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Hello I’m Domhnall MacAuley and welcome to this BMJ Leader “In Conversation”. Today I’m talking to Dominique Allwood and we are in London. Dominique, you’ve had a remarkable career from- Public Health Physician to a very Senior Management role in Imperial College Healthcare Trust. Tell us about your role and how you got there…
Dominique Allwood: As you say, I’m a Public Health Physician. My background is that I’ve been a medical consultant for eight years, a doctor for over 20 years, but at the moment I hold two main roles. One is as Director of Population Health at Imperial College Healthcare Trust, a large multi-site hospital provider that sits in London. And I’m also the Chief Medical Officer of an organization called UCL Partners which is an academic health science network, bringing innovation and research to improve health and health care across the population in North Central, Northwest London, and out into Essex. Both of those roles are quite synergistic because they focus on thinking about how we work, how we change, how we innovate, how we improve, to tackle some of the biggest challenges that we face in both healthcare and, more broadly, in improving health. And in my role in Imperial, I’m responsible for our work around improving health equity, and also recently leading a lot of our quality improvement work in the organization, so I bring QI into that. And then at UCL Partners I lead a range of things that includes our work on Net Zero, supporting the organization in our partnership to reach Net Zero, and population health work, our clinical engagement, and lots more. So, a busy couple of roles but fantastic that they’re very synergistic.
DMacA: These are incredibly important roles and many of our BMJ Leader colleagues will be looking and thinking, how do you get there, what are the steps you take in a career to arrive at this position?
DA: I’ve had probably quite an atypical career path as a doctor. When I first started studying medicine I thought that you have quite a linear progression – you do your undergraduate work, you may take a year out to do an intercalated degree where you get another degree as well as your medicine degree, then you go and do your preliminary clinical training, then you choose a specialty, you do the training, you become a consultant, and then you carry on your work. But, for me, some of the first deviations started early on in my undergraduate training. I didn’t want to go and do the typical degree that lots of trainee medics went to do, in pathology or anatomy, or pharmacology. I wanted to go and learn about healthcare management, which was quite unusual back then, about 20 years ago. So I did an undergraduate degree in healthcare management and learned more about the bigger picture of healthcare. I did a year of my regular clinical training after qualifying but then went and worked abroad in New Zealand, and learned a lot more about healthcare and how it’s delivered outside of the NHS, what we could learn, and got very interested in health inequalities and learning about indigenous health. That really spurred my interest in public health. I came back and I did a couple more clinical roles as a junior doctor but realized quite quickly that I wanted to move out into something that was more about the bigger picture of healthcare around population health, around leadership, management. Back then there wasn’t so much around formal leadership and quality improvement for doctors in training, and I remember thinking there are things that don’t work very well in my clinical role but I don’t really know how to change them. I felt like the thing I needed to do was to move away from clinical medicine and delivering direct care to change things. Whilst that isn’t necessarily the way to impact change, it’s actually turned out to be a fantastic move for me. But then, in my public health training, I didn’t just do the five years of training and finish, I took almost three years out of the program to do get back to healthcare and effect change through a number of fellowships. I was a Darzi Fellow in Clinical Leadership, I did some clinical transformation, I worked as an improvement science fellow and all sorts of other things.
Even within the Public Health Training Scheme, I managed to be quite flexible about the types of placements I did. So, I was able to go and work for a large management consultancy firm for part of my training, and learn how management consultancy interfaces with healthcare, learn about academia, policy, arms length bodies, the role of commissioning, all sorts of things in my Public Health Training. Then, I didn’t go into a typical consultant public health role, I went to work at a think tank at the Health Foundation. And then I got a role in the acute trust which has been really interesting and exposed me to what can you do around public health and population health within and from a healthcare setting. I was also doing some other consultancy work alongside so, I suppose, all along I’ve been looking for ways in which I can do, what’s described as typical or traditional training, but do it in a slightly different way that exposed me to some broader things. And that has benefited me because I’ve now ended up with a melting pot of experience. I’m somebody who’s clinical by background, I’ve got public health training, I’ve done management and leadership training, I’ve had roles as associate medical director so, I’ve gone up some of the medical management and leadership routes. I worked as a medical director at a Nightingale Hospital, that was during the pandemic crisis, and I’m doing a population health role, I’m working in an innovation organization. So, I like to have variety and I think what I’ve learned is that there are a number of different lenses to tackle a lot of the health and healthcare challenges. That’s what I’ve tried to do – to collect those experiences.
