Empathy and Collaboration in Healthcare To Lead Change with Sara Hurley, Former Chief Dental Officer of NHS England

[00:00:00] Welcome to Think Oral Where we connect the connected between oral and physical

[00:00:10] health. I'm your host Dr Jonathan Levy And I'm your host Maria Filippova. Let's get

[00:00:16] at it. Welcome everyone to another episode of The Think Oral Health Podcast where we connect

[00:00:29] dots and unexpected silos in oral health and overall health. I am pleased to be joined today

[00:00:37] with an exceptional and extraordinary leader who has done work in areas that we hold near

[00:00:44] and dear to our heart globally with an impressive track record and impact. The topics we have

[00:00:50] lined up for you today range from our favorite medical dental integration to impact at scale

[00:00:59] at a global level across different systems payment systems and operating models to what we talk

[00:01:06] about doing, turning ordinary care into extraordinary care. And we will talk a lot a little bit

[00:01:13] about that. With that in mind, I will tee up my partner in crime the co-host for this podcast Dr Jonathan

[00:01:20] Levy who will as usual introduce our guest for today. Well Maria thank you and first of all it's

[00:01:28] such an honor pleasure to have you as my co-host so we're both co-hosts but I'm even additionally

[00:01:35] excited the fact that this podcast we're going to have three people that I'd like to personally think

[00:01:42] as troublemakers we like to improve and change this industry. And it's such an honor to have

[00:01:50] Sarah Hurley here she's been the chief dental officer of England she took that role for over eight

[00:01:57] years and now she's taking on some additional roles as a non-exegitive director of sorry hot

[00:02:02] lands icb independent director university of self-falk and just more recently heading up an amazing

[00:02:08] group of dental leaders sdl and skull senior dental leadership and we're really excited

[00:02:15] to see where Sarah is going to take that group but you know Sarah has had an incredible career

[00:02:22] today and she is such a top leader in really creating what you said extraordinary care

[00:02:29] that has been done differently before. How do we improve and change the profession and she

[00:02:35] I know she likes to say how do we build these future aspiring leaders but in fact over the

[00:02:41] COVID-19 pandemic she led the dental professions through all of that developing guidance for the

[00:02:46] profession really on the safe delivery of care and managing risk but I can go on and on however

[00:02:52] I do want to jump in on our conversation so Sarah so happy to have you here welcome to our

[00:02:58] think oral health podcast with Maria myself. God bless and thank you it's unsupertiles to be with you

[00:03:04] connections are so important and I go back to the fact that our paths crossed back in what was

[00:03:10] pre-COVID 2016-17 and those connections haven't stopped and then when we meet in Boston last year

[00:03:19] it was if it was 24 hours ago it's that connection and again meeting Maria there are things that

[00:03:24] we can do and you call yourself a troublemaker I see you as a disruptor and I love disruptors.

[00:03:31] That's right well there's no shortage of disruptive ideas here today so let's start with maybe the

[00:03:38] most radical and the most important one Sarah you've been working in the area of putting the

[00:03:44] mouth back in the body. What do you think is the most promising thing that leaders could do today

[00:03:52] to advance the mouth body connection and feel free to put people on the spot because Jonathan and I

[00:03:58] are not shy of calling people out and making requests or invitations to do things differently so

[00:04:06] what is the most promising air in that you think would truly catalyze the mouth body connection?

[00:04:11] What are you excited about? Well I'm really excited about the fact that there is evidence.

[00:04:17] I'm an evidence-based practitioner so I will only do something for a patient or a population

[00:04:22] with the evidence and we have now a growing body of evidence that shows a clear connection

[00:04:29] between things happening in the mouth and things happening in the body and vice versa.

