SPEAKER_01: 0:00

Hello, this is Problems Worth Solving, the podcast where we meet people transforming health and care through human-centered design and digital innovation. I'm Sam Mentor, Managing Director at Healthier, the collaborative service design consultancy. If you enjoy listening, you can subscribe to this podcast and the accompanying newsletter at healthier.services. Today's guest is Dr. Catherine Halliday, a leading figure in UK radiology and president of the Royal College of Radiologists. She's led national work to improve diagnostic services, shape policy and lead responsible innovation. Today, we're going to talk about leadership, AI, service redesign, and how a human-centred approach can unlock change in one of healthcare's most pressured areas. Thank you so much for joining us today, Catherine. It's great to have you here with us.

SPEAKER_00: 1:01

It's really nice to be here. Thanks, Sam. Thanks for inviting me.

SPEAKER_01: 1:05

So I'd like to start with a little bit about you as a person so that we can get a background and understand what drew you into this space. So I'm curious about what you were interested in as a young person and how that led you into radiology.

SPEAKER_00: 1:20

Well, I always wanted to be a doctor. I can't remember a time when I didn't want to be a doctor. Initially, actually, I wanted to be a psychiatrist. I've always been very interested in what makes people behave the way they do. It took me a while to get into medical school. I didn't get in straight away and I kept trying. And then I met lots of interesting people when I finally did make it. So my career's had lots of ups and downs, but I've never regretted being a doctor for a second.

SPEAKER_01: 1:46

And what type of person tends to go into radiology?

UNKNOWN: 1:50

Thank you.

SPEAKER_00: 1:50

Well, that is a very interesting question, actually, because the role of the radiologist is really changing. And traditionally, I mean, there are a number of role models. I don't know, maybe many people listening to this will be too young to remember Green Wing on the television, where the radiologist is a person who lives in a sort of dark dungeon down below and doesn't really speak to anyone and actually gave himself coffee enemas, I think. It was a very, very odd person. And that is are traditional type though I've never met anybody like that I must say but traditionally a radiologist is somebody I think The stereotype is that it's somebody who doesn't really like to interact with patients or people, likes to live in the dark and just get through a load of tasks. But actually, in reality, our job is very much about people. It's very much about dealing with our colleagues, about understanding patients and the context in which their imaging has taken place. And of course, I'm a paediatric radiologist, so even more, I'm very sort of hands-on in terms of dealing with children and their parents. So it's not quite as withdrawn, I think, as you might think. And of course, we get all sorts of different people, but it does attract and particularly suit people who have a real attention to detail.

SPEAKER_01: 3:14

You mentioned kind of there's a perception of radiology happening behind the scenes. And I wondered, from your perspective, what's it really like doing the work?

SPEAKER_00: 3:23

Oh, it's, I mean, it's amazing. It's so varied. Honestly, every week, I've been doing it for 30 years and every week I see something that I have never seen before or come across a situation I've never seen before. So it's incredibly varied. And also it's developing so quickly. We've been so lucky to always really be at the forefront of innovation and development, new imaging techniques. When I was training, there were some people who had not really seen much ultrasound when they were training. You know, ultrasound came in sort of before I started, but then MRI was really new when I started. And now we do hundreds and thousands. And now we've got AI. So it's terribly varied on a day to day. Sometimes you're scanning people. Sometimes you're looking at images. Sometimes you're interacting with your colleagues. And also in terms of innovation and tech, it's got something for everybody there.

SPEAKER_01: 4:23

For you personally, what do you find most rewarding about the work?

SPEAKER_00: 4:28

So I love the variation. I love dealing with children. I love... Working in a team, that is so great. And again, it's one of the things that people don't really realize about radiology. I think the times when we add most value to patient care is when the pediatric surgeons or some of the pediatricians might come and talk to us and say, we've got this child and this is their issue. This is their social circumstance. These are the images. Let's put all that together and see what's best to do for that person now or that family. And then you're working with a really focused team trying to do the right thing for somebody who often can't really stand up for themselves. And that feels like proper medicine.

