Welcome to Transformational Thinking for Health Leaders. I'm Dr Fiona Day, EMCC Master Practitioner, Coach and Mentor, and a registered Chartered Coaching Psychologist with the British Psychological Society. This is a podcast that will help you meet your most complex leadership challenges and transform your perspectives, helping you to become a more effective and creative leader with a deeper understanding of yourself and your own world of work.

I'm committed to transforming health outcomes through my work and to supporting and developing outstanding medical and public health leaders who are able to thrive in complexity and chaos, bring clarity and compassion to those they serve, and improve health outcomes whilst also taking care of themselves in order to enable their own best work. I hope you enjoy listening to today's episode. Dr Imran Ahmad is a GP board partner for a large primary care organisation in London.

He's also an experienced GP training programme director, integrated care system GP clinical lead, and has recently been appointed as a representative to the London-wide local medical committee. Welcome to Transformational Thinking for Health Leaders, Imran. Thank you. 

Pleasure to be here, Fiona. Thank you. So Imran, tell us about your career to date and how you got into leadership roles.

Yeah, thanks, Fiona. So I guess my journey is perhaps a little different from listening to some of your other speakers on your podcast where I think with many leaders they know from quite early on in their career that they want to get into leadership. Whereas with me, I came into medicine with very traditional values and I was very much influenced by certain role models.

My father was a single-handed GP. I had a GP trainer who was really inspirational in terms of that traditional mindset of compassion, dedication, excellence, and giving your all to the patients in front of you five days a week. And I became a full-time GP partner in Surrey where I cared for my named patients five days a week where continuity of relations were everything.

And a lot of the leadership and business aspects that we need to learn as GP partners and leaders as doctors were, I think, as many people feel, I very much learned organically on the job. But then I also developed other interests, interests in medical education and training, and I did want to slowly get more involved in the leadership space. But patient care was very much the primary focus of my day-to-day work.

But about three years ago, I reached a crossroads where I relocated for family reasons, and I used that opportunity just to, I guess, hit the reset button on my career and create a space to really reflect on what I wanted to do professionally. And it was an opportunity for reinvention for me, was to consider how I could really use my experience to make more of an impact beyond individual patient care. And I was fortunate to join a group of ambitious partners at the time, and we started a journey to evolve our GP practise to become a large at-scale GP organisation focussing on growth and sustainability and system impact.

And I've also started to take on some wider system leadership roles. As you mentioned earlier, I've been a clinical lead for the ICB in the local borough in a transformation project, and I've continued as a GP training programme director, developing the next generation of clinicians. And I'm always trying to continuously seek opportunities whenever I can in the limited time I've got outside of my working roles to develop my leadership skills and self-awareness, including working with a leadership coach.

And I guess for me, the real reflections on my journey so far and how I got into the leadership role is that it's never too late to reevaluate your direction. I mean, I was fortunate to have the opportunity, but actually, looking back, I think it's really important that, for us as busy clinicians, is that whether we're going through change around this or internal reflection, I think it's really important to step back regularly from the day-to-day grind and ask ourselves, is this still what I want to do right now? And how can I shape my next five years to align with what matters to me most? And I think leadership journeys often really begin with self-reflection, curiosity, and purpose, not with positions and titles. So I love how you're kind of really congruent with your values and the kind of original values that you came to medicine with and that kind of more traditional model of general practise, but how you've kind of still kept a lot of those values as you've moved into leadership roles, but also how you have been really kind of conscious about your career direction and the impact that you want to have and, like you say, that kind of constantly re-evaluating.

And I guess for you, there was kind of this opportune situation of kind of moving for family reasons and then kind of rethinking and recreating what you wanted this next chapter of your career to be about. But it sounds like even since you've moved and started to recreate it, you're continuing to consciously recreate it on a kind of regular basis, aren't you? So yeah, really great to hear that, because careers are long, aren't they? And, you know, we're in a very dynamic context and we change and grow and evolve and that traditional three-stage model of education, employment in the same role, doing the same thing for 30 years, and then retiring is not really the model. That's the kind of the modern career, either in medicine or public health or, you know, indeed in most kind of professional careers around the world.