[00:04:33] One of the classic ones there is diabetes type 2 diabetes which I know you've spoken about on your

[00:04:37] podcast previously but it's not just the dentists now talking about this it's actually our

[00:04:43] nursing staff that are overseeing diabetic care pathways our GP colleagues our general practitioner

[00:04:49] are medics for me one of the most exciting things in England where we have a national institute

[00:04:55] for care excellence that gives guidance it actually took the guidance and said right if you're a GP

[00:05:00] seeing a patient with type 2 diabetes then you need to make sure they're getting an oral health

[00:05:05] check you need to make sure that they're looking after their gums you need to and this is the first

[00:05:09] time I have seen something that took evidence and didn't just plant it in the dental world or didn't

[00:05:16] just part it in the medical world they made it integrated so yes it's the first time I've really

[00:05:21] felt that the mouth is being put firmly back in the body and long long have I wanted that to happen

[00:05:28] both at policy level and practice level and it's just beginning to do it the dialogues happening

[00:05:33] there is changes and trends is brilliant is absolutely brilliant fantastic tell us a little bit more

[00:05:38] for those listeners who are not as familiar with the British system I had the privilege of being

[00:05:45] a patient in the UK when I lived there for three years and I did experience the private system

[00:05:51] that co-exist in parallel with the national health system so paint the picture if you will for us of

[00:05:57] what that NHS system looks like and how dental care is delivered in the UK in the United Kingdom every

[00:06:05] individual practice on the high street can choose to be providing private dental care but it can also

[00:06:12] put in a bid to deliver NHS dental care under a contract so the NHS doesn't affect own the practice

[00:06:19] it doesn't employ the staff it is a model where in effect the provider the practice owner is subcontracted

[00:06:27] and they are also contracted then to deliver a certain amount of activity over a period of time

[00:06:32] and it isn't always free some patients are eligible for care which is free at the point of

[00:06:38] others are expected to make a contribution and so there is a system in place now I'll be

[00:06:43] absolutely honest the contract system that supports those practices that are digging in to support

[00:06:49] of the publicly funded care isn't ideal and we have an I'm on the record as Chief Dent Rolf

[00:06:54] of Ringland saying the contract was not fit for purpose and there has been some slow changes

[00:06:59] to that contract so when you walk into a practice you know you might see there being two offers

[00:07:06] in terms of the care that could be provided and I'm keen that we maintain patient choice

[00:07:11] clearly not everything can be available under publicly funded services obviously some cosmetic

[00:07:17] things aren't clinically necessary so it is a choice for patients but I'll be absolutely

[00:07:22] honest again the ability to be able to get access to publicly funded care at the moment in England

[00:07:28] is not as good as anybody would want it and we are constantly as a profession and indeed with

[00:07:36] the number of patient groups looking to see what the government and the NHS can do is to both

[00:07:41] increase access and also improve oral health and to try and move away from a model that's

[00:07:47] predicated on an intervention and how we can do more prevention how we can support the patient

[00:07:52] to type two diabetes rather than having to wait for something to not go right in their mouth if

[00:07:58] in effect so yes we want to move to prevention roles and intervention and I think there's a

[00:08:03] cooperation that we need to explore it's interesting to hear you talk about patient choice

[00:08:09] and empowering the patient maybe we could double click on this here if you think about let's say

[00:08:14] those practices that are under an NHS contract do you see in the guidelines or the way

[00:08:23] practice is delivered more opportunities to connect medical and dental teams in let's say

[00:08:29] treating a diabetic patient as you just brought it up that two diabetes do you see that easier

[00:08:35] or harder to happen or give us an example where you think that's a successful collaboration are

[00:08:40] areas there that you think we need to do some more work. In England we've just moved to a wonderful

[00:08:46] system which is called integrated care systems so instead of individual areas of health each

[00:08:51] told you their own individual credit card and saying I'm going to deliver this we're now being

[00:08:55] able to think in a much broader way and one of the areas in the north of London adopted a far more

[00:09:02] proactive process for any patient walking into a diabetic clinic was then identified and referred

[00:09:08] to a receiving dental practice and that became commissioned care and that patient then was supported

[00:09:15] as part of their diabetic care pathway rather than an illness seen as a single oral health care

[00:09:20] pathway which is fantastic we had dialogue between all the clinicians involved and it was a

[00:09:25] multidisciplinary team it's not just always about the dentist we have dental therapists we've got

[00:09:30] dental nurses that can support with the oral health promotion so it really is a multidisciplinary

[00:09:36] team cross professions and that pilot not only worked very successfully in terms of integrating

[00:09:42] the healthcare professionals but in many cases we had patients where we were able to control

