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Hello, I’m Domhnall MacAuley and welcome to this BMJ Leader conversation. Today I’m talking to James Mountford, who’s the editor of BMJ Leader, but he has many other roles. James, you’ve had a most unusual career trajectory. Tell us what you’re doing and how you got there.
James Mountford: My initial job after graduating was as a junior doctor, and then I did a spell in consulting because, although I couldn’t express it like this at the time, I was frustrated at the lack of organization and operational management, clinical leadership, leadership in general, and teamwork between managers and clinicians, at the heart of getting a patient through a pathway. We didn’t learn any of that stuff at medical school or formally as a junior doctor.
That led me into consulting with a very simple logic which was, that being a doctor is about helping and fixing issues with patients and their families, and being a consultant is doing that with organizations. Through that, I learned a little about what I would call organization operations management, teamwork, insight into why people do stuff, and hopefully how we can better lead and manage. And then I was fortunate to get a Harkness Fellowship with the Health Foundation and the Commonwealth Fund, and actually see this in real life, in organizations in the US, the sorts of ones that we hear about here. I was able to go and study the Veterans Association, Kaiser Permanente, the Cleveland Clinic and see how they work, bringing all of these principles into their culture and the daily experiences of their staff, and the benefit of their patients.
Jenny and I had just got married and we were living in Boston- she’s a breast surgeon and was doing a fellowship in breast surgery- so, it was just a wonderful time for both of us, personally and professionally.
I’d say one other thing, which is that it was really only on leaving the UK, and seeing a system that thinks about health and organizes around health very differently, that I truly appreciated some of the things that we might take for granted about the NHS. Obviously, there are lots of different options in how to organize a health system beyond the UK and the US model, but no one here worries about losing their coverage, for example, or paying their medical bills. You take that for granted because it’s so deeply embedded in our system.
And to bring you up to date. After that, I was one of the early people to work in UCL Partners, and that became one of the academic health science networks. And then for a number years I was at the Royal Free as the Director of Quality- we were building improvement capacity into our daily work, making that a natural part and central to how work is done for everybody. I had an extraordinary experience in COVID in building the Nightingale Field Hospital down at Excel, and then spent time in the centre of our system in NHS England, as the Director of the National Improvement Strategy.
Now my day job is in health education with a group called Galileo Global Education, https://www.ggeedu.com which runs around 60 universities and colleges around the world, and has a big push into health professional education. It’s about growing the number of people internationally training as health professionals and equipping them with the attitudes and the skills that they’ll need to meet the need of a successful career in the years ahead rather than the years gone by.
DMacA: Let me take you back a little bit, because you’ve worked with IHI (Institute for Healthcare Improvement) in Boston. https://www.ihi.org
That’s a remarkable organization. Tell us about your experience with them.
JM: That was in 2005, and nearly 20 years on, I’m still both working in improvement and quite attached to IHI as are the other people, by and large, who did the fellowship with me. For people who don’t know it, IHI is not very big, around 100 staff, although I think it’s a little bit bigger now. It has virtual branch offices, but its centre is in Boston and it has certainly had a disproportionate impact on improvement in the UK, in England, Scotland, Wales and Northern Ireland, and other countries.
Its founder is a truly wonderful paediatrician called Don Berwick. Some people have heard of Don but perhaps haven’t heard of IHI. What IHI does and believes are that the principles of management, of variation and process in a way that understands reliability, can be applied to the delivery of health care, and lead to better results just as they do in the production of cars or in the industrial base where these theories were born.
And, if we bring it up to date with a perhaps a more human lens, it would be about the science of things like joy in work, kindness, and the human dimension, linked to getting better performance and equity in healthcare. Performance is an underused word or perhaps a ‘dirty’ word in certain health circles but what I mean by performance is results that matter balanced across something like the “quadruple aim”, rather than performance in a reductionist way, which is the balancing of books- are you hitting waiting targets. It’s much broader than that- are you doing well for every pound you spend across all the dimensions that matter, and doing better tomorrow than you are today?
DMacA: Lets bring you back to the UK, because you worked with another organization, the Advancing Quality Alliance.
