#EdInfluence
In his inimitable style, Nick unearths the secrets of good leadership from his guests.
Trusted by thousands of education providers across the country, Browne Jacobson is an award winning national law firm helping clients and partner organisations shape and influence education policy.
#EdInfluence
S03 – E03 with Sir Julian Hartley.
Sir Julian Hartley joined NHS Providers as chief executive in February 2023, having been chief executive of Leeds Teaching Hospitals since 2013. He previously worked as managing director of NHS Improving Quality - a national organisation set up to drive change and improvement across the NHS.
Drawing from this wealth of experience, Julian delivers some straight-talking insight into leading cultural change in the face of adversity, believing that:
“You've got to tell the truth as a leader - not putting a gloss or spin on it, but actually engaging positively and seriously with the reality".
Julian was awarded Knight Bachelor for services to healthcare in the 2022 Queen's Birthday Honours.
Let us know what you think of this episode - drop us a message and connect via LinkedIn.
Welcome to the latest episode of Ed Influence. I'm Nick Mackenzie from Browne Jacobson, and today I'm delighted to be joined by Sir Julian Hartley, Chief Executive of NHS providers. Thank you, Julian, for joining me today. I wanted to start by inviting you to tell me a story from your life that would give me a picture of who you are as a leader. Thank you, Nick. Great to be here. Well, I would have to start with the story of the last 10 years of my life, really which I think really crystallised everything I'd kind of worked up to from early on in my career. And that was the story of, the work we did at Leeds Teaching hospitals to effect major culture change, to improve quality of care, improved performance, bring in major improvement approach, inspired by global exemplars of improvement and achieve a level of staff engagement that was really quite awe inspiring in terms of what our collective teams were able to do. So I think just to say about that, that when I joined Leeds back in 2013, the trust was in some real difficulty. You know, this was an organisation that was hugely challenged in terms of quality, performance, financial, deficits, and there were the big high profile issues that some listeners might recall. You know, the activities of Jimmy Saville and the big inquiry into that children's heart surgery where the Leeds unit was suspended. It was in the news for all the wrong reasons. And so, joining the trust, I'm a yorkshireman, I'm from Bingley, not far away. My mom and dad had been treated in the hospital. This felt like a sort of defining moment really, in terms of joining Leeds. The challenge was huge, but the great thing is that I was given the opportunity to really pour everything I'd learned up to that point into it in terms of achieving a level of deep employee engagement, which all the evidence tells us is about, that is the key to unlocking, improvement more generally and effecting positive change in culture. And I can say a bit about how we went about that, but I think that period was certainly the most stimulating, challenging, difficult, but ultimately, you know, wonderfully sort of sense of achievement and togetherness from everyone I work with that I look back on that with great sort of sense of pride and achievement. So, extraordinary time and one which I treasure the memories. It felt quite personal actually, when you telling the story about where you grew up and your parents went into the hospital and was served there, Julian, was that part of it for you? Yeah, I mean, it was in the sense that, there was a, you know, a real sort of, feeling that this mattered on a personal level because of course, lead teaching hospitals provide some of the most important advanced tertiary services and making sure that they are as good as they can be and delivering the very best for patients across West Yorkshire, which included my own family. So I do think that for, for many chief execs who find themselves in those situations where they are working in the area where they have that connection. it really is personal and there is a real investment, I think, at that point in the engagement with frontline teams, the importance of dealing with, you know, all of the key sort of complaints and challenges and issues because you know first-hand what that means. So starting out with dealing with a whole range of enormous challenges was something which I felt hugely motivated to do. And also I knew that, you know, people I went to school with, people who I knew and grown up with would all be watching and would all be potentially using the services of the trust. So it does give an extra kind of level of purpose to the work that, that you do in that sort of scenario, Nick. Yeah. But you used the word motivation a moment ago, and I was curious, you said how challenging it was when you begun the role. How did you go about, what did you learn in terms of motivating a team in those challenging environments? Yeah, so I think it's a really important question, isn't it? Because I do think that motivation of teams is the central mission of any leader and any manager. And, being a chief executive of a big teaching hospital indeed any NHS trust is a privilege because you get to work with fantastic people, but you have a duty to really focus, I think, on the culture, the tone, the approach to really positively influence that sense of shared purpose, that motivation. So we went quite systematically through a process by which couple of weeks before I started, I wrote a letter in an old fashioned way, actually 2000 letters, to all of the key colleagues across the trust, senior nurses, consultants, and