SPEAKER_01: 5:24

So I think one of the things that I was interested in talking to you about is the fact that you're focusing on solving some of the most complex issues in diagnostics. There are some pretty urgent issues that you're working on. We know that over 65,000 patients are waiting too long for scans. And I wondered if you had a view on what's driving these delays and what are some of the ways we can tackle these problems?

SPEAKER_00: 5:47

The demand for imaging will keep on increasing. And that's right. Imaging is good for patients. It's much better to diagnose things quickly and early. So more imaging overall... is a good thing. And probably we do less. Well, we definitely do less than they do in other countries. So the demand will keep on rising. But as you say, people are waiting too long. And even though we are increasing the workforce, we're never going to be able to increase it fast enough to keep up with that increase in demand. So we do have to innovate. We do have to do something differently. And there are many, many ways in which we can do that. But what our focus should be on now is in creating capacity in the system. So AI can help us, definitely. Tech can help us. A lot of the time in the NHS at the moment, digital solutions actually don't help us. They often take a lot of clinical time. One of the effects of the sort of increasing digitization in the NHS has been to move quite a lot of administrative tasks from low-paid workers to highly paid workers because now most consultants will input their own data and we're often pretty slow at that. And the systems are often clunky and you log in lots of times and then you forget your password and it logs you out and the sort of everyday experience. So digital systems aren't working for us and we need to change that. We need to make sure that those people who are highly trained clinicians, not just doctors, but radiographers, nurses, those people spend most of their time doing what they've been trained for. So that's the first thing. We need to concentrate on AI helping us with flow through the system. We also need to look at who we're imaging. So as I've said, overall, more imaging is better for patients, but we still are not necessarily selecting the people who could benefit most. And in a resource-constrained system, which we're all in one way or another, but we have to make sure that we are, as it were, getting the biggest bang for our buck in terms of imaging. And we can use AI to do that, but we also have other systems in place. We also have a system... called iRefer, which is now a clinical decision support, which actually helps people to choose the right sort of imaging. So if you're a primary care doctor, for instance, you might go onto your computer and think, well, I want to request this person's got a headache. I might want to request, and they've had it for ages, I might want to request a CT. So they'll go and request that CT, but then the system will say, well, actually, no, an MRI is better for that. So instead of wasting that CT slot, we've gone straight to the most appropriate imaging. And sometimes the clinical decision support software will say, actually, imaging is really not going to help here. It doesn't really move the dial, but it does mean that some of the studies don't take place. And it also means that those studies that do take place are ones which are the best practice, you know, most likely to make a difference for that patient. So that's the sort of thing we need to concentrate on. And we need to also ensure that we've got the data to understand which tests really are making a difference to patients. And at the moment, we're not very good at linking that up. So we know we've got a lot of data around what tests we do, but we're not terribly good at linking up which ones really make a difference to patients with clinical data, with outcome data. So we need to get better at that.

SPEAKER_01: 9:39

And what about workforce? Is there a lack of radiologists in the system?

SPEAKER_00: 9:44

Huge lack. At the moment, there's about a 30% shortfall. And actually, that's due to go up to 40% in the next five years. So, I mean... That's what's preventing us from keeping up with the wait. And it's also terribly stressful for people. No one goes into medicine or radiology to provide a bad service. Everybody wants to do the right thing for patients. And so people feel a huge pressure. The staff... It's, you know, when in COVID we called it moral injury, you know, staff are trying so hard to do their best for patients, but they're so constrained by the volume that's coming at them that they actually can't do it. And of course, the difficulty with that is that feeling of being out of control, of not being able to do what you always wanted to do. drives people away. And so they retire early, they go into some other branch or whatever. And so it has a sort of spiraling downward effect. So people are leaving our profession much earlier. The retirement age, average, well, the average age of leaving the service is around 54 now, which is so young. So we have to make things better for people. So as we keep these highly trained people in the service.

SPEAKER_01: 11:06

And how do we create better working conditions that are going to retain those people? Similarly, where does service design come into this?