[00:09:49] the oral inflammation in their mouths so much so that it reduced their requirement to be triggered

[00:09:55] for a dual drug therapy for type 2 diabetes which means a better quality of life for the patient

[00:10:00] and if I'm sitting back as the Chancellor the Exchequer is actually a reduces a pharmaceutical

[00:10:06] bill the medicines bill says a bonus around so the new approach to commissioning care in England

[00:10:14] means that you now be able to look at something and say okay if we invest in oral health does this

[00:10:20] actually improve outcomes for diabetes yes it does if we improve the oral health of somebody of child

[00:10:26] bearing age actually does that improve the outcome for the birth and the early years

[00:10:33] we know there's a connection between oral health and cardiovascular disease we also know

[00:10:38] that if we help improve the oral health in those elderly or prone to frailty we're going to

[00:10:43] improve their ability to eat you improve their ability to eat you got the energy you don't slip

[00:10:47] you don't trip you don't fall you don't end up in hospital and we also know that if you can

[00:10:52] improve the oral health if you are admitted into hospital good oral health in hospital can actually

[00:10:58] reduce the numbers of days that you need to stay in hospital so hospital beds are a premium why would

[00:11:04] you want someone in hospital any longer than they need to be so invest in oral health you invest

[00:11:11] in outcomes and these are all connected to what we call non-communical diseases but they are the

[00:11:16] diseases of the 21st century certainly in the Western hemisphere very much so cardiovascular disease

[00:11:22] or heart stroke blood pressure when I start looking at things that are arthritis and frailty

[00:11:29] and diabetes you know these are the things that we're hearing more and more about

[00:11:34] they are controllable with lifestyle choices but let's face it not everybody does get that

[00:11:41] wealth of choice and that's where the inequality comes in that's where the inequality needs to be

[00:11:46] so if all health can be part of addressing that inequality that just makes for a more just world

[00:11:53] brilliant so wait one second way what says I got you two thought leaders here how do we make

[00:11:59] that happen we know that 58 systemic inflammatory diseases are connected to chronic inflammation in

[00:12:05] the mouth we also know that the insurance companies to provide some level of support the diagnostics

[00:12:13] I think get upstream to prevent this incredible spend let's just talk even about the United States

[00:12:20] 20% of our GDP is healthcare yeah or five trillion dollars now do we can convince the insurance

[00:12:28] companies to focus on prevention and wellness and upstream type measures to prevent these downstream

[00:12:34] systemic inflammatory diseases we know these things but what can we do is that the hard data that

[00:12:41] we could show that if you control paradigm disease you decrease cardiovascular disease you decrease

[00:12:46] diabetic incidence what can we do you've been the chief tell officer of England what are the

[00:12:50] learnings from England what can we share in the United States and how do we really make this happen

[00:12:55] yeah that's a problem so we are passionate as professionals and we can talk the professional

[00:13:02] lingo we can talk about the clinical evidence but that narrative doesn't necessarily always work

[00:13:08] with individuals that have got different agendas we all share prevention improving quality of life

[00:13:16] but the narrative in the language we use and I sense that for many many years the silo in which the

[00:13:23] dental profession has found itself has meant we're very good at talking to each other but we're not

[00:13:28] necessarily good at talking to other people we're not necessarily good at talking to bankers we're

[00:13:33] not necessarily to it at talking to insurance we're not necessarily good to talking to in some cases

[00:13:37] other healthcare professionals so we've got a model that has limited our ability to talk the right

[00:13:43] people in terms they understand so one of the things that I did in England was before we went and

[00:13:49] launched our pilot for diabetes I did and Maria will recognize I did a return on investment yes

[00:13:57] and that return on investment was a document that said for every 12 pounds that you are going to

[00:14:02] spend on this patient in an oral health environment it will deliver you 32 pounds return on investment

[00:14:10] in the following areas and deliver this in terms of quality of life in the patient will deliver

[00:14:16] in terms of days not lost from work so I gave the argument I gave them a metric that they recognize now

[00:14:23] we've all got measures of effectiveness and measures of success our measure of effectiveness is

[00:14:29] we want to better patient with better outcomes but the measures of outcomes for an insurance

[00:14:33] company a banker for a health service for a chance of the exchequer for a commissioner are all

