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Jonathan Darling

Hello, I'm Jonathan Darling, and I'm Vice President for Education and Professional Development at the Royal College of paediatrics and Child Health. Welcome to this leadership podcast series. The podcast comes out of our belief that better leadership skills good for all of us, not just a few, and our approach to leadership for each of us is vital to professional effectiveness. It positively changes the zone of influence we have around us. So, do you want to be a more effective leader? Then join us on this and future podcasts as we learn together about effective leadership. I'm really excited to introduce today's guest, Simon Broughton. Simon is a general paediatrician at King's College Hospital, and he's held multiple senior roles in education and training that he's going to tell us about during our talk, and he's currently our officer for recruitment at RCPCH. So, a warm welcome, Simon.

Simon Broughton

Many thanks, Jonathan. It's a great honour to be invited and to help to start this podcast.

Jonathan

Great. So, we're going to move on to our first question. And I'd like, if you would, Simon, talk us through your career journey briefly, to give us an idea of the kind of things you've done along the way.

Simon

Thank you. I think it's important, because we are defined by our journeys, and everybody's got a particular journey that's important to them. So, my medical training journey, I guess, started in Southampton medical school, and I went through from 1989 to 1994 and qualified. After finishing medical school, I did my house jobs. It was just one year at those times, and then did my training. Then from then on in London, where my wife to be lived, and finished my three years of SHO jobs, and did my registrar jobs. And I guess this is the first kind of particular, first real sort of serendipity moment I'd like to highlight. So, I was going off to Australia for a year to do a year in Sydney, doing retrieval medicine, flying around New South Wales, picking up sick children from all the hospitals throughout New South Wales and bringing them back to both neonates and paediatric patients. And my very final shift at King's College Hospital, where I've been doing general paediatrics, I'd stayed on for a bit longer after handover to socialize with my colleagues and say goodbye to them and a very esteemed professor, Anne Greenoff, run the ward. And normally, by this point, I would have left the ward, but I was still there at that particular time and she spoke to me and said, thank you for all of the care that I delivered to the neonatal graduates on the ward, and she asked how that she could help my career going forward, which is a massive honour to be asked that by somebody so influential. I hadn't really thought about research. Of course, I'd thought about it, and I'd utilized it during my training, but I hadn't really seen myself doing research. But then suddenly the penny dropped, and I thought, well, when I get back from Australia, it'd be really nice to actually have something to come back to, which is organized and the idea of doing research and the project that was proposed just sounded great to me so, I said yes. And you know, having those opportunities that come to you through life, they come to everybody, I think the first thing you have to realize is it is an opportunity, and then decide if you're going to take advantage of that opportunity, and then actively say yes or no. And I'm delighted that I said yes, and then moved on into really enjoy my year in Australia, and then to come back and to do a PhD with, Anne Greenoff which was, which was great. I'm very, very proud of what I achieved.

Jonathan

What was the subject of your PhD?

Simon

So, it was looking at the long-term respiratory morbidity in prematurely born babies following RSV infection and follow them up to the age of two. So, we looked at lung function before neonatal unit discharge, again at the year, and then looked at all of the different viruses they collected that they had by collecting nasal secretions from them when they were at home. So, I had to go to lots of homes, which was interesting. And then I developed a real time multiplex PCR, which was very trendy at the time, and was one of the first thing, first kind of real time multiplex PCRs for nine respiratory viruses, of course, now that's been superseded by other technologies and yeah, follow these families up. So, it was great. And that opened my eyes to research. I then went back into training. I thought that I wanted to be an intensive care consultant, having done my year of retrievals in Australia and done some intensive care when I got home. But then I kind of realized, actually I really like children to talk to me, and I enjoyed the outpatient setting, and I enjoyed actively collaborating with families and with children, which you obviously do on intensive care as well, but I wanted to do that in a more in a less stressful environment, so I moved into general paediatrics and finished my training.

Jonathan

So, you had been thinking of being an intensivist, and then at some point, you decided to go general, yeah.

Simon

That's correct, yeah.

Jonathan

And you mentioned your moments of serendipity when Anne spoke to you, but you implied there were other ones. Is that right?

Simon

There's been lots. So, when I became a consultant, one of the key things I wanted to achieve was to improve the experience of trainees going through the clinical work at King's College Hospital where I was working. I got appointed there in 2007, I then got into what would be ST1 recruitment, and I met another very influential person, so Hilary Cass, who, was the lead of the London School of Paediatrics at the time. And she called me after being involved in some interviews, and said, Simon, I think you're pretty good at this interview thing and recruitment. It's obviously something you care passionately about. Would you like to be a training program director and to help out with that? So again, another massive opportunity to which I straight away said yes, and again, was extremely proud to be invited by her to take this role up. And that really led me to many more of my education and training roles and opportunities sort of completed throughout my career.