SPEAKER_00: 11:13

Oh, well, this is the big question, isn't it? And I think there's been a lot of good work on this, but it's something that we haven't really managed to get to the bottom of in the NHS, I would say. And it has to be about looking after the people and getting the best out of the people. So I think there are... many ways in which we don't really make the most of our staff. And very good work by Michael West about caring for doctors, caring for patients, a great, great publication there, which talks about autonomy, the things that people value about their work, autonomy, belonging, and control. And of course, a lot of those things, control, we've talked about lack of control, you can't manage the workload, Belonging, we've lost that a little bit. We're not really creating communities into which people belong. And some of the technical advances since COVID, where quite a lot of us are remote, not getting together, doing stuff on teams, that actually undermines belonging even further. And the autonomy, people feel too much top-down control, right? I mean, it's important that we use data, but sometimes we use data as a sort of weapon against our staff. And we've got to be very, very careful about that. So it is about looking after the people. And I believe in the NHS, we don't really have the structures in place to do that. So If you're a clinical leader, you often get very, very little time to look after your staff. So you have maybe 12 hours a week for a department with maybe 70 consultants. So then you won't really be able to reach out to your staff. We don't really have a structure of having one-to-ones with people. In any other company, when I came here to work at the Royal College, for instance, the CEO will have one-to-ones each week with his, you know, the people on the sort of tier below and they will have one-to-ones with their team and they will have... So there is a kind of web, a network that spreads through the organisation. We don't really have that in the NHS. And so it's very hard to see how... culture and values can really effectively spread down through the staff. We've concentrated so hard on keeping people working, doing their clinical work.

SPEAKER_01: 13:50

What's the peer community like in radiology?

SPEAKER_00: 13:54

Well, it's very strong. We have some really good things in radiology, which have made our peer community very strong. So one of those is looking at mistakes or discrepancies, as we call them. The thing about radiologists is that if you miss something on a scan or misinterpret something, it's there forever for everybody else to have a look at. And so you might miss a nodule on an x-ray or interpret it as benign when in fact it is malignant, tragically. And those things will happen. And then Ever after, it's there and you can see it and you feel absolutely terrible about it. When you go back to look at it, you think, how could I have misinterpreted that? How could that happen? But because of that, we have a whole system in radiology called radiology events and learning. And what we do is we, any cases where there's a discrepancy of some sort, we submit those anonymously and have a weekly meeting or monthly meeting and we go over those. So we'll all as a team look at them and say, oh gosh, that was difficult or, oh yeah, maybe. But what happens is one, we learn from those mistakes. So, you know, we're taking that as a opportunity to learn. And the other thing is that even the most junior person understands that other people make mistakes too. And some of those other people are really senior and really experienced. And as a community, that teaches us about error, about supporting each other, about using error as a learning opportunity. And That makes us a very, very strong community. And I do think that other branches of medicine could learn a lot from that because it's not only good for the learning from your craft, but it's good for the culture of departments.

SPEAKER_01: 15:52

Does it feel like your peers have your back when you're doing this work?

SPEAKER_00: 15:55

Definitely. Yeah, definitely. When within our profession, we all understand, we all recognise that we don't get things right all the time. But I mean, that's true of medicine, of all aspects of health care. We don't get things right all the time. What's important is that we learn from it. But I think we don't prepare our young health professionals very well for the fact that they will make mistakes. And sometimes those mistakes will have very bad outcomes for people. That is the nature of our business.

SPEAKER_01: 16:31

It's impressive the way medically trained people are taking on so much responsibility and so much risk with their work. And that's just normal in a day

SPEAKER_00: 16:42

to day working lives. not let that mistake go to waste.

SPEAKER_01: 17:08

So I'd like to move on to talk a bit around AI diagnostics and how we keep it human. There's lots of excitement around AI as well as complexity. It's part of the diagnostic infrastructure and has become over the last few years. What do you see as the real potential here?

