Joe McDonald - Chief Executive, Hospitals South

In this episode of the One Health Podcast, Dorian Broomhall gets to know Joe McDonald, Chief Executive of Hospitals South.

In our conversation, Joe talks about the family events that led him to pursue a career in nursing, and about the difficulties he faced starting out as a male nurse in Glasgow.

Joe speaks about his experiences working in the UK, Malta, New Zealand, and mainland Australia.

He talks about what he has learnt about Tasmania, and about how he views the place of the Royal Hobart Hospital within the THS.

Joe speaks about centring the patient, and about how he approaches those difficult conversations with people who may have lost sight of that idea.

He also describes how effective it can be to exert influence through relationships.

Transcript

Dorian Broomhall:

Welcome to the One Health Podcast. This episode was recorded on the land of the Palawa people. I acknowledge and pay respect to all Tasmanian Aboriginal people and to their deep history of storytelling. My name is Dorian Broomhall, and I'm the Manager of Culture and Wellbeing for the Department of Health here in Lutruwita Tasmania. In this third series of the podcast, we're continuing to get to know executives from across our organisation as people as well as leaders.

For this episode, I got to know Joe McDonald, the Chief Executive of Hospitals South. In our conversation, Joe talks about growing up in Scotland and working across the UK, Malta, New Zealand, before coming to Australia. We talk about the family events that led him to pursue a career in nursing, and about the difficulties he faced starting out as a male nurse in Glasgow. He talks about how and what he has learnt since moving to Tasmania, and about how he views the place of the Royal Hobart Hospital within our health service. Joe speaks about putting the patient at the centre, and how he approaches those difficult conversations with people who may have lost sight of that idea. He also talks about the importance of influencing through relationships and how that can be a great way to get things done. I start every conversation with the same question, so let's get into it.

What did you want to be when you were in kindergarten?

Joe McDonald:

I wanted to be a soldier.

Dorian Broomhall:

I haven't had that one yet, that's very interesting.

Joe McDonald:

Yeah, yeah.

Dorian Broomhall:

Did you know what sort of soldier or just a soldier?

Joe McDonald:

No, just a soldier. Yeah, I wanted to be in the army.

Dorian Broomhall:

Did you ever join the army?

Joe McDonald:

I tried to, but I had some problem with my eyesight. So I tried to join the army when I was 16 years old as a junior leader and I failed the eye test. I wore contact lenses at the time, but my vision still wasn't good enough at that time, it's fairly strict around the eyesight. But yeah, so I never became a soldier.

Dorian Broomhall:

Then you kept that dream, so to speak, for that period of time, right through school?

Joe McDonald:

Yeah, yeah, absolutely.

Dorian Broomhall:

What was that like for you when you weren't able to join?

Joe McDonald:

It was pretty devastating, I guess. Both my grandfathers were in the Second World War, and one of my grandfathers, who was my Grandfather McDonald, we were very close, and he had lots of photographs of himself when he was a soldier during the war, and I think that's why I wanted to be a soldier. But I just decided I would follow in my father's footsteps after that. My father is an engineer and he worked in construction, he was a ventilation engineer, so I decided to follow my dad and went into an apprenticeship to become a ventilation engineer.

Dorian Broomhall:

And where were you in the world when you were growing up?

Joe McDonald:

Glasgow.

Dorian Broomhall:

Glasgow.

Joe McDonald:

Yes.

Dorian Broomhall:

Yeah, okay, and what was that like?

Joe McDonald:

It was great, I love Glasgow, it's a beautiful city, all my family were there, and there was lots to do. It was just, yeah, it was home, I guess. My family come from the east end of Glasgow, which is probably not the nicest part of Glasgow, but we had a very close family and we all lived very closely together, and as I said, I had a beautiful relationship with my grandparents, so that was nice.

Dorian Broomhall:

You're a long way from home now then, Joe.

Joe McDonald:

Yes, I am.

Dorian Broomhall:

How did you end up here?

Joe McDonald:

Well, that's a great question. I've been many places before arriving here in Hobart, and also here in Australia. So I grew up in Scotland, I became a nurse in Scotland, I trained as a nurse in Scotland and then I finished my training when I was about 26, and I left Scotland to go and work in Malta, which is a tiny little island just southwest of Sicily. And I worked there for a year as a nurse, and then I came back, it was only a year contract, then I came back to the UK, but I moved to England and I worked in a number of cities in England. Worked in Birmingham, Manchester, Blackpool, yeah, and then-

Dorian Broomhall:

Yeah, there you go.