So, you know, in terms of these leadership roles that you have grown into over the last few years, then from being a traditional GP partner to now being a board partner in a rapidly growing GP practise organisation, I suppose I'm just curious about how that's been and any challenges that you faced during that kind of process of transition. Yeah, yeah, I think it has been an interesting but at times challenging transition as well. So I guess there's a few different areas that I've had to navigate.

So one is a shift from a very clinical and operational focus to one of strategic leadership. As I mentioned earlier, our medical training doesn't really give us much in terms of strategic leadership skill set training. So it's been really important for me to actually upskill in that area and I guess move away from some of the comfort zones that I've had over the last 10 years.

So I'm talking about comfort zone as well, letting go of direct patient care. So the day-to-day basis, being very involved in patient care, you have to really step back from that as you're transitioning to a more leadership role and start to put more trust in wider symptoms and being able to shape wider symptoms. And adapting to organisational scale and pace of change.

I think as a leader, if you're not comfortable with showing that you're able to adapt to change, then those around you will see it. So change is really difficult carrying your employees, your staff with you on change. It can be really, really challenging for staff.

So you have to show as the leader that you're not only comfortable with it, but why it's beneficial to all of those around you. And we talked a little bit about the qualities and values that we inherently bring into what we do and it's balancing growth with that. So it's maintaining, making sure that when you're growing, you are maintaining those qualities and values that are so important to the direct patient care.

I think just generally developing a systems level perspective rather than an individual practise view. So I guess most recently I've been navigating the new GP contract changes from 1st of October and I've had to vary quite considerably what my approach might be to that as a larger organisation than being a more traditional hands-on partner if you like. Yeah, so I was a GP registrar when the last contract change happened 20-something years ago.

So obviously it's a kind of massive change. How is that going for you and colleagues? Yeah, it's really, I guess, a really interesting question because it was more of, I guess, put on us as a contract variation, but I think it's a really good example of why it's so essential for us as frontline clinical leaders to be very much driving the change for our organisation. So I guess one of the main things of the contract that many of us are navigating was the Department of Health created a need for us to have our online access open for routine queries for patients throughout all core hours right up until 6.30 and already when we're struggling in a system where you're navigating a huge mismatch between patient demand and capacity within your systems.

So this has, I think, led to a big challenge where if we're effectively opening up the channel for demand more, how can we do that? And I think you could sort of take a viewpoint that you just have to sit back and just deal with it, but I think it's really important that you actually look at a lot of the reasons behind what's driving patient demand as practises and organisations and try to adopt your systems to that. And for me, I guess, as a traditional partner, what I may be more inclined to do is very much pull my sleeves up, get stuck in more, be on the ground five days a week and have that perhaps a little bit more of a directive style or a kind of a pace setting style where you're very much there and just driving yourselves harder and harder, that sort of hero mentality. Whereas as a leader of a larger organisation, you have to take a different approach and you have to actually evolve your systems to be able to adopt the change and make sure that you're taking your staff with you and not risking them burning out and working harder.

So it's been an interesting challenge, but we're still in the middle of it. We're still busy and I'm sure we'll get there. Yeah, so kind of lots of changes going on there.

And I guess what I really hear as well is kind of knowing that you can flex your leadership style according to the context, but also being a pace setter is such an important part of being a leader and knowing the right pace, like you say, about not burning people out in the process. And leadership is such a kind of relational business. It is always about your relationship with your colleagues and the people around you and taking people on a journey, isn't it? So it sounds like you're doing that in a really kind of conscious way.

