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. Alwyn Abraham has been a consultant trauma and orthopaedic surgeon at University Hospitals of Leicester since April 2007. He's also a medical educationalist, a clinical and corporate healthcare manager and he's pioneered multidisciplinary and global health services. Welcome to Transformational Thinking for Health Leaders, Alwyn. Thank you very much for having me, Fiona. It's an honour and a really sobering occasion to be able to share my thoughts and my experiences with you and your audience. Thank you. Thank you. So, tell us about your career journey since we first met at Edinburgh Medical School in 1990. Yeah, please fill us in on what you've been doing. So, I mean, the basics, the mechanics of progressing through a medical career applies to me just as it does to most UK medical graduates, medical school and then, as they were called then, PRHO jobs, which was the equivalent of the current foundation jobs. It was one year rather than two years. And then I did core surgical training in Edinburgh and I then got a registrar training rotation in the Northern Deanery, which is centred in Newcastle, but included the hospitals in Durham, Ashington and Middlesbrough. And then after that, I did a one-year post-registrar, post-CCT fellowship in Manchester and then I got my consultant job in Leicester 2007. And it's coming up to 19 years since then. I mean, I've packaged that and summarised that in a few short sentences, but clearly a lot extra has happened in that career spell that I've outlined. But at the same time, life runs in parallel and everything that one might expect in 35 years of life since starting university to currently coming up to three years within my 60th birthday, a lot has happened in life in parallel with my career. So I'm very grateful for how things have turned out and I feel extremely fulfilled with how things have turned out. Thank you. That's great to hear. So you had a fairly standard journey to becoming a consultant and now that you've been in your role for 20 years, you're the longest serving member of the trauma and orthopaedic on-call team in Leicester, aren't you? So, yeah. And what's the most significant piece of advice you would give yourself, Alwin, if you could turn the clock back? There are probably some aspects of developing your personality, developing your emotional makeup, which is what makes you who you are. And a lot of that has been through trial and error, I'd say, in my 20-year consultant career and perhaps even before that. And there are probably several people I owe an apology to. I'm sure that figure runs into at least double figures, if not more. But I wish I had known some truths about managing myself, about managing relationships with other people, how to get the best out of other people. I wish I had learnt some of that, perhaps through a slightly less painful process than maybe I have. And that's not just at work, but that's clearly in your personal life too, a family life, bringing up four children has been a real education. So I think some of those lessons that I've learnt might have been less painful, had a different opportunity or a different avenue, have presented itself. So many great insights there. Yeah, thank you for sharing. And I know that you led a department of over 90 clinical staff during the COVID pandemic. Obviously a really difficult time for so many people, both in health services and in general. And I'm curious, Albin, what did those years teach you about the human side of health care and how to maintain morale and performance of your team when they're under extreme stress? Yeah, I'd say that 90% or thereabouts of the people that I was leading and I was able to lead, I was working with, stepped up to the plate. And I guess like most things, you spend 90% of your energy on 10% of the population. So there were some difficult relationships that had to be managed. But in the main, I felt proud to be part of a group of clinicians who saw a crisis on the horizon, who then saw the crisis on them, then they were in the eye of the storm. And I think in the main, I was really impressed with how people modified their work, their life to fit in. And I think on the whole, I think I was very blessed and very fortunate to work with people who volunteered and did roles that they were clearly not accustomed to doing. So I was really very humbled in the main by people, by people I was working with and who I fortunately had the opportunity to manage. Thank you for sharing that. Yeah, really tough. And I guess, you know, is there any learning from leading teams under stress that you'd like to share? Obviously, you know, the legacy of COVID continues, doesn't it? And health care teams around the world are under increasing pressure. Is there any kind of specific learning around that that you'd like to share? Leading under stress, I think that was the point that you were trying to encapsulate. And what I'd say is that what I've learned is that it's almost impossible to ask people to change their behaviour, to change their intentions, to change their perceptions. It has to be something that they consciously choose to alter. And I think if you can't change people's behaviours, the very least you can do is make them think. And the most powerful way you can make people think is by setting an example yourself. So I've always believed in leading from the front line, leading by example, getting my hands dirty, making myself available, answering emails, answering messages. I think availability is probably the best ability, as my son very wisely taught me when we were playing fantasy football. But yeah, I think making yourself available, leading by example, having the moral courage to take difficult decisions, but also at