Professor Roma Maguire, Professor of Digital Health and Care at the University of Strathclyde and Director of the Health and Care Futures initiative, speaks to Professor George Crooks, Director of the Digital Health and Care Innovation Centre. In their conversation, Professor Crooks shares his thoughts on leadership and the future of health and care delivery.
What is your model of leadership and how do you feel that it’s evolved over time?
I’m lucky that a lot of skills others attribute to me seem to come naturally, rather than having to read multiple tomes on leadership. I aim to lead by example, but I spend most of my time giving people permission to do the things they want to do, empowering them and protecting them from the environment round about them.
So I’m creating that kind of safe, nurturing environment and I’d like to say that I can inspire people from time to time. I make my extensive network of contacts available to those in my team so as they don’t have to do all of the hard yards themselves and it’s another way of creating opportunities for people.
Reflection, too, is very important and I don’t think we do enough of that. If you don’t step off that hamster wheel, you can miss the things that are in front of your nose.
What skills do you think leaders within our health and care sectors, now and in the future, require to transform how we deliver health and care?
I think the key thing for me is speaking truth to power. It’s never more important than it is at this moment. The reality is we have always dealt with crisis in demand and capacity challenges within the health and care service in Scotland by cajoling the system to work harder and faster, but not necessarily smarter.
We need transformational change both within formal public service delivery and in how we interact with our citizens, and how health and care systems react to citizens’ needs.
That’s about empowering citizens to make better informed choices to help them to deliver more of their own health and care themselves, and for their communities to support each other.
With digital, we don’t have to simply look at geographical communities for support, we can create virtual communities as well. That needs firm, brave leadership to point out that the way we’re doing things at the moment is a busted flush.
We need to do things differently, and that means taking risks. But if we don’t take risks things are not going to get better, but will get worse. However, I don’t really hear these conversations being had with a degree of consistency that I believe they need.
“I think the key thing for me is speaking truth to power. It’s never more important than it is at this moment.”
Are there any other skills or qualities you think the leader of the future should have?
Yes – leaders of the future need to listen more. What I found is the more senior you get in your field the more valued you are as an international expert. So you tend to go to events and you don’t actually do much listening. And that’s particularly true for our political lords and masters who will appear on day one for a keynote 15-minute presentation, perhaps five or 10 minutes early, talk to a couple of people, do their presentation, then are whisked away.
In digital health and care the landscape is changing almost minute by minute, hour by hour. How do these people – clinical leaders, political leaders, senior managers and others – understand the art of the possible if they don’t spend time listening to others?
And that goes particularly for things like the use of communication technologies and the digital landscape. Social media is a great example of that. Maybe if we listened to our children more, maybe if we listened more to the students that we teach about how they run their day-to-day lives, how they interact with each other, how they exchange knowledge, and transferred those skills using the digital tools and services that are readily available today, we may be in a bit of a better place.
In digital health and care the landscape is changing almost minute by minute, hour by hour.
How can leaders make that shift to seeing the art of the possible and pursue more of a prevention agenda?
We have to recognise a lot of change happens through the force of personality of a small number of people that were able to drive through their ideas, because of their personal networks and connections that they choose to use appropriately. And those of us working in health and care, whether you’re a nurse at the start of your career or a senior consultant, know that actually a lot of the service changes and evolution that you have has come about by working around the way the organisation is configured to do things. We’re doing work-arounds every day to make things happen for our patients to serve them best.
What we need to do is to design our systems in a way that actually supports the delivery of high quality, safe and effective care. I think Scotland has actually, out of all the nations, got a good chance of beginning to deliver some of that aspiration into our day-to-day practice. We’re beginning to put the building blocks in place now.
It’s not simply appointing a project manager to deliver a service change. Project managers do what it says on the tin and do it incredibly well. But that’s not what underpins change. You do need a different animal. You need someone who actually anticipates the problems before they happen, understands the cultural barriers and begins to smooth out those bumps in the road to make it easier to change and anticipates the problems before they arrive. We need people with a skill set and a toolbox that is different to the ones that we are deploying within the system at the moment.
Absolutely, but we know there are lots of challenges in terms of collecting data, storing it, the format and quality of data. What do we need to do to overcome them?