Jonathan

Just briefly mention them. We can't cover them all in this short podcast, but just run through a few of them.

Simon

Yeah, so after college tutor, then I was training program director and lead for recruitment for London for about six, seven years. I initially got appointed on a clinical academic split of 73PAs, but I kind of realized that being an academic is quite challenging to you know, you really have to keep that time precious and maintain that time, and I found that quite hard, and I was more suited to education and training and clinical work. So, Anne was very gracious, and then helped me to move those PAs more into education and training, and I took on a course director and a master's in paediatrics for King's College London for seven years, which was brilliant. And I collaborated with colleagues from King's College Hospital, from what is now Evelina London Children's Hospital and St George's, and it was a really fantastic experience of developing what effectively was a South London masters.

Jonathan

Was that something people would do during their paediatric training, so alongside clinical role, or would they step off and do that full time for a bit?

Simon

Yes, it was part time and over two years. So, it was done during training, was able to be done during study leave for the trainees and it was a mixture. The first year, it was all UK based, trainees, nurses, pharmacists, so it was very multidisciplinary, multi professional. But as it progressed, it started to attract more overseas students and then I handed that on to a fellow consultant, who carried on moving forward with that MSC.

Jonathan

Can I just return to this idea of serendipitous moments? Because you've mentioned two of them. There's several more, it seems, that have happened for you, but for people thinking about you know where they might go in their careers. I think the key thing is, doing the good job in the first place, because I imagine that's partly why those came your way. It wasn't just totally random. Is that fair to say? And the other thing is recognizing them. Can you give us a bit more reflection on how we make the most of those kind moments?

Simon

Yeah, well, I think these things come around when it's identified that you're really care passionately about that particular opportunity that may be coming up. And so definitely, I always say to trainees and to medical students, you know, you do whatever it is to get you out of bed with a smile on your face, and if you're going into work with a smile on your face, you're having a positive influence on everybody else who's around you, and effectively, that is part of leadership by demonstrating that you're enjoying being where you are and you're truly present. I think it is important to show that you're really committed to that particular role, and then opportunities do come around.

Jonathan

I like that, do what gets you out of bed with a smile, and if you're not, then try to find your way towards that, and then looking out for those moments and making most of them. And then moving on you, at some point, became clinical director at King's College.

Simon

Yeah.

Jonathan

Would you tell us a bit about how that came about and what drew you or motivated to do that role?

Simon

Yeah, it was as I progressed through my education and training roles, I'd worked collaboratively with colleagues from many other hospitals. I had developed a really good set of relationships with many clinical leaders across South London and across London. And initially the role came up as being deputy clinical director, because it was such a big role. So I took that on for a couple of years, and then progress to being the Clinical Director. It's, it was a massive honour to be clinical director at King's College Hospital in charge of over 100 consultants, you know, 750 staff, and I was the Clinical Director through the COVID pandemic, which was obviously a massive challenge.

Jonathan

Just say a little bit about King's College, because people may not know, it's not just a children's hospital. No, it's an adult and children's, is that right?

Simon

Yeah, that's correct. So it's, it's a big adult and Children's Hospital in in London. It's one of the four trauma centres in London, and it's probably the busiest, or second busiest of the trauma centres. In terms of Paediatrics, so, we have over 100 consultants. It obviously has the world-famous liver service that it runs. It's got big intensive care, big neonatal unit, respiratory, oncology, gastroenterology, endocrinology, and a really big general paediatric department as well.

Jonathan

And your clinical director role was for the children's side of the hospital. Is that right?

Simon

So just for the children.

Jonathan

And say a bit more about how, how you came to do the role you obviously keen to you've done the Deputy Director. But what made you step up for the director role?

