Making your mark in a new era of healthcare: a masterclass

PATRICK MARSHALL: Hello, everybody. I'll say hello, because that way, we get away with the time of day your-- whichever your time zone is. I'm delighted to be here. I'm delighted to be talking to everybody. And a little bit about me, just to give you a bit of context, leadership, I think, is a very active thing.

Many people think leadership is a series of concepts and constructs and models and frameworks. I don't believe that. I believe leadership is an active thing that you do every day. And it's the thing that allows you to come back to work the next day, in whatever sector you work. But it's particularly true in health.

And you can see from my abbreviated CV here, that I don't have a clinical background, but I have got 10 years worth of working in health care leadership. And that comes from a very practical relationship with leadership, in my case, from education. But it was whilst I was doing the job of being a school leader, that I actually began to study leadership. My own leadership, specifically, at doctoral level. And one of the takeaways I would offer you is that being able to reflect quite deeply about what it is you do as a leader.

Is a crucial element of how you will survive the next however many years you have doing whatever it is you're doing currently. It will also, I think, help you to think about where you might want to go and what you might need to get to wherever that desire is. And one of the reasons, perhaps, why people study leadership at master's level, particularly in the health context, is for promotion. And we shouldn't underestimate that. There are lots of very great personal benefits to be drawn from doing the master's program.

And because I have an absolute solid belief in making leadership practical, what you will find from the course that I lead is, all of the aspects of the theories we look at and we will, of course, cover all the theoretical models that you would expect, will have a practical application. And we will encourage you-- and I will strongly encourage you to become that reflective practitioner that my doctoral work was all about because I do believe it's that which allows you to understand far more deeply than anything you could read any piece of research you might find because actually, it's about you and your leadership that will really make a difference.

But yes, I've done this a number of times, I've led a number of programs, I've written a number of programs, and along with David Barrett, who I think the phrase is the godfather of the course now because he started this whole program. He's off to be a professor at the University of York.

He and I, basically, will have written all of the modules that you will study if you wish to come on to this program. What I want you to really understand, I think, is that health leadership is different from leadership in other sectors. And one of the reasons why we do an MSc in leadership at Hull is because we want to help you explore the difference.

And one of the standard questions-- so I'm going to preempt a question that maybe people would want to ask is, why is this not called management? Why is it about leadership and not management? Well, in health care, leadership and management are very closely aligned. And by management, ultimately, it's the kind of the getting the job done in a very practical sense. So it's about processes and about systems and about HR bits and protocols you've got to follow and the policies you've got to adhere to.

And of course, that is very much what health is about. Because if you don't do that and I were to go into a hospital and someone would say, I'm not quite sure how I'm going to treat you today, I'll just feel I'll do something a bit strange and a bit left field. Well, that's not a good experience for me as a patient. I want to know that what my clinicians will do for me is safe, is the best that they can do with the given knowledge we have, uses the best technology appropriately and will cure me or take away my pain I will do whatever it is I want as a patient. And that requires good evidence-based practice.

That then gets translated into protocols and that's why health has lots of what looks like managerial attributes about it. So what's leadership? Well, leadership is all the other stuff. It's all the stuff which means, why do I come to work? When I am at work, what does it feel like? Do I feel valued? Do I feel that my voice is heard? Do I feel that I make a positive contribution every day so I can come back to work the next day? Those are the aspects of leadership that we will touch upon. And we'll touch upon them in all sorts of ways.

And the first module is all about you. And it's about what you bring and who you are, and it will require you to go deep inside you, because no leader can do anything without a full, clear, and comprehensive understanding of themselves and how their context relates to the context in which they're working. And they're all unique.

So the way you do leadership will be different from the way other people do. It will look similar. You may be able to say, actually, I've seen someone operate in a really profound way, which I love, and I'm going to copy what they do. But even in your attempt to mimic what that leader has done for you or for other colleagues, you will do it differently because you have to.

And coming to my kind of-- the next slide, really, there are three aspects that I think modern health care leadership needs to focus on and the reason why it's so challenging. And that comes down to these three ideas. The first one is complexity. Health care leadership is one of the most complex areas that you could possibly imagine, and partly, it's because of what I've just said.

It has all of those managerial things. Things you need to follow, things you need to do really well, and quality can be measured and you can measure outputs and so on. But you also have all those human bits. The bits of people being tired, the bits of people having low morale, the bits of people not really understanding where the organization is going and what their part of it is.