SPEAKER_00: 17:23

Well, it's very exciting. That's the first thing. And very welcome because we've talked about the fact that we have capacity problems. And so we need all the tools we can get to improve, you know, to maximize the time that staff can spend doing the things they've been trained to do. AI should help our productivity or efficiency, whatever you want to call it. At the moment, we've been concentrating. I mean, about 80% of all the algorithms available are in radiology. So it's really in our wheelhouse. At the moment, a lot of the tech is concentrating on helping us with accuracy, which is always welcome. But it's not our biggest problem. Our biggest problem is capacity. So we might need to sort of move our attention a little bit from things that help us with diagnosis to things that help us select the right patients for imaging and also smooth the patient's pathway through their journey through the imaging department and also just make us a bit more efficient so there are things for instance like reporting solutions which can quickly record so you can just talk to a computer and it can reorder your stream of consciousness into a structured report and also make recommendations. So you might see some sort of a thing on a renal cyst, for instance, a fluid filled thing on a kidney. Now there's guidance about which cysts should be followed up and which you don't need to worry about. And I don't have that in my head. So I would have to look that up on a computer. I think, well, I know there's guidance, but I'm going to have to look this one up. But, you know, the AI can you that as you're doing the report. So it just makes you much quicker and more efficient. So we need to concentrate on the sort of admin side of things to help us do our thing more quickly. In terms of the diagnostic AI, we've still got quite a long way to go, I think, in deciding how to use that best. We have systems, we're developing systems to look at the accuracy of the algorithm itself, the accuracy of the output of the computer. But actually, what really matters is what is the combination of the computer and the human? Is that better? Is it worse? Sometimes it can be worse. Do patients who have had that technology used, do they do better? And those questions we still actually don't really know the answers to. So there's a lot of work to be done.

SPEAKER_01: 20:04

And where does the responsibility then lie? Because, you know, the conversation we were talking earlier about that risk that you're taking on and trying to make decisions and getting it wrong at certain times. Does that then mean that if you've done the scan with an AI device, And you've had the same decision as the AI. It's almost abdicating responsibility to the technology. Or does that responsibility always lie with the radiologist?

SPEAKER_00: 20:26

Well, it always lies with the radiologist. And so one really important part is to educate people about what the technology can do and what it can't do. Because the technology, like humans, is good at some things and not good at others. So the technology does miss things. For instance, I heard of a case where it can actually blind you if it's telling you to look somewhere You concentrate on that and you don't look at quite obvious things that you might have seen somewhere else. So I heard of a case the other day where the AI would only pick up lumps of a certain size or below a certain size. And actually that meant that the radiologist missed a much bigger lesion Because they were sort of distracted by the AI and that can happen. So we need to, first of all, to educate people what the AI can do and what it can't and what you still need to look for. And then we need to monitor it really carefully and we need to describe what those monitoring systems are. But at the moment, it's always the radiologist's responsibility to There are some algorithms out there now that say that they can manage without a radiologist. For instance, there are some that say that they can effectively identify normal chest X-rays or a proportion of normal chest X-rays, which wouldn't need to be reported at all. So if that were to happen, there'd need to be some changes in the law. We'd need to describe very carefully what sort of quality assurance needs to be in place. to protect patients whose scans have gone through that. And the responsibility for setting that system in place would be with the hospital and the radiologist.

SPEAKER_01: 22:10

You hear the phrase human in the loop a lot when we're talking about medicine and technology. What's the implication of that in this area?

SPEAKER_00: 22:17

So at the moment there always has to be a human in the loop. I think we need to think about that moving forward, whether that is always the right way. As I've said, sometimes the combination of the human and the computer can mean that it can be worse, actually, than either one alone. So we need to understand that. And I think we also need to describe the systems that need to be in place for some things that could be done without a human in the loop. What our polling showed about public attitudes towards AI was that people are happy for AI and technology to be used, but they do trust doctors and expect doctors to implement that safely. So I think that is where our responsibility lies for making sure that these are happening safely. And I think if patients get their results quicker, they're really happy.

SPEAKER_01: 23:17

I mean, there's a balance, isn't there, between speed, safety and empathy? Totally. How do you get that balance right?