Simon

Yeah, I thought that I'd develop the sort of competencies and capabilities that would make me a good clinical director. I think if I was going to define what they are, it's, I think you firstly, do need to have that clinical respect from your colleagues. People need to see that you're good at doing your day job, I think that's important. You need to be held in kind of high, at least reasonably high, regard by most of your colleagues. It's not possible to be liked by everybody, and if you try to be like everybody, you're probably not going to be getting out of bed with a smile on your face, but you need to be held in reasonably high regard by most of your colleagues and you need to want to do it to make things better for your colleagues. So, they were probably my main motivations. I would say, when you are in any managerial role throughout the NHS, effectively, you're always in the middle, and so you have pressure from above, so from the trust, from the medical director or from the chief exec, and then you have pressure from below, your colleagues, and you'll try, you only to try to work out where that balance is. For me, my balance was always closer to my colleagues than to the trust, which potentially could make me unpopular with some of my more senior colleagues, but I thought it was really important to have really good relationships with my colleagues and try to do the best for them, but also then to develop the best possible clinical environment that we could for children at King's College Hospital, and developing systems and developing infrastructure in the NHS throughout the last 7, 8, years has been challenging. But yeah, I think if you're motivated by those things, wanting to make things better, and being able to go to bed at night, even if there are lots of issues going on, because there will inevitably be issues and worries going on. But you do need to be able to turn off and go to sleep at night. Then I would suggest the role for anybody. It's incredibly rewarding and a really good step to whatever it is that you're going to do next in your career.

Jonathan

And if you were speaking to somebody sort of taking on such a role, or speaking back to yourself when you started, what do you think key things that would help somebody do that role really well?

Simon

Yeah, I think when, when we come into medicine. None of us, I don't think, start off wanting to be a leader, but we, the people that do get involved in any project because they want to change something, because they want to make something better, because they want to develop something, because they want to improve care. That is the right motivation to want to get involved in any managerial position. And if you're involved in a committee and that they're your motivations, then already you're demonstrating leadership capabilities and competencies, and you're inspiring other people around you by your enthusiasm and your motivation. Moving on up to the people, when they get to taking on more senior trust position roles, then I would say to, I've given advice to at least two Clinical Directors since I stepped down. Firstly, have a strong set up at home to go home to where you obviously feel as good a work life balance as you possibly can and to really enjoy your home environment, whatever it is. Secondly…

Jonathan

So, that's like a life outside work? Making sure that is there and important.

Simon

Yeah, is so important and you can't do these roles without having that. I'd say secondly, you need to really know yourself, and you need to know when you're most effective. So, I'm a really, really good morning person, and I'm not very good nighttime person. So, I can wake up at five o'clock in the morning, and inevitably, you're going to be receiving, you know, hundreds, 200 emails per day. You can't do them all as they're coming in real time. It's not possible. But I used to find if I got up early, that I could clear the backlog and then be ready for the day. I would walk into work. I'm very lucky that I lived, just lived just two, three miles away from the hospital, and that was a great time for me to be able to kind of clear my head, and also have telephone calls with people before I arrived, and usually in a good mood when you're walking. So, I found that really helpful and then,

Jonathan

The walking into work bits?

Simon

Yeah, just that time to reflect on what the day is going to bring you, and then you arrive prepared. I think people that have long obviously, most people don't have the luxury of being able to walk into work. I do take it as a particular luxury, but, but arriving ready to work is a is a great thing, and I'd actually achieve quite a lot walking in and then knowing when you're going to turn off, and being clear with everybody that after this particular time you're not checking anything else so that you can have your own time.

Jonathan

Yeah.

Simon

And if the person is motivated to want to make things better and has that kind of safety element built in around helping them to look after themselves, I'd highly recommend any managerial, senior, managerial type position in in all aspects of healthcare.

Jonathan

Thank you. And you've mentioned, as you've gone along, management there and also leadership. I'm just interested to know what the difference between those? But I wonder, is management more about systems and processes and leadership about people, or is it, how do you see them linking together?

Simon

Yeah, the classic saying isn't it is leadership is doing the right thing and management is doing the thing right.

Jonathan

Okay.

Simon

And which, I think there is some truth to that. I think some leaders are good managers, and some are not, and some managers are good leaders and some are not. So I think you need to surround yourself with people who are good at the things that you're not so good at. So in terms of someone who was able to read through 50 page documents that wasn't my happy place, I could do it and, you know, and then would be able to reflect on it and to deliver an opinion on that particular piece of work. But I'd also like if somebody else did it as well, and often I find the managers were better doing that particular analysis. So I'd say that is probably the key thing is surround yourself with people who are better at doing the things that you don't particularly like doing.

Jonathan

In terms of your leadership style, where would you say, how do you think you do it? What styles are there and what's your main approach?

Simon

If you go on any leadership course, you'll be taught lots of different styles of leadership. I would say probably the most important thing is to learn from other leaders that you've seen as you've been going through your career, and who may or may not be role models, but they're people that have inspired you. They've demonstrated their ability to lead and how they how they make things better. So, in terms of my style, I think I'm very collaborative. I take great pleasure in developing teams and making the team really effective, one of the first things I start doing when I take on a leadership role within the first year or two. Most leadership roles for me last 5,6,7, years. At the end of year two, I’m already thinking about succession planning and thinking who's going to take this over from me, and who's going to do a better job than I'm currently doing, and if I managed to successfully hand that over to the next person and they do a better job than I did, I take that as an enormous success. I'm collaborative, focus on the team, and I guess I'm more transactional.

