Next up in our CEO Series – and as part of our planned content for HTN Now September 2021 – we put the spotlight on Janelle Holmes, Chief Executive Officer at Wirral University Teaching Hospitals NHS Foundation Trust.
In this feature we find out how Janelle, formerly a nurse, rose through the ranks to become an NHS leader, and she also shares her thoughts on tech and digital programmes, as well as what it was like being one of the first trusts in the UK to take in COVID-19 patients…
Hi Janelle, how did you become a CEO?
I started out as a nurse, and I’ve been in the NHS for a long time. I worked my way up from a nursing perspective and then took some time out and did some work as an operational transformation lead, which opened some avenues. When I went back into management, I went into general management rather than nurse management and spent quite a lot of time at Salford Royal Hospital.
I worked for Sir David Dalton – [so it was] a good model of leadership and digital. It was probably one of the first digital organisations. I then moved over to Wirral in 2016, first as the chief operating officer and then as the chief executive, from 2018. Did I ever think, as a staff nurse, I’d ever be a chief exec? No, never.
Being from the north as well, I don’t fit the stereotype. I’m not one of those people that you meet, and they say ‘I’m going to be a chief executive in five years’, I just fell into things and enjoyed them and wanted to lead change. That’s how I became a chief executive.
Do you have any leadership learnings to share with our audience?
The biggest challenge in the last year, as you can imagine, has been COVID. Despite my background as a chief operating officer and working through swine flu concerns and major incidents, nothing could prepare us for COVID. We did the blueprint for COVID because we took the first repatriated Wuhan citizens, back in January  – before we had COVID in the country and before it was declared a pandemic in March. We were requested to be the first isolation facility since 1978, I think. We repatriated lots of British nationals and took the passengers from the cruise ship liner – The Diamond Princess – not long after that.
What I learnt was that you’re not an island. Support mechanisms and the partnership working across the system were key and I probably underestimated that as, since then, relationships across the patch – both at Cheshire and Mersey [Health and Care Partnership] and at Wirral-level – have been so much better because we’ve tackled adversity together. That opens avenues for further improvements across the system. I really valued the partnerships and not just with health providers but also local authorities and the support that can be offered.
We had 48 hours to convert what was our staff accommodation into an isolation facility. Everybody was frightened of the unknown – the media coverage was significant and there was a lot of fear from both staff and the local community. A learning from that is the importance of how you communicate – it’s best to be doing that face-to-face, in a genuine way, even if you’ve not got anything concrete to say. People just like to have honest conversations.
It probably comes back to having a nursing background, but it’s important not to ask somebody to do something that you’re not prepared to do yourself. There were patients cancelling appointments because they didn’t want to come on to site. But, when you’ve asked your team to pull together isolation accommodation, I needed to be the first person in there as we received all those people off the coaches, at midnight, when they landed. That was the right thing to do.
From an executive team perspective – being a new team and an organisation that was under the spotlight from a ‘requires improvement’ perspective – the fact that we were able to do that gave some credit to the team-working. From a staff perspective, there have been some issues around culture and staff feeling listened to, so some of that work was really important – putting a face to a name- and those bonds forged working together.
What’s your vision around digital and tech?
From my perspective, when I joined, I came from an organisation that had quite a long history an electronic patient record (EPR) and Global Digital Exemplars. When I landed in Wirral it was the same [but] different systems. We spent a lot of time as team pulling together our strategy, and our underpinning strategies – one of which is digital. For me, it has got to be about improving patient outcomes and patient experience.
To do that, the focus has got to be on having a fully functioning EPR with the ability to share across the system, so that you reduce the amount of hand-offs and time-outs and share information in a timely way. The Wirral Health Record is an important piece of work.
The second [focus] is giving patients access to their own information, so they can make informed decisions and choices, removing the burden on healthcare with more self-service. When you check-in for a holiday, everything is online, and ideally, we’d want the same for patients so that they can manage their own long-term conditions.
The third is about how it supports development of productivity and efficiency – so anything that reduces waste and duplication. And also, being able to use digital in a more effective way – everything we’ve done this year. We wouldn’t have been doing this 18 months ago, everyone was in the office without MS Teams – so how do we use this now to support patients? But we need to recognise people still want to see a face, which is probably what is driving pressures in Emergency Departments.
We [recently] rolled out capacity management and my learning were that all your change programmes to do with digital, need to be clinically led, as far as I’m concerned. If you can get to see capacity over your site that’s important. But a word of warning is that buying the system is not the same as people using it and it making a difference. All those change programmes need to be clinically led.
How have you changed your management style for remote workers?
We’ve had a bit of a forcing function, haven’t we? People couldn’t come in and we managed to set outpatient e-consult up. It was a programme of work that we earmarked about 18 months to two years for – and we switched it on in a month. There’s nothing better than a burning platform that makes you change your style, adapt, and adopt different ways of working. We were on a better footing because we had strong foundations, which made it easier to do some of that work.
I’ve not reflected much on how my style has changed because, when we are in the building, we still use Teams as we don’t want to risk each other. We got back in the room and then when the prevalence [of COVID-19] started to increase again we went back to Teams. I don’t think there’s anything that you can’t do from an online perspective.
[From a wellbeing perspective] I don’t think we’ll understand the true impact of COVID on people’s mental health for the next 12 to 18 months, but we have pre-empted some of that. For back office staff we’ve done a lot around home working and I don’t expect some that to change – it gives us some flexibility and we’ve got a lot of space that could be used for clinical work that’s used for offices. It can be a better work-life balance, as when I work from home that’s two extra hours that I don’t drive.
There’s a lot you can do with frontline staff. They can’t be home office-based but we’re really encouraging people to take their leave – we were one of the only trusts that didn’t stop annual leave during the pandemic, and we actually supported it. A lot of people chose not to take it because there wasn’t anywhere to go but we did do a lot of encouragement around that. And we’ve also thanked them this year by giving them an extra day off for their birthday.
We’ve also got some digital things – we do an employee assistance programme, which is an online programme with access to counselling and specialist psychological support, mental health first aiders etc. There is quite a lot going on around health and wellbeing. We’ve recruited psychologists, specifically to work in our Emergency Department and Intensive Care, because they were the staff dealing with the COVID patients.
How do you look after your own wellbeing as the boss?
There is a lot of responsibility but, from my perspective, there are a few things [I value]. Having a good team and being able to build your own team is important, as well as supporting each other to get downtime and recognising when people are under pressure.
I was on a CEO WhatsApp group, and somebody asked how people were feeling about their execs home working. My view is that you judge people by what they deliver and their outcomes, not the time that you see them in the office. I think that’s a bit more modern. It really is about making work and home life more balanced.
What advice would you give to other people from clinical backgrounds about applying for leadership roles?
I think you must stick your head above the parapet. I come from a working-class background, I went to secondary school and wanted to become a police officer but ended up in nursing. I spent a lot of time thinking that people have degrees and higher education but sometimes you see something and think ‘I could do that job’.
When I moved from nursing into general management I was asked if I’d feel disconnected from patients but, actually, these jobs allow you to influence patient care better than you ever could do as a staff nurse. That is something people should understand – you can influence the future for other people and leave a legacy.
It doesn’t matter what your background is or where you’re from, if you’ve got a passion for improving patient care then you need to step in, we need good leaders in the NHS. There are lots of people out there who probably wouldn’t even think about putting their head above the parapet. Feel the fear and do it anyway!