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#18 Simulation and Leadership in Defence Healthcare Training

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Virti Team
July 9, 2020

Description

This week's guest is Brigadier Toby Rowland, who is an officer in the Royal Army Medical Corps and who is currently Head of Defence Healthcare Education and Training. Toby has worked in roles ranging from operational planning to training delivery, interagency and international engagement to resource and risk management. On his journey Toby has developed a passion for transformative action as well as how to champion new projects and enhance existing systems. Tony's approach holds in focus the strategic perspective whilst taking time to understand organisational culture and, through engagement and consultation, the people that comprise it.
Alex and Toby discuss the importance of innovation and adaptability in delivering training, the role of simulation technology and the importance of building multi-disciplinary teams with strong leaders.
Resources
To see how the Defence Medical Services use high fidelity simulation in the development of healthcare teams and systems, the following clip shows emergency response training provided by 2nd Medical Brigade to NHS teams from York and Scarborough Hospital Trusts: https://youtu.be/-c-CeWvLCnE
To learn more about the work of the sociologist Jack Mezirow: https://en.wikipedia.org/wiki/Jack_Mezirow
The application of Mezirow's theory of Transformative Learning to the development of the individual within their workplace is published in: Corrie, I. and Lawson, R., 2017. Transformative executive coaching: Considerations for an expanding field of research. Journal of Transformative Learning (JoTL)4(1), pp.50-59 and is available at: https://jotl.uco.edu/index.php/jotl/article/view/193

Transcript

Alex (Host):

Hi, Toby, how you doing?

Toby:

Absolutely fantastic. It's great to be on the podcast.

Alex (Host):

Great to have you on. I'm delighted we could finally catch up, albeit that it is remote podcast during the end of the COVID-19 pandemic.

Toby:

Well, I think a lot of us have got used to working remotely and adapting in these circumstances and certainly for myself, my team, it's been a real emotional roller coaster over the last seven months when I joined the team. Just for everyone's benefit, I'm based at the Defence Medical Academy which is new organization, which is being set up within defense just outside of Birmingham. And we've got the challenge of transforming ourselves from a technical college to all intents and purposes into a higher education institute.

Toby:

And so we're all setting off on that journey together at the beginning of the year and COVID has come along and we've kept going throughout that time. In a time of a global healthcare emergency, keeping medics coming through training is really, really important. And the team's been fantastic at doing that. It's really given us some pointers for how we can use that and use those experiences and those lessons going forward. And I think that's probably an approach and an experience that's been shared by a lot of people, both within healthcare and technology.

Alex (Host):

Well, that's actually right. I mean before the podcast started, we were just having a really, really interesting conversation around some of the positives to come out of the COVID-19 crisis. But I think just for the benefit of everyone listening, obviously we connected and know each other from when you were on your industrial placement at Health Education England, in the UK, but you've also got an amazing background having worked at NATO and in a number of very prolific strategic educational roles. I was just wondering if you could talk through some of the components of your CV, really.

Toby:

That's really kind. I've been really fortunate and whenever I talk to people and they just say, explain a bit about yourself, they're always quite surprised by the variety of activities that we undertake within the military. And that's for good reason, because we need people who are adaptable and I've certainly benefited from that and had some fantastic opportunities. And I think really the key things that come out for me are, healthcare is very strong within that education and training. And as you say, corporate strategy and planning, but it really started before I joined the military, because I was pursuing a clinical research career, commercial biotech, home office forensics for time. And I was doing a PhD in leukemia research at the Royal Liverpool hospital.

Toby:

And I found all of that really interesting, particularly the discovery, that self motivation, but I did find lab work quite solitary and wanted something a bit more dynamic and, the teamwork, the problem solving leadership within the military appealed. And so to be able to combine that with the health care field, I really, really love within the defense medical services have been absolutely fantastic. And what it's enabled me to do over the 20 odd years that I've been in, is really have a range of experiences and roles from operating on the ground, building and preparing teams for deployment to those rural, remote and austere environments.