SPEAKER_00: 23:24

Well, we've got a lot of work to do, I think is the answer. But that is entirely what... doctors and particularly radiologists have been doing for many years. So that's absolutely 100% where we can contribute. And we've got lots and lots of experts who can work on that. And it's very exciting work. And it promises to be able to relieve some of the capacity issues that we've got and help us to deliver a better service. So it is a lot of work, but we're the right people to do it. And we're very happy to take that on.

SPEAKER_01: 23:58

We're talking a lot about kind of technical innovation in the space. I wondered what your thoughts are around innovation around service experience and, you know, what it's like to go through radiology.

SPEAKER_00: 24:10

Well, yes. And I think that's a very interesting question. And I think one of the things that we're very poor at in radiology is communicating with patients. Often Patients don't really understand where or when they're going to get the results and don't even understand that once you've had your scan, there's another step. You know, the other step is having that scan reported and analyzed by a radiologist. So patients could really do with a bit more information. So as they had a bit more control over what's happening, I think had previously had a role as the GERF lead, the Getting It Right First Time lead for radiology, where I went and visited 143 radiology departments in England. It was an NHSE project. I really saw people doing great things in this field, people who had patient navigators. So people employed within radiology to work with patients and say, yeah, this is what's going to happen now. And this is where you're going to get your results. And Sometimes concentrating on just getting more examinations done and getting more reported means that we don't concentrate on patients as we should. Some people are doing good work, but it's sporadic.

SPEAKER_01: 25:29

And how much work goes into the communication following the diagnostic. So I was talking to Jonathan Gregory in the previous podcast who was talking about work they've been doing with Macmillan around end of treatment communication and actually simplifying the letters and using not medical terms but terms that your average person can understand in the letters. Is that normal practice in radiology?

SPEAKER_00: 25:50

Well no it's not and actually you know most people in radiology get their result from another specialty. So the way it happens is I will write a report and that report will go to either the GP or the pediatrician or the pediatric surgeon or whoever. And that person will be the person who communicates the results to the patient. So my reports are not written for patients. They're written for other clinicians. But now, a lot of reports are now visible on the NHS app. Which is the right thing, but they're not written in a way that is necessarily accessible to all patients. And they can be alarming. You know, you might say there's a possibility of cancer because there is a possibility, but it's not very likely. And I mean, it depends who you are, but some people find this very stressful reading. So this is an issue.

SPEAKER_01: 26:48

But if you've written that letter for another medical professional, it's going to be a very different letter from the letter you would write if it was going to be viewed by a patient.

SPEAKER_00: 26:56

Absolutely. So we've had these conversations within radiology. So should we change the way we report? But actually, that's probably not the right thing to do. The right thing to do is to put in some other step which helps patients understand or enables them to access health. So either you could use technology. And in the States, they do this a lot so that all patients have access to their results. So the things that they do in America now are they have little videos and things embedded in their reports. So you might say you have a tear of your medial meniscus in your knee, and then there'll be a sort of link onto that of this is what a normal meniscus looks like, and this is what yours looks like. And that's sort of technology that does that. And then you have a link to say what normally happens. And so They also are employing people in radiology departments. So if a patient's worried about their report, they can then ring up and discuss it with a radiologist. So they have a whole system in place to look after it. And there are no shortcuts for this. If we're going to do this, we need to do it properly because we do need to look after patients properly.

SPEAKER_01: 28:09

And that all comes down to funding, I assume.

SPEAKER_00: 28:10

Absolutely. And recognising that it's an issue.

SPEAKER_01: 28:14

So just going back to the getting it right first time work that you were leading, which was a massive effort to understand and improve practice across the country. What were the biggest challenges and lessons from leading that redesign at scale?