And this is not just something that happens top-down, because whilst leadership looks like someone's in charge, and it's their job, and they're called a leader or the head of or the manager, actually, leadership is the interaction between you as a participant, as a professional, and your organization and the leaders around you who are trying to motivate you, trying to get you to do things, trying to check that you are doing things correctly, trying to help you be innovative.

All of those aspects are in tension with each other. And sometimes, it can feel a bit like you're being told what to do, and sometimes, it can feel like you're in charge of things and you have agency. But ultimately in health, because of that often relationship you have with your patients, that one to one frontline clinician to patient relationship, you have enormous agency in how you do what it is you do.

Now, that will actually be mirrored in the way you work with your team and the way you work with a wider organization of your hospital or your trust or wherever you work. So actually, health care is different for that reason as well. And health care leadership is different. And it has real opportunities for people to make their mark. And I think that's one of the titles of this thing. How do you make your mark in this complex world?

But the challenge is this complexity because all of those moving parts-- the people, the technology, the leadership styles, the culture of an organization, all of those things are moving around each other in dynamic relationship to each other. All of those things actually make being a leader really difficult.

But what you also will be able to understand from doing a master's is how that complexity and how those layers of different inputs and outputs operate and where you sit inside all of that. Because ultimately, what mastery is all about is about agency. It's about you being and feeling as if you're in charge or is if you have control because when we feel out of control, it's always a bad idea.

And it's bad for patients. And indeed, when patients feel out of control, it's bad for them because they can be very vulnerable. But it's also bad for you as an individual employee and a leader and a head of whatever you are. All of those things, when you lose that sense of control and agency, you actually are diminished, and you cannot do what it is you want to do, that you need to do as well as you should do it.

So leadership and doing this master's will help you understand that in a way that makes sense for you. The second one is related, really. And it's about, you don't do any of these things by yourself. It is not possible to treat any patient by yourself. You have to do that in conjunction with at least the patient. That's the very minimum collaboration. But actually, it's with all of those other colleagues.

And it's with all of the other systems and all of the other parts of the organization that you work in. So leadership is about understanding how collaboration works. It's about understanding relationships. It's about understanding how significant the relationship that you have with your colleagues, with your leader, with your subordinates depending on what role you have in an organization. All of those things are massively important in terms of delivering the best quality care for patients because nobody can do this by themselves.

And people that do do things by themselves end up either burning out completely or they end up getting into very strange places. And you can often see that from leaders who go off in a sense become almost isolated from their teams and from their organizations. It's never a good idea. And we will help you, in this program, to not go there. To understand those red flags which can pull you back to the idea of yes, but what's going on around you. And who do you need to relate to and how do you know what data is coming at you from your colleagues.

And the third point is I think they're probably more important than the other two. And that is, if you cannot be compassionate to yourself, firstly, it is impossible-- and there's lots of research on this, by the way. It is impossible for you to be compassionate to others. And there are lots of layers and levels of compassion here. So there is the self-compassion. The fact that you do the very best you can for as long as you can in the best way possible for you to do it. That's what's going on.

And sometimes, that isn't quite what you want, but you've got to forgive yourself and go, that's as good as it can be today, but tomorrow, it might be better. So that forgiving yourself is really important because leaders that get into that kind of it's not good enough, I'm terrible, I'm rubbish don't become useful or practical for other people and they certainly don't serve their patients well.

And leaders that think, it's all wonderful and brilliant and they don't need to bother aren't very good for patients or working with other colleagues either. So it is that genuine sense of understanding what's going on and being compassionate about what you can and cannot do. Being honest and truthful, which comes back to my point about reflection.

It's also important that you're compassionate to each other, to your colleagues. And that they are compassionate back to you. So these are reciprocal things. It goes back to the collaboration. Because without that compassion of and with each other, you simply cannot be that team that you need to be that will deliver for patients. And finally, it is about being compassionate to your patients, to the people you serve, to your clients, whatever you want to call them.

That is vital because that's what health care is about. It's about delivering compassionate care. And that's about holism. And it's about understanding that there is a human being who's worried and scared and vulnerable in front of you because they otherwise, they wouldn't be there. They wouldn't be involved in health care unless they're in that place of, I don't know what's going on, doctor, please help me or what does the scan say, to the radiographer, or how do I move my hand around for the physiotherapist, or whatever of your clinical background. Or indeed, whatever your administrative background.