the same time doing all these with kindness, not intending to overpower, hurt or belittle people. I think that's a really powerful lesson that I would highlight in the lessons that I've learned. Power is so important to be aware of, isn't it? I like to think of using power to empower others. Absolutely. And there's a huge amount of power that comes with enjoying the development, the progress, the celebration of other people's hard work. I mean, there's a huge amount to be gained from that. So for all that you might, you know, a lot of competitive medics feel the need to achieve. Actually, the achievements of others is probably something that you can celebrate a lot more than your own achievements. I know that collaborative working really matters to you and that you formalised a multidisciplinary limb reconstruction service, Albin. And I guess I'm just curious about what you've learned about building consensus with colleagues to ensure the best outcome for your patients. So a limb reconstruction service is essentially a small part of orthopaedics, which specialises in saving mainly lower limb cases, which are well on the route to an amputation, for instance, when there might be overwhelming infection, overwhelming blood, sorry, bone loss or overwhelming tissue loss after trauma, after infection. These are the two common scenarios. It's less common in this country than perhaps in other countries where trauma is much more complicated, where health and safety, driving safety is much less established. Fortunately, health and safety in this country legislation means that the vast majority of our citizens are safe, either on the road or in the workplace. And nor do we have, for instance, law enforcement officers or indeed gangsters shooting at us in Britain, which is the case in, say, in other parts of the world. And I'm thinking specifically of Iran. As we meet today, there are numerous calls for trauma surgeons, eye surgeons, neurosurgeons in Iran, because clearly the public have suffered at the hands of ballistic weapons. So going back to my own scenario. So number one, in Britain, the demand is a lot less. Number two, in Leicester, the demand is less than many other big cities in the UK. And that's partly because Leicester is a slightly smallest catchment population than, say, Sheffield, Leeds, Manchester. So that's one thing. And so it was a case of me setting up this service when I first came here to Leicester. There were a few consultants who were in the field, but it was a less collaborative team. So since I came, I've struck up a very close working relationship with plastic surgery, for instance, with microbiology, for instance, with certain physiotherapists, for instance, and some nursing staff, so that patients who are having really complex treatment can access help, advice, troubleshooting 24-7, pretty much. And a lot of that has been making myself available, like I said in the earlier part of the interview. Most of my patients have my personal mobile number, so they can text me or they can message me and be assured that I will see them the next day or within a few days. Or I can give them some really simple advice over the phone. And sometimes my patients are very, very far away. So if I'm in Leicester, sometimes I've got a patient in Skegness, which might be 120 miles away. The last thing they want to do is blue lights into a local hospital where their case is not really understood or at worst, drive all the way to Leicester for a five-minute bit of advice. So that ability to make myself available, I think, is probably, again, being a key. And clearly, that's something I enjoy. I enjoy making myself available, whereas a lot of people might find that very tiring, taxing to be available. But I enjoy answering people's queries in the right times, in the right place and at the right opportunity. So I think that's been my key field. I've gone a bit of a circuitous way explaining my service, but I think that's it in a nutshell. That really sounds like a great service. And I guess I can imagine quite a lot of psychological trauma as well as physical trauma for your patients too. Yeah. And the flexibility has also come in the way I've thought about it. You know, it's very, very common for specialists to be very, very narrow in their field, in their line of thinking. But I've realised the power that comes from looking at patients holistically, thinking about their psychological state after trauma, for instance, talking about PTSD-type symptoms. And for all that it's common to simply just refer someone to psychological counselling or clinical psychology or something similar, I've realised the power that comes with a surgeon talking about those things openly. And I do feel that in many instances I've been able to provide something similar that they might have got after a long, long wait, had they waited on the waiting list to see someone for PTSD-type treatment. So, yes, the ability to think outside the box, not just in terms of the service, but in my approach to managing patients. And I think that curiosity that I have to naturally look at things from a different angle, to look up new bits of information, to try new things, I think that's probably helped me in many ways. Did you know that workplace coaching is very well established as an evidence-based intervention for leadership, career development and increasing well-being 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. That's great to hear and I can imagine it really makes a difference. It sounds like a wonderful service. And I know these kind of developing trauma services has been something that has really mattered to you during your career and that you've helped develop a trauma department for 7 million people in Ethiopia. I mean, gosh, I guess that's a