Barts Health is an organisation that delivers care from 5 hospital sites; has 40 operating clinical units; employs around 24 thousand staff and spends around £2.5bn of public money. Each site has its own leadership team, headed up by a site CEO and over all of this is an organisation wide executive team, with shared support services - with Shane as the organisational CEO and accountable officer.The organisational operates with local identity and delivery, supported by the benefits of being part of a larger organisation. It has worked hard on reducing variation; develop hospital site leadership; used clinical networks to drive out variation and all supported by shared support services.Clinical networks work hard to establish how teams can be best in class and support across sites with capacity issues.The Group arrangements to include Barking and Havering hospital saw Shane appointed as the CEO; a shared Chair with Barts Health and the ambition to seek improvement and use some of Barts experience and capacity. Following the departure of the joint chair - separate Chairs were appointed and it was agreed to unravel the Group arrangements. Shane now leads/Chairs a formal partnership of acute providers/collaborative between Barts, Barking &Havering and the Homerton hospital. There had been little intertwining of infrastructure between the two organisations, therefore the unravelling was not difficult.The acute collaboration focuses on three key areas that were important to the three hospitals.Being the group CEO is a privilege; very varied, but important to keep the people/staff experience at the forefront of his role to ensure values, behaviour, inclusion and equity are a core focus. Shane plans to be in a different hospital each day and his key role is to create the environment for leaders to flourish. The balance is to ensure the culture is good, but always with a razor sharp approach on delivery and performance. Shane describes how his style has changed in the Barts health role - felt it would have been difficult to move into the role without multi-site experience (which he got at Bart’s before he was appointed CEO0. He learnt how to work through people and adapt to support change - not direct everything. Discussed succession issues and the opportunity for future CEOS - Shane felt that site CEOs =, under an accountable officer, were a great opportunity for people to learn their trade and become more confident.
Matthew Winn, podcast host and an experienced leader in healthcare in the UK.
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42:19
Collaborating across boundaries with Angela Hillery
Angela Hillery took on the group CEO role across the two mental health/community NHS Trusts in Leicestershire and Northamptonshire in 2019. The arrangement of joint leadership was initially to provide support to one of the organisations that was experiencing some challenges with leadership and quality. Over time the two Board realised there was benefit for both organisations.The two trusts remain as separate organisations with their own Boards. Roles were shared where there were gaps in leadership and opportunistically moved to a joint chair relatively recently.The group approach is operated through a joint committee - there they agree on joint work which has included, governance, tackling racism, social value, talent management, quality improvement and collaboration. they have created joint thinking through involving the non executive directors; developing Boards together and creating relationships.Angela described how merger and reducing independence is not something they are looking at. Currently their analysis is that there is no value in merging and they are focused on what each organisation wants to change and the value from working in a Group.The CEO role can only be successful if there is a great team of support around them. Angela has a managing director in each organisation. The CEO has to lead the cultural changes - be intuitive about how change has to happen; change for the right reasons, not just because it is expected and manage risks tightly.Advice for others in a similar position would be -1) bring executive teams together early and send regular time together 2) create a talent pool across organisations and support talent to thrive.
Matthew Winn, podcast host and an experienced leader in healthcare in the UK.
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42:01
Two hospitals - one Trust with David Carter
Two hospitals in luton and Bedford came together into one Trust in 2020. There had been over 10 years of discussions and speculation about the Bedford hospital site/Trust, which had the challenges of a small district general hospital and working effectively 7 days a week in all specialisms. The two hospitals had a long history of collaboration and the coming together provided economies of scale and was birthed from a politically charged debate about essentials on the Bedford site. The merger was underpinned by a commitment to maintain maternity, AandE and children's acute unit on the Bedford site.The local context is that local communities are wrapped around three large towns and small conurbations and the two hospitals serve these.David describes how they have developed cross site leadership roles for general managers and clinical directors - this has enabled benefits for each hospital site. The approach was influenced by the approach used at Barnet and Chase Farm hospital sites. Goal is for single teams across sites, no divisions - a flat leadership structure - reporting directly into executives. The merger was transacting as an acquisition, but they have culturally developed the approach as a merger. Trust has taken time to develop -but with joint roles; merged colours/new lanyards/executive teams on site in person across both hospitals throughout the week. The merger transaction concluded just as the pandemic took hold, which in some ways made things easier as many of the established rules and ways of working changed. Looking forward the larger Trust will ensure there is a larger pool of talent to draw from; developing clinical leadership is easier to support and staff can be at the very heart of all the developments across the organisation.
Matthew Winn, podcast host and an experienced leader in healthcare in the UK.
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48:24
Hospitals in a group with Maria Kane
The Group covers North Bristol Trust, University of Bristol hospital and Weston Hospital Trust. The Trusts had discussed alignment for some time as they faced fragile service arrangements, competition between the organisation for staff and capital and too much time responding to ill health rather than developing anticipatory models of care.The collaboration started initially with a joint clincial strategy, which developed into a single accountability framework that the Trust Boards signed off in December 2023. A joint Chair and then a joint CEO followed. This approach was supported by site managing directors.What made a difference initially ? 1) enthusiasm of clinicians 2) permissions to do things differently 3) focusing on the commonalities, not differences 4) proud organisations wanting to do things differently and developing joint digital approaches.The Boards developed a joint approach by describing their challenges and working on joint challenges together. This always involved putting a patient first methodology and developing a common improvement language and approach. The Trusts formally evaluated the group approach judged against the outcomes they wanted to achieve.Now the group has around 28K staff - develops work together; shares leadership approaches and have developed mature leadership teams, underpinned by a health research ethos.The Group CEO role is different to single hospital CEO roles because Maria has to be out of the detail, delegate to her teams and focus on approaches that drive the benefit of working together. This means working through what is right for the population and is already then leading to different investment decisions. Control has to be delegated to teams and data analysis has to be enhanced to ensure the focus is on the right issues.Maria describes how she had been used to a set of personal relationships and that underpinned how she worked effectively. Now she has to focus on maximum impacts; better use of data; work with teams across sites to make improvements; be non partisan; be an arbiter; narrate and manage relationships with external partners. Looking to the future, Maria see the duty to collaborate and cooperate in the public realm as being crucial. Supporting a new set of senior leaders is going to be key. As a leader you must be courageous, curious and look to improve care all of the time.
Matthew Winn, podcast host and an experienced leader in healthcare in the UK.
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46:40
Mergers and integration with Nick Hulme
Bringing together two hospital Trusts is a tough process - even more when one is under huge regulatory pressure. Nick explain the development of his Trust covering two sizeable hospitals and community heath service integration. Matthew Winn, podcast host and an experienced leader in healthcare in
the UK.
UK