Because remember, not all people involved in health care leadership are clinicians. They are administration staff, they are managers, they are senior managers. All of those people are also contributing to the care of the patient. It may seem more distant, you may not actually come across the patient every day in the same way as, perhaps, a doctor might. But you are. Sorry, if your job is not focused on that patient, then you're not doing a job properly.

And ultimately, leadership is about always delivering for those-- the people you're serving which, ultimately, in health care is always the patient. So compassion, collaboration, complexity, they're important aspects. So why is leadership important in its general sense? Well, because it is.

The latest report, on the next slide, comes from a Gordon Messenger's report he did for the government in June. And I accept that this is a little bit UK-centric. So apologies for those people who are going, well, you know, I work in a different health system. By the way, we do cover different health systems. We cover the financing of health, which is not always state tax orientated, it covers all sorts of different models from, yeah, social insurance through to private out-of-pocket expenses.

So we do look at the global perspective in one of our modules. But Gordon Messenger did, nevertheless, do a report. And what he said was that as many reports in health have done, is that leadership is really important. And if we want the best quality care, we have to pay attention to leadership.

And there are two other aspects of this report. One is, it's about diversity. It's about all the voices that are possible, that are out there in a health team and in a health system which will include patients and their families and their carers and acknowledging all of that. And it's also about making sure that people are trained, are developed, are taken forward in their skills and their interest around leadership.

So it's not something that's just sort of I'm a leader now because I've got this job or even I want to be a leader, so I'll do whatever I've got to do. It's actually about-- being a leader is a journey of learning. And we, in the module, talk a lot about Kolb's learning cycle, which is experiential. It's about what you do with learning and how you do it. And that's part of the fundamental building blocks of the course, but it's also the fundamental building blocks of learning. And ultimately, what Messenger's report was about was, yeah, this is really crucial, and we still don't do it well enough.

And what I also know from research rather than practice, that that's true across the world. That leadership is a challenge in all health care systems because it's difficult, because it's complex, because collaboration is hard, because compassion requires real effort. But leaders can do those things and they can make the system better, they can make patient care better, and they can make colleagues' lives better. And ultimately, I think you can make yourself better because these things all happen together. They are not separate from each other, they are linked.

So let's come to what the MSc looks like. So we have a number of modules. These are 30 credit modules. Oh, I beg your pardon. Sorry. I've just skipped over why-- sorry. Let's come to what you're going to get out of it first. I will come to the MSc in a minute. So why would you do it? Well, because it will make you better.

It'll make you better as a person, and I think it will make you better as whatever role you have in your life. So that could be a partner, a father, a mother, a brother, or sister, an uncle, an aunt, whatever. Whatever the relationship is you have with the world or relationships you have with the world, you will get better at it, why? Because your self-awareness, your understanding of who you are and what you are and how you do what it is you do will be clearer to you.

And that's very personal, and it can be quite uncomfortable sometimes. So I would not pretend that doing leadership is an easy thing or doing leadership is a thing without there being a cost to your own kind of self image sometimes. But what I will say to you is that by delving in, by exploring who you are and how you do what it is you do, you will always learn something about yourself, which is useful to you in the long term.

So it might well be that you discover that perhaps, that particular way of operating around somebody, by telling somebody what to do, might not be the best way of doing it. That might be something that you learn. But ultimately, that will be to your benefit. Because it will help you manage people in a better way. Because there's no question that the more collaborative you can be as a leader, creates a relationship with the people that you're leading, that allows for more creativity, more innovation, and more commitment.

So if you want your people to do the very best they can, you actually hook them by going out of your way to welcome them into what your vision might be. You don't do it by just simply barking orders at them. And we know from lots of leadership models, particularly in health, that's not true. You know, blame culture, really bad news. It's very common. We understand why someone wants to blame, something goes wrong. But ultimately, it doesn't actually make people safer. It actually makes people less safe. It is the truth, when you look at the case studies that we will on this module.

Obviously, you'll get knowledge, you'll get-- you'll work on relationships, you'll become a better networker, you will improve your promotion prospects. For those people that work in the NHS in the UK, an MSc, a level 7 qualification like this will allow you to access higher grades than you would otherwise get. And it is important that you have one of those. So there's no question there.

And I think I have yet to come across anybody who hasn't found getting their MSc in health care leadership useful to them. Even if they've changed roles or they change jobs even, it's a useful qualification for all sorts of reasons because it's got the word leadership in and obviously, it's got the word health care in. And I think there's a sense to which it will help you be resilient. It will help you bounce back from some of the pressures that you will have.