Joe McDonald:

Yep, after 10 years working for the England NHS, I then moved to New Zealand, to Wellington, and I was in Wellington for 10 years, and then I moved to Adelaide, and then from Adelaide to New South Wales, and from New South Wales to Hobart. And I've been here in Australia for about 11 and a half years.

Dorian Broomhall:

That's an interesting bouncing ball, and a few places, I suppose, I'm curious about. Briefly, is Hobart reminding you of Wellington?

Joe McDonald:

Yes, it does, Hobart reminds me of Wellington, which I spent 10 years, but it also reminds me a lot of Scotland. Not so much Glasgow, but I got out of Glasgow as often as I could as soon as I got a car and could get out, so I spent a lot of time in the Highlands, and Hobart reminds me a lot of the Highlands. One of my favourite places is Aviemore and Inverness up in the north of Scotland, and Hobart reminds me lots of that. In fact, Tasmania reminds me a lot of that, the rolling hills, the beautiful mountains, yeah.

Dorian Broomhall:

I've not been to Scotland, but I can imagine the similarities from certainly what I've seen on film, and those sorts of things. But what was the prompter for the early-20s gear shift or career change? So you trained as a ventilation engineer, and I imagine you did that for a reasonable amount of time, or at least some sort of time, and then you chose to be a nurse. What happened there?

Joe McDonald:

Yeah, I became a ventilation engineer just when I was about 17, and I did that until I was 23. My grandfather became unwell, he had dementia, he has dementia, led him to not eat and drink and decondition, so he ended up in hospital. I took some time off work to spend with my grandfather, and he became quite unwell.

And while I was visiting him I came across a guy called Stuart Anderson. Stuart was a student nurse looking after my grandfather. And I talked to Stuart a lot, and I guess I thanked Stuart for the care that he provided to my grandfather. And I had a conversation one the days my grandfather was asleep and said, "How is it being a nurse? What's that like? It must be amazing. Do you realise what you've done for my grandfather and therefore for me?" And he's like, "Oh, it's the best thing I've ever done." And when you asked me that question, what did I want to be? Stuart wanted to be a nurse. And I remember at the time everybody laughed at Stuart because he wanted to be a nurse, because he was male, so it was like, "Oh yeah, you're going to be an nurse, right." So it was interesting.

Anyway, a couple of months later my grandfather died, then a few months later I was working in a building that was across the road from a job centre in Scotland, it's a centre and they advertised jobs there, and there's a big poster in there that says, "Do you want to be a nurse? Apply now." So I walked in there, covered in dirt like a usual construction worker, and went, "Hey, I want to be a nurse." And they went, "Oh, you need qualifications to be a nurse." And I said, "Yeah, I've got lots of qualifications," because I left skill with good qualifications. And I said, "Yep, give me the form," and I filled the form, and then nine months later I was a nurse.

Dorian Broomhall:

So much to unpack in that in terms of perhaps some stereotypes from how the job centre people viewed you in your dust as you wander in. What was the perception like for a male nurse in Glasgow in that particular time? Stuart sounds like a trailblazer, really.

Joe McDonald:

Yeah, look, he was, and I hadn't realised that until I became a nurse. So I joined a class of 32 people, and there was four males in that class.

Dorian Broomhall:

That's actually probably higher than I would've expected.

Joe McDonald:

Yeah, so four males, it was interesting. I was very well accepted by the college, accepted by my classmates and my nursing cohort, if you like. The difficulty was, I think, that when I started working within the hospital, I did hospital-based training, so we did a few weeks of college, three months placement, a few weeks of college, three months placement, so it was really very much a hands-on nursing type training. It was more like an apprenticeship actually, which I had done previously so I thought, that'll be okay.

So it was really a lot of the senior nurses, what we call the nursing sisters and the nursing officers, that really struggled with the males being in there, and it was fairly difficult. I came from construction, and I was also, I was 23, so I was a bit more mature. Most of the people in my class, there was a couple a little bit older than me, but mainly were younger than me who were straight from school into, so I was slightly different, so I guess I had a little bit more self-awareness and I could pick up on some things.

