Craven, A. (2008), "An interview with Julie Moore, Chief Executive, University Hospital Birmingham NHS Foundation Trust", Leadership in Health Services, Vol. 21 No. 1. https://doi.org/10.1108/lhs.2008.21121aaf.001Download as .RIS
Emerald Group Publishing Limited
Copyright © 2008, Emerald Group Publishing Limited
An interview with Julie Moore, Chief Executive, University Hospital Birmingham NHS Foundation Trust
Interviewed by Alistair Craven
Julie Moore is a graduate nurse who spent ten years in clinical practice before entering nurse management. During her time as nurse manager and later director, she undertook an MA in Health Services Studies at Leeds University and was seconded to work at the Department of Health on developing nursing roles. After a year in general management, in 1998 Julie became a director in the newly merged Leeds Teaching Hospitals’ Trust.
She became the Executive Director of Operations at the University Hospital Birmingham in 2002, where she was responsible for the day-to-day running of two acute hospital sites. When UHB became a foundation trust in July 2004, Julie’s post became Chief Operating Officer as her role was extended to include all Operations, Clinical Service Development, infection control and the clinical transformation programme.
She became Chief Executive (acting) on 1 July 2006 and the position was made substantive in November 2006.
AC - Can you give us some insight into the day-to-day running of an NHS Foundation Trust?
My main focus, as I believe it should be for any CEO, is on patient care and how we can ensure consistent quality. In a foundation trust there is a very strong emphasis on governance, both clinical and corporate. I have a very strong relationship with the Chairman and we are very clear about our respective roles and responsibilities. We meet weekly and governance of the organization is always a topic. It is an exciting time for the Trust as we are building a new hospital to replace our two existing ones (the newest is over 70 years old), but one which requires a lot of the time and attention from the Chairman and myself as we plan for the move and what to do with the remaining sites.
Foundation trusts have to be strong in all aspects of patient care, including finance, so we have strong systems for approving and monitoring expenditure and a robust process for evaluating business cases and their implementation. We have an achievement-oriented performance culture in the organization. The operational divisions and corporate departments are held to account for their performance at a review which I chair. This is a great opportunity to thank staff for strong performance and delivery as well as identify problems when executive help is needed to meet an objective.
One of the most important and enjoyable aspects of my job is talking to patients and staff. It is important that I hear their views directly. We also have a system of unannounced director visits to the clinical areas to focus on clinical issues and one of the key areas is infection control. I also attend, when invited, any staff meeting to listen to suggestions or gripes and to answer questions. It is always great to hear of new developments and ideas from staff as to how to make things better.
AC - You began your career as a graduate nurse and spent ten years in clinical practice before entering nurse management. How useful were your early roles in helping to prepare you for senior management?
I believe they were extremely useful. I still retain a fair amount of clinical knowledge which is useful in talking to clinicians and clinical work really teaches you how to prioritise. Most importantly, it has given me a solid grounding in patient care and knowing what is really important in the job. I can still remember what it is like to be with a dying patient at three in the morning.
AC - How would you describe your management style?
Style must change according to circumstance and need. I see myself as quite relaxed and collaborative and I place great importance on having the right staff with the right skills and experience working with you in an atmosphere of trust. However, there are rare occasions when I do have to be more directive as some things are not negotiable, such as issues of patient safety.
AC - According to Brian James – CEO of Rotherham General Hospital – the culture of the NHS “does not accept an autocratic style of management, and nor does it respond to the notion of charismatic leadership – the primary quality required of leaders in the NHS is trust, quickly followed by technical competence, vision and the ability to effectively lead and manage change.” Do you agree with him?
I have found that the NHS accepts a variety of styles depending on the circumstance. Sometimes decisive and directive action is needed to rectify a difficult situation. One thing I have found that staff do not like is indecision: managers not taking action and letting a difficult situation drag on. However, this is on extreme and thankfully rare occasions. I have found that vision coupled with strong ambition to improve patient care, excellent communication, strong values, energy and a sense of humour are the essential attributes to do my job.
AC - Foundation Trusts are about devolving power from the centre to local people in a new form of social ownership. Can you tell us a bit more about how this works?