across section of, of managers and frontline staff to ask them what they thought the three priorities for Leeds teaching hospitals should be. And I was overwhelmed with the response, and a lot of it was about this sense of a lack of motivation, a sense of disengagement between the frontline and the senior leadership, a feeling that the focus was all about money and targets. And so the, the whole mission was one which was very clear from the outset, which was about engaging with all 22,000 staff in the organisation to try to create that sense of motivation, shared purpose, pride in working in the trust, focus on patience, sense of being recognised, rewarded, and given the encouragement. And that is what ultimately for me, the job was all about. So we set out a clear process to first of all offer all of those colleagues a chance to talk about what was wrong and why they weren't motivated. And I think in any job, you've gotta tell the truth as a leader. And the organisation has to hear you telling the truth about the organisation, not putting a gloss or a spin on it, but actually engaging positively and seriously with the reality. And that part of the journey was, if you like, the moment of catharsis, it was the moment of the outpouring of, real feeling about the frustration, the anger. And then from then on, the question was, so how together do we improve this? What kind of organisation do we want to work in? And in order to do that, we adopted a, an interesting approach called crowdsourcing, where every member of staff had the opportunity to give their view on what it was we needed. And everyone else could see each other's ideas, and everyone could give a thumbs up or a thumbs down, depending on what they thought. And the best ideas came to the top, we harvested them and created what even today is still flourishing, called the lead's way. And the lead's way was that sort of distillation of the culture, the values, the behaviours that everyone felt they could get behind, and that they wanted to see across the organisation in order to feel motivated to be part of a team that had the right approach, the right behaviours that focus on patients, but also that collaborative endeavour that the best organisations have. Sounds like a really interesting idea, the crowdsourcing. what was the inspiration for you for that? Well, I'd been doing a job before I joined Leeds, working for the then chief executive of the NHS David Nicholson, to bring together all of the different improvement organisations across the NHS. And I'd come across an organisation called Clever Together, who with a really inspiring guy called Pete Tom, who told me about the work that he had done with different parts of the service. And I thought, this is fascinating. This is a way of reaching every part of the organisation quickly, because previously the way I'd done this was, you know, taking a flip chart around seminar rooms and talking to groups of staff, which of course is good, important, but just in terms of coverage and just in terms of speed, this gave us a way to reach thousands of people very quickly and then follow up and use, if you like, the wisdom of the crowd, hence crowdsourcing to develop this approach. So that's where it came from. Nick and I quickly realised this would be a way of engaging in a conversation quickly and getting really strong views and opinions out quite quickly, and then feeding those back to staff to say, is this what you are telling us? And check them out. And you know that in that way you go through an iterative process which constantly checks back, which, which develops a sense of ownership of those values. You know, in too many places, you see the values are on the wall in the boardroom. But, you know, frontline staff wouldn't necessarily recognise that. And I knew we were winning when I'd walk onto a ward and I'd hear a ward housekeeper maybe saying to, you know, a colleague no, no, don't do it like that. That's not the Leeds way. You know, and this idea that actually there was a, it had a currency because there was a recognition that this was the sort of way that we wanted to be. And so that level of penetration, that level of embed embedding is fundamental for any culture in any organisation. I'm wondering, listening to you in terms of did the Leeds way get more ambitious as the staff got more used to this than we're sharing ideas and being more confident, more ambitious? Yeah, so what we, what we went on to do, Nick, was the Leeds way provided the foundation for major culture change, and it really helped us move the dial. But in 2015, we had the opportunity to team up, with an organisation called Virginia Mason in Seattle, who are the one of the global leaders on implementing improvement methods, specifically the Toyota production system, which people will know about from, you know, the 1950s, a very successful approach to guaranteeing quality. And you can apply those principles to healthcare and Virginia Mason did. And it focused on making sure that we were reducing reducing harms for patients. We're focusing on value added for patients, reducing waste, improving the experience for staff as well through the use of improvement techniques that look at carefully and unpack the process, but crucially, by involving frontline teams. Now, I think if we'd not gone through that process of creating the Leeds way, we wouldn't have been successful at implementing the Leeds improvement method, which effectively trained thousands of staff in how to do improvement, how to take apart a process over the course of a week, how to then put it back together, and in a way that was much more effective, reduced waste, inefficiency, duplication, shortened waiting times for patients and improve