Toby:

And being fortunate enough to work in areas, prehospital emergency care, primary care and secondary care, but then I've also been deployed worldwide on operational planning and setting up those networks, as well as, what I refer to as carpet land back in roles within the firm base in strategic corporate planning as well. And really to be capped off with the opportunity at a number of points within my career to work internationally as well. And you've mentioned NATO and the medical capability development education training I did there, but, I've also been deployed in a number of overseas multinational roles, and I was taught in these up the other day and I've actually been placed up one time and another on five of the seven continents.

Toby:

So, it's certainly been a real roller coaster ride there. And so to come back at the end of that, to heading up the Defence Medical Academy, a return to that first love of education and training, where I started out, it's just really good to be able to bring and knit all those things together.

Alex (Host):

It's very interesting. I'm always, always interested in people's backgrounds and motivations behind why they do anything and you a little bit like me, obviously have a passion for education training and also the wellbeing of employees or staff, in particular in the military. Where do you think that initial interest came from in your background?

Toby:

That's really interesting. I think to be honest, these things always start very young and, I came from a very rural area in mid Wales. What the poets would turn the great green rolling desert of mid Wales. And my family were always very focused on doing the best for each other and for looking after each other, and that sort of thing, I think, sticks into your DNA. And throughout my life, I've always sought out roles and opportunities where I can make a difference, where I can contribute and make things better, I hope, and think differently to innovate and to try and do so as collegiately as possible.

Toby:

So I think that really explains why, whilst I found clinical research really ticked a number of those boxes, it was the isolation and not being able to work collegiately with people and really bounce ideas off them and get that energy from really working closely with a bunch of likeminded individuals, that I missed. And I absolutely had that in spades within the military. So any role that I take on in future, I'll be looking for those elements. Now, I guess, that's very familiar to yourself and a lot of founders and entrepreneurs and innovators who tune into the podcast, because it's the stuff of life as far as I'm concerned.

Alex (Host):

It's really interesting. When we first met, one of the things I was most impressed with what you had done relatively recently actually, was in the simulation training that you were providing to some of the military personnel, specifically, and this is somewhat ironic in retrospect now we've been through COVID-19, but looking at setting up field hospitals and doing mass casualty simulations, to train up personnel at scale basically. And one of the things that struck me was that was such an innovative approach that you had taken to do that. I was just wondering if you could talk a little bit about that project specifically, and then anything else where you really feel that you brought an innovator's minds to how you were delivering training for these large organizations?

Toby:

The chance to take over, heading up that training and development opportunity for defense in terms of our field hospitals was really, really wonderful. And the thing one has to appreciate about that environment is that, whilst we have our units of that provide the framework for the clinicians to drop into, because the clinicians are out in the NHS, in the frontline, maintaining their skills, they then come to us at the last safe moment, if you like almost. And we have to really help them get ready to deploy into either an unknown environment or a really challenging environment.

Toby:

And so we have to do that really quickly, and that can be challenging at times, both from an organizational, but also an interpersonal perspective. And so, the use of simulation within that is really key, because the benefit it provides in terms of the being able to replicate the high fidelity, the high stress, pressing people, making best use of the time that we've gotten together, really helps an individual develop, learn something about themselves, but also helps us as the organization responsible for validating and assuring that, to look at those areas where, perhaps a little bit more work is needed.

Toby:

And traditionally, a lot of that work has been done over the years with observers using clipboards. And one of the things that we brought in was, increasingly sophisticated use of video assisted debrief within that process. And what I've found with both the human factors and those non technical skills that are involved, which look at the effects of teamwork, task, workspace, culture, and how it compliments the technical skills, is that, by showing people those interactions and helping them to go away and have a reflection about it, can take an hour or something, perhaps overnight, ideally. It really improves teamwork in spades.