And I guess I'm wondering about strategic thinking that you mentioned. And I suppose I'm just curious about your experience as a GP training programme director and a clinical lead GP for a local transformation project and how that's then feeding into your GP board partner role and helping you kind of grow and develop yourself as a leader in terms of what we call the vertical aspects of leadership development, the horizontal aspects being learning kind of technical skills around leadership, but the kind of the growth in gravitas and growth in ability to think strategically is what we call vertical development. So, yeah, I'm curious about these other roles, leadership roles, and how they feed into what you're doing in your kind of main job.

I think there's certainly been a big overlap in terms of these roles and what I do as my main role. And I think I've benefited from having a different lens, a different viewpoint from having different roles. So my training programme director role very much focusses on the future workforce.

So there's a big element of mentorship, sustainability in the future workforce, enhancing skills in developing people and planning longer term. And the other thing I found as a training programme director is the real added value in applying, I guess, the leadership lessons beyond the GP curriculum. So encouraging trainees to see themselves as future leaders, to understand how they can influence the systems that they work in, and actually using a coaching approach to help them identify and develop those skills.

So I think that's really important for the future of our workforce. With regards to the ICB transformation project that I'm involved in, that itself has been, I think, a real eye-opener in terms of new leadership approaches that I've had to adopt. So here there's been very much involved in an exposure to system leadership and stakeholder engagement and navigating different kinds of challenges with different approaches.

So complex change and innovation, working with multidisciplinary teams to enhance engagement with stakeholders at different levels and ability to manage change. And so that's been interesting as well. And I've certainly noted that often when you work with different stakeholders, sometimes you can really face challenges in terms of, again, I guess those traditional leadership styles and it may not work in that sort of setting.

So having to really build trust, build relationships across stakeholders and having a shared vision across organisations, I guess we're all working together. And here leadership, I guess, means more around facilitating alignment rather than trying to enforce control. So I guess these roles have very much reinforced my need to maintain and develop strategic thinking and an essence of collaborative problem-solving as well.

Did you know that workplace coaching is very well established as an evidence-based intervention for leadership, career development and increasing wellbeing with over 10 systematic reviews and meta-analyses consistently demonstrating this? It's also been found to be very effective in a recent systematic umbrella review of leadership training in healthcare specifically, as well as in other systematic reviews and meta-analyses of medical leadership development. And did you also know that coaching psychology, a subspecialty of both coaching and also of psychology, was shown in a meta-analysis to be even more effective? If you're enjoying this or any episode, please would you help me as a coach and coaching psychologist to contribute to transforming health outcomes and supporting health leaders by sharing my podcast with a peer or colleague? Thank you and now back to the podcast. Yeah, it's great to hear all of that and how, you know, as you become increasingly skilled as a leader and moving into those kind of system leadership roles and different ways of leading that are needed in terms of that kind of very much collaborative approach aligning multiple complex agendas.

And I suppose I'm curious, Imran, about, you know, how you've navigated this journey, particularly, you know, in the last few years where it sounds like you really kind of accelerated your own leadership development. What's been helpful to you? Yeah, so I think the impact of learning new styles, so first and foremost, identifying your own blind spots as a leader or your own developmental needs, being willing to adopt to learning new styles. And for me, there's been a lot about self-development but also coaching.

So I've been obviously fortunate to work with yourself as a leadership coach. And I think it's really important because sometimes you do need to reach out and seek external support to help guide you. And I guess that the key learning things for me is that good leadership, it's contextual, it's dynamic, it's not a one-size-fits-all approach.

And as I mentioned earlier, a shift from directive and pace-setting styles towards more collaborative and adaptive leadership styles, that's really helped me to be able to adapt to new challenges. And I think what I've found as being involved in a large organisation, I've needed to adopt to a greater emphasis on listening, empathy, feedback, developing more of a transformational leadership approach to help inspire and motivate each other and motivate others around us. And with that, you need an awareness of self-reflection and emotional intelligence as part of a leadership tool.