So it was a bit of a rough time, got asked question like, "Why are you here? Why didn't you stay in construction?" I had a shaved head at the time, so I had no hair. That was basically because when you're on construction you wearing hats all the time, and it was just the best thing. So I was seen very much as, I guess, as a skinhead, if you like, so how I looked, I was very much judged by the senior nursing profession, which I found a little disappointing, a little surprising. It did mean that I struggled a little bit around acceptance as an nurse.

Dorian Broomhall:

And what was it like for your family? Were they on board and supportive? Did they get it? Did your dad, how did he go with your gearshift, as I said earlier?

Joe McDonald:

Yeah, well, I hadn't told my parents that I had applied to be a nurse, but when I got accepted for it, I had my interview, got accepted, I then said to my parents the week before I was about to leave my construction job, "I just want to let you know that I'm going to quit my job, I'm going to go be a nurse." I was actually going to train in the local hospital, which was Monklands Hospital, which was a district general hospital. And my dad said, "Oh, I'm so glad you're getting out of construction, that's not the life I want for you," and my mom said, "I've never told you this, but I really wanted to be a nurse," she said, "but then I got pregnant with you," she said, "And I never fulfilled that dream," she said, "so I'm so glad that you are going to go do that." So my family were very supportive.

Dorian Broomhall:

That's incredible, especially when you might have that, we talk a lot in leading and managing terms at the moment around difficult conversations, and that's a difficult conversation for anybody to go and have, but you go forth and you have it with good intent, and look at how it can go.

Joe McDonald:

Yeah, it was good, I just wanted to be honest with them, and I didn't have to explain anything, that was the end of the conversation, "When do you start? I'm so excited for you." And my mom went and told everybody she knew that I was going to become a nurse.

Dorian Broomhall:

And how did they go when you left Scotland?

Joe McDonald:

They were okay. I think that part of the reason why I, as I said, when I was little, when I was young, I wanted to be a soldier, was because I wanted to travel the world, and at that time I knew that my grandfathers had both travelled the world, but they did that in the army, and I think that was my driver, I wanted to travel the world. But I was also conscious of the fact that nursing would give me an opportunity to do that, at that time construction wouldn't, but nursing would as well, as well as helping me, I think, give a little back for the care that my grandfather received.

Dorian Broomhall:

And why Malta? I've not been there, I know people that have, and it sounds like an incredible place, but what was the draw there in the first instance?

Joe McDonald:

The draw there was that when I was a student nurse I shared a flat with another student nurse called Mark, and his mom was Maltese.

Dorian Broomhall:

Wow.

Joe McDonald:

So we visited Malta on holiday when we were student nurses, and we stayed with his family. So I fell in love with Malta a little bit, and then I just happened to be going through a nursing magazine called The Nursing Times, which at the back of it has got jobs, and it says, "Do you want to be a nurse in Malta?" And I went, yes, I do.

Dorian Broomhall:

You're a bit of a draw for a bit of a poster, aren't you, Joe?

Joe McDonald:

Yes, I am. So the poster was there and I was like, yeah, okay, I'll do that. So I think I'd been a nurse in the hospital that I trained in for two years, it wasn't a big hospital, it was a smaller hospital district general, 300 beds, not massive. And I think I wanted to gain much more experience, and I thought having experience in a health system on a tiny little island would be amazing, and I knew it was a beautiful place to live. It was only 12 months so I figured it would be a key.

Dorian Broomhall:

And what did you learn from 10 years or so in the NHS?

Joe McDonald:

The NHS, look, from my perspective, it's a free healthcare system, it doesn't rely on private hospitals very much. Private healthcare in Scotland was very, very rare, and even in England, there's lots of low socioeconomics of private. I didn't hear about private healthcare until probably 10 years as a nurse, at least. Probably when I came over to New Zealand is when I first really realised the influence of private healthcare. So I loved working for the NHS. I think that when I worked there it probably was better than it is now. I think that I worked in some of the big, after I trained in a smaller hospital, my desire was to work in the biggest hospitals that I could, but I never wanted to go to London. London was too big. I definitely don't like London too much, too many people.

So look, I loved the NHS, I think they provide really good care. I think they struggle, and they struggle now, but I think when I was there, which was 30 years ago, 20 to 30 years ago was that ten-year period, it was pretty good. There wasn't nursing shortages, in fact, there was more nurses than there was jobs. When we qualified we were all worried that we wouldn't get jobs, so it was a different time then, I think. But look, the NHS, both Scotland NHS and England NHS, gave me the opportunity to move around, work in different hospitals, gain lots and lots of experience, and really I moved around so much really to gain different experience and more clinical experience, to push my way up against the clinical ladder was what I really wanted to be. I wanted to be a NUM. I actually wanted, I always wanted to be a chief executive.

