Clinical leadership case study: consultant forensic psychiatrist and chief quality officer

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Dr Amar Shah, Chief Quality Officer, East London NHS Foundation Trust, on becoming a clinical leader.

My journey

I am the Chief Quality Officer (CQO) at East London NHS Foundation Trust (ELFT), a new role for the organisation and unique one in England. I think I’m the only CQO for a provider trust in England, although it’s a fairly standard role in healthcare providers in the US and was recommended in the Keogh review in 2013 as a way for trusts to increase their focus on quality.

I’m also a clinician, a consultant forensic psychiatrist, and still practise clinically. For me, personally, my journey hasn’t really been about aspiring to the board or climbing the ranks. The work has led me there, and my purpose in being at the board now is to support our efforts to continuously improve. The principal reason trusts exist is to provide high quality care for the population, and so it feels intuitive that boards should seek to bring some expertise on quality into the boardroom.

I am still learning about how to be most effective in the role, as is the board, particularly with regard to the interplay of my role with the Chief Medical Officer and Chief Nurse’s responsibilities. For me, it’s a sign of the board’s commitment to quality that they value the insight and experience on quality management I bring to board discussions and decisions, and it adds to the multitude of reasons why I love working at this organisation.

The turning point

When I finished my clinical training in 2012, I started working with our medical director at ELFT to plan and prepare for a new approach to quality. The two years of preparation drew mainly on skills I’ve honed outside the NHS, as well as within the NHS. I’ve spent 20 years helping run a charity in the UK, and I bring a lot of my learning from that sector to my efforts to inspire and engage our staff around quality improvement.

I’m not sure the trust would have appointed me to the board if we hadn’t built belief that quality improvement really worked, helping us harness the best that everyone has to offer in helping us achieve our mission. I didn’t set out to achieve a board role the position or power isn’t important for me. The work is my passion and having someone at the board to guide and provide expertise on quality is now critical to helping us achieve our mission as an organisation.

Key barriers/challenges and how I worked through these

With the kind of whole organisational transformation work that I lead, there are many, many challenges, and also many, many sources of joy and inspiration. The key for me has been to not get overly influenced by either the successes or the challenges, and always play the long game. See the best in everyone and roll with resistance. Resistance is a good indicator of missing relevance, so keep experimenting with different messages and routes until you find something that resonates.

As a fairly young (39) medic in a board role, I do wonder what the future holds. I haven’t exactly followed a traditional pathway, either through my training or after, and am in a fairly unique role. However, I’m confident that if I hold onto what brings me joy in work, the future will continue to offer new and exciting possibilities.

Organisational support to make this happen

I am immensely grateful for the trust the organisation placed in me, as a relatively unknown and junior doctor just post-training, to lead our quality improvement programme across the trust. Key to this was having a senior sponsor who could champion my work, unblock barriers and give me license to disrupt the system, so that I could try new things and learn as I go.

My top tips

  • Take some time to really understand what brings joy to you at work and find a way to hold on to this. Aspiring to the executive or board is great, but isn’t an end in itself.
  • Focus on your own agency to influence behaviour and culture, as these will be the most important requirements to be effective in an executive role.

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