Toby:

And if you can then incorporate that video assisted debrief with other elements of simulation, like extended reality. And this is the bit that we're looking at, at the moment, to help people prepare and to think about the challenges that they're going to be facing when they do come together, we can really maximize that time and deliver increasingly safe care, safe for the patients. But also, and I think this is really important that people sometimes overlook it. It's about the safety of the working environment, the clinicians, so that they can have that chance to have reasonable challenge, constructive challenge, and make sure that the right decisions are made.

Alex (Host):

It's fascinating, especially now having been through simulation training myself when I was training in healthcare, that the more realistic you can make things. And the more that you can basically effectively trick the learners into thinking that something is real, the better experience they're going to get and the more learning they're going to get out of it. We've spoken about this previously on the podcast, the ability to reflect and pull out really unique data insights into how people perform in these high pressure environments is absolutely key for training. When you were introducing some of these things, did you ever come up against any roadblocks or hurdles you had to overcome, to really convince people that using new ways of training and innovative ways, was in their benefit?

Toby:

Well, it's interesting you say that, because there's a saying by a good military writer, one of my favorites, Basil Liddell Hart, who said, that the only thing more difficult than getting a new idea into the military mind is getting an old one out.

Alex (Host):

I think we'd use that, the healthcare, another big organizations actually as well.

Toby:

But what I would say is that, was, there's always the initial skepticism and the raised eyebrow, because of the mindset that we adopt and people's willingness, and actually, they're keen to learn, they're keen to do the best, that actually, when you actually walk them through it and show them the benefits it can deliver, then, to be quite frank, the mist falls away from the eyes, they're convert pretty quickly. One of the things we found really useful was that, when we got the new video assisted debrief technology up and running, one of the first things I wanted to do, was start recording some guides and some examples of how things can go wrong and the things to pick up and look for when you come together in these teams.

Toby:

It goes back to those human factors and those nontechnical skills. And as soon as we started putting those together and story-boarding, some good examples and the bit we always look for, where the friction really come out, as the chemistry comes in, as a handover from the ambulance into that emergency department team. And as the team start coming together from all of the other departments to help that assess and that survey, go on, where can the frictions play out? And just to show some examples. The clinical staff always stepped up to the mark. I don't know where these amateur dramatics come from, but it's looking at the professional every single time.

Toby:

And as soon as you can do one of those and show this to people, this is what we're about. These are the things we're going to help you with. So take that reassurance, take the opportunity. We are going to test you. We are going to put you under pressure, but my goodness, it's going to pay dividends later on. And as soon as you show people the benefits and put it in context, then that's where the change occurs.

Alex (Host):

And although we're talking about technology and innovation, I think it's probably fair to say that, actually even the concepts like nontechnical skills and human factors in the grand scheme of how long medical training or military training has been around for, these are relatively new concepts and those themselves needed to be introduced and people needed to be won over, just on those concepts, is that fair to say?

Toby:

This comes back into a number of things that I'm interested in at the moment, because I go back to 2018 and the King's fund report on adoption of new technology and innovation. Where it quite rightly pointed out that, technologies are really great enabler, but unless people really seize the opportunity and they change their patterns of work, they change their roles, and they really leverage the chance, then you're never going to fully exploit the benefits of technology. And so this always keeps coming back down to the person and in something like healthcare, where the interactions and relationships between the clinical staff and with the patient and the patient's relatives and families, and any other providers that are involved in it, there were some, and in that high pressure environment, where difficult, difficult conversations have to be had, then the human factors play out all of the time.

Toby:

And if you look at, the famous book is obviously by Matthew Syed, Black Box Thinking, was looking at the application of these ideas within the aviation and healthcare industries. You've got to be really acutely aware of when you've got highly trained individuals working in hierarchies, under those pressurized situations, they could be tired. How do you make sure you make the right decisions? How do you have reasonable challenge? And the thing we've learned the lesson from, I would say, over the last 10 years, is, when that challenge is made, it's up to the individual receiving the challenge to respond to it.