On the last day of college we had a graduation and it was like, where do you want to end up? And I rather arrogantly said, "I want to up to a chief executive, that's the end point for my career." And someone said to me, "Why? Don't you just want to be a nurse?" And I says, "Well, nursing is about caring and looking after patients, but who better to make decisions about providing the best care for patients than the chief executive of a hospital?" And everybody went, okay.

Dorian Broomhall:

Yeah right, they said.

Joe McDonald:

Yeah, that's what they said, yeah right. Yeah, so I continued, I moved around a lot, but it was specifically to gain more experience to build my CV, to grow and develop as a personal leader and a nurse.

Dorian Broomhall:

Really curious then, you clearly remember that end of your college when you said, "Yes, I'm going to be a chief executive," and you had the reasons for it. Then now that you have that role and you have that seat, how do your ideals from that time connect with your decision-making now?

Joe McDonald:

Yeah, I mean at the time most of my class laughed at me and thought, wow, it'll never happened. And I was like, yeah, well, you know what? It's not been the easiest journey to get through my nurse training, so I'm sure that it's not going to be an easy journey to get there, but I've got a long career ahead, so I'll take the time. I think that the more my career has progressed in health, the more that I have felt that I can greater influence care, and greater influence services and patient care and have that greater influence over my core values as a nurse and how I believe a health system should be providing for the community and the patients.

So I think it is, I think right now I have a great deal of influence across what happens in hospital sites, and indeed Tasmania, because I sit on the health executive of Tasmania as well. So yeah, I think that it's given me what I thought it would, but I think I thought that I would still be able to do some clinical work, and I haven't worked clinically probably in about seven years.

Dorian Broomhall:

Okay, so not that long since you've worked clinically then, that's interesting.

Joe McDonald:

No, no. In many of my roles I set one day a fortnight aside and I put a uniform on and I went to be a nurse, so I did that, yeah.

Dorian Broomhall:

Yeah, I think that that's something that we don't always see too, that link for people when they get to a certain level of their role, in whatever profession they might be in, that link back to actually boots on the ground, so that's quite recently that you've still been able to do that.

Joe McDonald:

Yeah.

Dorian Broomhall:

And I don't mean that with any disrespect, I think there's an enormous workload that goes with being a senior executive that's quite difficult to then make the choice to go, well, is that actually the best use of my time right now, given what you're saying about influence and ability to make decisions, so I think that's entirely reasonable.

Joe McDonald:

Yeah, it does become tough, you do become very time constrained and you just have to be very disciplined to set that time apart. And it's probably something that I'll be able to do in the future, I think your first 12 months in any role you do become time per, you're trying to learn so much, absorb so much, that I think I often find out by the time I'm in my role for the second year that my time becomes a bit more of my own and I manage my time better, just because I'm across more so I need briefed on less. So I think that that'll certainly be something I'll do in the future.

Dorian Broomhall:

So there's almost an explicit choice for you then in that first year to, my metaphor is be a sponge.

Joe McDonald:

Yes.

Dorian Broomhall:

Noting that there's downsides to that, right?

Joe McDonald:

Yes, indeed.

Dorian Broomhall:

So I suppose I'm really curious then, and perhaps some of the people listening will be curious too, given that at the time of this interview I think you've been in the role for less than six months, right?

Joe McDonald:

Yeah, three and a half.

Dorian Broomhall:

Yeah, there you go, less than six months.

Joe McDonald:

Not that I'm counting,.

Dorian Broomhall:

Not that you're counting at all, right? What was your strategy coming in? You're new to Tasmania, I think you mentioned before we started the conversation you'd visited for a week before, and like so many others realised that this is a place you want to spend time.

Joe McDonald:

Yeah.

Dorian Broomhall:

What was your strategy coming in?

Joe McDonald:

It was basically just to come in, understand Tasmania as a state, understand the THS as a health system, and understand the department of health and a health executive. So my goal was to come in for six months and just sit and be a sponge and learn as much as I could, but also identify as many gaps as I could and develop a work plan that I would need to work on. But obviously working on a plan as a chief executive, you need to build the relationships first, so it's also about building those relationships as well and spending as much time. You got to identify the key influencers and the key players within Hospital South, but also within the Department of Health as well, and I'd spend a lot of time trying to build those relationships and build that one-to-one relationship.

