Interview with Francis Andrew – Royal Bolton NHS Foundation Trust Medical Director
By Dr Hannah Baird
Chair of the FMLM Trainee Steering Group
What is your background?
I originally set out to be a neurosurgeon, after my mother suffered an acoustic neuroma. I really enjoyed the neurosurgery job as an SHO, but it made me realise I was more interested in the acute patients on the neuro intensive care unit, rather than those with more chronic conditions. So, I thought about emergency medicine as an alternative career. I had been significantly influenced by an A&E consultant, John Sloan, who was the clinical director of A&E when I was a medical student at Leeds General Infirmary, particularly because of his approach to leadership. I wanted to acquire more critical care skills than was the norm at that time, so I took a post as an intensive care lecturer.
After training, I was appointed as a consultant in intensive care and A&E medicine at the Whiston Hospital, a post I held for 14 years, during which I developed major interests in the care of patients with mental health problems, deteriorating health, head injuries, and sepsis as well as information technology. I subsequently became involved in all sorts of leadership work in A&E and ITU which led directly to my appointment as clinical director of the ITU at Whiston. I wanted to take on the challenges of being a medical director, but the job was not coming up at Whiston. However, I was fortunate to be appointed to the Royal Bolton Hospital as there was something very special about the place. I had visited a lot of other places but found a friendliness combined with a real can-do attitude at Bolton and I have now been here almost two years.
What are the main leadership challenges for you at the moment?
The biggest leadership challenge is making sure everybody remains calm and is able to do their job. This is incredibly important as we are in a sort of battlefield situation. People look up to the medical director for leadership, so they expect me to remain calm and offer them direction, even when it is possible the medical director might not feel calm in that situation.
I am worried not just for patients but for staff as well, especially clinical staff. It is important to remain calm, show confidence and direction as well as demonstrate first-rate listening skills - not only to listen but to show that you are listening and then take action where appropriate. If you cannot take the action you would really like to take, be honest with people and explain why.
Dealing with information overload is difficult. Trying to sift through all the information to decide what is immediately relevant and important has been a real challenge.
Another challenge has been trying to link the Trust with our community and primary care partners. They are facing significant pressures, particularly around the situation in nursing homes and we may not have had complete sight of that as a healthcare system. We have colleagues in primary care who are doing an extraordinary job in really difficult circumstances and possibly without the level of PPE which we have in the Trust. They have risen to this and other challenges and I have learnt a lot from them. I think we have linked up with primary care very successfully; we understand each other’s world and have shared our problems and solutions. I am proud of the work we have done in this area.
Also, I am concerned for patients who may have had heart attacks, strokes or other illnesses but did not come in because of concerns that family and friends would not be able to visit them, or they might become infected with Covid, or just thought that we are closed to everything except Covid cases. So I am working with our comms team to get communication from the Trust into the public arena to assure colleagues in primary care, as well as our communities, that healthcare needs can and will continue to be met within the Trust.
Is there anything you have been able to draw on in this time?
I think the NHS has delivered a lot of useful resources during this crisis. I have tapped into the changing treatment frameworks, but I think the NHS could have done a bit better on the ethical frameworks. In terms of leadership resources that is an interesting question.
There have been some good articles on leadership in a crisis in the BMJ, particularly the need for clear communication and attentive listening, and the need to provide very simple messages with a clear direction.
I have also gone back to leadership and management articles focusing on how to deal with uncertainty. At the end of the day, I make decisions, that is what I am responsible for, but I must accept that sometimes I can make the wrong decision. I can live with that if I have sought the right stakeholder engagement and listened to the right people in coming to that decision.
You have to be humble as a leader, if someone points out the decision was wrong and it can be changed, you have to be humble enough to agree to changes based on new information or input from others.
I normally do a lot of reading around leadership. I think this crisis has provided an opportunity to reflect and on leadership in general. I am currently going through an audio book called ‘Atomic Habits’, which talks not only about the habits you need to develop as a leader but also how to sustain those habits. All good leaders need a set of habits to make sure they get the job done. There is also ‘I am surrounded by Idiots’ by Thomas Erikson, on how to understand people and classify their leadership behaviours. It has been on my list of books to read for a while, so thanks to the crisis it is now my bedtime reading and it has proved useful.
I was also lucky enough to go on the Nye Bevan Leadership Academy course. I think I used to be a very black and white, linear person but I am now trying to use de Bono’s hats[i] to understand other peoples’ different perspectives.
I have gone back over the Nye Bevan course, particularly to articles on the concept of reflexivity, which is about understanding the impact one has as a leader on the environment and the audience you have in front of you. Through this I have become much more self-aware of my behaviours and body language to assess their impact on how I am coming across to people.
Are there any particular examples of innovation you have seen?
We have seen some amazing innovation in telemedicine led by primary care and supported by IT colleagues. There has been innovative use of snorkel masks and we have managed to get the governance behind that very quickly. Real innovation has come through the way that we process patients in A&E, and among clinicians across divisions and across directorships. We have not really seen this before; there is less silo working, a lot more togetherness. This I think is good for the NHS - we were struggling at times, pre-Covid. I had often wondered why we were not using telemedicine more, for consultations with patients as well as Trust meetings. Now we have been forced to engage, everyone has taken to it, so why would we want to go back to something which was more clunky and less efficient?
With thanks to Dr Richard Parris who was instrumental in arranging this interview.