Toby:

And to do so in a way that is constructive, because if you can do that, not only does it help the decision making at the time and ensures the right thing is done for the patient at the time, you get a much better team, because people, and this is a thing that has come out to time and again, certainly of the years that I've been observing this, is that if team members feel valued, of course, if it contributes to their wellbeing and their view of self. But actually if they're feeling valued for the skills and their expertise, and that's being recognized within the clinical setting, and they are given that opportunity to contribute and contribute constructively, then team performance goes up.

Toby:

There's a saying, I keep using and reminding people that, accountability can be given, but responsibility can only be taken. And it's how people use that within those situations, is crucial to creating an effective multidisciplinary team. And that's something we're looking at as we go forward, not just moving away from, the emergency care setting into those wider health care networks that both we need and what health care needs.

Alex (Host):

It's a topic that has come up again and again, actually on the podcast, even just last week, I was speaking with Sarah Furness, RAF helicopter pilot who now does coaching. And one of the things that we were talking about was actually understanding that high performing individuals, firstly, they want to train and they want to learn, but they want to be rewarded by seeing what they are doing have impact at an organizational level or having real benefit. And I think that's one of the things that often is lost in some high performing teams that you do need to reflect back and empower the individuals within the teams and the teams as a whole to really get the best out of them.

Toby:

No, I completely agree. Creating those adaptable teams is something that just requires a bit of thought, in my view, and how do you unlock that potential? There's a number of touchstones I've come back to within my career. It does start, I think, knowing your people, their strength, their abilities, their aspirations, and when you're put together with some colleagues at relatively short notice, just taking that time to understand, what motivates them, their background and their roles, can really make a difference in terms of the bonds that you can form. But I would say just stepping beyond that, it's about adapting to the situation and COVID has challenged us all in this respect. And it's also from speaking to colleagues, really brought some real stars to the fore. And I would say to anyone that if you want to adapt to a situation, just try and spot who those people are that are, that are stepping forward and give them the opportunity, give them the resource to really make a difference.

Toby:

So that deliberate effort to include people, is something that we're really driving forward in the Defence Medical Academy, and giving the time and the opportunity to contribute to really key decisions rather than, just asking, when people might like to have a lunch hour. We've taken it to the step of, setting out the purpose for what we're about, helping define our values and setting the direction of travel for the next couple of years. Because if you can find a way of going forward, that really calls on, the culture and the skills and the motivations of the people you work with, it's going to be so much more successful.

Toby:

And that co-creation of opportunity is a really important one. And so, when then a challenge comes along, like COVID, you are in a mindset of feeling you can offer up ideas and to see them being listened to and reflected back on them. Some of them you offer up, and you won't get anything back, but the benefit that we've gained from doing that in our adaptability and our responsiveness has made an absolute difference. And I would say, it's actually shortened the work that we were going to have to do over the next year and a bit, down to a couple of months. And we're ready to take the next step as a result of that approach.

Alex (Host):

Unlocking potential in people is so important. From my experience, it's always very difficult actually, firstly spotting the high performers at an early stage, because as you currently say, often, it's just in times of crisis, that that becomes, very, very obvious to people. What sorts of, I guess techniques have you seen to, firstly identify people who are very high performing in the roles that are in, particular at an early stage, and what other sorts of things have you seen that works very effectively for actually unlocking people's potential with, I guess, focus on everyone being slightly different in how they learn, how they train and how they actually implement teaching and training?

Toby:

There's a few things I'll just offer on this, as a good start point, I know a lot of us have been exposed to various tests, like, Myers Briggs, or Madeiras and McCann in the past. We all note that down and we have a bit of reflection about it and we think about self. But how many times do we actually take that opportunity to think, right, hold on, what's the actual makeup of my team in terms of the skills that they're showing there? And actually when I have that opportunity to task, organize a group for a particular project, why don't we have, think about, who might perform well within that setting and in what sight type of roles? Because before I started thinking like that, the number of times I've put people together and thinking, right, person X does this job and so that looks a bit similar to this task we're going to hand out here, we'll just give it to them.