And I think that that's where I've spent the majority of my time to date, and it's probably where I'll probably spend a little bit more time there, but not much more time, I think. Sometimes I say the more I learn, the less I understand, and that seems to be my mantra at the moment, but it's been a very exciting journey and I've loved every minute of it actually.

Dorian Broomhall:

You've actively looked for opportunities to connect with parts of the service outside Hospital South's traditional home of the Royal Hobart Hospital.

Joe McDonald:

Yeah.

Dorian Broomhall:

What have you noticed? What have you learned?

Joe McDonald:

I think it's such a diverse state. It's not huge as a state, but it's very widespread. I think the differences between the South and North and Northwest, they're three very different health services in the way they work. I think because Royal Hobart's the tertiary catenary centre, I think that everyone thinks it's the epicentre of healthcare in Tasmania. But I think the North and Northwest too, and all the other facilities around, they actually, they're all pretty key to the success of the Royal.

And I think that that's what I've discovered is that I understand why it's one health system, because it's small enough that it actually relies on each other. There's so many interdependencies, I think that's probably my biggest discovery, is that people that work at the Royal when I first came think the Royal is the most important part, and it does provide a really important tertiary service and services, but it's also, it's very dependent on the rest of the system as well.

Dorian Broomhall:

That's a really interesting and I think useful view. And I think part of the challenge that many of us, no matter what we do in the organisation, sometimes struggle with is we end up in our little part of it, right? Because the part's actually important that you're working on, and for so many of us that can be at times overwhelming, just getting through the day to day, and whatever it is. But the blinkers end up coming on, and it's rare that people perhaps have the insight to be able to see the full system. How do you think that's something that we could approach differently, seeing what we do as our part in that full system as you've experienced it?

Joe McDonald:

Look, what I do at the moment as I meet weekly with my chief executive colleagues. I meet with them, just the three of the CEs, so that's the CE from the South, North and Northwest, we meet for half an hour every single week. We've done that for since not long after I started, and that was about me building my connections to them. I'm trying to standardise what we do, I'm trying to share learnings from what I've learned, what they've learned, what they've done, how they've addressed some stuff, and I try as much as possible to align and support what they do in the North and the Northwest and the South, which is relatively new. The South have always done it the South way, but I'm trying to do it with a different way, but also gives me a CE support network. And there's also a weekly meeting with the three CEs and the deputy secretary, and again, that allows us that opportunity to talk through any issues, escalate any issues, and really start strategically thinking about what we need to do as hospitals in primary care.

And so I think that's really been useful for me, being in the role less than six months, is having that support of the other chief executives and the deputy secretary. We strategize and decide, what are our priorities, what do we need to do? And that's really helpful and keeps us as a tight small group, I guess. And we disseminate out, when people give me a business case, the first question I say, "What do they do in the North? What do they do in the Northwest?" And they say, "Are we the royal? You're not like the north, not like the Northwest." And I said, "Yep, but can we just check and see what they do there? They do provide this service, it may not be a level six service, but they do provide it, I'd really interested to see what they do." So I try again, not reinvent the wheel, not do something differently from is done elsewhere, because if we do that, that consistency across the state, is where the efficiencies come from.

Dorian Broomhall:

A bit of a gear change, something I'm interested in, since you retrained early, you've largely been a career in healthcare, right?

Joe McDonald:

Yes, absolutely.

Dorian Broomhall:

I think one of the strengths of our leadership in this organisation is that we've got a diversity of backgrounds, at our health executive level we've got a diversity of backgrounds.

Joe McDonald:

Absolutely.

Dorian Broomhall:

If anything, it's actually useful having people like yourself in there because it's probably good to have a few more people who have been in different healthcare contexts around that table. What are your key learnings in the last, I don't know, five or so years being around how you approach being a senior executive with a healthcare background, what are your thoughts on that?

Joe McDonald:

I guess it goes back to why I became an nurse, this is about the patients about providing care. So I always try to take it back to the patient, I take it back to what are we trying to provide for the patient here? What do we need to provide for the community? So that's always where I zone in there. If we're not here for the patient, what are we here for? If we're not here to provide services to the community, why are we in healthcare? So I guess that's my primary focus has always been about healthcare, providing safe healthcare and providing really good healthcare. I hate the term high quality, because it implies that you're looking for high quality but right now you provide low quality, I think we just need to provide really good care.