Jonathan

Say what you mean by transactional.

Simon

So transactional is working together and being very aware of other people's needs and helping them to be able to do their job, and understanding that you both have to give and take a little bit. You know, the transformational leaders are more able to kind of stand up and give big speeches, very good at the big blue sky thinking, but less good at the detail and so And there's absolutely a role for both types of leaders and for all other style of leadership. But you know, for me, I'll say collaborative and transactional.

Jonathan

And when you mentioned about really bringing on the team so you go into a new role, you find you got team around you, or you're building that up. Just say a bit about how do you do it in practice? What do you do to make a team work, build up?

Simon

Yeah, so I've developed quite a few teams throughout my career, and I think it goes back to finding people who are good at the things that you're not so good at. So, I inevitably needed a detail person when I was doing the team. But then you try to involve as many stakeholders as you possibly can with your team. The issue I've had is sometimes you make teams too big, and they become unwieldy, and if they become too if they're too small, then it's too much work for anybody to be able to get through it. So, there is a sort of fine line about the size of a team, and it obviously depends on the size of the project. Try to make it as multi professional, multi-disciplinary as possible as you can try to involve the most important stakeholders in paediatrics, which are children and families, to get their opinions and then, when you've got your team, important things that they really enjoy themselves, hopefully, and that they have a clear vision about what it is that they want to help to achieve. Sometimes teams are set up for a short period of time, like a start- finish group, and other teams are set up for much longer. But you do need to have an idea about what you're going to have to do, what success looks like when you get there, and then, and then, how to measure that you're actually getting there. Yeah, so I've enjoyed developing multi-disciplinary, multi-professional teams to for most of the projects I've been involved with.

Jonathan

So you're talking there about team that is the right size, the right skill set, the vision that shared, that you kind of build up together, that collaborative approach. And I think another key thing is about how you bring people on, as you've talked about and thinking succession planning, but also in their different roles. How do you best empower people to be the best that they can be in their roles?

Simon

So if I was to take sort of new consultants, for instance, so, the first bit of advice I would give to new Consultants is, firstly, really kind of learn how to be a consultant, and it takes at least three years, and probably up to five years before you feel able to really do your clinical job really well. And then during that time, if you're meeting regularly with these people, which you hope that they've got mentors to help and support them, during that journey, you begin to identify what it is that gets them out of bed with a smile on their face and I think it's about then enabling them to move forward and do more of that as their career moves on and. And then I think you have a happy workforce who hopefully are doing stuff that they enjoy. So I think that would be my main advice to colleagues, whether they're trainees or consultants, is, you know, really focus on the stuff that you enjoy.

Jonathan

Fantastic. Can we just move on to your role as Officer for recruitment? Because that's a big role you've held now for quite a few years. Can you just give us some insights into how that came your way or want to apply for it, and what you've learned from doing that role?

Simon

Yeah, so as I said, I've been London's lead for a group of quite a long time, and so I thought it was the natural transition to think about taking on more of a national role. So the role was advertised, and actually I was encouraged to apply again, possibly another serendipitous moment, by another giant, the late Simon Newell, who called me up, and he was kind and ebullient, and he said he thought that I should apply for the role. And I, of course, immediately thought that it was good idea, much like the other serendipitous moments. And I applied. Actually, I didn't get it. I lost to another great person, who was David Evans, who went on to be brilliant in that role, and then obviously an excellent vice president of the college as well. When David moved on to the Vice President role, I reapplied, and I got it at that point. So in total, which is unusual for a college role, I've done this for coming up to 10 years. Normally they're five years. The college was kind and kind of reinvented the role and went from assistant officer to officer after five years. So I've had the real great opportunity of working with the recruitment team for all that time, and we've worked through many challenges. Obviously, COVID being the main challenge, where, literally within hours, we were having to change processes that we were going to run for recruitment and went from face to face to being on, you know, Teams or other platforms overnight, and that was a massive challenge, but I've taken great pride in our ability as a team, and that team has really developed over the last 10 years. So, you know, we've gotten from having just over 500 people applying ST1 for about 450 jobs, and now we're having about 1500 people applying for the same number of jobs. So, I think it has been successful. It's not just down to that team. There's other components there as well. So, there's the Choose Paediatrics campaign, which is incredibly enthusiastic and full of energy, and hopefully we're inspiring the medical students and the foundation trainees of the future to come into paediatrics and then really working with trainees and consultants throughout their careers to highlight what they're particularly enjoying and what they see as there being their kind of main opportunities going forward. Another role that I do with the college is look at the kind of lifelong careers aspect. I help with that as well, and that's a great honour, because you start to think about what you do at the end of your career, when you get to you know, your mid to late 50s or your early 60s, and how we transition into a role that maximizes the effectiveness for those fantastic members of the workforce with the most experience, but at the same time, doesn't exhaust them. Yeah, so it's been an absolute honour to be involved for the 10 years, and I probably say out of all the roles that I've undertaken, it’s probably the one that's given me the most personal satisfaction.