So on a professional level, what is your organization get for doing this? Ultimately, it's about making what it is you do better for other people than not just yourself. And that is described the leadership culture. A number of our modules touch on culture and you are part of culture in your current role. Whatever you do, whatever role you have, you are part of the culture. Understanding what part of the culture you are is really important.

It will help you to improvement work. One of the modules specifically talks about that and actually says, how do you do something which will change what it is-- how you're doing it. It will make you safer, it will obviously, develop collaboration, not just in your own organization, but actually across your organization, particularly, in health care systems where that collaboration is encouraged.

And you'll become much more aware of systems. We don't go into massive amounts about systems leadership, but we do-- systems leadership is part of what any health care system is because of its complexity. It will improve your organization's care of patients and it will improve their safety. And it makes them resilient. It means you come to work tomorrow, which is really important, because otherwise, people can't or they want to give up or they want to do something else.

I think it translates to-- it's very structured every week. And it's about 17, 18 hours, but that's broken down into various bits and pieces that you'll do. We try never to give you more than a 20-minute talk at. So forgive me for going on longer than that. But that tends to be the kind of-- you don't have to sit and listen to someone go on for four hours. It's 20 minutes in short blocks.

The assignments are always split into two 2,500 words for the four modules. So 5,000 words total, but there's an A and a B part for each one of the modules. And the capstone is a 10,000-word project around their leadership, which can also be something very practical in work.

So we encourage people to think, how can that relate directly to what you're doing in your practice? Whatever that is. So yeah. So it's not easy, it's going to take you several hours per week. It's a 12-week block. There's a weekly webinar, which again, you can come to-- some people come to more than one of those webinars, of course, if they run. And there's then the assessment weeks where you can do it. Some modules are split, so you do an assessment half, an assessment early and a bit late, most of them are at the end.

Yeah. But it's doable. People do get through it. And we are flexible insofar as things will happen. Stuff happens at work, stuff happens to you. You may get ill, there may be a crisis in your family, all of those things happen. And of course, there are policies and processes which can allow you to step back for a short period of time, have a bit more time to finish off that assignment and so on and so on and so on.

But it does help if you can keep that momentum going for the two years because there's no question that this works as that kind of it's a tight, structured, it's going to be a bit helpful, you're going to really go for it kind of model. But you'll get through it rather than waiting for three years where you can do other things. So it's very much you do need to focus your attention, but it's very doable.

There's lots of really innovative world beating projects going on. So part of the networking that inevitably you're doing by coming to the University of Hull and doing it online is you get access to that just because you're there, you're one of the students. You will see these people, you'll be around those people, you'll have access to those people.

But I think more importantly, it is also the relationship with CGD, which is the frame, if you like. And knowing that part of what this particular course offers, which is very different from other courses I've led, is that structure, which will help you get through the weekly process. So some online courses can feel a bit like, if you've got a very good tutor you might be OK, but you might get lost. There is less chance of you getting lost. There's more systems in place. There's more structure and pattern to see how these things work.

And I think people can trust to the system that has been successful, not just in health care leadership, but across a whole range of different master's programs, online master's programs where people have been successful and really gain benefit. The same benefits you might get from a face-to-face course. But to be honest with you, practically speaking, trying to get people out of practice to come and do training almost impossible these days.

It's just not going to happen. Yes, it's going to be out of your time, your discretionary time. Some organizations are more flexible about, and you can negotiate with your organization because they are getting benefit from it to say, can we have-- sorry. Can I have an afternoon to do this or-- it's possible. And I think you do need to be active about what the organization you're working for is getting out of this because they are getting something.

Sometimes, those organizations are paying. So they are investing too. And sometimes, you can get them to invest if you're clever enough at pitching what it is you're doing and how that might relate to their organizational needs. So I think there's loads of possibilities of making the system better, making yourself better. And I think, it being worth that enormous investment because it's not just an investment of money, it's an investment of time and energy and creativity in your life.

But I do think, ultimately, that-- I say, I have yet to see anybody who has completed an MSc in leadership, and I've probably come across upwards of 100 of them now over the 10 years. And every single person will have-- when you say to them, well, was it worth it? They will all say, yes, for different reasons, and in different ways, and with different outcomes, but yes, it's been worth it.