pretty massive undertaking. I wonder if you could tell us a little bit more about that, Alwin, and how it influenced your perspective on UK health services and how or whether you bring a more kind of global mindset to your job these days. So probably best for me to say why I did it and that's a much more difficult question. But I'm, you know, I'm a great believer in how medicine is practised in the UK and I, for all that the GMC and all of its edicts get a hard time, I think some of the directives which come out of the GMC, for instance, the multiple consultant reports, 9 GPCs and at the centre of the GPC is what your values are, what are your principles. And I think the most effective consultants are those, sorry, not just consultants, I think the most effective clinicians, either in primary care or secondary care, are those in whom the values and principles are extremely clear. So I think I did it as a way of self-development, of wishing to fall in love and maintain the love for medicine and the reasons why I did it in the first place. And it's very easy to be surrounded by negativity and it's a common scenario, isn't it, that people are disillusioned with how healthcare works in the UK in spite of the NHS being as it is. So I think I did it as a way of partnering with enthusiastic people who had a great need and also fellow medics from Britain who felt similarly enthusiastic about giving something back in a very meaningful way. So I'm very grateful to a registrar of mine, actually, Laurence Wicks, who went out to Ethiopia initially in 2013 and two years later said, Alwin, you need to come out with me. I was his clinical supervisor at the time, so we went out together. And since then I've been back about 10 times and a lot of it is credit to Laurence and a few other people, including Chris Kershaw, who was a senior colleague of mine in orthopaedics, Richard Power, who was also clinical director at the time and who had tremendous connections with Rotary and who multiplied my efforts clinically into something much more powerful. So I mean, just to summarise, Ethiopia wasn't blessed with orthopaedic specialists. Ten years ago, there was just one meaningful department in the capital, which was very stretched and which did all the training for a country of 90 million people. And since then, we've achieved a training rotation outside the capital and many other rotations have come up in parallel. So I'm not saying ours is the only one outside the capital, Addis, but there are many others that have also similarly flourished. We have left behind partners who specialise in pelvic trauma, acetabular trauma, spinal trauma, children's trauma, hands trauma. So no longer is it the case that if you had a really nasty fracture, you had to be put on the back of a pickup and driven 600 miles to the capital. You can actually have treatment in the northern part of Ethiopia. The region is called Amhara. That's the province around Lake Tana. Lake Tana, a bit of trivia, is the source of the Blue Nile. The Blue Nile comes from Ethiopia, the White Nile from Kenya. They meet at the confluences in Khartoum and then you get the Big Nile in Egypt. So that part of northern Ethiopia was very impoverished when it came to orthopaedic care. And I think there's been tremendous benefits since. And that's not to say we've fulfilled all the need. No, we haven't. There seems to be a lot more to do. But local orthopaedic surgeons and the whole orthopaedic community have risen to the challenge, knowing that there are people outside Ethiopia who are rooting for them. So that's really been the success story of that particular project. Sounds like a really amazing endeavour and also this kind of great opportunity to train and develop other people. So let's talk about your role as a trainer. So you're a trainer, training programme director and also the national organiser for training orthopaedic trainers. So you obviously really have a significant influence on the next generation of surgeons, don't you, Erwin? So what do you hope your legacy will be regarding culture and standards of trauma training in the UK into the future? I'm very proud of how training works in the UK. In fact, I think, like we say, the NHS has become a victim of its own success. I think you could probably say that about education, medical education in the UK too, to a certain extent. Medical education in the UK is second to none in terms of the interventions, in terms of the metrics, in terms of the accreditation, in terms of the systems that exist to provide the public with the quality of specialists they deserve. And I am a huge supporter of postgraduate medical educational standards as the standard present in the UK. And I think these standards will only exist, they will only be sustainable if we have enough humans in the system willing to make it work. And I am a small cog in the wheel. So I've been training programme director for core surgical training. I've been a training programme director for higher surgical training in TNO. I'm very fortunate now I'm on the specialist advisory committee, which oversees the curriculum for orthopaedics and which sets the standards for accreditation via alternative routes, for instance, Caesar, Portfolio Pathway, etc. So I've learned a huge amount. And in return, then, fundamentally, it's made me a better trainer. I think if you, you know, if you come to me as, you know, if you get allocated to me in the future as biopic TBD as a trainee, if I'm your AES or your clinical supervisor, then I think I do understand what surgical training is trying to achieve. And I think I can give you meaningful feedback. And fundamentally, trainees develop if they get feedback. And that's a really difficult, complex concept. But I think that's fundamentally what