The golden ticket

Dr Aoife Molloy shares her experience about being on the National Medical Director's Clinical Fellow Scheme class of 2014-2015.

I felt like I had just won the golden ticket when I heard I got a place on the National Medical Director’s Clinical Fellow Scheme. I was full of a sense of excitement and magic, I had heard one of the previous fellows say it was like being lifted up above the jungle canopy after years of battling through the thick undergrowth. It gives you a sense of perspective, a sense of the bigger picture and a feeling that things can and do improve.

Meeting my co-fellows was an instant confirmation that a magical year was about to unfold. We were united by a sense of optimism, activism and pragmatism. We planned to co-produce peer-reviewed articles, opinion pieces, videos, maybe even a book. The reality of coordinating work with 23 other like-minded, strong-minded individuals was a lesson in realism!

I was hosted at the National Institute for Health and Care Excellence (NICE) in London. It is a unique place to work: a highly efficient corporation with a public sector heart. I was working alongside highly talented people with multiple qualifications, all united by a drive to make healthcare better in a systematic, methodological way.

NICE produces guidance on how healthcare should be and sets the gold standards we strive for everyday on the frontline. It was hard to reconcile the gap between the reality and pressures working on the frontline in clinical medicine with the efficient, clear, gold standard set by NICE. Addressing this challenge was the everyday work of the team I was hosted in – the Health and Social Care Directorate. They focus on implementation of NICE guidelines, or putting guidelines into practice. I felt I was able to contribute some clinical knowledge and experience of everyday challenges faced working in the NHS.

I learnt a lot about the breadth of NICE and the sheer volume of high quality resources produced to help improve quality in healthcare. I worked with inspiring teams on the Student Champions Scheme. We ran workshops across the country, teaching undergraduates about NICE resources, in particular NICE Evidence Search. I worked closely with my co-fellow and wise friend at NICE, Ahmed Rashid, on developing a pilot post-graduate workshop to teach doctors and allied health professionals about the organisation.

I developed an approach for adapting guidelines to different contexts with NICE International. I researched how NICE supports disinvestment in the NHS. I set up a ‘Collaboration for Shared Decision Making’ to address how we really give patients a choice in decisions about their healthcare. I reviewed articles for the monthly NICE bulletin: ‘Eyes on Evidence’. By working on so many different projects, I learnt about leadership and management through doing and I am grateful to NICE and to my supervisor Professor Gillian Leng for giving me such a wonderful opportunity.

A very enjoyable part of the job, for me, was collaborating with other fellows in different organisations. I worked with fellows at The BMJ, Care Quality Commission, NHS England, the Royal Colleges and Health Education England on joint projects. I felt like we were bringing organisations together by working with friends we’d made through the fellowship.

As a group, we didn’t quite write a book, but I definitely made some real friends, wrote a few articles, presented at international conferences, worked on really innovative patient-centred projects, developed a grasp of policy-speak and developed a real appreciation for how slowly (and surely) change comes about. I discovered the value of skills I hadn’t recognised before. Getting things done, for one. Bringing solutions, not problems, as Bruce Keogh said, for another.

As for the work-life balance… I’m not quite sure I have quite got it right, or that there is even such a thing! My two toddlers survived the year and we wore (mostly) clean clothes. The hardest part of work life balance for me was switching off. I would find myself thinking about the population risks and benefits of true patient choice through shared decision making as I was playing with my children. Equally disturbingly, I would hear nursery rhymes going around and around my head in meetings with my healthcare heroes.

I end the year, as I began it, with a great sense of ‘something’s got to be done’ and the important power of individuals to be agents for change, but feeling empowered, knowing myself a little better and inspired by the friends I’ve made.