To be a leader is to be both a visionary as well as an expert communicator. The mission is to rally support around a cause, connect people to its associated goals and then to empower them with the tools and confidence they need to deliver these goals. Often to achieve this, leadership demands first, an ability to notice opportunities others might not be able to see and then to confidently influence the motivation in others to take action and seize them. Blazing a path forward, during a time when women had not yet achieved the important gains in senior leadership representation that are becoming more prevalent today - Melanie Martin’s career spans over 25 years - first as frontline care worker then onwards to senior digital delivery at NHS England & Improvement (NHSE/I). In the upcoming interview, Mel reflects on this career: the question that launched it, the question that transformed it and the question that still drives it: “what really matters to patients?”
To start us off… Could you give readers a little insight into yourself, your role in the Transformation Directorate at NHSE/I and how you arrived at it?
Happy to do so. My name is Mel and I’ve worked in the NHS for over 25 years - I first joined in 1997. I trained as a physiotherapist and worked clinically (with some detours into research and education) until 6 months ago. The move into Digital was gradual, progressive and instigated by a process of trying to solve some broad-based healthcare problems that I’d been frustrated by in clinical practice. Constantly, I was asking myself: “what really makes a difference in a patient’s life?” And, “what really matters to patients?” As I got more involved in designing services and tackling sticky problems, I naturally transitioned into digital and technology as an enabler to do this. 6 months ago, I joined NHSE/I as Senior Delivery Manager. This has taken me completely out of clinical practice and into digital health design and the delivery of whole pathways of care. So, rather than trying to affect the lives of patients, one at a time, I’m starting to figure out how to make a difference to populations of patients. To eventually, making a difference that will span across the whole of NHS England.
It's such a privilege to be able to speak with you because I’m on a similar journey (though still right at the beginning). I worked as a paramedic first and then moved into digital and technology. How would you relate your experience, thus far?
Thank you for sharing that with me because I’m really interested in the stories of clinicians taking leaps of faith into different sectors. It was a really big decision for me to leave working in a hospital after 25 years. Initially, I was worried that my opinions might be less authentic if I wasn’t in touch with what was happening inside hospitals and the community by directly working in those services day in and day out. But I haven’t forgotten what I’ve seen and I haven’t forgotten what I’ve heard. My learnt experience of clinical practice continues to inform my approach of consistently involving patients in the co-design and co-production of services. So, my worry was unnecessary. My experience has been that I’m still never far away from my patients despite no longer working in a hospital.
How do you navigate the argument of valuing “lived experience” within the context of professionalized industries (such as healthcare) where anecdotal evidence is not considered to be as reliable as empirical or theoretical evidence and so is often disregarded?
That’s a very good question. It’s not to say that “lived experience” is not considered by medical professionals at all. But I have always fought the corner of qualitative feedback more than most and I do wish that I’d banged on that drum a lot more loudly with some of my medical colleagues. My master’s research was a qualitative grounded theories study asking patients about their experiences with self-management. So, I’ve just naturally always had a greater interest in experience data and the patient voice being woven into everything. What I advocate for is making sure that we’re asking the right questions: “Do you actually want this service or product?” “Would you use it?” “Does it make your life better?” “What does good care look like from your point of view?” It’s about making sure that we’re addressing needs, not just ‘nice to haves’ but the real core needs of patients and we’re only going to get that from the experts experiencing the problem we’re trying to solve i.e. the patients. So, that’s usually the stance of my argument. Ultimately, “lived experience” is really important because it tells us that healthcare is messier and more complicated than e.g. computer systems driving appointment schedules. We need to be motivated by this reality and our theories, assumptions and processes can’t give us the information that we need to address these realities.
Something I’ve been reflecting on is that when I look back on my experience working in healthcare… There was a culture embedded into the training I received that taught one to be authoritative – teaching a psychology of “you know better than your patient.” This unwavering confidence was meant to inspire trust. And, it was an institutionalized hierarchy and accreditation earned via years of disciplined study that gave one the credibility to say, “I know better than my patient.” More practitioners are becoming aware of the flaws in this system – particularly within the treatment of chronic illnesses. But, trying to embed a more patient-centred approach within a traditional top-down industry where a single account of “lived experience” may be contradicting years and years of accumulated documented “evidence.” It’s difficult to justify. How have you sought to overcome this challenge?