JM: For a number of years I had the privilege of being a ‘non-executive’ at Advancing Quality Alliance based in the North West. AQUA, has intellectual roots in improvement, and relationship roots that trace to IHI through some of the founders, David Fillingham and David Dalton. And, I guess, trying not to sound flippant, AQUA is trying to do things that I think people, who are from outside of our system, might imagine would happen routinely, including collaboration across different parts of the NHS intellectually, but also practically, around big challenges. So, for example, issues around mental health care and safeguarding, issues around patient safety, issues around flow, collaborating across the Northwest to make progress. And when I say collaborative, people who do know the IHI or the AQUA way, will know that there is the concept of collaboration, but there are also specific tools and methods of running distributed collaboratives, which are trying again to maximize the efficacy of the learning and the results that each node in the collaborative gets.
I’m particularly delighted that while it must have been about 12, 13 years ago that I joined the AQUA board, I’m still in close touch, and its current CEO is my good friend and colleague Sue Holden, who I got to know in NHS England. And I’m really pleased that AQUA has now got a footprint that expands not just in the northwest of England but internationally, and that’s something that Sue has been championing.
DMacA: You’ve spoken about collaboration, and you’ve spoken in an international context and that brings us right up to date because Galileo is a truly international organization. Tell me what you do with Galileo.
JM: We’re trying to grow our footprint in health professional education. The ambition is to have 100,000 students internationally by 2030 studying for health professional degrees around the world. At the moment we’re at twelve and a half thousand across seven schools, different professions, different continents. There are several countries where people are studying for health degrees within Galileo which overall includes 60 universities and colleges, with 250,000 students in total. At the moment health is about 5% of that but we want it to grow to become a third pillar- a third leg with equivalence to the main existing areas of creative arts and design, and business & management.
My job is quite simple in the sense that we’re trying to grow from what we’ve got. We’ve got medical schools, physiotherapy schools, nursing schools. Our university in Cyprus has just landed its license to operate Veterinary Medicine, starting soon to go with Dentistry and others, 13 health professions in total. It’s about helping those schools to learn from each other and to grow new courses, new campuses, grow the number of students, and to ensure that they are fit for the jobs that they need to do and also grow the number of institutions that are part of Galileo. So, that means partnerships or acquisitions with existing schools internationally.
DMacA: Listening to this fascinating career trajectory, what brought you to the USA and to this international organization? If someone wanted to follow that career, what would you advise?
JM: The first thing to say is that I couldn’t have predicted it. And I don’t offer this as advice, I offer it as a reflection on what I’ve done. But, I would say that being really clear about some things and sticking to them and being very flexible about others has led to the path that I’ve followed. The things that I’ve been clear about are that I’ve wanted to work with people who inspire me, who I find to be extraordinary human beings for their values and their energy. I’ve mentioned Don and Sue, but I’ve been so lucky to work with many, many others including, for example, David Fish at UCL Partners and now Martin Hirsch at Galileo.
Your career seems really long when you’re starting on it. As you get through life, it starts to be shorter and you start to think: “let’s not waste time in places that I’m not adding as much as I can, and I’m not working with people who inspire me on things that I find inspiring”. And new challenges represent important steep learning curves.
This theme goes right back to my time as a junior doctor about – how do we bring alongside that basic clinical knowledge and energy in clinical teams, an organizational wrapper that allows those skills to be best able express themselves, which is the very core of being a satisfied professional and giving good care to your patients, and good value to whoever is funding the system. Cancelling operations for lots of patients at the last minute is frustrating for everybody. And that was the situation that I found myself in back around 2000.
So I’d say, think about the causes that really matter to you, find great people to work with and then, be flexible about the sort of organization that you’re working in, or even the specific work that you’re doing. Keep your head down doing a good job at what you’re doing but also looking to the horizon and where it might take you. Looking back, that’s something that I’ve followed and it has been it is endlessly fascinating.
DMacA: As part of inspiring this new generation and communicating that vision, BMJ Leader has a role. Where do you see the role of BMJ Leader itself?