Jonathan

I think there's been quite a lot of changes you've alluded to, and I guess part of leadership is helping teams and health systems through change. Do you have any insights into how in leadership, we can help through change better?

Simon

I think firstly, you need to understand the problem, whatever the problem is at that particular time. So with the recruitment team in particular, we obviously sit in with part of the Royal College normal processes, and have good support from Vice Presidents and presidents, and I've had the opportunity to work with the last three or four presidents very closely, which has been great. But then also we're part of national bodies, so the Academy of Medical Royal colleges, the National recruitment office, etc. So a lot of our rules and laws come from those particular bodies, and we have to kind of respond to those and integrate them into paediatrics and make them suitable for paediatrics. But one of the things that, for instance, we've said no to, so there was a push for all PD, for all specialties to use the MSRA assessment.

Jonathan

Could you say what the MSRA stands for?

Simon

So this is the medical specialty recruitment assessment, this is something which basically is an MCQ, but also like a situational judgment type test, and it's been shown to be incredibly effective for identifying certain groups of clinicians going forward, and saves on a lot of time of doing interviews and shortlisting, etc. But it's not, certainly not set up for paediatrics, and it was extremely unpopular with our trainees and with the consultants as well to be used as a mode of determining who should come into paediatrics. We did use it for one year during COVID, but we only counted it towards 20% of the total score. Thankfully, we've managed to convince the powers above that this was not suitable for paediatrics, and we're stuck to shortlisting and interviews, which I think we all agree is a better way of identifying the paediatrics the great paediatricians of the future.

Jonathan

So part of change is understanding the systems and having good links to all the people we work with and partly being able to say no. You know, as you come to collaborative view as to what is good or bad for our specialty.

Simon

And if you do say no, you need to have a very clear why.

Jonathan

Yeah, that's great. Well, we're coming towards the end, but I'm just interested as to whether you can recommend any author or course, or any resource that might help people in a leadership journey that has helped you?

Simon

I think the best course is life and is going along and taking those opportunities that come up, those serendipitous opportunities, and also creating your own opportunities, and really looking at the leaders who are around you. We use the word leader, but anybody leading a ward round, anybody who leading a multi-disciplinary team meeting, they are the leader in that room, and they will be exhibiting, you know, behaviours that you can identify to and think about emulating as you go forward in the future. In terms of authors, I pretty much love everything that Atul Gawande has written, and I think he's a truly inspirational sort of human being and doctor. So, I found his books very helpful.

Jonathan

If you were picking one of his books to direct people to, which would you go for?

Simon

Gosh, I'm probably going to not answer that, if that's okay, because I found them all to be to be equally effective. No, I've really, I've enjoyed them all.

Jonathan

Fantastic. And as we close, is there any one point you'd like to highlight about leadership, you think we should sort of take home message?

Simon

Yeah, I think leadership is for everyone, and I think it's really important that as you're going through your journey, if you really want to change something, if really want to make something better, if you want to improve patient care, if you want to improve the experience for your patients, your children you're caring for, then do get involved and bring that enthusiasm to the table. Take opportunities, if you want to, as they're coming up to you through your life, you know, say yes to things that are going to get you out of bed with a smile on your face. Yeah, learn from others, and then be very giving with what you have experienced and what your learning has been, and hopefully then you become the person that inspires the next generation.

Jonathan

Well, Simon, that's been really amazing to talk through some of your experiences. Thanks for sharing with us. Thanks everyone who's been listening for joining us on this RCPCH leadership podcast. I hope you'll join us again for future episodes.

Simon

Thank you very much.

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Kirsten Olson

Thank you for listening to this Leading the way episode from the Royal College of Paediatrics and Child Health. The thoughts and opinions expressed in this podcast relate solely to the speakers and not necessarily to their employer, organisation, RCPCH or any other groups or individuals. You can find the transcript to this episode and more from the Leading the way podcast on our website, RCPCH Learning – go to learning dot RCPCH dot ac dot uk.

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