I think, initially, I did a lot of things wrong. I didn’t have a network around me that I could go to for support. When I started to get more serious about “connecting the dots” and “influencing change” I began by talking to other people. But, I had to work hard to find people to talk to. I was needing to go to conferences and ask awkward questions with my heart pounding as to whether I would sound daft or not. What I learnt, though, was that there were a lot of people like me. And so, then it became more about joining up dots in the NHS, joining up dots within the community of clinicians that I worked in and joining up dots across “women in tech.” Also, joining up design thinkers with agile thinkers. This is how institutional change happens and what it has become - is a whole community of people building a new body of evidence by testing old assumptions. Now, people won’t consider your work to have high value if it hasn’t had a patient voice in it. If it hasn’t been co-designed or co-produced. But this idea of “co-production” doesn’t mean disregarding old theories completely. I asked the question at a conference this week: “does co-production mean starting with a blank page?” I don’t think we do. We start with an idea, an assumption. But the point is, we test them. We ask. Like the work on remote-monitoring I’ve done with Unboxed. We started with a paper prototype and then we built the idea up from conversations with patients in waiting rooms.
So, it’s about influencing change by advocating for a process that draws from the best of both worlds? You start with a theory but then to validate/invalidate those assumptions – that you can only get from conversations with patients?
Exactly. Clinicians make a lot of assumptions. We think we know what is best for our patients, we think we know what our patients want and we think we know how to solve their problems because we know the “solutions.” We also like solving problems. We don’t like to see patients in distress. We don’t like to see our clinics busy and people waiting for a long time. So, we try to come up with solutions but we don’t always get it right. So now, advocating for “patient-centredness” is really just about advocating for it to be okay to admit this to ourselves and consequently, to consistently test our assumptions even if they are theory-backed. I can now give many examples where the shift from “doctor knows best” to “patient knows best” is already happening.
When it comes to being the person, as you mentioned, attempting to connect many different dots by facilitating cross-collaboration… I imagine this is quite difficult in practice because essentially, you’re attempting to de-compartmentalize problems and bridge the divide between departments who have different ideas, priorities and ways of working. The siloed approach is much simpler. Isolating and reducing problems makes it easier to process them. But, as you’ve pointed out, this is ineffective because, in healthcare, the reality is a lot more complex. How do you find your way through the messiness of it all?
It's difficult. There often isn’t a willingness to collaborate. People are often trying to solve problems in their own ways, within their own departments. And, they often don’t share their failures. We only talk about the good stuff. It’s not an intentional barrier, just a cultural one and so, in many ways, siloed practices continue to win. But there are many examples that give me real hope that better collaboration is possible. In 2019, I was successful in being awarded a top digital health fellowship. It was a Health Education England funded programme for one year. What this did was give me the gift of time to be a clinical product owner, working with Unboxed, driving forward a digital transformation project. As the beating heart of the project, I could test some of my ideas around collaboration by influencing behaviour across an integrated care system. Measurable success meant that we could show the benefits of people pulling in the same direction, across boundaries, on certain shared problems. This track record made it easier to convince others. COVID has also accelerated this. Suddenly, we’ve been forced into a situation where we’ve needed to trial alternate approaches to problem solving and some of these approaches have been successful. Again, this makes it easier to convince others of the benefits of cross-collaboration. Another encouraging thing has been acceptance into the Digital Health Academy. This is also a Health Education England funded post-graduate diploma in Digital Health Leadership. Through this programme, I’ve met 100 other people who share this mission of “trying to connect the dots.” Having this kind of support, albeit virtual, really helps and gives me the hope and encouragement that I need to push through.
What does leadership mean to you, specifically, good leadership?