things for staff. So we used that approach and scaled it up, and that really did raise the level of ambition in terms of the impact of that approach, which actually was invaluable during, for example, the pandemic where we used that approach to bring down the lead time for vaccination from, you know, 35 minutes to, to 14 minutes. And those are spec specific concrete examples of how the method can really help frontline teams, redesign work and improve it significantly. And the mantra that only those people doing the work can improve the work is one that we really took to heart. And did you get, I mean, you said that you could apply it to healthcare. Was there any resistance when you were trying to draw the parallels? Yeah. There was, there was some suspicion about, you know, an American hospital and what was this all about? And, would it work in the NHS? But, you know, other trusts had already, gone down the path of, you know, a clear improvement approach, a clear improvement method, and had met with success, not an enormous number, but enough to demonstrate that this was, you know, a tried and tested method with a lot of evidence behind it, and therefore we used that to persuade some of the naysayers. But actually they quickly became interested and engaged. And, you know, actually some of the strongest cynics became some of the biggest advocates when they saw, actually this was, you know, this was based on almost a scientific method of how you actually are forensic about a process and then rebuild that, taking out all of the inefficiencies, all of the things that don't add value to patients, all of the waste of movement, time, effort, energy duplication, and the consequences ultimately that that can improve quality. It can mean additional patients on a waiting list. It can mean shorter time in waiting rooms. All of these really practical things kind of converted people to the benefits. And many wanted to be involved. And a lot of, you know, a lot of consultants, a lot of junior doctors, a lot of nurses, physios, OTs. But also, interestingly, Porter started to do a safety huddle, which was about them working with some of our elderly care consultants, spotting where, you know, challenges on bottlenecks lay being briefed on, having a huddle to talk about what they could do to support that, understanding the state of play across the hospital in terms of where the main pressures were. So it spread and it deepened and, and it really was, I think, a game changer for us. Certainly. Sounds it, switch intact slightly. I wanted to focus a bit more about some of the challenges you might have encountered as a leader and how you, you dealt with them. what did you find the most difficult part of being a leader Can be quite lonely. You, you do feel it's very much you are accountable, particularly as a trust CEO, you're accountable for a huge number of things. I think that was crystallised for me during the pandemic when we were, you know, really up against it in terms of securing sufficient personal protective equipment for our staff. And I can remember one weekend over Easter where we were running particularly short and within hours, you know, of running out of, of gowns. And we turned the whole of the finance and procurement team into a call centre to source gowns from across the region. I mean, we, we managed it, but goodness, it was at that point, the idea that I wouldn't be able to protect staff from, you know, in terms of dealing with patients with, with covid, was the worst feeling in the world. So it's at those moments you realise the enormity of the responsibility and what you have to do just to sort of, you know, try and deal with that and work through that. And, that's where you realise these are important and onerous roles. but for me, those are the moments that it most comes home is when there's the prospect that you can't deliver for your people, that you let your teams down. And that's a very difficult thing to sort of contemplate. And in those moments where, where do you go for support for energy around you? Well, from the people I worked with, from my immediate team who are, you know, outstanding from my chairman, from my colleagues on the front line, you know, and I would always, in some of those moments at other points when I was feeling fed up, I'd get out and talk to staff at the frontline about the things they were doing and about the innovations that were happening. And you'd always come away with a spring in your step after those conversations. 'cause despite the challenges, you always got a sense of the enormous level of commitment, dedication, and actually ideas from frontline staff that gives you a feeling of encouragement, but also feeling that actually we can do this, you know, that we've got such a strong team. So those are the energy points I think, for me. And I'm sure for a lot of CEOs, they draw energy from those encounters. And thinking about, I can imagine, particularly through, the pandemic, incredibly busy time for you. How did you go about making time to think as a leader in those times? Well, there wasn't a lot of time to think,'cause it was an absolutely 24/7 full on operational response. However, we did manage to carve out time to together as an exec team, indeed as a trust board to reflect on where we were, not just with the management of the pandemic, but thinking ahead, thinking about how are we going to recover? How are we going to support staff through this? How are we gonna deal with the, what we knew would be a significant backlog of cases, of patients to treat. So we did, And I think that's about just the discipline of creating the time and just making sure that you do that. And indeed you get offsite to do that at times, to create the space for that