Author:
Vicky Le Grys

Vicky Le Grys is a Programme Director at Cardiff and Vale University Health Board. She led the development of the Health Board’s Major Trauma Centre before being one of the senior leaders in the development of the Dragon’s Heart Hospital.

I have always had an interest in the theory behind leadership as I completed a Master’s degree in Human Resources management, with a dissertation in leadership development. However, I could never have imagined where it would take me.

Prior to the COVID-19 pandemic, I had only worked for Cardiff and Vale UHB for just over a year. Before that, I had worked in NHS England, in HR and Operational roles and for the last 8 years developing and leading the Major Trauma Network in Bristol and the South West.

This was a hugely important time that shaped my career forever. It made me appreciate the importance of developing clinical networks, working across organisational boundaries to achieve a common purpose.

However, when I started on the South West Major Trauma Network in 2010 networked models of care this was a relatively new concept. This model, based around whole patient pathways allowed us to develop new structures and ways of working that were different to the traditional silos that we work in in the NHS. It also brought a degree of autonomy, my team and I had the permission to develop ways of working and systems, working outside of traditional organisational constraints.
This whole process taught me a lot about the importance of multidisciplinary and cross organisational working, the need for continuous and open communication and engagement, the crucial role of audit, research and outcomes data to inform service development, and having a robust but fairly flat structure that supports teams to make decisions and implement change.

So when the opportunity to develop the Major Trauma Centre role came up in Cardiff and Vale UHB, it was a natural step for me. I wanted to use my experience to support the development of a new network for Wales.

When I came into the role, it was a two-year fixed term so it was somewhat of a leap of faith. People I spoke to at the time said it would take longer than that to launch it, but we managed it within a year.

I was really lucky that I was working alongside some passionate and brilliant clinical and managerial leads and surrounded by a huge team of people in existing roles from different specialities who wanted to get involved. Inherently, my role was about supporting and encouraging them, capturing that enthusiasm and momentum, and developing a structure and plan that allowed them to do their jobs as best they could.

We needed the experts in each area of the pathway to shape and plan their specific areas and lead on the delivery of these component parts. But we also needed to provide the space for them to come together to deliver the shared vision and achieve the goal within the timeframe. Without that expertise, and the willingness I don’t think we would have had the gravitas for it to develop the way it did with such pace. The clinical experts not only lead on the implementation of new pathways and processes but they helped to write and present the business case and really got into the detailed planning, it was clear that this was a new way of doing things.

Just as we were getting to ready to launch the centre, COVID-19 hit.

I was taking a bit of annual leave following the decision to postpone the launch of the Major Trauma Centre when I got a call from the Health Board’s Chief Operating Officer asking me to join the team to build a temporary surge hospital in Cardiff to the meet the anticipated demand on beds.
We had to approach it in a similar way to how we developed the Major Trauma Centre, a whole system approach but with much tighter timescales; supporting experts to make key decisions about their areas at pace. We needed a clear aim of what we were doing and why we were doing it, something which we could return to in moments of doubt and darkness in the midst of such challenging times.

At the time, the infection rates were increasing at such as pace that meant we would need to find 2,000 extra beds in just two weeks to meet the demand. So, the message was clear: based on the data we had, we needed to build what became the Dragon’s Heart Hospital in just days in order to save lives.

That being said, working on the Dragon’s Heart Hospital was the furthest out of my comfort zone I have ever been. I certainly suffered moments of imposter syndrome, thinking “can I actually do this? Am I the right person?” but in reality I didn’t have time to worry about that for too long!
When you start a new job, there’s always an already-established team of people who can support you. But at the Dragon’s Heart Hospital, everyone was new to what we were doing so it did feel like we were all in it together, we had to rely on each other’s skills and knowledge and there was a lot of trust built very quickly.

I think that’s what allowed the process to be as transformative as it was. We were all coming from zero: there wasn’t the type of hierarchical structure you see elsewhere in the system. Instead, it was completely collaborative and built on the need for speed and scale and therefore it didn’t matter about your job title just that you had the skills to do a certain task or job.

We started from scratch and we felt like there was nothing we couldn’t do. We weren’t fighting the inherent barriers of doing things the way they’ve always been done. The 3 touch points during the day to allow the teams to come together, make decisions, agree actions, escalate problems, link people together and be heard was very important. Not always easy to chair but invaluable for allowing people to just get on.

This was a big lesson for me from the Dragon’s Heart Hospital. If we want staff be truly innovative and make real change to our services then we need to empower them to progress and develop their ideas fully, share in the vision but making it real for them and support them by giving them support and space and connect them to others rather than being averse to changing the status-quo.

Being a leader in a system such as ours is about having an intimate knowledge of its strategy so that you’re able to demonstrate to your colleagues how their individual work contributes towards the whole.

We have to trust that the people who are delivering care to patients every single day have valid ideas about how they can improve what they do. Everyone can be an expert but if you allow an organisation’s culture to get in the way of their ideas, they will simply be lost.

Trust is the most important thing. Trusting people, trusting your colleagues, trusting the process, trusting yourself. Everyone has moments where they question whether they’re up to the challenge. It helps if you have someone who’s willing to fight in your corner but you might not always have that person so you have to have confidence in yourself and how your own work is contributing to the system’s shared goal.

Secondly, you have to focus on the relationships. Getting the right people on board should really be the starting line for any new project and providing the structure and space for those relationships to flourish. We’re all guilty of working in our own silos to an extent but we can accomplish much more if we work to break those barriers down first.

I think that we already have a very engaged workforce; it’s clear that everyone who works in the NHS cares a lot about their job and making things better for the people we serve. There are also a lot of really skilled people out there whose talents are unutilised or under-utilised. We need to tap into that talent and really bring it to the forefront of our service delivery by making the goals of an incredibly complex system seem tangible to people at every level of that system, bringing them together to achieve them.

That’s what the Dragon’s Heart Hospital did, and what I believe its namesake, the Dragon’s Heart Institute has the potential to do. If we can capture that spirit of collaboration and the feeling that we’re, each of us, pulling together towards a common purpose there will be nothing we cannot achieve.