Good leadership, to me, is where a leader is really compassionate about what it is that they’re trying to do. I’m a bigger picture person, I like a shared vision, I like us all to be on the same team, I like us all to be pushing forward together. And so, these are the sorts of qualities that I appreciate in leadership. I also appreciate that it’s not always smooth and that you kind of go down cul de sacs and all those cliches. But… If you’ve got good leadership and everyone has a shared vision and alignment to this vision and you’ve all decided on the main problem that you’re going to focus on then - much is possible. However, this possibility only exists if there is good leadership. I find that I’m moving into the realms of being described as a leader. I’m a lot more comfortable with this now than I was two years ago. But what kind of leader do I want to be? I’m still trying to determine this. I know that I want to be compassionate, I want to be authentic, I want to be real in all of what I do but I also know that not everyone will respond to that kind of leadership at every moment. So, leadership, I like to say, is mostly about being adaptive.
Can you identify what was at the root of your initial discomfort in being labelled as a leader and what’s changed to enable you to feel more comfortable in that role?
You might have to ask me this question again in a year’s time because I still feel quite uncomfortable. Largely, because I feel like there’s still so much for me to learn, still so much for me to know. However, a turning point was last year during an exercise where I’d sought some feedback from my peers and senior leaders around the impact of the work that I was involved in and some questions around my leadership style. It was based on a self-assessment framework provided by the NHS Leadership Academy. The feedback that I got was really positive. That was nice and showed that I was on track, that’s good. But something that really stuck with me was a comment which said: “you’re already a leader, you just don’t know it or feel it yet.” I’ve tried to use this statement to help me reframe my discomfort. I’m focusing on my years of experience as a clinician, my problem-solving skills, my pragmatism and my ability to connect with people rather than focusing on this apprehension around everything that I feel I still need to learn.
Considering the history of relations between power, hierarchy and perceptions of women in leadership… When it comes to complex problem solving and having strong opinions – have you found there to be an unconscious bias that still exists towards women or have we, both in healthcare and tech, progressed past this?
I think, generally, we are not through the issues of unconscious bias. We’ve definitely not tackled all of the disparity women of colour still face. I’m acutely aware of this and so have been working in my organisation to promote allyship with organisations such as the Shuri Network which has been set up to support women of colour in technology. But, as a white woman… I look around me and do I see someone like me at work? Yes, I do. I see strong women leading. This is empowering and gives me hope that we will eventually push through the issue of unconscious bias entirely.
Why is it so important to have diverse representation in senior leadership?
About three years ago, I attended a mini conference and up on the stage there was… All men, actually. That was my main observation. At the time, I was breaking more and more into digital health and so asked myself: “I wonder how you get on that stage?” Next, I said to myself: “I want to be on that stage.” The next year, I was on that stage. Now, it’s not about being on the stage. It’s about having the opportunity to contribute and being valued when you do. Those panels need to be representative of everyone making contributions to emerging digital health culture. And, there needs to be diversity so that, within organisations, people can see their own identities reflected in their role models. We want people to be saying: “could I also be a role model?” And, “how can I get on that stage next year?” Remembering that these mini wins are not about the stage but about the contributions that they represent. We need every member of the organisation to be motivated in this way.
A final question for you. What advice would you have given to yourself, 25 years ago, right at the beginning of your career? And, what are the qualities that you think we need to encourage in individuals, today, in order to ensure that Digital Healthcare continues progressing?
Well, I think if I was giving advice to myself, I would say – “take your curiosity and go with it!” We should be able to design jobs or roles that enable us to bring out the best version of ourselves, to use our best skills. I would also say, “be authentic, keep being yourself, but recognize that having a sort of framework – a ‘what good looks like’ framework – is an important thing.” You need to be able to evidence your approach. And, for people that are perhaps newer to me in the NHS. I would say, “Look, if you’re a problem solver. Keep going. But think about working with improvement experts as well. Bring digital and improvement closer together.” Because I think that there’s a lot of alignment in the mindsets and principles – we’re all starting with the same problems, basically. Then, “think about what you want to do by solving that problem or what you want to achieve by solving that problem. That’s where you’ll find your value proposition.” I really think that I would have banged on many more doors a whole lot sooner if I’d known what I know now. So, this is my final piece of advice: “Knock on those doors! And, don’t stop knocking!”