[00:14:38] different so I had to learn what did success look like for them and I had to then put my evidence

[00:14:45] into those terms and I did a previous change approach many years ago when I was working with a

[00:14:51] British Army where we wanted to invest time and effort in the oral health of recruits so people

[00:14:57] joining the Army straight from school whose teeth hadn't necessarily had the best care for again

[00:15:03] a variety of life choice reasons where they may not have had the choices and what I was able to do

[00:15:08] is I wanted two hours at every recruits training program and it was always all too busy and then I had

[00:15:13] to find the narrative so I did I got really cheeky I found the major general that was responsible for

[00:15:18] recruiting and I stood in front of him and I gave him two options you can sit in my chair for two

[00:15:23] hours today or you can sit in my chair for six hours in 18 months time what would you choose for

[00:15:27] yourself well Sarah I'm quite happy to sit there for two hours right if you choose that for you

[00:15:31] you've got to choose that for the recruit but then I he needed a bit more and I was able to show him

[00:15:37] that if I invest your time and effort in a recruit today this recruit would have greater success

[00:15:42] passing through training but also have and we've done a piece of work what's been recently done by

[00:15:47] the British Army which has shown that our investment in recruit oral health has a dividend

[00:15:53] that lasts for five years after they passed out of training that's a dividend that keeps a soldier

[00:15:59] a sailor or an em and doing the job that they were originally paid to those are the things it's

[00:16:03] finding the right narrative and I'm covering lots of narrative here on just I'm consuming oxygen

[00:16:09] no I love that that's why we want to that's what we need that's what we're doing you've lived in

[00:16:16] healthcare insurance business you know it so well let's get into the KPI's and the metrics

[00:16:22] that we can give these insurance companies what do they need let's connect the dots a little but

[00:16:27] what do they need so that we can get upstream with prevention and think about this

[00:16:31] impaction impacting financially supporting of the prevention wellness world I love that Sarah

[00:16:38] went straight to return on investment I think that's a critical component and I probably would add

[00:16:45] two more things there one is the time period over what period of time right Sarah had a very

[00:16:53] simple 12 pounds invested gives you over 30 pounds in return so the first edition is over what

[00:17:00] period of time nothing in the body happens in a quarterly basis unfortunately most of our

[00:17:07] industries and businesses including healthcare because healthcare is a business runs on quarterly

[00:17:13] cycles and so we have this fundamental existential social mismatch between the financial decision-making

[00:17:22] and the clinical outcomes that take a couple more quarters and we're used to materialize

[00:17:28] and so we need to be able to online time horizons and align incentives because the savings are

[00:17:34] there it just needs takes sometimes takes more than a quarter to get them so that's why I think

[00:17:39] the NIH is a good example because you can take with a longer-term view horizon on that patient

[00:17:45] and you could invest in their future health by investing in preventive services investing

[00:17:52] in oral health today because that pharmacy bill is going to be lower if you take care of their

[00:17:57] oral health and they'll control their A1C's level the team of globing A1C so that's one the

[00:18:02] second piece is in healthcare the one is the type where I said the second one is who does the benefit

[00:18:09] of crew two there's so many stakeholders that are so interconnected and again Sarah gave a

[00:18:14] beautiful example that over $30 in savings comes not only from medical savings from additional

[00:18:22] interventions or pharmacy bill but it comes in the shape of productivity retention like employees

[00:18:29] being able to go to work more often and not miss days at work and so some of these savings are

[00:18:35] occurring to the employer others are including to the health system but then again the health

[00:18:40] system has different flavors right different payers in a health system so no one who's pockets

[00:18:46] does the savings of crew two because these may not be the same pockets that the outflow

[00:18:51] the investment comes from I think healthcare is full of well-intentioned amazing leaders who just

[00:18:58] we haven't figured out how to follow the incentives and line up the right stakeholders of

[00:19:03] incentive benefits if you all so for those of you although our listeners who are trying to

[00:19:08] bring in integrated health solutions who are trying to make the case for an integrated

[00:19:13] care delivery system I think what we want to measure is not only return an effort we want to

[00:19:18] very measure the time horizon and we want to measure the stakeholders to which those benefits

