Leadership & culture in healthcare

In this episode of series 7 of Leadership and Culture in Healthcare, Matthew Winn is joined by Professor Jugdeep Dhesi, Consultant Geriatrician at Guy’s and St Thomas’ NHS Foundation Trust, Professor of Geriatric Medicine at King’s College London, and President of the British Geriatrics Society (BGS). The conversation explores clinical leadership through the lens of geriatric medicine, examining how credible clinical voices can shape policy, influence system design, and advocate for better care for older people at a time of profound demographic and service pressure.
Professor Dhesi begins by reflecting on her personal and professional journey into geriatric medicine. Raised in Essex by first-generation immigrant parents, she trained in Leicester before initially considering careers in neurology or endocrinology. A period of time away from training proved pivotal, allowing her to step back and reflect on what she valued most in medicine. This led to a clear realisation that her interests lay in whole-person care, multimorbidity, polypharmacy, and the interface between physical health, mental health, and social care—core principles of geriatric medicine. This insight prompted a move to London to train in a unit with strong clinical and academic pedigree, laying the foundation for her later leadership roles.
The discussion then turns to Professor Dhesi’s role as President of the British Geriatrics Society. She describes the BGS as one of the UK’s largest medical specialty associations, with a multidisciplinary membership across the four nations, united by a single mission: improving healthcare for older people. As President, her role extends far beyond ceremonial responsibilities. It involves setting strategic direction, working closely with vice presidents responsible for policy, workforce, education, clinical quality, and research, and motivating clinicians who undertake national leadership roles on a voluntary basis alongside demanding clinical jobs. Central to her leadership is maintaining focus on the needs of older people amid an increasingly complex and pressured health and social care landscape.
Professor Dhesi reflects on the long-recognised but insufficiently acted-upon challenge of population ageing. Despite decades of warnings, health systems remain largely organised around single organs or conditions, rather than around the needs of the population that uses healthcare most—older people living with frailty and multiple long-term conditions. She discusses how geriatric medicine has historically struggled to be heard at national policy tables, and how the COVID-19 pandemic acted as a catalyst for the specialty to step forward and assert its voice. Through sustained advocacy, evidence generation, and collaboration, she describes how the BGS has increasingly influenced national conversations about service design, workforce planning, and value-based care.
A significant part of the episode focuses on Professor Dhesi’s work in perioperative care and the development of the POPS (Perioperative care for Older People undergoing Surgery) model. Drawing on her experience as a medical registrar witnessing preventable complications on surgical wards, she explains how better pre-operative assessment, optimisation, and shared decision-making can transform outcomes for older patients. She emphasises the importance of embedding research alongside clinical innovation, enabling services to demonstrate both clinical and cost effectiveness. Evidence from POPS programmes shows that when geriatricians, surgeons, and anaesthetists work together, a substantial proportion of patients choose not to proceed with surgery because it does not align with their goals or offer meaningful benefit—an outcome that reflects better, more personalised care.
The conversation then turns to shared decision-making, realistic choice, and the ethical responsibility to support patients in choosing not to pursue interventions when the risks outweigh the benefits. Professor Dhesi highlights that “doing nothing” can sometimes be the most appropriate and compassionate option, particularly later in life. She argues that these conversations, while often described as difficult, are essential and require honesty, clarity, and strong clinical leadership.
Looking to the future, Professor Dhesi expresses cautious optimism. She sees opportunity in the emerging long-term planning agenda for the NHS and in a renewed willingness to rethink how care is delivered. She stresses the importance of clinical leaders who retain credibility through ongoing practice, bringing frontline experience into national decision-making. She also speaks passionately about diversity, inclusion, and the need to support leadership development for people from different socio-economic, cultural, and geographical backgrounds, ensuring that national leadership does not become London-centric.
The episode concludes with a powerful call to action around public awareness and advocacy for older people. Professor Dhesi challenges the accepted norm that older people often lack a dedicated specialist overseeing their care, arguing that just as children expect paediatric leadership, older people deserve coordinated, specialist-led care—delivered by the most appropriate professional within a multidisciplinary team. As she approaches the end of her tenure as President of the BGS, she reflects on the Society’s growing visibility, influence, and membership, and her confidence that geriatric medicine will continue to play a central role in shaping a more person-centred, integrated, and sustainable healthcare system.
Quotes from the episode:
Clinical Leadership & Influence
• “It’s very much giving direction for the overall team, ensuring that we are delivering against our vision and our strategy, but also trying to inspire and motivate people during very challenging times.”
• “You have to have credibility as a clinician back at your home base—it gives you the platform to speak with authority when influencing change nationally.”
• “Clinical leaders need to bring shop floor experience into decision-making; that’s how we make policy meaningful and effective.”