Toby:

And then a couple of weeks in, and you're thinking, right, that's not really working. I really should have spotted that. So I think, even at that level, you can think, right, what are people's motivations for coming into this? The other aspect I would just offer, perhaps if you don't know people as well, is just to take a step back and just to look at how people are interacting with each other and how they're responding in a particular situation, the people will come forward. And one of the things I did in a previous role was working with some of our part time clinicians. And so, they will work in the NHS for the vast majority of their year. And then they'll come to us for a couple of weeks, a year, put on a uniform and go into a different role.

Toby:

And we would invite, chief executives and chief operating officers, et cetera, down to see what their people were doing with this. And the number of times that we had a member of a trust, come pass and say, I never knew that person was in the military, but I always wondered why they were so good at organizing and interacting with others in a crisis. And it's taking that time to step back and actually see what's going on. In terms of how people learn and their learning styles, that phrase, lifelong learning is one that's a bit hackneyed and it's been around for a while, and they've even picked one up the other day, which was infinite learners, constant need to acquire new knowledge, which was something I think a lot of founders and innovators will recognize.

Toby:

And with technology providing access to a whole range of learning opportunities and that chance for the self directed learner to get stuck in there, that can be both a blessing and a curse, depending on where they're getting the information from. And the challenge for us within the educational community is to keep pace with what's going on and keeping pace with not just the technology and the new ways of delivering learning, but actually the pace with the learners themselves and how they want to pick up that training. And so part of the work that we're doing with the Defence Medical Academy at the moment, is on prototype training, looking at how we can really adapt to requirements and apply our knowledge where needed in order to meet what's needed, those people who are working on the front line.

Toby:

It was a challenge we'd set ourselves anyway and COVID really bought it to the fore. And I think probably the lessons that I've taken from that, are that we've got to be prepared to think carefully about what is the core requirement here, strip back what we're doing in terms of process and procedure, to the essential elements and make sure that you've got governance and assurance in position for the training, but that it's focusing on the core elements and to do those really, really well. And if you can then apply mindset and draw people into the team to develop that content at pace, you can turn stuff around really pretty quickly. And we're really pleased with the fact that, our military medics, they make up 25% of our workforce. They have no NHS equivalent role, they're a military specific role, because they need to deliver what we need within the military.

Toby:

We were able to provide in a couple of weeks, some courses to enable them to work within a ward setting, within a trust hospital and within an ICU setting, an intensive care capability setting within a trust hospital. And they were on the ground working with the Nightingale temporary COVID facilities that were set up around the nation. And so it just shows what you can do. And our next challenge is to set the agenda for the next couple of years, in terms of some of those other training targets we're going to be engaged with. And by doing that, what I really want to demonstrate is both to our staff, give them the confidence that this is something they're really, really good at, and we can deliver, but actually for wider defense and for the NHS, that this is something that we can bring to the party, we can offer.

Toby:

Because we do have that benefit particularly I think within teamworking, to so many of our staff has that adaptability and a broad range of experience as a result of their backgrounds, that actually they can think about how to keep stuff together quite effectively.

Alex (Host):

And this is all really leading into, not just health care organizations or military organizations, but any organization, whether it's a corporate, needs to really be thinking about in my opinion, which is the future of work and the future of what a workforce looks like. And going back to what we were talking about earlier with COVID, one of the things that has completely changed up, is how people are interfacing and how they're working remotely. But equally, even before COVID, the whole future of the workforce was looking to be one where people were potentially more flexibly working. They were going to be interfacing more with technology in their day to day roles, whether that's artificial intelligence or robotics, or things like that, which perhaps traditional mechanisms and teaching and training weren't really taken into account.

Alex (Host):

As well. I think it's fair to say as an increasingly diverse workforce, in terms of backgrounds and locations and geographies, is that something that's really driving, I suppose, your strategy going forward over the next few years?