to happen. It did mean working out of hours. It did mean, you know, pushing the envelope in terms of people's, into people's, you know, private time. But, but in the end, I think that was worth it from the point of view of giving us all a sense of, of a plan beyond the immediate challenges of the pandemic. I wanted to- you've obviously had a number of leadership roles, you embark or recently embarked on a, on another one. I was thinking, is there a mission that connects the roles that you've had that's drawn you to them? Yes. I think that's right. I am drawn towards organisations that need, a kind of a cultural reset, a sense of the organisations perhaps that are at a low ebb, and where the people's heads are down and so on. I'm drawn to the idea of wanting,'cause I believe so strongly in the power of engagement with frontline teams. And that's certainly been the story of the NHS trust I've worked in. I mean, in this job I'm drawn to the fact that the NHS overall I think is in a difficult place with all that's going on at the moment with, you know, dealing with backlogs, with workforce challenges, industrial action, you know, all it's, well, you know, we can't open a newspaper or turn the television on without another story about the NHS. And I think the important thing for me is to shine a light on the great things that are happening across the NHS, despite those challenges and the extraordinary job that our trusts are doing to support staff and deliver for patients. And therefore, this job is an opportunity to talk about that. And also to make sure, you know, to have a strong voice at a time when the NHS is under quite a bit of challenge, from some quarters. So important time in terms of the debate about the NHS that we have, a strong voice as we do in NHS providers to champion and support, our NHS organisations and all the patients that they serve, Quote, so often misattributed. But I came across one, recently when it said, a leader is a dealer in hope. I was just wondering how important hope is to you as a leader? Well, it's fundamental. But I would perhaps explore that question, Nick, by saying, you can't just be, kind of wildly optimistic and, you know, unreal about the reality. You've got to take on board where we- because the thing about leadership roles, as I said at the start of this, is people can spot a phony. They can spot spin. You've got to be honest and straight and tell it as it is and reflect back the truth of the situation. But at the same time, I think leaders do have a responsibility to offer a path to an improved position, a better future state. And how, you know, how everyone can play their part in that, how everyone can feel part of a collective endeavor to improve services, the support for patients and indeed the workforce. So I think hope is important. I think it's got to be leavened by realism, but I think it is always the duty of the leader to try to take people with them on a journey where you can derive some positive reinforcement from the 'cause. There's always good things going on. There are always, in any organisation, even the most challenge, there's always things to point to to say, this is great work. We are making progress. And it's very important to reflect those back as well as the honesty about the challenges. And so, what do you think- if you're gonna sum up a few key core qualities of an effective leader Yeah. What would those be for you? Well, for me, they would be, a focus on engagement. And when I talk about engagement, I'm talking about a systematic approach to engaging all staff across an organisation through high visibility, through good communication, through recognition. And recognition comes in all forms. I was always very keen to get to the retirement dues of long serving staff. I was always very keen to get to significant sort of milestones in people's career and celebrate with them. It's important that people feel that their chief exec cares about what's going on in their organisation, in their lives. So being able to be visible and connected is massively important. I think that in turn speaks to the point about the role of the leader in shaping the culture. And I think key quality is an ability to see the culture of an organisation and have an idea about how you change and develop that, how you set the tone, how you take people with you on that journey, and how you develop your own immediate team to adopt the same kind of values and approach.'cause I think that that really does matter. And of course, the other quality is about a sense of humor. You can't do these jobs without, you know, being able at times not to take yourself too seriously and to be able to have a laugh with colleagues because it's hard work and it's full on. But it is ultimately a privilege to do this. The National Health Service is, you know, one of the most important, if not the most sort of cherished institution in this country. And therefore, the importance of stewarding one of its organisations through difficult times is an honour. And, and I think that's not to be taken lightly, but making time for yourself and your team to come together and think about those things, and to think about the way that you shape that culture and purpose is a central part of the quality of, you know, I think any CEO across the service. And, how have you and how do you continue to sustain yourself as a leader? I think through both drawing energy in the way I described from visiting and getting out there, but also making peace with the fact that you'll never get through all the emails. You'll never be able to cover off all the issues. You'll never know everything about what's going on in your own organisation that you have to trust, people delegate, otherwise, I think you would