That's my aim and that's been my learnings in the past five years, that if you talk to a clinician, whether it be a nurse, doctor, allied health, or anybody, or even some of the support services, if you bring everything back to the patients, the commonality, why we're all here in health, we are all here for the patients in the community. So I've learned to try and refocus everything back to that, back to what about this patient we're talking about, we're talking about a patient. And sometimes when I'm having difficult conversations about this patient, "We need to do something for this patient, we need to move this patient faster," that's the case of how would you feel if it was your mum, your dad, your brother, your sister? If this was you or your family in this situation, would it be good enough? So I try and link it back to that patient all the time, a patient, our patients.

Dorian Broomhall:

Have you got any examples of where you've needed to remind somebody of that, that you could share? Because I think that that's profound and something that gets lost perhaps in the noise of everything that's going on, because there's just so much happening for so many people. And sometimes if that does get lost, or someone can see that something probably could be better, but they're struggling to take that step, to raise that issue, how might you approach doing it? Maybe it's easier when you're the chief executive, someone would say, because you've got positional authority, and I think that's okay to an extent, but it doesn't actually make it any easier. But what's the approach that you might suggest?

Joe McDonald:

Yeah, look, my last show, COVID, that everybody's aware of, there was a man who was trying to see his mum. His mum was dying, his mum was terminally ill. He was creating a bit of a kerfuffle at the main entrance of the hospital. He'd driven from Victoria to Northern New South Wales, because he couldn't get there any other way. There was some discussion about had he breached lockdown in Victoria? And there was all these issues around it. So the staff and the hospital was in lockdown and you had to come in the door and go through a screening process, so this gentleman was creating a lot of problems about it.

I got called, I was the manager of the hospital, I got called because there was an incident going on, and I went and took the man aside and said, "What's wrong?" He explained to me, "I've had a phone call, my mum's dying. I've just driven all the way from Victoria. I've probably breached all sorts of rules because I've driven, but I couldn't fly, I couldn't get anywhere. I need to see my mum before she dies." And I said, "Okay," I said, "just sit here for a moment," I took him in an office in the back of reception, and I went and spoke to reception and says, "Can you call the number of this ward?" Called the number, I spoke to them and said, "Mrs. Smith, is she terminal?" "Yes." "Did someone call her son and say, 'Your mum's terminal?'" "Yes." "Who was that?" "It was the doctor."

And I said, "Okay, well he's here now." "No, He lives in Victoria, Victoria's in lockdown." And I said, "Well, he's here." And they said, "We should call the police." And I said, "No, let's not call the police because we're not here in the business of applying the law around COVID and travel." I said, "How well is Mrs. Smith?" And she said, "She's probably not going to last very long." And I said, "Okay, well I'm going to let this man come up." So I went in and I said, "Okay, I'll take you up to see mum." So I put him in a full gown, put him in a full PPE, and I took him up to see his mum. As it turned out his mum was in a single room, so we got in the single room and I said, "You can take all that stuff off, just set it on the chair, spend time with your mum, before you leave the room you need to put all that stuff back on again."

I went back and spoke to the staff and said, "Where's your compassion here? Where's your care here? How would you feel if you knew your mum or dad was dying and you couldn't get to see them and someone was saying you can't see and spend the time with your mum or dad in the last few years of their life, how would that make you feel?" And they all went, "Yeah, well, I wouldn't like it. And I said, "So could we maybe have managed us differently?" And they went, "Well, we could have did what you've done," and I said, "Yes, why didn't you?" And they said, "We're so scared that we bring COVID into our hospital." And I said, "Yep, but sometimes the care is what's more important. We can manage the COVID, we can never manage the impact of this man not being able to see his mum in her dying hours."

Dorian Broomhall:

That's a really beautiful story, thanks for sharing.

Joe McDonald:

It's okay.

Dorian Broomhall:

I think that there's something wonderful in that ending around the staff being petrified of COVID in the hospital, because of course, to an extent, they're actually thinking about patients and managing that accordingly. But as you say, that's a risk that we can absolutely do wraparounds, as you sort of point out. And there's probably many examples of that in our system every day where it's like, oh, well we don't do that because a rule somewhere says this is exactly the way it has to be all the time. Can we have a conversation about that?

Joe McDonald:

Yeah, absolutely.

Dorian Broomhall:

And how do you approach that if you don't have positional authority, do you think?