DMacA: I love this concept of the collection of experiences. It’s certainly not a linear career trajectory. It’s been so innovative and exciting. Tell us about each of those components. I’m interested in the management consultancy, I’m interested in the think tank, how do they compare, how do those different organizations compare with our traditional experience of healthcare.
DA: First I spent six years at an organization called the Health Foundation and I also spent about four or five months as a public health trainee working at the Kings Fund. Both are in that bucket of think tanks, together with the Nuffield Trust and there are many others, but those are quite well recognized. They have the ability to act independently, they don’t sit under the NHS England infrastructure or integrated care systems, so they can act independently and provide an independent voice, thinking, research and analysis on a number of topics that they choose to be important and pertinent. And, I guess, that gives them a lot of freedom about what they can work on, what they can say, and how they can speak to both healthcare leaders, politicians, and others, about some of the issues, challenges, and opportunities within healthcare.
I found a real affinity working at the Health Foundation because they had a really big portfolio of work on improvement and that’s an area I’m really interested in. But I also got the chance to build on the intersection of – how do you take improvement in healthcare and extend some of those methods out to tackling some of our wider and health challenges- and I got to set up a whole portfolio and program of work on anchor institutions, around big healthcare organizations being anchored in their communities, and leveraging some of the power they have as employers and users of resource and facilities. I was able to convene loads of interesting people, I was able to think deeply, commission research, and set up networks, all sorts of things that I guess you don’t have the opportunity to do, or have the freedom to do in a more traditional healthcare setting. Some of the foundations are very well resourced, they have big endowments and so they have the opportunity to spend money and resources where they want to.
I remember doing a careers questionnaire about what types of places do you want to work in. I really like being creative, I like having freedom to think, and set stuff up, and be a bit of an architect, and it was one of the places that came out top. It said, go and work in a think tank or Foundation because you get the opportunity to do that and I don’t think I’d quite realized that there was that flexibility, so that’s been really useful.
I guess, from the other side, I’ve had a number of management perspectives. I’ve experienced healthcare management as a manager in healthcare, I’ve learned about management through doing both an undergraduate management degree, and recently just completed an MBA because I’m really interested in how we bring management rigor into the work that we do. I think it’s really important to use our people and our money really well, and demonstrate that, and think strategically about how we circle that resource to deliver our objectives. But I was also really interested then in management consultancy, which is bringing in management and professional services expertise into organizations to help them do some of their strategy development, manage some of their projects.
Consultancy is interesting. There’s a choice and intention about how much resource a public sector organization should be spending on management consultancy but often we have gaps in both knowledge and capacity that are filled well through management consultancy. So I got to learn all the different things that consultancies do; how to be a more intelligent commissioner, and think about where I would or wouldn’t bring consultancies in, and also how to bring some of my knowledge and skills, about bringing evidence-base into consulting. Yes, I’ve really learned a lot about some of these disciplines that sit alongside healthcare which are about management, leadership, teaching, research. Management and Leadership, whilst different, go hand in hand so I was keen to learn both.
DMacA: For people who are looking at this career, I’d like to focus in on one or two components The first thing is Darzi Fellowship in Leadership. Tell us about that.