drive yourself, you know, mad, I think, you know, you can't possibly hope to micromanage in the way that, you know, some people might think in terms of everything that's going on, particularly in an organisation size of a hospital. So, making peace with that, and then being able to walk out of the door and go and do something completely different and switch off is massively important too, because you're no good to people. If you're bad tempered, worn out, fatigued, cross, you've got to kind of find those things that give you, refill the battery and give you the renewed energy to engage with the, challenge. And, and what are the sorts of things that you would do? Give me an insight to the sort of Well, I would, okay. I would get out on a narrow boat on the canals of England, Nick, I love that life at three miles an hour, down the sort of green corridor of a lovely rural canal is an absolute antidote to the, kind of challenges of running a big hospital and the pace at which that works. So that's one thing I do. I also, enjoy following the fortunes, which wax and Wayne of Manchester United. So I'm a season to get older with my son, and we go there and we watch them. It's not been a bad season, but hoping for more next season. But, you know, I, I think that's- these are things that take you away mentally, physically, from the demands of the day job. And everyone has their own, I'm sure things that give them that. And those tho those are mine. Yeah. I think, I was with you on the, on the canal when you said about the slowing and the pace. I think- Yes, yes. So can I just- we havn't got too much time left to today, Julian, but I just wondered if there was a team that you'd been part of when you weren't the leader and a leader that you followed and I'm curious why did you follow them? Yeah, I mean, I would say, Nick that I drew a lot from Linda Pollard, Dame Linda Pollard, my chair, she led the board, I led the organisation. Linda led the board. But for any chief exec, working with a chair is a critical relationship. And I was fortunate to find in Linda, you know, a kindred spirit, but someone who, who was really clear about her expectations, and she was challenging and motivating and equal measure. And she continues to be so, but she's, great in terms of that, sort of sense of seriousness of what we all do together, but actually a sense of fun on a personal level. And the fact that we spend a lot of time at work, we might as well enjoy it while we can, you know, and I think that I learned from her that balance of really serious and high setting the bar high in terms of expectations, but at the same time doing it with a smile on your face and actually throwing your whole self into it and working, you know, with a great team. But she, you know, I learned a lot from, from her in that way and from a board perspective, how she ran the board, how she got the best out of the board. 'cause, you know, chief executive is accountable to a board of directors, non-exec and exec. And so that relationship between chair and chief execs fundamental to how we do our jobs. And we need our boards to be engaged in, you know, the board had be engaged in the Leeds way, the Leeds improvement method needed to sort of give me the headroom around some of the financial challenges and performance. And, you know, that what Linda is greater at managing that. So I would say she's been really influential in that regard. Thank you. And so if you were gonna give advice to a, a new or a learning leader, what would be the best advice you would give them? I would say, I would say, throw yourself into it. Bring your whole self to the job. Make mistakes, because every, when we do our improvement work, fail stands for first attempt in learning, and that is how we should view mistakes. And I made plenty as I was making my way. I would also say, be curious. Get out there and understand what is going on in the area that you are responsible for. Spend time with frontline colleagues. Appreciate and understand what they are doing. Have big eyes, big ears, but a small mouth, as in don't be in transmit mode all the time. Appreciate and understand what's happening and absorb that. And that will give you, I think, and does, you know, a sense of, deep understanding of what's happening, but also the respect and support of the colleagues that you manage and lead because you're showing you care, you're interested, and you are prepared to get out there and get stuck in and support them on the front line. And final question from me today then, yeah, To think of legacy. What do you want your legacy to be when you, when you finish your last leadership role? Well, if that feels like, gosh, that's a sort of feels like a weighty question, Nick, but I think, really, I think, I would like to think if I could have some influence on the fact that the NHS prizes a positive engaging culture and puts a real premium on improvement, continuous improvement and quality improvement as the north star of, of how it approaches big problems and challenges, and prizes, the importance of engaging frontline teams in trying to address those challenges. That those would be the things that I would like to think I could have had some influence and impact on. Thank you. There, there's lots more I'd, I'd love to ask you, but I'm afraid, I think our time's up for, for today. But I just wanted to thank you again, Julian, for joining me today. I've thoroughly enjoyed the discussion, but I think what you said a moment ago about fail will definitely stick with me. Yes. And I hope our listeners have got some interesting insights from you. So I look forward to you all joining us on our next, in our series of Ed Influence podcast. Thank you very much, Nick. Enjoyed it. Thank you.