[00:19:23] accrue then make sure that they're at the table Jonathan you've done something beautiful in your

[00:19:28] clinic in Manhattan where you are able to talk to your patients both up on the medical and the

[00:19:34] dental side but you've created a microcosm where these are activated patients who've taken charge of

[00:19:40] their own patient care and unfortunately we don't have the vast majority of the system with

[00:19:46] patients who fit that profile right they're activated patients so that's kind of where I am and

[00:19:52] maybe both you and Sarah and we could think about even if we have the clinical evidence the

[00:19:57] return on investment time horizon stakeholders how do we operationalize this Sarah from your

[00:20:03] experience in the UK and I love that you give examples of the dental clinics right the diabetes

[00:20:09] pathways what were the key pieces that you need to put in place to operationalize this diabetes pathway

[00:20:17] or high risk pregnancy pathway or cardiovascular pathway was it around data and

[00:20:22] operability was it around education was in mindset what did you think was the kind of the

[00:20:26] turning point that made that all that happen it's getting the right people around the table and

[00:20:32] it's the blend of people around the table so even if you have the right people around the table if

[00:20:37] you can't get them blending if you can't get them understanding the evidence and more importantly

[00:20:41] the opportunity I sense I've been quite lucky that I've managed to be able to network and I've

[00:20:47] over my whole career I try and remain connected to people John us and I we've remained connected

[00:20:54] so you build on those connections you know where you've got people with similar passion

[00:20:57] and the other one I think you have to be quite tenacious I had a boss.

[00:21:02] We know if you were too about the issues.

[00:21:06] Because in all this we're challenging established also doxy yeah we are challenging an established

[00:21:12] model and I think you have to be a little bit of a salesman without a shadow of a doubt but

[00:21:17] backed up by the evidence so the biggest one was finding the right allies to get around the

[00:21:22] table I was very fortunate that we were able to bring people to the table that had had

[00:21:29] personal experience of their oral health not perhaps being as good as it could do and therefore

[00:21:34] understanding how it was going to contribute to the broader outcomes whether we diabetes or

[00:21:39] an adverse pregnancy outcome and the lived experience of those individuals as probably more

[00:21:44] compelling than my arguments and if we brought the right people around the table and then the

[00:21:49] commissioners again because we're working in a slightly different environment it was making sure

[00:21:53] we had the right commissions around the table and whenever we're spending public money it isn't

[00:21:58] just about the patient's voice in here it's in our case the taxpayers voice and I have to demonstrate

[00:22:04] that for money and often in a public health system there isn't enough money to go round so why do

[00:22:09] we have to spend more money on this and where am I going to stop spending it elsewhere and getting

[00:22:14] that balance was quite tricky so finding the right people getting corralling the passion

[00:22:20] backed by the lived experience backed by the evidence and then at least you're in a good place to start

[00:22:26] and then you have to know that it's going to take a long time and that requires you and the team

[00:22:32] to be consistent none of this is said just like changes don't happen with patients health

[00:22:38] over short period of time neither does policy and at times it felt like waging through

[00:22:45] at times it felt like nothing was going to change but tenacity will out and certainly when you

[00:22:51] know and I think for me that one of the lightballs I think I was the first chief dental officer ever

[00:22:57] to be invited to a British Medical Association conference wow I spoke to them and I probably created

[00:23:05] more advocates outside the dental arena than I did inside the dental arena and that opened up

[00:23:12] a whole new set of relationships and connections fantastic so network network network love it

[00:23:18] so much to learn Sarah what you were saying I started uh I'm saying we said okay you have

[00:23:26] being the chief dental officer of England you have the doctors opting in or opting out on the NHS

[00:23:33] what was the biggest obstacle that you saw for the national health system that you faced

[00:23:40] that one where you faced the challenge and you were able to navigate and improve and two a

[00:23:47] challenge where it just you couldn't make much headway against though dentistry I certainly

[00:23:53] England I think it is globally it tends to be quite a siloed activity is often referred to in England

[00:23:58] as the Cinderella service of health man and it certainly feels like that it's perhaps not

[00:24:04] necessarily seen as a vote winner but it could certainly be a vote loser the politicians will

