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Doctors at Work Podcast.

Episode #61

How to make changes in the NHS

Mat Daniel


We all see problems at work, but how can we change things for the better? In this episode, Gideon Johnson tells me that mindset is key. It starts with going into work with eyes open, and an attitude that looks for solutions rather than just dwelling on problems. You don’t have to have it all worked out at the start, all ideas begin small, and talking to others will help you gage the interest and gather support; chances are that you’ll discover that most other people will agree with you than something better is needed! Implementing change is often difficult, but a mindset focused on the bigger picture and on making a difference to others helps sustain you when faced with challenges to bringing your ideas to fruition. Supportive and enthusiastic colleagues help too, as does asking for help when you need it. And when it comes to navigating the complexity of large organisations, his tip us to align your ideas with organisational policies and missions.

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Gideon Johnson (He/Him) is a senior academic at Kings College London, boasting over a decade of diverse clinical experience spanning three continents. With a background as a senior nurse leader, practice educator, and senior specialist nurse clinician specialising in adult trauma Intensive Care Units and critical care, Gideon holds current, unencumbered practice licenses in Australia, the United Kingdom, and the United States. His unwavering commitment to the nursing profession and the service of humanity is the driving force behind his remarkable career.
Instagram: g.johnsondr

Podcast Transcript

 Welcome to Doctors at Work. My name is Mat and this podcast is about doctors careers. Today we’re talking about how you can make change happen in the NHS. Now we all see problems at work, but how can you change things for the better? In this episode, Gideon Johnson tells me that mindset is the key. It starts with going into work with eyes open and an attitude that looks for solutions rather than just dwelling on the problems.

You don’t have to have it all worked out at the start. All ideas begin small and talking to others will help you gauge the interest and gather support. Now chances are that you’ll discover that most other people will agree with you that something better is needed. It’s just that perhaps they haven’t done anything about it or maybe they don’t know how.

Implementing change, of course, is difficult, but the mindset focused on the bigger picture and on making a difference to others helps sustain you when faced with challenges to bringing your ideas to fruition. And of course, supportive and enthusiastic colleagues help too, as does asking for help when required.

And when it comes to navigating the complexity of large organizations, It helps to align your ideas with organizational policies and missions to try and make things happen. I hope the episode’s useful.  Welcome. Tell me a little bit about yourself.

Thank you very much, Matt. My name is Gideon Johnson. I’m a senior academic at King’s College in London and Predominantly, my background is in nursing, and I’ve specialized in critical care nursing over the last 10 years.

I’ve been fortunate to work across three continents, Australia, the UK, and also hold licensed practice in the United States. So I was previously a senior nurse leader in the NHS, which I’ve just transitioned from that to my new role in academia. I’ve also been a practice educator. I’m being a clinical nurse where I’ve worked alongside other nurses and medical staff  alongside my professional career and work.

I’m completing a doctor of philosophy, PhD, and in the final year of that program, I have co curated a voice recognition program, which is a novel intervention to prevent acute brain dysfunction in critical illness. And I’m excited and looking forward to publishing the results of that research.  Um, process which I’ve undertaken

what an exciting career and I’ve invited you to talk today about making changes  in the NHS or healthcare in general.

And I know that that you’ve, you’ve held a variety of different roles in various different systems. Can you tell me a little bit more about the kind of changes that you have implemented during your career?

Thank you very much for that question. The NHS has.  is growing and change significantly, especially since the last three years.

And which means certain changes are timely and need to occur to be able to carry on the, the growing force, as well as the increase in demand of health services. So, in the various roles I’ve held in the NHS.  But as a clinical nursing intensive care unit, and as a practice educator, some of the changes I’ve been playing, I’ve been like, the implemented sorry, it’s around redesigning how educational curriculum at  integrated in practice.

So as a practice educator in intensive care unit, I designed an intensive care program for clinical nurses in ICU, where you’re able to translate the theoretical knowledge that underpins critical care practice into the patients that they are caring for.  And this program was just going out what our patients need, the patient demography we’re caring for in that NHS and what current evidence says around critical care practice and bringing those together and designing a simplified and standardized education for the nurses.

