues to dispense safely, and just as importantly, for us to work out where there was a problem. We could digitally interrogate clinical records in a way that we weren’t able to do before.
“As a result of that, it enabled us to bring back in-house dispensing, which had been a significant benefit to the trust. It’s more convenient for patients who are getting discharged if we can facilitate their discharge by dispensing to them on the ward, and they can go away with the medications without going to a GP or the pharmacy.”
Having pharmacy techs working across their services who deal with dispensing in a new model of workforce helped too: “Not only could we dispense, but because we had pharmacy techs doing that work, they were able to have the necessary conversations and engage with patients around medication, safety and optimisation.
“We knew from patient feedback that they actually wanted more of that. The new model allowed us to improve our quality of care, which is perhaps something we wouldn’t have understood when we first started the challenge of modernising our approach to pharmacy. And that was the benefit from it, an unintended positive consequence.”
Changes observed
“Every day is a school day when you come to work, even as an executive medical director – that is my approach,” John said. “Even though you might come into an organisation with significant experience as a clinician or as a clinical director, or working for the CQC – when you enter a new job it’s like your first day at school and you have got to start learning stuff quickly.”
He noted that the trick is to understand who the experts are in the room. “My job as the executive medical director was some ways is to understand who the experts are and seek their counsel to inform my judgements,” he said, adding that how you listen to people and relate to them informs the culture of the organisation and helps people to feel engaged.
“I think that’s one of things that we did well at Humber, and our staff survey showed us that over the last four years. People feel that they have an ownership over part of the organisation, and they can influence decision-making, which isn’t something they would have historically experienced.
“I would say from a professional perspective that I understood that, but the success was founded on that ability just to spend more time listening, and less time talking.”
Ambitions within his role
“I have the same ambitions now that I had when I first came out of medical school.”
John believes that anyone who comes to work in healthcare does it from a holistic point view, wanting to make a difference.
He explained, “When you start off it’s more focused on the patient in front of you, but as your career develops you take on different roles. You perhaps start to think not so much about individuals and more about groups, cohorts and populations.
“In my medical director role, I’m always conscious that behind every statistic is an individual. But we have to think about services across a much wider cohort of people. The risk and downside of that is you lose that personal touch, but if you’re chasing targets like 80 percent or 90 percent, you can be left wondering about the ten percent of people left behind. There is a tension there.”
Advice for the medical leaders of the future
“I think the advice I’d give to medical leaders would be the advice I’d give to any leader,” said John. “Whether they are medical, nursing, or corporate, I think there are a couple of things you need to do. I think you need to embrace some formal training, and in doing formal training you will get exposed to some of the theory of leadership and management which is helpful to understand.
“You can then build that into a personal development plan which includes coaching and mentoring and getting feedback. I think you can adapt and change your style over a period of time. I’m the same person now that I was ten or 20 years ago, but in terms of how I work in a corporate role, I’m much more aware of the choices that I’m making and how I lead than I might have been five or ten years ago.
Expanding further, John said that feedback and engaging in development is about learning to understand yourself, what works well, and learning to understand others too.
“I think the gift of leadership is having that ability to understand others just as much as you understand yourself.”
Many thanks to John for sharing his thoughts and experiences.