Toby:

No, there's two important elements in there for me. Just going to the individuals themselves and actually the patients, I think COVID-19 changed so many perceptions and from a patient population perspective, being able to access care, whereas traditionally, a lot of people would not have accepted, interacting with an app or having a consultation over the net. They will absolutely do that now. And that's going to be so key in delivering the care that we need, with the changing demographics, the increasing complexity of the patient population, and how to fund, how to deliver this from a workforce point of view. I think in terms of the teams that sit within that, those multidisciplinary teams, the new ways of working, there's a piece of work underway at the NHS at the moment, known as the future doctor project, and some of the initial ideas are online already.

Toby:

And the future doctor within all of this has been given that challenge of thinking about, the skills and knowledge and the behaviors they're going to need for the 21st century and their role within those transformed multidisciplinary teams. How do you provide oversight and assurance of quite complex care pathways? How do you serve as a bit of a catalyst for change, not just in terms of the adaption and the adoption of technology, but how then that applies within the team and leadership comes to the fore within this, and it's an area I'm particularly passionate about. We're doing a lot of work at the moment, to think, how can we unlock leadership potential and enable people to make the most of those opportunities and challenges going forward.

Alex (Host):

Just getting back to one of your earlier points. We had a Danny Ryan on the podcast a number of weeks ago, and one of the things that we talked about was, actually very nicely reflecting back what you mentioned a little bit earlier, which was, leaders and particularly high performing leaders, one of the big traits is continuous, or as you said, infinite learning and that ability to continuously adapt and learn. Obviously, leadership in any organization is incredibly important. What about in healthcare? Where are you seeing, I guess, teaching and training on leadership being particularly effective?

Toby:

Well, this is a real hot topic at the moment, because, I think widely there is a questioning that's going on about what's the value of traditional leadership training that's being undertaken across all sectors at the moment. One goes on these courses and I've been on a fair number myself, you get some benefits of it, but how much of it actually sticks? How much of it you take back to your workplace the next day? The core for me, in terms of what leadership needs to be doing, particularly within healthcare, when it's a pressurized environment, it comes down to acceptance of responsibility and the ability to make decisions under pressure with incomplete information. There has been a trend, I would suggest over a few years that perhaps, I think one of the most difficult sentences I would see written down is let's start an email trail on that one, just to track what's going on.

Toby:

And that can lead to some really dangerous situations, because we've just, this last weekend celebrated the 72nd anniversary of the NHS. And yet you look back over that 72 year history, and there have been over 30 public inquiries into catastrophic failures of care. And if you look at the common themes within those inquiries, it comes out time and the time, and again, it's poor communication, professional license relation, disempowerment, weak leadership. But the good news that comes out from all of that, I think, is that, within health care, within the military, within academia, people have these common values of selflessness, of professional integrity, of wanting to serve a greater good and they're dedicated to what they do.

Toby:

And we can absolutely do something with that. But it is making a step from teaching people leadership theory. It's about applying it within context. And the view I've taken on this, is that, I think two things need of that. And that's a suitably developed view of self and an ability to relate self to others. And that comes to the fore in an area we've been looking at called transformative learning and its application to leadership

Alex (Host):

Is really, really exciting, I think that this area of both leadership and I suppose it's human factors, non technical skills as well, which makes up what effective leaders do as they lead teams. One of the things that always struck me was, and again, I guess this is in part why I decided to found a technology company to do this, which is, a lot of the things to do with leadership, as you've mentioned, they're relatively subjective and can be quite theory based, and then you're looking at how they're implemented. In a simulation training setting, are there any particular data points or things that you look for, if you're specifically trying to teach or train leadership, if you're running say simulation training, for example?

Toby:

Yet again, you're on the money in terms of where I'm thinking on this. We're one step behind that at the moment, in that the approach I want to take with this is, we've got a number of strands of work ongoing at the moment, is that, we're at how we can bring together a number of pieces of simulation equipment so that we can apply it and focus on three steps, preparing the individual, individual into team and team into system. And by getting that flow through running, not solely within the Defence Medical Academy but within partner organizations as well, I want to start building up some data on how people perform within certain settings. But then over the top of that, what I want to bring in, is this transformative learning approach and looking at the individual.