Joe McDonald:

I think it's just having the conversation, it's just saying, "Look, have you thought about it this way?" I didn't tell the staff off, I understood, they were applying all the rules under COVID that we had, they were doing everything right, and they weren't doing anything wrong, they just forgot to care. They forgot the compassion, the empathy, how would I feel in that situation? And I've held positions before where I've had very little authority, but it's been a professional lead role. I'm thinking of when I was associate director of nursing, I didn't have any operational response, but I had professional responsibility of 500 nurses, and you influence with relationships.

I influence by trying to talk through the story, trying to highlight the risks if we act or if we don't act, and it's about trying to give that different perspective. If I'm talking to a non-clinician, I try and give that clinical perspective. It's the care, the empathy, compassion, I think that's where I go most of the time. And I use the clinical argument, I use all my experience that I've had across the past 30 years to exert as much influence as possible. It doesn't always work, and it hasn't always worked, but certainly if I have done the best I possibly can, then I can walk away knowing that I've done the best I possibly can. And if I haven't been able to change this decision or sway the decision, that I've done everything that I can. I'm fairly tenacious, I don't give up easy.

Dorian Broomhall:

Something that we talk a little bit about through our programmes with One Health, and our management programme especially, is the importance of creating a relationship of caring personally and directly with somebody. We make reference to Kim Scott's Radical Candour framework, this idea that you need to create that connection, have that trust with somebody in order to be able to hold them to account, to be able to challenge them in such a way that it really, really works, and you need both. What would you advise to somebody who perhaps is thinking, I don't really have any networks, I don't feel like I know that many people even though I've been working here for a long time, how do you approach doing that? Networking I think gets a bad rap, for good reason, for some of the contrived events that might go on, but what's an approach for someone to develop their networks?

Joe McDonald:

I develop my networks just by connecting with people, talking to people. Sometimes you just see, often if you're in large groups and stuff, you see someone standing on their own, I go talk to them. It's sometimes hard to walk into a big group, so I concentrate on the people that are either on their own or the people that are in smaller groups, and walk up and introduce myself and tell them what I do and ask them what they do. I think it's hard walking up to people you don't know, but it's also just something that I think that over time you lose the fear of it, I think.

And there's also expectations of your role that you have to go and meet people and build those relationships, so I think it's just something that I learned to do. I found it difficult to start with, but I think that I, and often you go and talk to someone you know, or vaguely know, and they introduce you to who they're with, and then that's how your network starts to grow. And so I think it's just taking that leap of faith. The people within the framework that you work in, be it health or be it another government agency, there is a commonality there, they're not strangers, there's something we have in common, and I think you just accept that, acknowledge that, and then build on that, and I think that's how I've built relationships as well.

Dorian Broomhall:

Yeah, I think there's something really wonderful in that, and I'm even thinking about the very useful cafe that's in your hospital. You observe the different tribes, is what I tend to say, hanging out in different clumps, having a break and doing whatever, but that commonality from someone who doesn't know who anybody is, they see a room full of healthcare professionals mixed in with members of the public going about their business, but even that, that's a platform, isn't it?

Joe McDonald:

Yeah. In my last job we had a coffee shop, and I sent out an offsite email across all the 2000 staff and basically called it a Coffee with Joe and invited people to email me directly to pick a coffee chat with me where I could just go. It was people that I hadn't met and didn't know me, and it wasn't about work, it was just to go and get to know everybody, and I was urging everyone to do the same, go have a coffee with someone you don't know. And that was about trying to build those networks within the hospital, it was really trying to get some of the wards and some of the services out of the silos and get to know other people, and the feedback I got on that was really, really good.

Dorian Broomhall:

On one hand, profoundly simple, but it requires someone simply starting. And I think on that, we'll leave it there, and Joe, thanks so much for the-

Joe McDonald:

Thank you.

Dorian Broomhall:

For the conversation. And whilst we haven't had a coffee whilst we're having the conversation, I'm really grateful for your time, that I've been able to have a proverbial coffee with you and share in the conversation, and I hope that many others have the opportunity to do so as well, so thanks very much.

Joe McDonald:

Thank you, Dorian, it's been a pleasure.

Dorian Broomhall:

Thanks to Joe McDonald, the Chief Executive of Hospitals South, for taking the time to speak with us, and to you for listening. Hope you found something in our conversation that you can take away into your own work and your life. Join me again for our next episode when I speak with Brent Feike, our Chief Information Officer.