Daniel Allen talks to Hilary Hall about her journey from physiotherapist to AHP lead for Dorset’s integrated care system.
Hilary Hall’s career could have worked out very differently. As a recently qualified physiotherapist in the late 1980s, she spent a year living and working in Canada, gaining experience in cardio-thoracic care and enjoying the skiing.
Then, headhunted for a job at Toronto’s Hospital for Sick Children, she accepted the post but had to return to Britain to renew her visa. During a locum position in Norwich, she had a glimpse of what the future might hold.
‘I’d been working under quite a prescriptive approach in Canada,’ she says. ‘The doctors were telling me what physiotherapy their patients needed after cardiac surgery. But in England, they were asking my opinion – what did I think we should be doing with each patient?’
She had learnt a lot in Canada but decided not to return. ‘I felt, as an autonomous practitioner, I had more opportunities in England.’
In hindsight, that looks a wise decision. Now, as AHP lead for Our Dorset, the county’s integrated care system (ICS), she is serving as a role model and inspiring her AHP colleagues to think and work in innovative ways.
ICSs in England are intended as a means of offering improved, more joined-up care. They evolved out of sustainability and transformation partnerships and aim to bring the NHS closer together with local authority organisations.
There are few blueprints for Ms Hall to follow. Hers is a new role and although other areas are following Dorset’s lead she believes she is the first physio to be appointed to such a position.
She took on the ICS job last October, a part-time, fixed-term contract that allows her to continue as head of therapies for Poole Hospital NHS Trust for the rest of the week.
She came to that post via Portsmouth then Southampton where she worked in paediatric cardiac and adult thoracic care – ‘a dream job for a respiratory physiotherapist’, she says.
A team leader, she had eight other physios working with her in Southampton but was conscious that her career was leading to a high degree of specialism that would perhaps close off other options.
In Poole, the trust supported her leadership aspirations and she began seeking out opportunities. ‘I came to Poole as an inexperienced physio manager and over time have developed my leadership role,’ she says.
Her style as a leader has evolved from a natural inclination to embrace change and to be comfortable with it. Simply put, she sets out a direction and vision, and encourages others to shape and lead aspects of it.
I’ve adapted my leadership style over time. In the beginning I was probably more “I’m the boss”. But as I’ve become more experienced and confident, I’m happy to let other people take more responsibility and for me to have an overview.
She is an advocate of ‘systems leadership’ (see below) and it is easy to see why, given that its guiding principle is to emphasise leadership qualities that reach across organisational borders.
Learning to lead has not come without occasional stumbles – for example, when she began managing other professions in her post as Poole’s head of therapies.
‘I started off managing occupational therapists,’ she recalls. ‘Initially, I assumed I understood and knew what they did. But I then realised I’d underrated and undervalued their contribution.
‘I’ve learnt now when managing other professions to learn and listen. They are the experts and my role is to empower and enable them to lead, to be their spokesperson and facilitator. And that’s very much how my leadership style is now.’
Describing how that approach might work in practice, she cites the example of two relatively junior physiotherapy staff members in her department, one registered, one not, who were encouraged to develop a website to showcase Poole Hospital’s musculoskeletal services. They did such a good job, Ms Hall asked them to work with the local clinical commissioning group to produce something similar.
‘Others might have sent a more senior person but these are people who know what they’re talking about and have done an amazing job, so we’re happy for them to represent us.’
Similarly, as a dedicated trauma unit, Poole Hospital has a multi-professional working group that informs and guides the unit’s work. Ms Hall encourages front-line clinicians to participate in the group rather than therapy managers.
ICSs exemplify this ‘new power’ approach, as think-tank the King’s Fund has described it. New power values collaboration, sharing, ‘crowd wisdom’, whereas old power is rooted in authority and hierarchy.
Ms Hall is careful to emphasise that old power has its place. ‘If you’re in an operating theatre and you have a crisis, you want everybody to do the right thing at the right time. Sometimes you need that approach but mine isn’t like that. I want people to learn from their own experiences.
‘What I like about this method is that you know what you need to solve but you don’t know what the solution is. You start on a journey and take little steps. It’s a quality improvement approach but you empower other people to do it and solve it, working their way through rather than imposing a solution.’Collaboration, facilitation and empowering others are important skills in her ICS role, and Ms Hall readily agrees she is learning as she goes.
‘I’ve also learnt to be patient,’ she says. ‘I’m quite a dynamic person and to do things properly you really do need to be patient.’
And she is understanding more about the contribution AHPs can make to collaborative approaches to care. ‘I’m really having my eyes opened about that.’
She adds: ‘What I say to AHPs in Dorset is you all have a part to play in clinical leadership. My role, in this ICS lead position, is to ensure they are well informed and empowered, and whatever opportunity they get, whether it’s a multidisciplinary team meeting or something more senior, I urge them to think AHP and to speak up.’
According to the NHS Leadership Academy, one way of understanding systems leadership is to see it as a means of working beyond organisational boundaries on matters that are either of mutual concern or which cannot be resolved by one person or institution.
The academy offers this definition of systems leadership: ‘Leadership across organisational and geopolitical boundaries, beyond individual professional disciplines, within a range of organisational and stakeholder cultures, often without direct managerial control.
For more on old and new power in the NHS, visit the King’s Fund website.
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