JM: BMJ Leader is one of the relatively few journals within the BMJ stable that cuts across horizontally. Most of them are specialty journals in a vertical sense, for example, cardiology, ophthalmology, emergency medicine, sports medicine. So, we cut across that and we want to be the place for academic research and investigation and debate around the topics to do with leading and managing in the arena of modern health systems. We want to do that internationally.
I often say that each letter is wrong. ‘B’, we don’t want just to be British and ‘M’, we don’t just want to be medical and ‘J’, we are more than a journal. We have lots of blogs and events and things.
So, with that said, in some ways we do behave like a classic journal — publishing, I hope, high quality methodologically rigorous social science based research on leading and managing health systems. But, we also want to signal priorities and need in areas that matter to us as a team.
One of the things I’ve done as an editor is to broaden and diversify that editorial team, diversify geographically, professionally and on gender and race. When I joined everyone editorially was based in the UK, were doctors, and a man. We’ve now got people who are managers, who are allied health professionals and nurses, into the team and then we try to focus on areas which are particularly germane or fast moving.
We had a special topic collection on equity, diversity, inclusion and social justice. We just published an editorial on kindness and human connection that we want to use to launch BMJ Leader into further exploring that area. There’s a fundamental belief among us that the act of giving and receiving health care is fundamentally human and, in how we lead and manage we often lose the sense of connection and, as people go through formal training they become less empathetic. There is good evidence for that. How could that possibly be helpful? So we build a team, shine a light into areas that we think are worth exploring. Other areas include ‘digital healthcare’ and we’re also looking geographically with a particular focus coming up on Africa. And, something that affects us all in different ways, sustainability and how we lead for sustainability.
I would like BMJ Leader to be a place not just where academic experts or senior leaders go, but anyone who is curious about how they could play a bigger part in turning lots of resource into good results for patients, which is what managing and leading is about.
I’m really pleased that we’ve got Fellows on the team, and doing things like Twitter chats, book reviews, events, working with FMLM our co-owners, and things aimed at students and people earlier in their careers. We want BMJ Leader to be dynamic and very broad in terms of how it focuses on this challenge of helping people lead and manage better in health services.
DMacA: In describing BMJ Leader, you’ve also described the editor, in its dynamism and breadth of vision. And with that breadth of vision, you also make a personal contribution in your humanitarian aid.
JM: It’s a cause that I think has touched many of us, and certainly me, and it feels very live. We’re here now exactly two years after the Russian invasion of Ukraine. And two years ago I was completely appalled, shocked, at all sorts of levels at the pictures we were seeing. I wanted to do something other than send tweets and have conversations with friends about how awful it was. That opportunity to do something came to me through the timing of a job transition, a reconnection to an old colleague who happened to be just on the other side of the Channel. By mid-March, they had welcomed 50, then 100, and then around 300 Ukrainians into the local community around St Omer, in the north of France. I was volunteering with Solidarité Ukraine [https://solidariteukraine.org/], a grassroots organization that my friend Mary had founded, mobilizing a local community through all sorts of resources: host families, social housing, teaching and learning French, helping people displaced by the war who had arrived in the community to feel safe and to be safe.
I hadn’t really thought about it before I went but, the connections between my day jobs and what I was doing there in a different field were very clear. At root, if you have trust and common purpose, you can do a great deal – even when you don’t share a common language (I don’t speak Ukrainian or Russian!).
DMacA: Thank you very much for sharing your life, your ambitions for BMJ Leader, your life as a leader yourself. And of course, your humanitarian contribution. Thank you very much indeed.
JM: Thank you for the opportunity Domhnall. I’ve greatly enjoyed it.
James Mountford
James’s career has spanned medicine, healthcare management, policy and education. After an early stint as an NHS doctor, James turned to management consulting – sparking an ongoing fascination with how to organise for learning across large systems, and best motivate people. As a Commonwealth Fund/Health Foundation Harkness Fellow, James studied the operations and organisation of American group practices, which provided excellent experience for subsequent Quality Director roles at UCLPartners and the Royal Free London, and as Director of National Improvement Strategy at NHS England.
James is now Health Strategy Officer for Galileo Global Education and Editor-in-Chief of BMJ Leader.
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.