So when these nurses come from overseas.  Wherever the background they’ve come from or newly graduated that they are able to understand that comprehend these information and directly translated into practice. So, that has also gone beyond the nursing workforce to the medical workforce, being able to design the simplified programs that directly.

addresses the need of our patients, but also relates to theories in current evidence. It gives, puts new medical and nursing staff that confidence to acquire the skills and knowledge that they need to go into practice and provide safe and effective care. So a patient seen I did this, not just solely just had to go through the cycle of change and employing the change methodology and consulting both the nurses and the doctors, as well as the leaders to ensure that it’s implemented effectively.

Where did the idea come

from?  Um, the idea, personally, I have always wanted to do more for my patients and I am passionate about providing that highly evidence based care that is safe and also person centered to my patients. And this is where even my research activities have been around person centered care.

And I continue to challenge myself and also benchmark, look at what is being done out there. And the privilege of practicing across more than one country did help me come up with this insight. So I picked things that are done in different ICUs that I’ve worked, and then looked inwards to what the demography of the ICU where was currently needed.

And that’s where the idea came to design a program that is centered to the population that we’re caring for. And I did have methods to evaluate the effectiveness and that came from both feedback from the patients and feedback from the From the clinical staff who were undertaking the program

So it’s something that you you’re going to work.

You have your eyes open You’re you’re linking one context to the next you link in theory and practice You’re looking for problems and then trying to come up with a solution So so it’s that it’s going into the workplace aware, you know, what are we here for? What are we doing? And then, and then thinking, how can we do things better so that, you know, that’s a mindset, isn’t it?

There’s a mindset, which is, how can we do this better?

Absolutely. I agree. It’s that mindset. Personally, nursing and medicine, for me, it’s not just a job. It’s always been about being a highly influential leader who impacts. On on on services and brings change that are productive that are effective. So that’s the mindset I go into.

I know that we are dealing with problem. People are coming being really unwell. People are coming needing something and.  I could just take those problems and catastrophize them and make them problem, or I could also just transform those experiences and make them positive. So that’s the mindset I go in.

That’s why no matter how big a problem is, I certainly think of the solution. Um, that’s solution driven. And the solution doesn’t have to be imminent. It could be a long term solution. But I already come with that approach to turn these around. And that’s where I start to contextualize  those problems into possible solution.

And in turn, I then bring the pieces together and often curate a solution for those problems.

So one of the things that I often see from doctors early on in their career is that they’ll say, I want to do a project, but I don’t know what to do. They come to me, you know, for project ideas. And I’m thinking, well, You know, what project ideas do you have?

And people struggle. They want to do something, but they struggle to think of ideas. So what tips would you give to somebody who’s thinking, I want to do something, but I have no ideas.

Thank you. Um, this is really interesting, Grayston. I think once you have an idea and you’re really passionate about that idea, don’t hold it within yourself.

Just say it.  In a certain, in certain contexts, we worry, oh, I really want to maybe I want this idea to be big, but I don’t want someone else to steal the idea. Don’t worry about that. Your idea will always be your idea. Just just speak it to someone. Share it with someone. The more you talk about it, you realize there are other people with the same mindset or there are other people who are fascinated by that, who actually want to learn more about it.

And then you will be able to build allies from that. And it might not be the allies who help you with the scientific thesis. Measures of the or the funding or or the communication, but at least having just people who are interested and who support that can give you that assurance that this is a valid idea to start with.

And the next step will be finding an appropriate person who you can discuss that idea, the person who might take it further to you. For for nursing or medical staff, it is a quality improvement idea about improving the induction experience of of doctors who are starting in the unit, then you might want to look at who is the link consultant for junior doctors or education.

There is a chance that this. This  conserved and or this senior leader sort of has that idea or would like it but don’t have the time to do it. So if you come up with that idea, you actually showing them that, yes, you have the time and their role in that will be to then link you to the right resources for funding or give you time of your clinical work to be able to work on that.

And I think when you go to the senior leaders, it’s important that you sort of Have clarity what you want to do. It doesn’t have to be robust yet. It’s basically, um, I want to redesign our induction process. I think the way our induction is done, we still not clear what to do after the first two weeks. So I sort of wanted to write like a checklist of what to do.

I think it would take about one month to do that. I might need the support of two other persons to do it. And I might need just three. Three days off clinical work to be able to do it. So it makes it a bit more constructive for the person who is going to take that further to know the amount of resources you’re asking.