[00:24:11] tell you that their postbag at the moment are full of letters from constituents once you just know

[00:24:16] where their NHS dental service is but it's never funded it's never funded in the way that we'd want

[00:24:21] and the funding when it is released is released to be focused on interventions not prevention

[00:24:29] and I comes back down to the some of the fanings with the existing contract and the need to move away

[00:24:35] from drilling and filling to what we were taught at dental school our clinical philosophy

[00:24:40] prevention comes first we are all physicians and healers we need to move away from the surgical

[00:24:46] model there are people that need our surgical skills absolutely but it's actually being

[00:24:51] out to understand that we need a new model and I am going to punch if I can find him an absolutely

[00:24:58] so a Harvard professor of engineering who said once you never change things by fighting

[00:25:04] the existing reality to change something build a new model that makes the existing model obsolete

[00:25:10] and this chat was called Burke Minster Fuller absolutely brilliant guy and a man that did engineering

[00:25:15] but knew how systems and think about how systems worked so I sensed that much of my challenge

[00:25:22] was actually the existing model the biggest problem is the existing model in our case the existing

[00:25:29] so I have provided I hope foundation over eight years to change so we introduced a thing called

[00:25:36] phase causes of treatment so instead of thinking a patient's got to walk into the door and you've

[00:25:40] got to do all the fittings that need to be done and that's it they're out the door it's how do

[00:25:45] you see this patient over a longer tutor all over a year and how do you see them for a pathway

[00:25:51] a clinical pathway and how do we get the system to recognize that the patients on a clinical

[00:25:55] pathway but there are multiple things going on on this pathway of which prevention has to be key

[00:26:02] so you know as one as I do Jonathan when a patient walks through with a problem our first

[00:26:06] ambition is to make sure if they're in pain to get them out of pain to stabilize that patient

[00:26:10] and then you don't move on to complicated care until you know that you've got a stable foundation

[00:26:16] you don't build a house or a rocky foundation you don't build great dentistry unless you have a good

[00:26:22] oral health foundation so prevention's key so yes eight years of fighting or trying to dismantle

[00:26:28] I suppose the model and try to create a new model and that's one of the things I'm now moving on

[00:26:34] to with a community interest company where we are bringing a salaried individuals to deliver a

[00:26:40] prevention focused clinical philosophy and we're going to be delivering only publicly funded

[00:26:45] dental care and you know back to Maria's comment at the beginning our mantra is we are going to do

[00:26:52] ordinary dentistry extra ordinarily well and prevention is a heart of that I wanted to be an

[00:26:57] oral health institute not a dental center wow what beautiful health institute not a dental center

[00:27:06] and I think the undercurrent of this whole conversation has been this notion of transformation

[00:27:13] this notion of change and how do you lead folks through the scary path of change and Jonathan

[00:27:22] started us by calling all this group of this conversation partners trouble makers or disruptors

[00:27:28] we have to appreciate there has to be some empathy for different types of leaders some leaders

[00:27:34] are wired to be more comfortable with change and disruption others are more comfortable with a

[00:27:39] structured process and visibility and predictability and so for those of us who are leading that

[00:27:46] ambiguous change there's definitely something to be said about do you risking doing mystifying

[00:27:53] change and making it much more breaking down into those incremental steps that others could relate

[00:27:59] to and find less scary I believe that the only constant is change I've embraced it as part of my life

[00:28:08] and I find it interesting and I approach it with curiosity I think if I look at both you and

[00:28:14] Jonathan I think we are we found our tribe right we're all comfortable with change excited by change

[00:28:22] and I do believe that there's certain level of responsibility of those leaders to approach the

[00:28:27] vast majority of the current system with empathy it cannot be an immensity can't be like well you

[00:28:32] guys are old school and I've got the new way that's not how we create dialogue so tell us a little bit

[00:28:37] about maybe successful models where you've seen the change agents and the champions of the status

[00:28:44] quo come together and find a language and have find the shared path because that's truly where breakthroughs

[00:28:51] happen absolutely and I think the real transformation I'm seeing is that we are moving from organizational

[00:29:00] competition to system collaboration no I think we have a new breed of leaders that are I'm going

[00:29:08] to use the word democratic they build consensus you have to work hard to get by in you have to