So, I mean, for example, I could give you an example and that's when we first set out on this journey, managing resistance to change within our organisation has been a big factor. And I think whereas some of our traditional leadership styles as clinicians on the ground, the kind of top-down decision-making, I've had to take a step back. And I think with some input from my coaches' guidance, I've had to sort of realise that sometimes you have to have a bit more of a need for more of an inclusive approach.

And so, for example, a series of listening sessions with team members at different levels of the organisation where you can discuss concerns and ideas openly, make staff really feel listened to, that not only helps in addressing resistance, but giving a sense of shared ownership and collaboration among the team. And I think then you really create more of a purpose of the team feeling empowered and aligned with your direction and they feel like you're taking them on the journey with you and very much a shared decision-making. I guess very much like I remember you said to me once, a big part of it is about diagnosing a problem, I guess, like we do traditionally with patients, identifying the pattern and then applying the right style.

And so much of that skill set we can transform towards a wider leadership within our organisations. Yeah, it's great to hear how you're using that increased kind of self-awareness to be able to kind of observe the situation and you call it, you know, in terms of emotional intelligence, it's kind of like the psychological edge of leadership. You know, leadership is incredibly demanding of our psychology in terms of, you know, learning how to be able to observe what's happening and then engage our prefrontal cortex to work out what needs to happen next rather than kind of being driven by emotion like we might normally as human beings be driven.

So, yeah, thank you for sharing all of that. And I guess, you know, I know, you know, your roots are really in the clinical demands of being a GP, aren't they? And that you're still practising clinically. And I'm curious then, you know, how are you balancing the clinical demands of being a modern GP, a contemporary GP with your leadership responsibilities at board level and your other roles? You know, I imagine your, you know, your weeks are pretty full, aren't they? So how do you do that? And do you have any advice for anybody in similar positions? Yeah, yeah.

I mean, I think this in itself is a huge challenge, how you balance your weekly needs across the week, clinical against your leadership and board responsibilities. I mean, some of the requirements, I guess, are fairly obvious in a sense. It really does require a strong sense of prioritisation, a strong sense of time management, boundary setting with people around you, including the leaders within your organisation, often quite sort of challenging conversations we have to have with each other to ensure that we're all on board with what our individual needs are.

And I think certainly had to have much more of an emphasis on delegation and on developing capable teams as well. And recognising when to step back from clinical work to focus on strategy. I think, as I mentioned earlier, sometimes there's that track that you can flip back into your comfort zones, what you've been comfortable doing for many years, but often you just have to take the strength to say, I need to step out of my comfort zone and focus more on driving the strategy and driving the organisation around me.

And just, but still really important to maintain connection with the frontline to keep decisions patient centred and to ensure that the team very much see you as one of them, as a frontline clinician, not just somebody who's in the background. So I guess one of the most important pieces of advice I would give that I found helpful is that you really need to trust your team and you need to see delegation as a growth tool, not a loss of control. And delegation isn't just a case of making your life easier so you can get on with the work that you do, but it is very much a growth tool.

It is very much allowing those around you to be able to grow and learning lessons from that. So seeing where, if they make mistakes, but as you delegate to them, you can help to support them constructively and help them to take more work on. So it sounds like you're growing a really kind of psychologically safe culture around you of safe to experiment and safe to learn and grow and develop, but with this very much kind of growth mindset of, there's kind of like, there's no upper limit really, is there, in terms of human potential here and how far your staff can grow and develop.

And I love what you were saying earlier in terms of the registrars and helping them to see themselves as leaders. And it's not a kind of label that you kind of get stuck onto you, but it's kind of, it's already there and helping people to, it's about cultivating an identity as a leader that kind of gives people some kind of internal confidence that then allows them to display more leadership behaviours. So, you know, just thinking about, you know, this reflections that we're taking here in your own, you know, around your own leadership journey and any advice you'd give other clinicians who are looking to take on leadership roles.

Yeah. Yeah. So I guess first thing I'd say is, is don't underestimate your clinical experience and how much of a foundation that is for credible leadership.