And they will take that information and they may give it to you. And if they can’t, they might now streamline it or make other recommendations for you to help you deliver the project.

So we’ve got that. It starts with a mindset and the mindset is  You know, I’m going to look for ways to fix things. You know, there’s lots of stuff that could be done better, isn’t there?

Everyone, not just in the NHS. So there’s a mindset that says, OK, I’m going to have my eyes open. How can I make this better? You’re looking for solutions. And then, and then sort of there’ll be a little spark that sort of says, Oh, I wonder. And it’s not about ignoring that spark. It doesn’t have to be perfect, but sort of say, okay, now let’s talk to some other people.

And you probably find that other people also think that, that, you know, that this is a problem. And then it’s kind of then working collaboratively, um, to make it happen.  So what, what else? Okay. So we’ve got somebody that’s got idea. You’ve outlined already, uh, uh, uh, how one might take that idea forward. So what else would be your top tips for somebody who has an idea?

How else can people make it happen?

Another way, um, I think you can  Personally, there will always be constraints and going to a senior person may not always bring your idea to reality. And that’s why I also consider sort of thinking outside the box. I have to think of when I wanted to do my when I was doing my master’s, the research methodology I needed to adopt for my master’s would require lots and lots of senior buying for that to be implemented.

I wasn’t able to get the amount of senior resources that I needed. So I had to just redesign my approach to was that, um, research study and redesigned it in a way that I would require less resources and support from anyone else.  And that means when I get that result, I can then. Publish it to external community and then get external support and resources.

And that was what then became the foundation towards my PhD. So in the NHS, you’ll find that you, there may not be resources available. You might not get time off clinical work to go do this, but you can then consider, um, taming your idea in a way that. You can still deliver it without requiring resources as I give an instance around.

You want to change the induction process. It might be just you taking that leads to be the one to show new stuff around to introduce certain things to them and then take that record for yourself and and take that evaluation for yourself and feedback for yourself. And it’s something you might go ahead to publish to or present.

To a wider community and then get support externally Or maybe join external organization or groups that are working on something similar And then you might get that support that way. It doesn’t have to always be where you are  So

again, there’s a that’s a very pragmatic approach because I wonder some people might say oh This this is the perfect way of doing it.

But you know, I haven’t got time money buy in Um, and some people at that stage might just give up and they say, well, you know, it can’t be done. It’s too complicated. But actually, sort of, you know, what you’ve outlined is, well, okay, you know, this can’t be done now, might be able to be done in the future, but it can’t be done now.

Um, and then, then you’ve kind of, you’ve broken it into smaller chunks and say, okay, well, I can’t do the whole lot now. But what can be done? So, yeah, so again, kind of this is a mindset shift, which is, it doesn’t have to be perfect, you know, what’s achievable, what can I make, rather than, so it’s a focus on what can I do, rather than what can’t I do?

Absolutely. And it’s a baby step. Um, he doesn’t, just the letter, just coming up with the idea is incredible enough and something anyone should be proud of.  And doing the little you can do, even if it’s just, um, following the journey of one junior colleague or two, um, mentoring them throughout their first few years in practice, that is big and that is significant.

And the feedback you get from that, it can be the basis of, of your bigger proposal for a bigger project because you’ve done it with one or two persons and it was successful. So it doesn’t have to always go big from the start.

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This podcast is part of my mission to help doctors create successful and meaningful careers. You can be part of that mission too by forwarding this show to one person who you think might benefit from listening. Thank you. Now on with the show.  So I’m interested in what distinguishes a person, um, what distinguishes a healthcare professional.

that sees an idea and takes it forward from a healthcare professional that doesn’t take it forward? Because, you know, we all see the same problems, don’t we? And yes, you know, there might be a different mindset, but all of us, you’ve seen a problem. Everybody else will have seen exactly the same problem that you’ve seen.

So what distinguishes a person that sees a problem and does something about it? from a person that doesn’t progress it?

Thank you for that question. Again, it’s the, the purpose of the journey that distinguishes these two persons. It depends, like I said earlier, for me, nursing and medicine isn’t just about Treating people, being, having a good career.