[00:29:15] understand in your allies but bluntly what's in it for them and actually sometimes there is a

[00:29:22] personal growth for somebody by the involved in trade change others that is the altruism or

[00:29:29] doing good by being good at the change for others there is a financial dividend there is a

[00:29:36] status dividend so understanding that how you can make that positive climate to build a consensus

[00:29:43] but you then have to be really honest with yourself you have to look and say okay what are my values

[00:29:50] and what's in it for me and understand then that others need to see that because you cannot expect

[00:29:55] people to be honest with you about what's in it for them unless you are you are being and I think

[00:29:59] you're right sometimes allowing your team or the organization inside your head understanding almost

[00:30:05] your diurnal rhythm I mean I'm not saying that they need to know what time of the day to bring you

[00:30:09] a cup of coffee and what time to leave you alone but understanding that openness and I heard today on

[00:30:15] the radio that this year's most looked up word is authentic and I think that that's it but for me

[00:30:21] the most important word here in the leadership for the transformation change I'm going to use the word

[00:30:25] integrity so it's personal integrity integrity of the aim so everybody can understand that's a

[00:30:31] holistic when it's going to do integrity of everybody else's ambition and as you write I love

[00:30:37] the word empathy because everybody's going to have a slightly different ambition and you need to

[00:30:42] factor that in because I'm going to come up with another great quote the only thing predictable

[00:30:47] about the future is it's unpredictable and whilst we like unpredictability we like it we see

[00:30:51] it as an opportunity for change but others they want that plan they want every milestone they want

[00:30:57] to hit all laid out and I often say to individuals when we're developing our planning okay that's

[00:31:03] plan A so what is things change so what what's plan B how do we optimize that change and we do a lot

[00:31:10] of scenario planning and that helps people get a bit more comfortable with change so those are

[00:31:16] lessons I don't know and I can't take credit for developing any lessons I have to say 30 years

[00:31:21] with the British army and they've been me to understand leadership management change and so

[00:31:27] formed my way of thinking in my approach not everybody wants to spend 30 years with the British

[00:31:32] army I get that but I think the leadership traits are coming out loud and clear across industry

[00:31:38] across healthcare laterally in healthcare I think we're perhaps the laggards in understanding how

[00:31:44] leadership this clinical leadership's always been a bit hierarchical yeah and I think we need to

[00:31:49] move to much more democratic model of leadership wow wait let me go right there because as a student

[00:31:54] of leadership I love what you just said 30 years in the military we know the leadership style

[00:32:00] of the military is really more of a command control and very hierarchical right we see no one

[00:32:06] going to disagree with you there Johnerson that's what you believe from the movies I wasn't in it

[00:32:11] so please educate me but also Carl A the military which I've always understood and it's in corporate

[00:32:18] America command control versus the Biden set up and the servant leadership model of certain

[00:32:25] organizations where you're really building a deeply trust and inspiring mindset less about managing

[00:32:32] people more and about empowering them tell me you're going to have that dichotomy and where you started

[00:32:39] and where you've landed today in leadership theory Johnerson race yourself oh goodness

[00:32:47] wait friend yeah so I'm not going to do command control so the motto of Sandhurst which is

[00:32:53] the crucible of British army leadership is served to lead nowhere is a servant leadership model

[00:33:02] the embodiment of trust a soldier a sader or an airman is not going to follow an instruction

[00:33:10] to do something unless they trust the leader and that trust is a 24-7 real life experience

[00:33:18] and it is a very very different it isn't you know the honor of the stone movies platoon the yelling

[00:33:25] to be out on its the moment you shout you've lost not only control but you've lost respect

[00:33:30] from everybody else and respect it so absolutely so let's put the movie and the mantra to one side

[00:33:37] I have seen an experience more transformational leadership in 30 years in the military my role models

[00:33:45] I would say 99% of my role models have been individuals I have been privileged to serve alongside

[00:33:52] serve with and deliver the actions the delivering on the agenda for justice

[00:33:58] because that's what I think that we are all about we talk about moving forward on a front line

[00:34:05] and for an organization that is constantly under political pressure and constantly under the

[00:34:14] media microscope that every action is looked at and to be honest health service is exactly the same