So much of what we do, we do just develop leadership skills very much in terms of what we've had to navigate throughout our clinical experience. So it's really important just to remember that serves as such a bedrock for credible leadership. One of the other things is that leadership is learned, it's not innate.

So invest in your personal development, invest not only in terms of external resources, but far more than that, I guess, internal space, time and time to reflect, time to actually put principles into practise because without that, it's very hard to actually develop your leadership. Seeking mentoring and coaching early, seeking the right coaches and the right mentorship. So mentorship and coaching, it is, I think, really important.

But on top of that, it's about your own ability to be able to grow as well. And I guess one of the most important things for me is about remembering that leadership, it is a growth journey and growth journeys always have some sense of discomfort, stepping out of your comfort zone. So the common things that we hear so commonly, the imposter syndrome, it's almost certain that at some point you'll get a sense of imposter syndrome, but that discomfort is what helps us to grow.

And at times it can be challenging for us. It can be psychologically challenging when we feel very uncomfortable and when we feel challenged. And it's really important that we have a big sense of self-awareness, that's a big part of it, being able to embrace the discomfort, I think is a huge part of growing as a leader.

And as we mentioned before, always lead with your values, know what your values are and lead with them. And have the conviction to stick to your values, particularly when they may feel challenged because of whatever pressures are going on around you. It's so important that we keep patient care and team wellbeing as central to what we do on a day-to-day basis.

Yeah, some wonderful advice there. Thank you for sharing that. And finally, Imran, I suppose I'm curious about as you look back so far on this first half of your career, I'm sure that you're going to go on and do some amazing things into the future.

But looking back so far, what do you feel most proud of so far, do you think? Yeah, so I would say what I really feel most proud of is helping people to move forward and locking potential in others. So particularly say people might be stuck at a part of their career or if they feel that they've reached their ceiling, making them realise that they can still grow. So some of the proudest moments for me, for example, are say supporting GP trainees to overcome barriers.

So I've been involved in some GP trainees who say have got stuck on their consulting assessments for linguistic difficulties or other reasons and being able to see them succeed to not only come over those barriers, but eventually become really confident and independent GPs. I think that's been one of the most proudest moments for me. I guess that also reflects a little bit in terms of that coaching leadership style, enabling people to focus on their own reflection and empowerment rather than direction so that they know that they're driving in a direction that's their own rather than being empowered on them from the outside.

And I think that just, I guess, spills onto just generally developing future leaders. That's what I'm really, really passionate about continuing to do. So supporting colleagues to grow both within the organisations I work in and the other work streams around me, but being able to grow themselves, taking ownership and eventually surpassing me.

So what I'd love to see is that I have leaders around me that are actually surpassing me, challenging me and helping me to step back and succession plan. I think that's a real true mark of leadership success. So one of my favourite quotes when I've done a little bit of leadership, thinking about leadership is a Chinese philosopher Lao Tzu who said, a leader's best known when people barely know they exist.

The people will say, we did it ourselves. That's the kind of leadership that I would love to aspire to one day. Thank you, Imran.

It's really wonderful to hear all of this and how, again, you know, that kind of really kind of values congruent leadership, but also you're really, how you really embody growth mindset as a leader. And yeah, really inspiring to hear that. And I'm sure really inspiring for everybody around you as well.

So thank you for sharing all of your views and experiences and reflections with us today. Really appreciate it and wish you every success for the future. Thanks very much, Fiona.

It's been a real pleasure again. Thank you. If you've enjoyed this podcast and would like to find out more, head over to www.fionadayconsulting.co.uk and you can receive three hours of free CPD through my health career success programme.

And there's loads of other resources to support you as a medical or public health leader on my website too. I greatly value any feedback and to know what you would like more of. So please don't hesitate to get in touch with me at fiona at fionadayconsulting.co.uk to help me to better meet your needs.

Thank you for listening and for your commitment to transforming health outcomes.