I've been able to achieve is become a better trainer. I'm very grateful for these opportunities. Creating cultures of where it's safe to give and receive feedback is so important, isn't it, to psychological safety. So it's great to hear that that's how you've been working. And I guess, you know, thinking back over the last 35 years from when I first knew you to chair elect of World Orthopaedic Concern, I'm just kind of curious about you as a leader and, you know, whether you always felt ready for the next level of leadership or have there been any moments where you doubted yourself along the way? Always doubted myself, always doubted myself. I probably don't doubt myself now because I feel really comfortable with who I've become. But like most young adults, and I'm sure you will reflect in a similar way, Fiona, you will say there was a version of you 20, 30 years ago, which was still searching for comfort in who you are, what you stand for, you know, are you comfortable in your own skin? And there was a lot of, you know, there's a fair bit of history to Alwyn Abraham through youth, which meant that I was not a natural leader. And I remember being absolutely petrified at medical school, having to stand up and do an announcement or having, you know, having to answer a question in front of lots of people in a lecture theatre or in a seminar. And literally, I was the guy who would get physiological responses when I was put on the spot, you know, tachycardia and all of that. But socially, one-to-one, I was fine. But I probably had a lack of conviction. And I think that's the main change. I feel all my experiences have given me a real conviction of what I do. And I don't claim to be nowhere near the best orthopaedic surgeon or the best specialist in my field. I think I'm average, and I'm happy to be average. But more important, I have a real conviction of how I want to use it and how I want to use it for the betterment of people I work with, the system I work in, and the people, the patients who are under my care. We know that, you know, adults grow and develop during the course of their lives and that they move from this kind of socialised stage where we're validated by external exams and kind of society's views and exams and awards. And that kind of tells us that we're good enough. And, you know, we can move beyond that to develop our own internal standards. And that's called moving to becoming self-authored. And you described that really beautifully. Yeah. And I can see that very clearly in some of my colleagues. Some of my colleagues are extremely gifted technically, and they cruise through exams, through training. But they flounder at the other end. They're not quite sure what it all means. And they are still a spark rather than a flame. And I think that's a really powerful thing to consider. How will you change your career from a spark into a flame? And that's how you then leave the best version of yourself for others to feed on. So, yes, I think it's a really important lesson that I wish I had passed on to my younger version. So obviously your flame is burning really strongly, Alwin. So, yeah, what's coming up next for you in your professional life and the foreseeable future? Well, like most big acute hospital trusts, mine is floundering. So out of 135 trusts in the league table, we are like 101st. And so as in my new role as deputy divisional director, if I can elevate it five places in the next five, ten years, I think that would be an amazing thing if we could be in the mid or low 90s rather than 101st out of 135. And anyone who works in the big teaching hospitals, Leeds, Sheffield, Manchester, Liverpool, they will know what it's like to work in a big acute trust with all the complexities and all the inefficiencies and all the challenges. And mine's no different in that sense. We have the biggest busiest ED in the country, one ED for like one million people. And so that puts a huge amount of stress on the acute service. And, you know, as Nick Robinson very wisely said at a recent orthopaedic conference, it's the economy, stupid. If our economy is stressed and stretched, then so is our health care. So I can't see us benefiting from increased investment, increased infrastructure in the NHS. Unfortunately, we have got what we have and and it's all down to the human factors of trying to make make it worst as best possible. So I'm not I'm not kidding myself. I don't think, you know, UHL will be elevated by several places in my in my of my tenure. But if I can if I can somehow get a little bit of change to make us a slightly more effective department, achieve some of those KPIs which are seen on a national panel and which are visible to a public, you know, to the public and to patients, then I think that, you know, I think it would be fantastic. There's a reality of working within our resources for sure. And it sounds like you have a clear vision of how you can progress things. So, yeah, thank you for being here and sharing with us today about your professional life over the last 35 years. It's been really great to connect with you again and to hear more about all the amazing work that you've been doing and continue to do. So thank you again. Well, thank you very much yourself, Fiona. I mean, you were very, very kind. You were very kind. And you gave some of your some of your time to talk me through my some of some interview, perhaps. So I think credit to you to to make me think at the very least about about some of these concepts that I've talked about today. It's been my pleasure. Thank you again for joining us. 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 www.fionadayconsulting.co.uk to help me to better meet your needs. Thank you for listening and for your commitment to transforming health outcomes.