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Hello, I’m Domhnall MacAuley, and welcome to this BMJ Leader conversation, where we talk to the key opinion leaders in health and medicine around the world. Today we’re talking to Oscar Lyons, who is originally from New Zealand but based in Oxford. Let’s take you back to the very beginning, to your school days, were you always a leader?
Oscar Lyons: That’s a tough question…When I grew up in New Zealand, I grew up in a family of three brothers, my mum and my father were both musicians, which means that we were really struggling for income a lot of the time. And so we had a very low income and lots of economic instability, and lots of music in our lives – but that doesn’t always make up for financial instability. I had a lot of fear that things would go wrong and so I often ended up in positions where I was able to help influence the way things went, to help prevent things from going wrong, and that kind of lead me into medicine. A teacher of mine suggested that I should think about it, and I realized that there are few jobs with as good job security as medicine; you won’t make a massive amount of money in medicine but there’s definitely a lot of job security, and that took me through medical school. And then I started work in a very rural part of New Zealand where we only had nine resident medical officers, junior doctors. I found myself at a point where I was pretty competent clinically but really out of my depth in terms of leadership. And so I ended up applying for a scholarship to come over and do a doctorate.
DMacA: Let’s stop you there for a moment and wind the clock back a little. I read a piece in the New Zealand Herald that suggested that your life was moulded by a traumatic experience when you were young…
OL: I talked about economic instability. And when I was ten years old, my mum and my three brothers and I needed to escape from my father. We escaped out of Dunedin with the help of the police and the women’s refuge, came to Auckland on the other island of New Zealand with, literally, a couple of black plastic sacks full of clothes and shoes. There was not just economic instability but there was definitely some family instability. Although a massive amount of love and care. It was amazing strength that my mother, in particular, had – to be able to take four children out of a situation like that.
DMacA: We talked a little bit about leadership at school, but you were involved in a number of organisations when you were a student.
OL: Again, I was always in these positions of wanting to help make sure that things didn’t go wrong. When I played soccer, I was always the defender trying to prevent things from going backwards. And so, when there was need for people to step up into some roles at university, I took those on. For example, I was Education Events Coordinator for the Auckland University Medical Students Association.
DMacA: During medical school career, you did something that was really different for a New Zealander. Tell us about your medical student elective.
OL: In my final year in medical school I did a two-part elective, half in Fort William in Scotland and the other half in Lerwick, on the Shetland Islands. It was an absolutely incredible time for me. I haven’t come across music anywhere in the world like that in Shetland, particularly in the winter – which was when I went.
DMacA: Tell us a little bit about the medicine as well.
OL: The medicine is really interesting. I had an interest in rural medicine and Shetland is a 12-hour ferry ride, or an hour and a half flight, north of Aberdeen. It’s one of the most isolated places in the United Kingdom and that means that there are specific challenges in healthcare. It means that they have to deal with a much higher level of uncertainty and have to be able to deal with emergencies at a level that most other regional hospitals don’t need to. I often teach about the surgeons I saw operating in Shetland. They are aware that their complication rates are a little higher than on the mainland because they are so much more stretched in their scope of practice. And nowhere else have I seen such a willingness for consultant surgeons to band together and support each other through complicated operations. We often saw two or even three consultant surgeons assisting each other in operations to help ensure they were able to deliver the best possible care they could for their patients, who were incredibly grateful to be treated close to home with their family at hand, rather than being shipped over to the mainland far away from family during the stressful time that is any operation.
DMacA: Then you qualified and went to a rural hospital. Tell us about that.
OL: I worked in Hauora Tairāwhiti (a rural NZ hospital) in Gisborne, a really small town in East Cape of New Zealand. As I said, there were just a few of us there, and it’s one of the only places in New Zealand that has a Māori majority population. Our patients in the hospital were 80% Māori and that really had an influence on our experience there, working with the richness across New Zealand Pākehā and Māori cultures. And so we had a lot of Māori culture and language imbued into our work there and it was also very hard work at times. One of the things that comes with being in that area of very low socioeconomic status, together with Māori ethnicity – which is in itself often a disadvantage in terms of health – is that there’s inequity of access to health support for Māori people. We ended up seeing a lot of very late-stage disease progression and having to work with people who were in really difficult life circumstances to try and help support them through what is always a difficult experience – being in hospital and being unwell.