Yes, and I go back to the phrase I used earlier; speaking truth to power. We talk a good game in Scotland and we have very rich data sets. The reality, however, is that significant amounts of that data are not accessible to the digital tools we have today or those are coming along. And so machine learning and AI algorithms can’t work on our datasets because they’re not of sufficiently high quality. We continue not to collect data in a standardised way – believe it or not, we cannot even record a patient’s gender consistently in Scotland at this moment in time.
How do you determine where you target your resources for best effect? The one thing for me is listening to the needs and aspirations of individual citizens. To understand that, you need to understand the lived experience of people and that means being able to blend citizen generated data, and formal health and care data with other data gathered by government and other organisations as they transact their business with citizens, so we understand that lived experience of citizens. But that’s only half the story. We’ve then got to engage with the population to ask them what is important.
So it needs strong leadership across the piece to recognise the base problems and then bring communities together to work on these as shared challenges. And that’s where I think bold, decisive leadership comes in.
When I started in clinical practice, which was in the 1970s, cancer survival after five years was not that common but now it’s more the rule than the exception for many cancers. But the issue is that although people are living longer than five years, at what cost for some? Because we know that a lot of cancer treatments are very disabling in themselves. So we need to engage and understand – do you want to live for an extra 20 years depending on others, or do you want to live for five to six years, actively enjoying life, participating in your own communities with your families?
Difficult decisions, difficult conversations, but these are the ones we need to have. But to do that, we need to understand the lived experience. So that is important and then in Digital Health and Care Innovation Centre (DHI) and with academic colleagues in Scotland, we are now beginning to really grasp the nettle of these things like value-based and outcomes-based pricing for new medicines that also requires us to collect data consistently, in a standardised way ,to understand that lived experience.
Particularly as a load of the new medicines come with a very high cost. We have very little evidence when they become available, but are you going to deny your own family, perhaps, the potential access to our life transforming medicine simply because the evidence is still emerging?
We need to have discussions about how we square that difficult equation and we’re not really having those with citizens at this moment. But there are ways of doing it and using AI and digital next-generation tools and services can allow us to manage that risk in a more dynamic way than we ever have before. By collecting near real-time data and beginning to amass that evidence so that we take the decisions away from accountants. We actually even take them away specifically from clinicians and put them in the hands of a collegiate partnership – between the citizens, the clinician and the accountant.
Much of what you seem to be suggesting is about handing over the role of leadership to the citizen – empowering people to be their own leaders.
You’re absolutely right. I am not for one minute suggesting that everybody in Scotland becomes a data scientist or has the intellect to get a PhD in mathematics, applied physics or whatever.
But each and every one of us has got a lived experience that they have amassed just by being. We can use digital technologies to unlock that lived experience and make it available to others. So if that’s about everybody taking on a leadership role at whatever stage they are, wherever they are in their life, wherever they are within their community, that’s absolutely fantastic from my point of view.
Those who are trained as health care professionals do not have all the answers, and that’s one thing that I’ve really found enriching in the University of Strathclyde, which hosts the DHI. It doesn’t have a medical school or a nursing school but it has science and humanities disciplines that actually are creating as much benefit for the health and care language as those with clinical specialities. Perhaps in the 21st century it’s going to be less about the medical model of care and more about the technological, sociological model of health and care that is going to make the most difference. Time will tell.
Is there anything else that you think needs to change?
I think we need to look at our education system and we need to stop having silos from preschool and nursery school to primary school to secondary school to further and higher education. We need to look at it as a continuum and we need to start to put things in the curriculum that actually support people to have the tools to cope with the world that they’re going to inhabit when they leave that cocooned environment of the family, where others are making decisions for them. How we actually support them in STEM subjects but, equally importantly, in entrepreneurship and those types of soft skills we need in a new world where digital tools and services will be ubiquitous in how we run our lives. We need to design them in a way that these tools serve us and not the other way around.
Discover more about the Digital Health & Care Innovation Centre (DHI):
The Digital Health & Care Innovation Centre (DHI) is a national resource, centre of excellence, and world-class contributor to innovation, funded by the Scottish Government and the Scottish Funding Council, and located in the Glasgow City Innovation District. It is a world-leading collaboration between The Glasgow School of Art and The University of Strathclyde, with a focus on innovating in digital health and care to help the people of Scotland live longer, healthier lives while providing sustainable and inclusive economic growth. DHI is regarded as part of Scotland’s Innovation Infrastructure and their mission is to transform great ideas into real solutions, through collaboration and co-design. They play a pivotal role inspiring, enabling and combining world-leading industry and academic expertise to create person-centred digital health and care solutions.