Leadership & culture in healthcare

In this episode of series 7 of Leadership and Culture in Healthcare, host Matthew Winn speaks with Dr Shelagh O’Riordan, consultant community geriatrician, national clinical leader, and President-elect of the UK Hospital at Home Society. The conversation explores the evolution of hospital at home and virtual wards, the realities of clinical leadership, and how care for frail older people can be fundamentally redesigned around what matters most to patients.
Dr O’Riordan begins by describing her career journey. After many years as a hospital geriatrician, she made a deliberate decision in 2016 to move into community geriatrics, recognising that continuing in the same hospital model would only intensify pressures without improving outcomes. She joined a community trust and helped develop proactive frailty services, integrated community teams, and community hospital support. When COVID-19 struck, her team rapidly pivoted from proactive care to a full hospital at home model, establishing one of the largest and most mature frailty hospital-at-home services in the UK. That service now delivers hospital-level care in people’s own homes, both as a “step-up” alternative to admission and a “step-down” pathway to enable earlier discharge.
A central theme of the discussion is the distinction between “virtual wards” and true hospital at home. Dr O’Riordan explains that hospital at home is not simply remote monitoring or phone calls, but the delivery of genuine hospital-level care at home. This includes senior clinical decision-making, access to investigations, point-of-care testing, and treatments such as intravenous therapies. She stresses that the defining question should always be: would this person otherwise be in hospital? If the answer is yes, then hospital at home should provide the same intensity and accountability as an inpatient ward.
The conversation then turns to risk. Dr O’Riordan challenges traditional clinical notions of risk, arguing that what clinicians or organisations perceive as risky often differs profoundly from what patients value. Many frail older people see hospital admission itself as a major risk, associated with loss of mobility, independence, cognition, and dignity. She shares powerful reflections on how deconditioning is often caused not by illness but by hospitalisation, noting that frailty patients cared for at home have far shorter lengths of stay and often better outcomes. Hospital at home, she argues, enables more honest, compassionate conversations about goals of care, including end-of-life preferences, because patients remain in their own environment with control over decisions.
Dr O’Riordan reflects on how working in people’s homes changes power dynamics. In hospital settings, patients can quickly lose agency, while conversations about risk and dying are often rushed, impersonal, or conducted in unsuitable environments. At home, those conversations become more humane and aligned with what people actually want. She emphasises that supporting people to remain at home — even when that includes the possibility of dying there — is not about taking reckless risks, but about respecting autonomy and delivering care that aligns with patients’ values.
From a leadership perspective, Dr O’Riordan describes her role as that of a pioneer rather than a “farmer.” She sees her responsibility as persuading others that hospital at home is possible, safe, and effective, and then enabling multidisciplinary teams to deliver it. She highlights the importance of shared leadership, strong operational management, and close partnership between doctors, nurses, allied health professionals, and managers. No single leader can deliver this alone; success depends on trusted teams, robust governance, and collective ownership.
At a national level, Dr O’Riordan discusses the behind-the-scenes work required to embed new models of care. This includes influencing NHS England, regulators, royal colleges, and NICE to ensure guidance, standards, and governance frameworks support — rather than block — innovation. She notes that the UK is internationally advanced in hospital at home precisely because of the NHS’s ability to align policy, regulation, research, and funding at scale.
The episode also explores workforce and culture. Dr O’Riordan explains how she recruits for values, courage, and advocacy rather than rigid job roles, building diverse teams across different professional backgrounds. She places strong emphasis on psychological safety, supporting staff to be brave, and developing to take clinical responsibility in new ways. Developing the next generation of leaders is a priority for her, achieved not through courses alone but through mentorship, sponsorship, and shared national work.
Looking ahead, Dr O’Riordan describes her ambition to take urgent frailty care even further out of hospital — including the possibility of removing frail patients from emergency departments altogether and creating alternative urgent care pathways that work directly with ambulance services. She acknowledges that one of the hardest unresolved challenges is financial: shifting activity out of hospitals does not automatically release money, and meaningful change may require courageous decisions about bed closures once alternatives are fully established.
The episode closes with personal reflections and advice. Dr O’Riordan speaks directly to women in healthcare leadership, sharing her own experience of working part-time, raising children, and being told leadership was not compatible with that path. Her message is clear: persist, ignore discouraging voices, and support other women to lead. She ends on a note of optimism, believing that hospital at home and community-based frailty care will continue to grow — and that the NHS can be proud of how far it has already come.
Key quotes from the episode:
• “Hospital at home is unbelievably good — not because of me, but because hospital at home works.”
• “Deconditioning isn’t caused by illness; it’s caused by hospitalisation. It just doesn’t happen at home.”
• “The first question should always be: would this person be in hospital otherwise?”
• “What clinicians think is risky and what patients think is risky are often completely different things.”
• “Many patients think going to hospital is incredibly risky — because they know what they might lose.”
• “Just because we can do something doesn’t mean we should.”
• “At home, the power dynamics are completely different — people have control over their decisions.”
• “I’m a pioneer, not a farmer. I need others around me to make the system work day to day.”
• “You don’t recruit for job titles — you recruit for values, courage, and people who will fight for their patients.”
• “If there are hospital beds, they will get filled — even corridors become beds.”
• “To women in leadership: don’t let anyone put you down. Keep going. We really need you in this space.”

Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

Key Lessons from Partha Kar
Context
In this episode of Leadership and Culture in Healthcare, Matthew Winn speaks with Partha Kar, a senior clinician who combines frontline practice with national leadership roles. Partha reflects on leadership developed through clinical credibility, long-term system experience, and a strong commitment to accountability, team culture, and patient voice.
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Core Leadership Insight
Leadership is not a title. It is a set of behaviours grounded in vision, accountability, and trust.
Effective leaders create momentum by being authentic, surrounding themselves with expertise, and standing visibly with their teams—especially when things go wrong.
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Three Pillars of Effective Leadership
Lead with a Clear, Personal Vision
• Leaders must believe in the direction they are taking others.
• Enacting someone else’s vision without conviction erodes credibility.
• Authentic leadership builds trust because people can see when belief is genuine.
Leadership takeaway:
If you don’t believe in the vision, neither will your team.
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Build Teams That Are Better Than You
• Strong leaders actively seek people with greater expertise in data, operations, and specialist knowledge.
• This requires humility and confidence, not control.
• High-performing cultures value competence over hierarchy.
Leadership takeaway:
Your job is not to be the smartest person in the room, but to create the smartest room.
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Take Visible Accountability
• Leaders must “put a flag down” on accountability.
• Take credit last and responsibility first.
• Teams perform better when they know their leader will protect them from unfair blame.
Leadership takeaway:
Trust is built when leaders absorb pressure so teams can focus on delivery.
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Culture in Practice
Be a Guide, Not a Gatekeeper
• Leadership should enable progress, not restrict it.
• Patient voice and staff voice are powerful drivers of sustainable change.
• Control-based cultures slow innovation and damage morale.
Respect Over Popularity
• Effective leadership does not require universal approval.
• Respect comes from integrity, consistency, and doing the right thing under pressure.
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Leadership Under Pressure
• The defining moments of leadership occur during challenge, not success.
• High-credibility leaders stand up publicly when things go wrong and say, “This was my call.”
• This behaviour strengthens loyalty, resilience, and performance.
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Practical Reflection Questions for Leaders
• Do I have a clear vision that I genuinely believe in?
• Have I surrounded myself with people who are better than me in key areas?
• When things go wrong, do I step forward—or step back?
• Am I acting as a guide for my team, or a gatekeeper?
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Final Thought
Sustainable leadership is built on authenticity, accountability, and respect—not hierarchy.
When leaders stand with their teams, culture follows.
Insightful Quotes on Leadership and Culture from Partha.
Leadership Identity & Purpose
“In your journey, be a guide, not a gatekeeper.”
This captures a core cultural stance: leadership as enablement rather than control.
“Being a consultant is a leadership role in its own right.”
A reminder that leadership is about influence and responsibility, not titles.
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Vision and Authenticity
“A lot of people don’t come with a vision. They come with trying to enact somebody else’s vision—and that’s always a struggle.”
“You may not believe in it when you’re doing the job, and that always shows.”
Authenticity is positioned as essential to credibility and momentum.
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Building Strong Teams and Culture
“You need to surround yourself with people who are better than you.”
“That’s not humble bragging—it’s being fortunate enough to have people who know more than you in their field.”
This reflects a psychologically safe culture where expertise is valued over ego.
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Accountability and Trust
“You put a flag down on accountability. I will stand for the team.”
“You don’t just turn up to take the prize—you also take the media when things are not right.”
“The team respects that you will take the flack on their behalf.”
A strong statement on protective leadership and moral courage.
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Leadership Under Pressure
“The best leaders stand out not just in success, but in times of difficulty.”
“They don’t just put it on the players—they say, ‘It’s my call. I made the call.’”
This draws a powerful parallel between healthcare and elite sports leadership.
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Respect Over Popularity
“People may not like your style, but they will respect that you’re doing it for the right reasons.”
“That respect is what allows you to drive things forward.”
Culture is framed as being built on trust and integrity, not consensus.

Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

Podcast Summary
In this episode of Leadership and Culture in Healthcare host Matthew Winn interviews Karen Poole, CSP “Influencer of the Year” and Allied Health Professions (AHP) Rehabilitation Consultant.
Karen explains her dual role: clinically as a consultant physiotherapist, and strategically as an AHP rehabilitation consultant influencing service design, patient pathways, and system change. Her work focuses on advocating for rehabilitation as a core part of healthcare delivery and ensuring services are designed to deliver the best outcomes for patients and populations.
Karen describes her non-linear career path — from neurophysiotherapy, to specialist clinical roles, to organisational AHP leadership — before becoming a consultant. A pivotal step in her leadership journey was moving away from pure clinical practice into an organisational leadership position where she could “have a seat at the table” and influence strategic decisions affecting rehabilitation services.
A key theme of the discussion is the lack of a clear, structured pathway for AHP professionals to progress from advanced practice into consultant roles, in contrast to medicine and nursing where career routes are well defined. While consultant frameworks exist and NHS England pathways are emerging, Karen highlights inconsistency in access and support nationwide.
She emphasises that senior clinical leadership is essential for rehabilitation services, particularly in organisations without rehabilitation medicine specialists. Her role fills a leadership vacuum and strengthens advocacy for rehabilitation at system level.
Karen concludes by stressing the need for stronger succession planning, clearer routes to consultant roles, and better workforce development in AHP — framing this as a strategic leadership issue rather than solely an individual career problem.
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Key Leadership Quotes
On leadership influence and advocacy
“I consult across pathways about patient care and I work across those systems to be able to influence for change.”
“Really working to advocate around patient care, but also around the services and how we design them… so we can get the best outcomes for our patient and our population.”
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On stepping into leadership beyond clinical identity
“It felt very different for me… moving away from my clinical ‘why’.”
“She said: ‘You’ll have a seat at the table… to start to be able to influence.’”
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On leadership as filling organisational gaps
“There wasn’t that senior voice to advocate for rehabilitation in its broadest sense… so the rehabilitation consultant role became an opportunity.”
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On leadership development and readiness
“You don’t suddenly wake up one day and you’re a consultant. You need to grow into that.”
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On system-wide leadership responsibility
“How are we succession planning and how are we supporting our workforce and our future workforce to move into these pivotal roles?”
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On structural leadership challenges in AHP
“We have the framework… but the gap is how we pragmatically support people to get there.”
“From advanced practice to consultant isn’t necessarily an automatic step.”
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Core Leadership Themes
Leadership is Influence, Not Title
Karen’s leadership is defined by system-level impact, not role labels — influencing pathways, services, and strategy.
Leadership Requires Stepping Out of Comfort
Moving from hands-on clinical work into strategic leadership is emotionally and professionally challenging, but essential for impact.
Leadership Is About Advocacy
Senior clinical leaders are necessary to champion underrepresented services like rehabilitation.
Leadership Needs Structure
AHP leadership development lacks clarity and consistency compared to medical and nursing routes.
Leadership Is a Workforce Responsibility
Succession planning is framed as a leadership obligation, not an individual career concern.

Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

“Leadership and Culture in Healthcare – Clinical Leadership with Andrew Hodge
Host Matthew Winn interviews Andrew Hodge, Director of Paramedicine at a UK ambulance service, about clinical leadership, professional identity, and system-wide working in the NHS.
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Executive Summary
Andrew Hodge describes the emergence of clinical leadership within paramedicine as a turning point for the profession. He explains how the creation of board-level paramedic roles has given the profession a strategic voice within organisations traditionally dominated by medicine and nursing.
His leadership journey reflects a career deliberately broadened across multiple parts of the NHS — from frontline paramedicine to commissioning, clinical governance, patient safety, and consultancy roles. This system-wide experience has shaped his leadership style and belief in openness, learning culture, and multi-professional teamwork.
Hodge highlights that real leadership influence increases at executive level, where it becomes easier to shape strategy, represent the profession, and integrate paramedicine into wider pathways of care. He stresses that leadership now extends beyond ambulance services into primary care, hospitals, mental health, and prisons, positioning paramedics as system-wide clinicians rather than just emergency responders.
Culturally, he champions transparency, learning from incidents, professional respect, and integrated working. He sees the future of paramedicine embedded in neighbourhood teams, urgent care hubs, and cross-organisational models — where flexibility, collaboration, and system leadership are key.
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Leadership Themes
Clinical Leadership = Professional Voice
Paramedics finally have representation at executive level, shaping decisions affecting the profession and patient care.
Leadership Through Breadth, Not Just Promotion
Hodge’s influence comes from wide system experience — ambulance services, primary care, commissioning, governance, and consultancy.
Culture Is Built Through Learning & Transparency
Patient safety, openness, and reflection are foundational leadership responsibilities.
From Profession to System Leader
Leadership today is not just about leading paramedics — it’s about leading across systems and organisations.
Multi-professional Working Is the Future
Effective care comes from integrated teams, not professional silos.
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Key Quotes on Leadership & Culture (verbatim)
On professional leadership and representation
“At one time there was no chief paramedic on a board representing the profession.”
“It’s been a really important development… to have a chief paramedic on a board.”
“The role is to be the voice of the profession.”
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On leadership at executive level
“It’s been a lot easier… at exec level with directors to kind of just be alongside them, shaping it as you go.”
“I’ve got the opportunity to represent us and put things forward and try to steer the direction of travel for our profession.”
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On culture, learning and transparency
“Working on that serious incident agenda and how we learned from incidents and develop openness and transparency.”
“That was nothing to do with being a paramedic — it was just really good experience to be in a different part of the system.”
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On leadership as influence, not position
“The crossroads between clinical practice, leadership, research, education, supervision… that influenced the organisation in my small way felt really important.”
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On multi-professional teamwork
“Multi-professional working — that is much better.”
“If we can do that going forward as part of an integrated neighbourhood health team… that would really help the system and patients.”
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On future vision and culture change
“What excites me… is having more flexibility to go into different settings.”
“That would be really good for our profession — but it actually would really help us help the system and patients and partners much easier as well.”
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On leadership growth
“Learning to be on a board has been one of the steepest learning curves I’ve ever had.”
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Final Leadership Takeaways
• Leadership grows through experience across systems, not just promotion.
• Culture is led through visibility, honesty, and learning from failure.
• Professional influence changes when clinicians sit at board level.
• Integration, not siloed working, is the future of healthcare leadership.
• Clinical leaders must balance profession-first thinking with system responsibility.

Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

Podcast Summary – Leadership and Culture in Healthcare with Dr Steve Turner
Host Matthew Winn speaks with Dr Steve Turner, consultant paediatrician and President of the Royal College of Paediatrics and Child Health (RCPCH), about leadership, responsibility, and building a culture that supports children, clinicians, and the wider health system.
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Who is Dr Steve Turner?
• Consultant paediatrician in Aberdeen since 2003, originally from Blackburn.
• Works across general paediatrics, respiratory medicine, research and national leadership.
• President of RCPCH and Vice Chair of the Academy of Medical Royal Colleges.
• Continues to practise clinically, running clinics each week.
“I’m first and foremost a clinician… it would be difficult to do the role if you weren’t experiencing life as a clinician.”
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What the College Does
The RCPCH has four main functions:
1. Setting training standards for paediatricians.
2. Setting care standards for children and young people.
3. Advocating for the paediatric workforce.
4. Advocating for children and young people.
The College has over 25,000 members and is explicitly multi-professional, reflecting that child health depends on whole teams, not just doctors.
“We didn’t become the Royal College of Paediatrics — we became the Royal College of Paediatrics and Child Health.”
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The Role of President
Turner describes leadership in the College as enabling connection rather than control.
“I don’t see myself at the top of a triangle — I see myself at the heart of a circle.”
His role includes:
• Representing the College publicly.
• Advocating for clinicians and patients.
• Bridging understanding between clinicians, professional staff, and politicians.
“People who aren’t doctors don’t understand what doctors do … and why would they? Part of the role is explaining the reality of clinical life.”
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Leadership Style and Philosophy
Key leadership principles highlighted in the discussion include:
Connection Over Control
“My job is connecting people.”
Leadership is about enabling relationships and communication, not hierarchy.
Authentic Clinical Leadership
“You’ve got to be experiencing life as a clinician.”
Credibility comes from staying grounded in real patient care.
Creating a Risk-Taking Culture
As reflected in Matthew’s closing comments, Turner’s leadership message is about psychological safety:
“The challenge is about risk-taking culture.”
Healthcare leaders must move away from fear-based cultures toward learning and improvement.
Collective Leadership
“Leaders, managers and clinicians must work together.”
Strong organisations depend on trust across professional boundaries.
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Children at the Centre of Leadership
Turner emphasises that leadership in healthcare must prioritise prevention, early support and long-term outcomes for young people.
“We need to invest early in the life course.”
Matthew reinforces this:
“Twenty-five percent of the population are our future — and they need fabulous futures.”
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Closing Message
The conversation concludes on a hopeful and human note — that leadership should feel positive, not punishing.
“We need regular fist-bump moments for all.”
This reflects Turner’s belief that leadership should energise teams, celebrate progress, and keep children firmly at the centre of decision-making.

Matthew Winn, podcast host and an experienced leader in healthcare in the UK.