Creating change from within

Until she took up her current role, Tracey was Chief Executive of Australia's largest charitable hospital group. We asked her to reflect on the challenges of working in two very different health care systems and how she thinks we can reform the NHS from within.

Are the health and care challenges we face in England very different from those in Australia?

There are many parallels between the two health systems, with the key pressures being an ageing population, a growth in long-term financial constraints, escalating costs from technological advances, growth in community expectations and the challenges of integrated and personalised care. We are all having to provide the best possible care in a constrained environment.

There are, however, a few differences particularly between the geographies and population size of the two countries. Australia is more than 31 times the size of the United Kingdom, but the United Kingdom has three times the population.

We are all having to provide the best possible care in a constrained environment.

The State of Victoria in Australia (where, from 2004 to 2008 I was Chief Executive of Eastern Health, a large group of public hospitals) is a similar size geographically to the United Kingdom but has a population of 5 million people, which is less than half the population of London (more than 13 million people). These differences alone bring different challenges.

There is a big focus at a policy level in Australia on the social determinants of health, which I have not seen as much of in the United Kingdom. In Australia, this focus is driven by a huge gap in life expectancy in the Australian community: the indigenous population has a significantly lower life expectancy than the non-indigenous population.

Where do you think the potential lies for the NHS to achieve the transformational change that is so necessary?

The NHS needs to shift the paradigm from an illness to a wellness system. We still predominantly treat people when they're ill rather than focusing on keeping them healthy at home. There needs to be greater focus on prevention and primary care and more integration between health and social care. The health and social care system appears to be quite fragmented in the United Kingdom and I'd therefore like to see a more population-based approach to funding service delivery and performance.

To what extent do you think this improvement can be brought about by improvement from 'within'?

External top-down approaches have a very important role to play in achieving specific goals but deep and sustainable improvement has to be brought about from within. There are almost 10,000 individuals working in Imperial College Healthcare - the potential in harnessing that enormous energy, innovation and commitment is what makes me optimistic about meeting the very significant challenges for future health care.

As we develop our new organisational strategy, we are looking at the lessons we can learn from approaches such as the Cleveland Clinic's patient experience programme where all staff came together around a clear vision for patient care to achieve remarkable results.

You have a clinical background. How can we get more clinicians involved in the leadership of NHS trusts?

I think it is extremely important for clinicians to be involved in leadership, as they understand the competing pressures of quality and cost. Imperial runs a paired-learning programme that aims to create a better understanding of new ways of working between clinicians and managers, helping them to understand each other's work and breaking down the barriers that can so often get in the way.

Our aim is to create an environment where enhanced engagement between clinicians and managers leads to successful quality improvements, improved cost management and enhanced personal development.

The programme was created by one of our clinical leaders, Dr Bob Klaber, who is a pediatrician, and its aim is to create an environment where enhanced engagement between clinicians and managers leads to successful quality improvements, improved cost management and enhanced personal development.

The organisation also runs a number of leadership programmes, including one specifically for aspiring clinical leads. Imperial has also teamed up with Imperial College to run a certificate in medical leadership - aimed at clinical directors and chiefs of services - for our aspiring clinical leaders.

In Australia, there is a defined pathway that takes doctors into clinical management. A trainee doctor does three foundation years of clinical training and can then specialise in medical administration, as doctors specialise in a particular area in the United Kingdom.

The programme is run by The Royal Australasian College of Medical Administrators (RACMA) and at the end of the programme participants receive a Master's degree in health or business administration as well as a fellowship of the RACMA. This puts aspiring clinical leaders in a good position to become a medical director or even a chief executive.

Finally, given the prominence of men in leadership roles in the health sector, what advice would you offer to aspiring women leaders?

My advice to any aspiring leaders would be as follows. I'm a big believer in both formal qualifications and experience.

It's been helpful in my career to have a mentor from outside the organisation. I've found it useful to brainstorm with someone who has objectivityand also to learn from their experiences. It is also a great opportunity to reflect on career options.

A work/life balance is very important, as is the support of your family and friends. It's extremely hard to strike a balance, but if you have support and encouragement at home, it can make a huge difference as a leader.

As a leader you need to have a great team who want to work for and with you.

Finally, be true to your values and leadership style. As a leader you need to have a great team who want to work for and with you. In my experience I have dound that integrity is essential to earning the trust and respect of your team.

The King's Fund Annual Conference 2014, High-impact approaches for long-term improvements, is on 13 November. Click here to find out more and book your place now.