Toby:

And I appreciate some people might not be familiar with this work, because it's one that's come onto my radar. And it looks at the area of study of self. And there are three core steps and it's the work of American sociologists Jack Mezirow. And it starts with disorienting dilemma and our minds make shortcuts all the time. That helps us make sense of the world. It enables us to make decisions, but the difficulty with that as we would all recognize, is that sometimes those shortcuts are wrong and you make the wrong assumptions, you draw the wrong conclusions, and this affects your perception of reality. And for those who are familiar with cognitive behavioral therapy, that then plays into how we think affecting how we feel. And when an experience happens that doesn't fit within that construct that we've made, it can be disorienting.

Toby:

Now, if it happens unchallenged within the work environment, people just put it to one side. But the approach that we're adopting is using a combination of coaching techniques to really bring those disorienting dilemmas to the fore. And whilst that's in the forefront of the mind, go into the second step, which then critical reflection and use the discomfort created by the disorienting dilemma is an opportunity to find a solution to make a change, and then to bring that element from the individual into a rational discourse within the team. And obviously being we've been working with the team at the time. I'm really interested in that progress as we step through that process through the elements of, individual, the team and the system, is how we can make a noticeable difference in the effectiveness of teams working in situ, within the normal place of work.

Toby:

And so to really bring all those elements together, we're setting up at the Defence Medical Academy, a center for defense medical leadership, to really combine and to synthesize, not only the simulation and the teamwork, but looking at the ability of the individual to go on that journey. And it's that last element, if we get that right, that will be something that will endure beyond the days that they will spend with us. And it will be something that will last longer than the traditional leadership approach. And I can include in the show notes, a number of resources, but in particular paper, by a Lawson and Corey on this one, that just thinks about how you practically apply this approach.

Alex (Host):

And I think that, that blended methodology of teaching and training and improving human performance, which is one of both reflective coaching, but also integrating actual data points, whether that's from a simulation environment or whether it's from real world performance data. And certainly my experience, and as you say, from the literature, the thing that really seems to optimize team performance, organization performance, and certainly, individual performance, and really showing people that you are teaching and training, that some of the more subtle things they might do, or they might not notice, have significant effects, whether that is in the form of communication and soft skills training in a team setting, whether it's things like, how they are managing their team, or whether it's their decision making under pressure. As you say, Toby, I think it's that blended methodology, which going forward is going to be one of the really transformative things.

Toby:

Completely. And we're already having a number of conversations with colleagues in both the NHS and academia to see how this can be applied in practice, because we mentioned earlier on, and I didn't get the chance to really probably pause in it as much as I should have, is that, in the multidisciplinary teams that we're going to need in future to deliver care. And sometimes that will be a team that's physically formed in the same location, but to give these care networks that we're going to use, it's going to be a lot of remote working, and a lot of working at distance. Those skills become even more important. And it really quite neatly brings together a number of the themes that we've been talking about, is ensuring that we give people that professional opportunity to contribute, to give them that voice, to make sure that we have as an effective and efficient care pathway as possible.

Toby:

By looking at how that needs to happen, not just in different clinical settings and different environments, but actually different parts of the country and different areas, not even as big as rural and remote city and rural, it's just even around a city. I'm just outside Birmingham, second biggest city in the United Kingdom. And there are a number of trusts around Birmingham and each of them has their own characteristic and it's scaly, culture, and its own vibrancy and has to be context specific in terms of what we do and the needs, not just of the local population, and their are different healthcare requirements, but also the people who serve and support them in that.

Toby:

It's a really, really exciting piece of work to be involved in, to combine both the human factors, the personality traits, the people element of it, with the benefits that simulation and technology can really offer in terms of, the access to training, the money it saves, but also the safety it provides. And to try things out, to get yourself into the mindset of this is the situation we're going to be working in. How do we perform better in that role, in that environment? And we ask those questions of colleagues in terms of, how would we respond when this happens to us? And that ability to think about things beforehand, before they actually happen, just makes for such an improved outcome.