[00:34:20] so you could say that I moved from one organization to another there wasn't much difference but I

[00:34:24] saw more transformational leadership in the military in 30 years than I saw in the national health

[00:34:29] service in the eight years I was there I saw a much more paternalistic I saw lots of good talk

[00:34:34] in the NHS about transformational leadership I saw a hell of a lot of management a lot of management

[00:34:42] but management and leadership are not the same thing and the military has some very good managers

[00:34:48] it has some outstanding leaders and that is why I see many of those outstanding is in the US as well

[00:34:54] being called in to support advice the political agenda in all the right ways that lived experience so

[00:35:02] no command of control people don't respond to command of control there's a time and a place where

[00:35:07] there's an imperative absolutely get that but that's not how a military would work it wouldn't it

[00:35:12] would disintegrate if it all ran like the movies oh my goodness I love it I love those conversations

[00:35:18] because I teed it up saying we'll talk about putting the mouth back into the body and we'll talk about

[00:35:23] international impact and here we are completely changing people's perception about leadership

[00:35:29] and what military style leadership looks like and I am really excited this is what gives me so much

[00:35:35] joy to find ourselves in a completely different place where originally without the conversation will

[00:35:41] take us so Sarah thank you so much I can thank you enough for sharing your perspective your experience

[00:35:47] for challenging some of the orthodoxies that we all consciously or subconsciously held I'll raise my

[00:35:55] hand and admit to that myself include it right so very excited to have you very excited about

[00:36:02] continuing the conversation all of us are going to the humanitarian mission by the Glogot Foundation

[00:36:09] and love rule coming up in a couple of days so putting some of those service leadership

[00:36:15] principles that Jonathan and you talked about in practice maybe a couple of like one partings up

[00:36:21] if folks wanted to get involved to be part of your work just support that movement where could they

[00:36:29] find you what are the causes you care about what is your call to action to our audience and we'll wrap

[00:36:34] it up with that so I would love the Archon Jewel be the Glogot Foundation if Jonathan would be

[00:36:40] so kind I think this is the platform so if I've got that wrong Jonathan please stop me but my

[00:36:48] I would love the sort the ambitions the commitment to flow through the Glogot Foundation

[00:36:56] through the Glogot Foundation we can start corralling and then we can connect to some of the big

[00:37:02] oral industry partners the medical partners who then are going to support us in developing

[00:37:08] the oral health advocates so we've got leaders we need more leaders we need the future proofs

[00:37:14] of leadership but the other thing we really need to think is that how do we all become better

[00:37:19] advocates because if you do the advocacy we use the right language there it turns on investment

[00:37:23] the dividend as a timeframes if we can talk transformationally then actually we nudge change

[00:37:32] as well as drive change and sometimes nudging change creates a more sustainable outcome

[00:37:38] than actually a command and control approach to driving change although Jonathan I might have

[00:37:44] to put on my kevna or bring it out to elucidate that's amazing Sarah we're so excited for all of us

[00:37:53] to be with you at the Glogot Foundation and let love rule mission is really has evolved

[00:38:00] and the idea of building aspiring leaders going through the experience of the foundation where we

[00:38:04] get more out of it than the people we serve and we do serve those people but we realize that we

[00:38:10] also have to educate and serve and inspire the people who are doing this serving so as you like

[00:38:17] to say and I've heard you say this just before we serve to lead but you have to deserve to lead

[00:38:24] and you got to put that time in to really learn these leadership skills communication skills culture

[00:38:30] building to inspire our people around us and I look forward for us to spend the next 10-12 days

[00:38:36] next week together helping the people of the Bahamas and for all of us to grow personally well Maria

[00:38:44] we've done it again we've had this amazing podcast with an amazing guest Sarah Hurley Sarah thank

[00:38:49] you so much for joining us on our Think Oral Health podcast thank you continued thank you thanks Sarah

[00:38:56] very much it's lovely take care take care thank you

[00:39:06] thanks for listening to the Think Oral Podcast for the show notes and resources from today's

[00:39:11] podcast visit us at www.outcomesrocket.health slash think oral or start a conversation with us on

[00:39:21] social media until then keep smiling and connecting care