It’s meant being a highly influential leader that has that power to impact and change people’s life. And I guess this is the primary difference because the person coming with this mindset would always want to change things. Whereas the other person who just want to get by, do their job, may not want it.

But I do believe  one can influence the other. And I think the difference there is that perseverance. I also believe that some people  don’t do anything about the problem just because they’ve seen other people fail. They’ve tried before and they just give up and they just don’t want to bother doing it anymore.

And it’s just remembering that perseverance is the key. And because it didn’t work now doesn’t mean it won’t work tomorrow. And just remembering that the work we do in the end of the day While you’re caring for people who are not your loved one, most of the time, your loved ones will be cared for by someone else at some point.

And it’s just keeping that mindset that your, your changes or the work you’re doing now may not be immediately appreciated, but somehow there is. A way that you will impact someone who may impact someone and it was some somehow come back to you. So I think the difference of not wanting to do anything about it, it just comes by just shifting your perspective from the failure parts, the fearful part to more of the, the The impact, the positivity, the ripple effect it could create positively towards you and your loved ones and, and just sort of do something about it.

And maybe forming an ally with people who do something about, about the problems and sort of help supporting them and sort of learning how they get through those, those.  does negative decisions and does knockbacks and if you build a team together then you’ll be able to challenge and motivate each other.


how have you dealt with, um, setbacks? Because I can’t imagine that it, that it all would have been perfect. So what would be your top tips for, for knockbacks?

Multiple I have, of course, I have dealt with multiple setbacks in, and there has been times when clearly the change would not benefit me in any way, and the actual persons who would benefit then turns back and don’t like it.

So, um, I think I always think of the purpose. Why did I start this? Why did I want to do this? I mean, if it was to make someone else’s life better or more comfortable or a lot more, um, streamlined,  that’s a good purpose, I believe. With my conscience, and I believe the moral code of almost everyone. That’s good.

So as long as the purpose is good, I keep to that. And even if everyone else thinks is bad, but I know the purpose and the intentions are right. So I remember that and try to remind myself with that. And I just also think in a bit more to face a data approach. So when I think of a solution, I don’t just go with plan a, I actually go Most times have a plan B and C  and sometimes a plan C might also be moving on to another NHS trust to implement that which.

Um, it’s totally nothing wrong with that. You see within the NHS. So, uh, there has been changes where in a place I was working  plan a failed plan B failed and what I really needed to make this change because I know it will really help people. So, if this place didn’t want it, then I would take it to the other placing.

That’s another way of sort of instead of letting that.  Dream be crushed. I sort of pick myself up and go, and that’s by having multiple plans. And, and the thought was, was not to take anything personally. It wasn’t because my idea was bad or it wasn’t because it’s coming from Gideon. That’s why it’s not accepted.

It’s just more thinking about it objectively. These people were not ready to accept this change at this time, the resources were not available, or they might not be able to mitigate the circumstances that may arise from the change. And that’s why it did not go through. And that then goes back to the second point I had raised, then you might consider your plan B, or you might consider taking it to another place that they may be ready to accept the change.

What would be your top tips for influencing? The people around you when it comes to change and projects

get to know the people around you first and their needs because that’s where you understand the roots of the problem. So, I mean, people. Can complain, raise concerns, but in the end of the day, it’s just a concern unless you understand where that it’s actually coming from.

So my first thing, we get to know the people, get to know their journey and their walk, who they are, if possible, also outside of their professional environment, because what they do outside of the professional environment could be what motivates them to keep their profession. And it’s important to know, have that knowledge and information.

And the second tip is just remain positive and  your project is not going to be a success if you don’t even believe it yourself. So you want to believe there is possibility for growth. Possibility for change and this can get better and just discard the mindset of, Oh, it’s been this way for 20 years.

It’s never going to change. I moved towards the, it’s been this way for 20 years. It’s been very difficult to change, however, or I think it can get better if I start from today. And that’s just that positivity and to keep around it. And I know though, another way is I’m forming partnerships. So it doesn’t always have to be.

Your idea for everyone to work with could also be supporting other people’s ideas and an initiative taking it further for them and following them on that journey. You don’t have to be getting published in the work or it doesn’t have to directly benefit you as long as it benefits them or benefits the service and just be a part of that.