DA: That was probably one of a couple of very transformational, I would say life-changing experiences. I probably sound a bit evangelical but I was somebody who’d been interested in leadership, taking the lead in teams I was working in or projects, naturally and intuitively, but didn’t really know much about what sits behind that in terms of the theory, the practice, the ability to improve what you do, and so I had some coaching and decided to apply for this Fellowship. It’s been a long-standing Fellowship that’s run for a number of years now, and it has been great to find other people who are like-minded. But, what I did was that I found some people who I guess were a bit of my ‘tribe’. I found people from completely different specialties who had similar mindsets on how they want to look at life and what they’re interested in doing, in terms of stepping into leadership roles and challenges. It was run by the King’s Fund at the time with some fantastic leadership development. I remember having my eyes opened to understanding about personality types and that there is a difference. When you interact with your colleagues or your family- you know that you’re having a bit of a rub but before I did that kind of stuff, I didn’t really have the language or the knowledge to understand some of that stuff in terms of frameworks. I learned a lot more about learning, and how to be an adult learner, and around action learning which is taking things, reflecting on them, having conversations with people to try and unlock things, and then to go and try stuff out and come back.
I learned about coaching and mentoring and I also learned much more about the nuts and bolts of leadership through my fellowship, through the experiences we were having. You’re employed by an organization for a year in a role that is about exploring your leadership and undertaking projects from a very different perspective to what you would have done potentially before. So, I learned a huge amount and one of the biggest things that I learned was trying to be mindful of – what’s it like to be on the receiving end of me.
For many reasons that Fellowship was instrumental in changing some of the direction of the career I had. It enabled me to take a couple more years out so I went on and pursued a number of other opportunities and I think it really cemented my understanding of leadership, and understanding what I think good leadership looks like, and how you try and embody that, and learning from other people. It was my first fundamental learning and foundation in it and something I’ve really carried through and, I think it’s exactly 10 years almost to the day that I finished that program. It’s definitely stuck with me.
DMacA: That was 10 years ago so let’s bring you up to date. With all that experience, you’ve just done an MBA. How did the MBA add to your global knowledge in healthcare management?
DA: It was a really great opportunity to understand more formally about how, as a manager, you have an impact both with people that you directly line manage, about the way in which you manage up into your organization, and, taking on a bigger perspective. I’d never done anything around internationalization or global healthcare strategy but it taught me, from a management perspective, how you’d go about starting to develop the strategies and the links and the partnerships and that’s been very helpful for my current role. I do a lot of learning with organizations internationally but I’d never thought about how to be more strategic. There was quite a lot about strategy. I learned much more about marketing, engagement, and communications. I sit in a public health background but I’m doing a lot where I’m trying to engage people, particularly clinicians. This thing about the messaging, the receiver, how we’re going to really shape and change behaviours through our strategic marketing and communications. That was really interesting and relevant to me. I learned a lot more about- what does it mean to try and think about your organization with a more commercial lens, around making better value of your resources even if you’re not profit driven. That’s helped me also think about some of the smaller organizations I’m involved in as a board member and as a trustee- how to be more managerial, commercial, values driven. And it’s helped me in my day jobs where I’ve been a line manager, in thinking about the teams that I manage. I don’t think an MBA is essential for everyone, but it definitely helped me strengthen my understanding of how organizations operate, the environment in which they’re in, the internal things they can do to make themselves better in service of their employees, their customers, and their stakeholders.
To be a good leader you should probably have some good management understanding, and to be a good manager I don’t think you can just be focused on the resources, and the numbers, and moving people around. I think you do need to have leadership qualities. I’ve really enjoyed building both my leadership and management capability to bring to some of the roles that I’ve done, including my medical management leadership roles.
DMacA: I have one final question and it’s a rather abstract question. You spoke earlier about the value of some of what you did was in the ability to have the ‘freedom to think’. I can’t think of a greater contrast between our perceptions of healthcare management and healthcare administration, and the ‘freedom to think’. How would you advise people in their career to retain that ability and the ‘freedom to think’?