Journey into Geriatric Medicine
• “I realised I liked looking at the whole person, managing multiple long-term conditions, polypharmacy, and the interface between physical and mental health—not just a single condition. That led me to geriatric medicine.”
• “Having a bit of distance from training gave me the opportunity to reflect on what I really enjoyed about medicine—it was a real epiphany.”

Advocacy for Older People
• “We often organise healthcare around organs or conditions, not around the needs of the biggest users of healthcare—older people. That has to change.”
• “Just as we expect children to have a paediatrician overseeing their care, older people deserve coordinated, specialist-led care. That’s what we’re championing.”
• “Part of my role is making sure the issues facing older people are heard and informing how services and the workforce develop for the future.”

Shared Decision-Making & Patient Choice
• “Sometimes ‘doing nothing’ is the right thing. Supporting patients to make realistic choices about their care is essential, especially later in life.”
• “One in four patients on the POPS model decide not to go ahead with surgery because it won’t deliver what matters to them. That’s not failure—that’s better, personalised care.”
• “We need honest conversations about realistic choice versus patient choice. Not everything can be solved with intervention, and that’s okay.”

Optimism & Future of Healthcare
• “I’m generally an optimistic person. Despite challenges, we have opportunities with the 10-year plan and a resetting of the healthcare landscape.”
• “We’re seeing people with imagination looking at new ways of doing things, not stuck in old patterns. That’s encouraging.”
• “Diversity and inclusion in leadership is essential. People from different backgrounds and regions should have the chance to lead and shape care.”