DMacA: You’ve spoken about people who had very difficult socioeconomic conditions, and you’ve spoken about their medical problems, but you then took a major turn in your own career.
OL: I’d always been interested in asking questions through medical school, so I think it was quite natural for me to go on to further studies and specifically doctoral studies. The way that happened was that a friend of mine, Nick, suggest that I apply for a Rhodes Scholarship to come over to Oxford at the end of the medical school. And I’d been rejected out of hand – I didn’t even get through the first stage! But another wonderful mentor of mine, Mat Lyndon, who works in the South Auckland Clinical Campus, suggested that I apply again. And second time round, I was lucky enough to get through – not just through that first stage, but all the way through. And so I was given an opportunity to come over to Oxford to study whatever I wanted to study. At the time I was also very interested in the mental health of health professionals. I realized, though, that we’re in a space where we do know quite a lot about the poor mental health of health professionals and what needs to be done is we need to make some changes. That really aligned with my interest in leadership, which had been stoked in part through extra work I’d done with the New Zealand Rotary and the New Zealand Army through medical school, and through my experiences of being out of my depth in terms of leadership. For me, leadership is about achieving results with and through others. And, for me, that is what was needed in the mental health space as well. We need to make changes for the better to try and support our staff, support those staff members in terms of how they interact with others in their teams, and with their patients, and with the organizations and systems, to try and get the results they want for their patients. That all sounded like leadership to me. And so I came over to Oxford to do my DPhil focused on healthcare leadership development.
DMacA: Let me ask you a little bit more about the Rhodes Scholarship. Tell us more about the process, what the Rhodes Scholar aims to do, why it was conceived, and who should apply.
OL: The Rhodes Scholarship is a fairly famous international scholarship to Oxford University. It has been contentious at times in its past, but its aim is to support the development of a group of young people to be leaders in their given generation. It focuses on four particular elements: academic strength is the first and foremost, but there are three other elements. These are: energy, often exemplified by activity in sports; cultural activities which for me was music and then; dedication to our communities and to service. They often say that one of the things that characterizes Rhodes scholarship is that it is fundamentally about the energy to try and make the most of the opportunities we have. There are a hundred or so Rhodes Scholars internationally each year, some from specific areas but there are also global scholars which means that people can apply from anywhere in the world. And it gives us a really incredible opportunity to be part of a cohort of outstanding people, and to be supported to study whatever we wish in Oxford that might help us in achieving impact within our communities.
DMacA: So you have this wonderful opportunity to study anything you want. Tell us about the process of choosing what you decided to study.
OL: For me, it was quite a reverse process. I thought that I wanted to come to study a Masters in Higher Education and then to look at doing a DPhil, a PhD, in something related to leadership in health care. One of my mentors at the time, Prof. Andrew Hill, talked about the difference between a master’s degree and PhD. A master’s degree, he explained, is fundamentally about attaining mastery in a particular field. That means that someone has decided what constitutes mastery in a field, and you learn the things that they have set out for you. Doctoral study, or a DPhil, is about trying to learn how to question our assumptions and ask really good questions so that we can try and increase the body of knowledge in an area. It’s not so much about gaining mastery of an area, it’s about learning to change our mindset, to work towards figuring out what our assumptions are and finding out what further questions we need to ask along the way.
DMacA: Now you’re involved in many different aspects of leadership teaching in Oxford.