DA: That’s a great question. I’ve been really lucky that, given that I have part-time roles and some of them have been more operational than others that even in the most operational bits, I know that in another part of my week I’m probably going to have a different kind of work pattern and set up, with different timelines pressures, and the ability to do that. I’m really aware of how much pressure there is currently, particularly in healthcare, and I guess the ability to try and stand back and look at some of the problems in a slightly more strategic way, or to try and start to focus down, more in being more present for the individual things that you’re being able to do, is really important. And the ability to think, to understand, the challenges you’re facing, the opportunities to go and look for new ideas, hear and learn from other people, share that learning, feels really important to me. So I think it’s always really important to have something else to give you time and space. It might also be a bit of an outlet- whether that’s a choice to do education alongside clinical work, or pursue research, or innovation, or leadership, or quality improvement even within your role, setting up stuff so that it’s not just a complete feeling like a grind of delivery the whole time. That feels, to me, really important and it’s been able to sustain me through a long period with a lot of pressures through healthcare. But I totally recognize that it’s a difficult trade-off for people to make. But then, we are talking about leadership, so it is about how do leaders help create space to help their teams to do that- in your one-to-ones and your online management conversations, how are you challenging and asking the questions that make people think differently and start to slightly zoom out of what they’re doing, to have that chance. That might only be a few minutes a week, but the way in which we curate our meetings, our interactions, gives us a bit more freedom and ability than we might initially think.
DMacA: Dominque, it’s been such fun chatting to you. Thank you very much for such a refreshing and exciting and innovative approach to leadership and management – which medicine doesn’t often see as that exciting. But you’ve really brought energy to it. Thank you very much, it’s been a really enjoyable chat.
Key Quotations:
“To be a good leader you should probably have some good management understanding, and to be a good manager I don’t think you can just be focused on the resources, and the numbers, and moving people around. I think you do need to have leadership qualities.”
“I remember thinking there are things that don’t work very well in my clinical role but I don’t really know how to change them.”
“… what I’ve learned is that there are a number of different lenses to tackle health and healthcare challenges. That’s what I’ve tried to do – to collect varied approaches and experiences.”
“Consultancy is interesting. There’s a choice and intention about how much resource a public sector organization should be spending on management consultancy but often we have gaps in both knowledge and capacity that can be filled through management consultancy.”
“I don’t think an MBA is essential for everyone, but it definitely helped me strengthen my understanding of how organizations operate, the environment in which they’re in, the internal things they can do to make themselves better in service of their employees, their customers, and their stakeholders.”
“I’m really aware of how much pressure there is currently, particularly in healthcare, and I guess the ability to try and stand back and look at some of the problems in a slightly more strategic way, or to try and start to focus down, more in being more present for the individual things that you’re being able to do, is really important.”
“And the ability to think, to understand, the challenges you’re facing, the opportunities to go and look for new ideas, hear and learn from other people, share that learning, feels really important to me.”
Dr Dominique Allwood
Dr Dominique Allwood is Chief Medical Officer at UCL Partners and Director of Public Health at Imperial College Healthcare NHS Trust. A Consultant in Public Health Medicine by background, she has worked widely across healthcare in leadership, management and advisory roles for provider and commissioner organisations, academic institutions, national bodies, management consultancy, charities and think tanks.
She provides leadership and expertise on a range of areas including environmental sustainability, clinical engagement, quality improvement, improving equity and population health, anchor institutions and learning health systems.
She holds an MPH, is a Fellow of the Faculty of Public Health, has undertaken a Darzi Fellowship in Clinical Leadership and is an Associate Editor for BMJ Leader Journal and on the Board of The Patient Revolution. She recently completed an Executive MBA at Henley Business School.
Professor Domhnall MacAuley
Domhnall MacAuley currently serves on the International Editorial Board for BMJ Leader.
Declaration of interests
We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.