Alex (Host):

I think it's fair to say that you and I could probably talk about each one of these individual components for most of the day, but in the interest of our listeners times. One of the things that we get to, just to wrap up, is have you just give an amazing example of human performance that you have seen.

Toby:

I've given a fair bit of thought to this and I'm afraid my thoughts kept coming back to a real hero of mine. Someone, I was lucky enough to meet and work with a couple of times, which was General Charles Krulak of the United States Marine Corps. Now, perhaps a bit of a cop out for a military person to pick another one. But I'm actually not picking him for his military exploits. He's an incredibly inspiring leader. He has challenged convention throughout his life, but what really came through to me, is that he had a genuine commitment to people. He knew his people, he trusted them, he empowered them. And number of times he was an innovator within his career.

Toby:

The United States Marine Corps was having a real look at its recruitment and training issue when he was probably about half way up the rank structure, and he challenge convention and said to them, look, normally you will send your top flight people, your real Jedi Knights, if you like, into certain roles, related to operational planning and development, actually, if recruitment's our priority and this is going to be our future, then we need to put our best performing people into that. And it took a few difficult conversations to turn that ship around, but you put your resources where you want to make a difference. He was also someone who thought widely, and he identified well ahead of time the challenge that the modern era was going to bring from a technology point of view and the fact that it was going to compress the battlefield into a few city blocks, and you could have troops on the ground providing humanitarian aid in one area, peacekeeping activity in full combat in the other, all within the glare of the modern media.

Toby:

And so he provided that sort of insight within his military career, but then we stepped away, he went over to MBM bank and he was CEO of their European operations. And I lost track of him for a number of years. I remember distinctly, I was standing in a train station looking up at the television screen that was broadcasting BBC news and General Charles Krulak being parachuted in, to take temporary charge of Aston Villa FC, during a particularly turbulent time in the club's history. And I thought, well, crikey, if any of us can have a journey half as interesting and rewarding as that, then we're doing all right.

Alex (Host):

That's incredible. Certainly once you've been parachuted in anywhere, particularly to Aston Villa football club, you know you've made it. Toby, it's been an absolute pleasure catching up and having you on the podcast, we will include a number of the resources and the links that you've mentioned in the text that goes out with the podcast. Is there anything in particular that you would recommend, any organizations or leaders should pick up or be reading, if they're looking at implementing new types of training or innovating in the way that they train or manage their people?

Toby:

Crikey, there's so many, there's so many good resources out there at the moment. This is something I'm working on at the moment in terms of a thesis, if you like, in that, there are any number of books and resources out there at the moment that gives some really good advice, but unfortunately it's context specific. And it's either, I would say, for someone who's worked in the public sector, so many of the books and texts are focused on the private sector to begin with. And there are different factors at play. And so the challenge I would really say to people is, think about your people, think about the environment and the culture and the context within which you're operating and then find, seek out resources that really make a difference in that context.

Toby:

And so hence why it comes back too for me, it's about people, and understanding what we're trying to do. And if you can marry up what you're trying to do to the culture and the values and the motivations, for those people who you already around, then it's got a far better chance of sticking and you're going to get far better success, far quicker, than if you try and shoehorn something onto the top of it, which just doesn't resonate and there's too much friction. And, you'll be scratching your head in a couple of years time thinking, well, why didn't that work? It worked in the book.

Alex (Host):

I think, you've pretty much perfectly summarized everything we talked about really in that little wrap up as well. It's been, again, an absolute pleasure speaking and I'm hoping that as things begin to return to normal, we can catch up, very, very soon.

Toby:

I'll really look forward to it. There are great many conversations to be had and having those discussions and learning what people have taken out of the past few months, which have been turbulent, they've been difficult for so many people, but real hope has come out of it for me in terms of so many things we do.

 

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