OL: That really happened by accident at the start, because I was specifically focused on trying to elucidate the elements of leadership development that we needed to get into medical schools, into already really quite crammed curricula. I realized that we didn’t know enough about how to evaluate leadership development programs to really know what worked. My DPhil focus then changed slightly towards evaluation. And, along the way, I was asked by the Director of Medical Education at Oxford University Hospitals if I’d be interested in a programme to try and support young qualified doctors who are on representative committees. At the time I thought that he was asking me about evaluating the programme, and then he said, “can you set it up in six weeks?” I got the idea quite quickly, but it took a bit longer than six weeks. We took about four months to put that first programme together, which itself was only about four months long. But then I got involved in both running and evaluating leadership development. And what I realized is that, through the research that I was doing, the systematic reviews I was publishing, there’s such a massive industry around leadership development and so much of that is driven by financial factors rather than by research and by trying to have as much impact as possible. What that means is that there are a lot of providers out there who would never look at my research. Those who would look at the research, really are most of the way there – because they are already asking “what is the best evidence and how can we improve our programs?” And so I realized that by delivering programmes, by showing best practice and integrating evaluation, and integrating best practices of evidence into those programmes, we could work as role models to try and show people what really good leadership development was. That then ended up going in two directions: I ended up setting up an organization called “Thrum Leadership” -which is where I develop leadership development programmes as a consulting firm working outside of Oxford – as well as delivering programmes directly within Oxford University. I run a module for the Master’s in Surgical Science on Leadership and Management and, for a year, I was the Programme Director for the Master’s in Global Healthcare Leadership.
DMacA: Do you see the future as being “Thrum Leadership”?
OL: Absolutely not. I mean, we never set up with the idea of taking over. We organically developed. We never tried to reach out and to get more customers. It was always to do with people coming to us and asking us to run more programmes based on our reputation, based on the quality of the programmes we were delivering. I love the autonomy of running an organisation and being able to just change things when our knowledge of best practices changes, when we notice things that we could improve, or when we do our evaluations and we find areas that could be better. For me, it is a wonderful vehicle that allows us to have impact. It helps bring in the funding that I use for my research, through Thrum Leadership specifically. It funds a wide range of research, including a big umbrella review of other systematic reviews of leadership development across health care that will hopefully come out in a couple of months’ time.
Through running programmes, Thrum has given me the flexibility to do research and to apply it into practice. I see it as an option for us to be role models, rather than something that will take over. There is no way that one organization can provide all that we need to support clinicians and non-clinicians and their leadership development throughout their careers. It is a massive job that needs to be done. And so I want us to be an organization that can help other organizations, who can look at us and say – “we could do those things, we could implement evidence in that way, we could have more impact for our clinicians, for the teams they work with, the hospitals, the organizations, the systems they work with, and for the patients that fundamentally they serve.”
DMacA: The obvious question then is, what is the future?
OL: I haven’t worked clinically in a number of years now, and I really do miss the feeling of knowing that I did something worthwhile on a given day. Research and running programmes are much longer games. I’m aware that we can have a lot more impact through research, through education, through leadership, than as individual clinicians but I do miss the day-to-day satisfaction. I love teaching and I definitely want to have teaching as an element of my future career. And I really want to try and help us have more impact through supporting people in this really essential part of the work that they do in healthcare.
DMacA: Finally, I should ask you, and I know you’re an accomplished musician, where is music in your life now?
OL: All over the place! I had three gigs last weekend and I have two gigs this coming weekend. I knew when I was young that being a musician was too economically unstable a career for me to feel comfortable, but I grew up with massive love for music. Music is something that, for me, brings me connection with friends and ability to connect with the audiences we play. It is an element of creativity, of mindfulness, of focus on something, of learning. It’s an incredibly important part of my life. And so, I absolutely want to keep it in my life. At the moment, it’s mostly singing with jazz big bands around Oxford, although I also play bass guitar sometimes for the big bands, or in our small jazz combo. It is just a wonderful way for me of connecting with people, of being well and healthy, and really enjoying life, enjoying our time together.
DMacA: Thank you very much for talking to us today, sharing your leadership journey and your musical career. Thank you very much indeed.
Dr. Oscar Lyons
Is a researcher, educator and doctor who specialises in healthcare leadership development. He worked as a doctor in Hauora Tairāwhiti and Counties Manukau (Aotearoa NZ) before completing his DPhil in “Evaluating Medical Leadership Development Programmes” at Oxford University. After his DPhil Oscar was the first Programme Director for the Oxford University MSc in Global Healthcare Leadership. He now runs Thrum Leadership Ltd., a spinout from his DPhil research that supports real-world impact from leadership development in healthcare through evidence-based programmes and research. Oscar is Associate Editor of BMJ Leader, Assistant Director of the Green Templeton College Health Systems Development Centre, and Module Lead for Oxford University’s MSc in Surgical Science and Practice. Oscar spends his spare time singing in bands, playing bass, cycling and rowing.
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.