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

In this episode of Leadership and Culture in Healthcare, host Matthew Winn is joined by Professor Adrian Boyle, Consultant in Emergency Medicine at Cambridge University Hospitals and immediate past President of the Royal College of Emergency Medicine (2022–2025). The conversation explores clinical leadership at its most exposed: leading a national professional body in a politically charged environment, under intense media scrutiny, and amid unprecedented pressure on urgent and emergency care.
Adrian reflects candidly on what it meant to hold the presidency during a period of sustained crisis for emergency departments. He describes the role as far more than representational, requiring careful judgement about when and how to speak publicly, knowing that statements could act as “Exocet missiles” in the policy and political arena. A recurring theme is the ethical tension between “being right” and “doing the right thing” — particularly the responsibility to avoid unintended harm to patients, such as increasing anxiety or deterring people from seeking care. Adrian emphasises that leadership decisions are rarely clear-cut and always involve trade-offs, requiring deliberate anticipation of second- and third-order consequences.
The discussion situates emergency department crowding not as an isolated failure, but as a visible symptom of wider system dysfunction — including delayed discharges, lack of community capacity, workforce pressures, and insufficient preventative services. Adrian describes how urgent and emergency care often competes with other parts of the system for political and policy attention, characterising this as a form of “Victim Olympics,” where services such as GP access, dentistry, elective care, and emergency care vie for visibility based on public and parliamentary pressure rather than system coherence.
Adrian traces how his leadership capability was shaped by a diverse career path, including clinical work in southern Africa, academic training in statistics and epidemiology, and senior departmental leadership during the COVID-19 pandemic. He highlights the importance of data literacy, credibility, and evidence-based advocacy, noting that the College deliberately framed its arguments through robust analysis to strengthen its influence. His experience leading an emergency department through the pandemic exposed him to intense change management demands and deepened his focus on staff wellbeing, resilience, and moral leadership under pressure.
A significant part of the episode focuses on policy-making and implementation. Adrian critiques the NHS’s tendency towards “initiative-itis,” where repeated plans and directives risk conflating activity with progress. He explains how the College took a deliberately challenging stance on urgent and emergency care plans, pushing for genuine collaboration, proper evaluation, and realism about priorities. This advocacy contributed to NHS England commissioning independent evaluation of proposed interventions through the National Institute for Health Research — a concrete example of how clinical leadership can shift system behaviour.
Looking ahead, Adrian outlines ongoing national work to define clear service specifications for emergency departments, arguing that without clinicians setting boundaries and standards, others will define them instead. He also discusses the College’s engagement with Parliament, including work through the All-Party Parliamentary Group on Emergency Care, producing regular reports on issues such as exit block, crowding, mental health, and children’s emergency care. He highlights the strategic nature of policy influence, including building alliances and identifying advocates within Parliament.
The episode closes with a strong message to trainees and early-career clinicians: leadership is not a distant or abstract concept, but something developed through engagement, research, and professional involvement. Adrian encourages listeners not to be bystanders, but to actively shape the systems they work within. Reflecting on his presidency, he describes it unequivocally as the best job he has ever done — challenging, demanding, and deeply meaningful.
The episode offers a rich, honest exploration of clinical leadership at scale, illustrating how credibility, courage, data, and values intersect when clinicians step into national leadership roles at the heart of healthcare policy and public debate.
Quotes from Adrian:
National Leadership & Policy Influence
• “We knew that what we were saying would land like an Exocet missile. Being right isn’t always the same as doing the right thing.”
• “Every leadership decision has trade-offs. They’re never completely obvious, and you have to spend time anticipating the consequences.”
• “In health policy there’s a kind of ‘Victim Olympics’ — the services that generate the most noise and anxiety get the most attention.”
• “If everything is a priority, then nothing really is.”
• “There’s a real risk of confusing activity with progress. Publishing a plan doesn’t mean you’ve fixed the problem.”
• “If clinicians don’t define what emergency care is and isn’t, someone else will do it for us.”
Clinical Leadership in High-Pressure Systems
• “Emergency department crowding isn’t the problem — it’s the symptom of everything else in the system not working.”
• “Leadership in healthcare is about weighing harm: not just what’s happening today, but what your actions might trigger tomorrow.”
• “You can do an awful lot of harm if you speak without being absolutely solid in your evidence.”
• “We spent a lot of time agonising over what our words would mean for patients, not just for policy makers.”
• “Change management during the pandemic was extraordinary — and the wellbeing of staff had to be at the centre of every decision.”
Emergency Medicine & Its System Role
• “Very few people go to A&E compared to GP or dentistry — but when emergency care fails, the consequences are immediate and visible.”
• “Emergency medicine sits at the sharp end of the system, receiving the impact of failures everywhere else.”
• “Exit block is not an emergency department issue; it’s a whole-system issue.”
• “We need clear service specifications for emergency departments so that expectations are realistic and safe.”
Developing Future Clinical Leaders
• “Don’t be a bystander. Get involved — in research, in your College, in shaping how the system works.”
• “Leadership skills don’t come from training programmes alone; they come from experience, credibility, and engagement over time.”

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

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.
⸻
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.
⸻
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.
⸻
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.
⸻
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.
⸻
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.
⸻
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.
⸻
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?
⸻
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.
⸻
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.
⸻
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.
⸻
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.
⸻
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.
⸻
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.
⸻
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.”
⸻
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.’”
⸻
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.”
⸻
On leadership development and readiness
“You don’t suddenly wake up one day and you’re a consultant. You need to grow into that.”
⸻
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?”
⸻
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.”
⸻
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.