SPEAKER_00: 28:26

Oh, well, it was the most amazing experience, the most amazing experience. One, Tim Briggs, who started the whole program. I mean, it was visionary and amazing. He has worked tirelessly to get this program off the ground, not only in orthopedic surgery, but in everything. He's done really great things for medicine in the UK. So with that program, and actually that was real leadership. He just did it and took other people with him. He saw there was a problem and he did it. So that's one lesson. If you think there's a problem, no matter who you are, just go for it. And I learned that so many times through that trip. So during the process, you take data, whatever data you have, and you go and discuss that with the different departments. It works best when you can get everybody in the department into that. So it'd be like the chief executive or the medical director or both, and then all the helpers and the porters and the PACS people. And then you can start a conversation and actually you can just unlock things in the room. The chief executive would say, well, why haven't you got anywhere to do that? And they say, well, nobody's found me. And they say, well, we'll get that now. You know, so that's amazing. And it was so I met so many people who were just working really hard in really difficult circumstances to do the right thing for their local population. Inspirational, totally.

SPEAKER_01: 29:52

And how important was the collaboration in there?

SPEAKER_00: 29:54

Well, the collaboration goes all the way through. I mean, one with your other clinical leads, the other clinical leads from the other specialties were incredible. And it was great to talk to them. Two, the collaboration and the team are quite small. I got great advice from one of the past presidents of the Royal College of Radiologists, who is my co-lead, Giles Maskell, and had an absolutely wonderful project manager, Gail Roadknight, who ran the whole thing, Elaine And Quick was a radiographer who came with us and a service manager and Lucy Proling, all of these people. That was a great team. And then when you get there, often the helper will never have been in the same room as the medical director or the CEO. And so to get people in the same room and have that conversation, that's the thing that is magic.

SPEAKER_01: 30:47

How did you do that in a meaningful way? People are so busy in the system.

SPEAKER_00: 30:51

Well, our project manager did a lot of work on that. And it depends on the leadership in the trust as well. Those really good trusts will see this as an opportunity for them to get to know more about what is really happening on the ground, led by someone else. And it's free. You know, really good leaders embrace this process. Those ones that are not led so well, it's really hard. And we've flogged off to various places and there'd be like two people there. And so, you know, and you walk into a department immediately, immediately you can tell about the leadership. A hundred percent. Leadership is so important. I mean, everybody says this, but actually you can tell the minute you go into a department if it's got a strong leader.

SPEAKER_01: 31:38

I'm a big advocate for co-design when you're thinking about change and bringing people together to think about how those changes can be made in a way that works for them. It sounds like this was a co-design approach you were taking with these teams. Can you tell me a bit more about how that made the changes stick or examples of how it worked?

SPEAKER_00: 31:55

Absolutely. I mean, you know, the innovation that goes on is unbelievable. I think people very rarely get the chance to be together to talk about the innovations that they've done. I mean, one brilliant innovation was around paediatric MRI scanning, so scanning toddlers. You know, for an MRI, you need to keep still for quite a long time. And of course, toddlers can't do that. But most of the time, we need an anaesthetist and, you know, a whole load of equipment that you can take into the MRI scanner and things like that. So it's a very expensive, labour-intensive process that can't be done in a district general hospital. It has to be done in a big hospital. In one place I went to, the helpers there had said, toddlers sleep really heavily. Why don't we do them at bedtime? So they got the toddlers into the department around about seven o'clock and they bring them in. They had a travel cot. They bring their kind of blankie and their bottle or whatever and play with them for a little while, put them to bed in a cot. And then they'd fall asleep. Then they'd put some dear little headphones on, lift them up, put them in the MRI scanner, do a 45 minute MRI scan. no medication, no nothing, then put them in their car seat and take them home.

SPEAKER_01: 33:13

So no anaesthetic?

SPEAKER_00: 33:14

No anaesthetic.

SPEAKER_01: 33:16

And they would lie still enough for that?

SPEAKER_00: 33:17

Yeah, they're fast asleep. And, you know, this, I've been a paediatric radiologist for 20 years by the time, I'd never thought of that, you know, and this was, and in fact, it's gone on and it's other people have had the idea as well around the country, but now this is now much more standard practice. And this was a helper. This was a very low band person saying, your toddler sleep really heavily normally. It's just, and that sort of thing is just light bulb.