As a foundation trust, I have dual accountability as the accounting officer – to Parliament and to the membership of the trust (c.80,000 members). The members are local residents, patients and staff, i.e. those with vested interests in the trust. The members elect patient and public governors. There are also stakeholder governors from local partner organizations such as the city council and universities. The Governors appoint the Chair and Non Executive directors and approve the appointment of the Chief Executive.
The role of the Governors has been evolving as it was a new concept, but they are a very valuable body who give up their time freely to seek to improve patient care. They can be challenging, but they are always positive. They are great ambassadors for the trust and also act as a critical friend, telling us when something has not gone right.
AC - In your annual report statement you lay out the objective of increasing the number of patients choosing to be treated at your hospitals. How will you go about achieving this?
We have some of the most skilled and talented clinical staff working in this hospital but like a lot of the NHS we do not publicize this as much as we could. We achieve excellent clinical results and this should be the most important factor for patients and GPs in selecting where to seek treatment. We need to make these results readily available for anyone to see. But coming to a hospital is a very stressful time for anyone, and as well as excellent clinical care, we need to make sure that every single part of that visit is as easy as possible, from being greeted by staff at the door to easy transport.
AC - UHB is the leading teaching hospital in the West Midlands, with strong links to the University of Birmingham. What do you aim to achieve as a teaching hospital? How does this benefit your “customers?”
A teaching hospital has three functions, to treat patients, to teach medical staff of all grades and to undertake and promote research. We are able to attract world class staff to work here and the research element means that our patients always have access to the most up-to-date treatments and procedures.
AC - In 2006 you received the go-ahead and financing to develop an on-site “Learning Hub” to help support low-skilled Trust employees. Can you tell us about this project?
We believe strongly that the Trust is an essential part of the community and has a significant role to play in the economic health and regeneration of the area. Economic health is a significant factor affecting physical and mental health. We are the second largest employer in Birmingham and we have sought to use this economic strength to the benefit of the local population. The learning hub offers training and development to unemployed people to skill them up for jobs in healthcare and construction (to work on the new hospital building). This is a joint project with the Learning and Skills Council and Advantage West Midlands.
AC - Your annual report acknowledges that the framework for assessing a Trust’s performance is becoming more sophisticated, for example by increasing focus on the experience of patients. What is your take on this?
I believe that patients and the public do need concise information to know how good their local trust is. The “stars” system attempted to do this in a simple way. However, there are many elements that make up patient care and it was believed that more information should be provided. The current system from the Health Care Commission attempts to do that with more indicators measured, but it is less readily accessible for anyone wanting quick information. It also measures some odd things, which I can’t see the relevance of, such as “occupied bed days”. It is a target for all trusts to reduce these, but if a trust is successful in attracting more patients, these should obviously go up. My main criticism of the current system though is that it does not measure clinical outcomes, which is the main factor I would use in choosing a hospital.
AC - One interesting method you employ in terms of communication strategy is to offer a “Chief Executive Hotline” – a phone number for queries, comments and ideas. Has this idea been successful so far?
Yes, it offers an easy way for staff and others to let me know of a problem or to ask a question. Its use is falling now though in preference to e-mail. I get a lot of e-mail from patients, public and staff.
AC - UHB sees partnership-working as vital to achieving its objectives for healthcare and being a community asset and is active in partnerships at local, city-wide and regional levels. What do these partnerships involve?
We have already mentioned the Learning Hub which is seeking to bring local unemployed people into employment in healthcare. We have a major partnership with Consort Healthcare who are our PFI partners in building our new hospital scheduled to open in 2010. We work closely with the Universities who train our clinical staff, we provide placements and we work together on other areas like research and development. Some of our key partners are the local Primary Care Trusts who commission services from us, but the relationship goes much further than that. Together we seek new ways to provide healthcare that retains the clinical quality, but is more convenient for patients, such as consultant based clinics in GP surgeries.
AC - Finally, what is the next important event in your corporate diary?
The Trust is being visited by Alan Johnson, the (relatively) new Secretary of State for Health who is focusing for this visit on organ transplantation. We have one of the largest solid organ transplant programmes in Europe at UHB and together with two of our surgeons I am on the national Organ Donation Taskforce. It will be a chance to show him the excellent work we do here and discuss with him the shortage of organs and steps we believe could improve this.
You can find out more about the University Hospital Birmingham NHS Foundation Trust here: www2.uhb.nhs.uk/Homepage.aspx