And what I have enjoyed doing sometimes if I.  If it means just joining that meeting to contribute to one or two points while I’m having my lunch, I’ll just do it and just to support them and move the idea forward because when, when it’s time for years, you will then automatically get support as well.

For your, for your own project,

and how did you find your, your, your allies, your partners? How did you find people that are like you, that will, that will support you and help you and, and, and infuse you?

How I find them,  I, I think they are incredible. They, they inspire me and the beautiful thing about these people is  sometimes.

I come up with an idea for a change and within me, I already think it’s harsh and oh my God, this is going to be hard. But then when I share it to them, they sort of make me see many angles of it. I mean, this is what we’ve been asking for all these years. We can do it. And that motivates me. And I think one very humbling experience for me  is when they carry that on when I have moved on.

I think in my previous role, it’s one of the things I am so proud of that  my deputies and my staff, they carried on the things I have done, and they are, they are leading on needs and they are doing it. And that’s just so humbling to know that the value and treasure my time with them enough that they didn’t just discard those things that they are.

Putting their own ideas and spin on needs and carrying it on. And, and that’s just what, what I find rewarding about it because now it’s no longer about me. It is now about them and the patients they are caring for. And that’s a legacy that I do appreciate with them. I think they are the motivation and the reason why I keep going.

What about navigating the system? You know, NHS is big and complex. There’s ethical permission, quality improvement and processes, senior leaders that have to be informed. So what, how did you manage to navigate the challenges of working within a very large system?  It is

very challenging, I have to say, especially when people’s priorities are different to yours.

It’s, it’s first of all, understanding the system and understanding the key stakeholders and being very familiar of this processes and approval processes that you need to obtain before you proceed  and. I also  go to the point of sort of finding out people who have done similar things or something at all to understand those challenges that he encountered.

So I can be more prepared  to that for that. The research I’m doing currently needed to go through the full ethical.  process, the hospital approval, the NHS because it was with a vulnerable population. Um, I didn’t quite haven’t quite found anyone who has done it, but I did seek advice from people who have been through something similar and that just enabled me to prepare through every stage and provided all that’s needed.

You cannot always change the mindset of people. You can’t force them to prioritize what you’re doing because they still have their own priorities. Again, I think it’s being patient. I’m persistent as well,  following the right, um, policies and knowing how it applies to what you’re doing. There are policies for everything.

It’s important for you to learn and know what those are and then apply it.  And when you, when you use that in a diplomatic way, I think it’s also sort of puts people in a position where they have to comply with the policy, then they will sort of have to respond to you. So it’s just coming around.

knowledge and awareness of the protocols and what you need and the processes and applying it diplomatically and people People who do not personally want to support that will then be bound Within the policy to sort of step in and support because that’s within their limits to do so

So it’s it’s finding that that way in that aligns with, with organizational’s way of working and policies and organizational missions and aligning whatever change you want to make with whatever organization as a whole is doing.

Absolutely. And just that building that relationship and collaboration as well. And I think, um, some people may not prioritize it because they don’t see how it benefits them. If you spend some time to uncover the full Projects and contracts, they might see how it benefits them and you might get a buy in as well.

So, I’ll bring us to a close and maybe I’ll, um, ask, um, what would be your top tips for doctors at work?

Top tips for doctors at work, get to know your nurses.  So, in the NHS, your best friends are your band 6, band 5 and band 7. They will make your day easy or make it difficult. So, respect, get to know your nurses.

know them by their name, respond to them  and learn from them because they have a lot of knowledge as much as you do  and work collaboratively with them and have your break. Be well rested and just take on only as much as you can do. I think the most difficult and frustrating thing for nurses is when you tell them you’re going to do something and then you don’t do it and it delays everything.

Can do something. Be realistic with your time. I’ll get back to these in three hours time. That’s No, they will challenge it, but that’s what you can do realistically, then keep to that. Okay. And just, just don’t see it as just a job or the salary. It makes it more difficult to get through. Just see it as your highly influential leader.

And it’s such a great opportunity that you get to make a difference in people’s lives, put your patients and your nurses. And that’s just the mindset I think will make every shift get easier and easier for you. And instead of thinking about the paycheck and the working condition, which is very difficult and it would just only make it harder.


Thank you very much.  You’re welcome, Matt. Thank you.

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