SPEAKER_01: 33:46

It sounds really obvious once you've talked about it. Of course it makes sense.

SPEAKER_00: 33:50

I could not believe that I'd never thought of that. And I was just, oh, oh yeah, of course.

SPEAKER_01: 33:56

Easier for you and easier for the toddlers as well.

SPEAKER_00: 33:58

Better for them. I mean, general anesthetics, you don't want to give little children general anesthetics. We don't think it's much good for them.

SPEAKER_01: 34:04

So the changes that came out of this process that you were leading, were they top-down changes or was it more kind of participatory and people were making the changes themselves?

SPEAKER_00: 34:13

It's more participatory then. And I think that's the thing about health service improvement. I mean, it's a complex system. So you just edge things forward a little bit each time. But what it did was, first of all, it showcased what people were doing in radiology. So in previous times, radiology has often been regarded as a problem, you know, a blocker. We can't get things through radiology. And when the more senior managers in the hospital had it showcased to them all the things that radiology All the different departments in the hospital or primary care, the many different sorts of things they did. And they would suddenly think, wow, that's something actually, that is something to be dealing with all of that. And just as you say, co-design, just discussing some of the big issues they had. Sometimes, one department I remember, they couldn't get as many people through the CT scan because when they needed to cannulate the patients, they didn't have a separate room to do it. They had to do it on the scanner. So that was wasting scan time. And they said, well, we've asked, but nobody's given us one. The chief executive was just able to say, oh, right, we're doing that now. And so getting people together and making time to do that is absolutely crucial. We are squandering the expertise we have in the health service because we are not really listening to the things that people know could be improved.

SPEAKER_01: 35:45

I'd like to move on and... speak about leadership a bit with you now. So you've written about the urgent need to value leadership in medicine more. What does great leadership look like to you in the system today?

SPEAKER_00: 35:58

Well, I mean, there is something about authenticity, about people, you know, it's actually not about necessarily learning or it's just about being yourself and trying to make things better and other people seeing that you are trying to do the right thing. So I think you just have to do what you do. So I don't think there's necessarily a right way or a wrong way. I do think we really hamper people. When we talk about leadership in the NHS, we tend to take people away, give them a learning course, do their Myers-Briggs score or whatever. But actually, we make it really difficult for people because we give them no time. We give them no support. So actually, as a clinical director in a radiology department, what you need is data. You need to be able to really see what's happening. And you need a person who understands healthcare data to help you. You need good secretarial support. You need time to work with your staff and look at ideas and just hear how they are. And If you don't have that, no matter how much training you have, you won't be able to be successful. It's a bit like sort of victim blaming in a way in that people are really trying hard and we're saying, oh, you need more training. You know, it's because you don't know how to do it. It's not because they don't know how to do it. It's because we're making it impossible.

SPEAKER_01: 37:25

How do you personally lead when time and energy are in short supply?

UNKNOWN: 37:29

Yeah.

SPEAKER_00: 37:29

Well, I honestly, I don't really think of myself as a leader. I just rely on other people. I see other people who I get a lot of help. I mean, in this job, I get lots and lots of help, which is great. So one of the things is when you get more senior, it all becomes more easy because you get a lot of help. And also people listen to what you say, which is something that You know, for most people, that just doesn't happen. So it gets easier. And also, I surround myself. I'm lucky to be surrounded with people who've got a lot of good ideas.

SPEAKER_01: 38:04

You've highlighted the lack of time, support and recognition for clinical leaders previously. What's the impact of that?

SPEAKER_00: 38:12

The impact is very bad on the person who's trying to do the leading. So we don't have many people stepping up for medical leadership. It's seen as impossible. Sometimes people think, oh, you're going over to the dark side, you know, because medical leaders don't have enough time to develop their staff and to work with their staff. It can be seen as quite confrontational. So people who step up who are trying to do the right thing, it takes a huge toll on them. And it means that people are scared to step up. And it means we are not making the most of the talent that we have. So we've got to really change that because nothing's going to change unless we can persuade more people to do that.

SPEAKER_01: 38:58

And what are the things that you need to change?

SPEAKER_00: 39:00

So I think we need to support the people more who are doing those leadership jobs. Give them time. Give them resource. You know, to economize on administrative staff and have the people who are the clinical directors doing all the admin work, that's ridiculous. The number of doctors who are writing rotas, I mean, that's ludicrous. We need to give people support and time. And Often we use our data to say, well, if everybody just works a bit harder, we can do a bit more. And that's just not the way to do it. We need more fundamental change. So we need to give people the time to innovate, to make more time. But that's quite a brave step.

SPEAKER_01: 39:42

Mentorship is important. And I think it's played a role in your own career. Can you tell me a bit more about that?

SPEAKER_00: 39:48

A hundred percent. I have had some wonderful people who have... faith in me and supported me and taught me so much. When I started in medicine, it was a much more hostile environment for women, particularly. I still do think we have an issue with women's voice not being heard. We have a lot of data around that. I've had a lot of very strong male mentors who have helped me and supported me throughout. Tim Briggs, I've mentioned, my husband, Giles Maskell, who I mentioned in Girfed. A lot of people who've really supported me. and taught me to just have faith in myself. And I would like to try and pass some of that on to other people.

SPEAKER_01: 40:34

What advice would you give someone who's thinking about maybe stepping into a leadership role in the health system?

SPEAKER_00: 40:41

I'd say do it. Do it. There are huge rewards. That's the way to make a difference. Get yourself some good support. Don't blame yourself too much. Learn from mistakes, but don't wallow in them.

SPEAKER_01: 40:56

Before we wrap up, I'd like to look ahead to the future a little. What are you most optimistic about right now?

SPEAKER_00: 41:03

Well, one of the things I get in this job is I get to look around other health services. We're very fond of telling ourselves how everything's terrible and there's definitely a lot of room for improvement. But actually, healthcare in the UK is not as bad as we think. There are a lot of places in the world where if you're poor, you get no access to healthcare. And that's not the way it is in the UK. I mean, there are tremendous health inequalities, we could definitely improve, but at least we have healthcare that is free for people. So that's good. We have a hugely wonderful staff and we have great education, great systems in place. We're very lucky in that regard. You know, the Royal Colleges really support education and standards. So our healthcare system is actually not too too bad. And we've got the building blocks to do a great deal more.

SPEAKER_01: 42:00

How do you see radiology evolving over the next five, 10 years?

SPEAKER_00: 42:04

It's going to change, no question. We can't continue to do everything ourselves. Technology is really going to have a big effect. We need to lead that change and make sure it's having a good effect and not just making things more complicated. We will still be needed. When you're dealing with humans and You need another human to understand the complexity. We'll be doing more clinical liaison with other groups, but patients are getting more complicated. People have the multimorbidity. People have more than one condition. More people have more than one condition. So you need to understand the interplay as well as with social factors and human factors. And that's where radiologists will really have a lot to offer.

SPEAKER_01: 42:49

If you could wave a magic wand and change one thing about the system now, what would you change? I

SPEAKER_00: 42:55

think I'd change the sort of structure. I'd put that one-to-one system in. So I'd make sure that everybody in the health service had a regular one-to-one with their line manager, which was not necessarily sort of judgmental, but it was kind of developmental with their manager. So as we have that web going through the health service of good ideas being able to come up from the bottom and culture being spread down from the top. I think it's about making sure we have time to develop our staff and every staff member should have regular time with their manager.

SPEAKER_01: 43:32

What's next for you, Kaf?

SPEAKER_00: 43:33

Well, I'm not quite sure. I mean, it's been an amazing experience being here at the college. I've loved it. Some wonderful people here. And I would quite like to keep trying to do some service improvement work. So anybody out there want to... I'm available.

SPEAKER_01: 43:52

Amazing. Kath, thank you so much for taking the time to talk to me today.

SPEAKER_00: 43:56

Thank you. It's been a real pleasure, Sam. One of the perks of the job.

UNKNOWN: 44:01

Thank you.

SPEAKER_01: 44:09

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