Dr Bruno Holthof, the CEO of Oxford University Hospitals
Andrew Rosen: Bruno, you've been involved in health care for 35 years, maybe more—starting when you attended medical school. But even though you earned a medical degree, you've never practiced medicine. Instead, you pursued an MBA and became a consultant with McKinsey and Company. What led you down that path?
Dr Bruno Holthof: I've always been fascinated by biology and medicine. I remember being in high school and talking with other students about what the discovery of DNA might mean for the future.
But when I went to medical school, I found myself drawn to the organisational aspects and system impact of health care. I started taking courses around microeconomics, macroeconomics, and accounting.
The dean of the medical faculty told me, 'If you have an interest in this, we have a need for health care leaders who have a medical degree but also an interest in how health care systems work'. So they encouraged me to pursue an MBA degree and also a PhD in health economics.
Q: It's a rare combination of skills, to be sure. So that explains why you became a consultant after medical school. Why did you decide to leave that life behind and start directly leading health care organisations?
Holthof: As a consultant, I took on a project to turn around a bankrupt public health care system in Belgium. And the question was, 'Can it be saved?'
I realised that I didn't just want to develop a report and hand it over to a client; I wanted to implement the recommendations. And that was what made me switch to be the chief executive of that system.
It was a public health care system, with all of the advantages and disadvantages of public health care systems around the world. The leadership was focused on conserving what was there, rather than looking at the environment and what was changing and how the organisation had to change as a consequence.
The root cause for the bankruptcy was that the country's reimbursement system had changed, but the leadership had not adapted. The reimbursement system created an incentive for reducing length of stay, but the organisation still kept the beds full rather than making sure that patients returned home as quickly as possible.
As a consultant, I became skilled in analysing problems and offering solutions. But that was very different than working as a leader of an organisation, to change the behaviour of 7,000 people. It was a great learning experience.
Q: You've said elsewhere that you learned from your experience in Belgium about the importance of leadership. What does leadership mean to you?
Holthof: I like to keep it simple: Leadership is how you can have impact on an organisation. And there are different styles of making that impact. There's no single success formula that I've seen, because people have different styles—but you need to make sure that the leadership team as a whole covers everything that needs to be covered.
Some people are very action-oriented; they get things done. Others are more reflective but are very good at diagnosing and sensing what needs to be done. And then you have medical expertise, nursing expertise, and business expertise.
So you need to mix the different expertise and styles that are needed to have an effective team. It's not about an individual alone; it's about how does the individual fit in a team. The leadership team at the top needs to make sure that people in the organisation can create the right context for delivering a great service.
Q: Many academic medical centres around the world choose for their top leaders, their chief executives, to be doctors. Do you think that's necessary?
Holthof: It's not necessary. I think it's helpful to have this background to understand the science and how that impacts the way care is delivered. But that's not the only valuable perspective.
If you really want to drive innovation in health care, which is my passion, you need academics; you need very good clinicians, but you also need entrepreneurs and investors. You need all of these different types of expertise to really make innovation happen.
A career change: Shifting to Oxford
Q: So after all the years you spent in consulting and working in Belgium, how did you end up coming to Oxford?
Holthof: A call came asking if I was interested. And in that first discussion, John Bell, who's the Regius professor here, talked about why I might come here and what I might do.
The conversation was really all about innovation. Oxford has a very long tradition of innovation and changing the way medicine is practiced. And we discussed what the next wave of innovation would be, and how I could help bring that into reality. We talked about genomics—which calls back to my old fascination with DNA—and of course Oxford is pretty advanced in applying sequencing for diagnostics and therapeutics.
So that certainly was a topic where we immediately found common ground, but we also talked about digital transformation and the disruption that digital health will bring. Oxford's Big Data Institute was under construction at the time, attracting a large number of scientists with different backgrounds looking at big datasets, and how that will improve diagnostics and treatments.
So the main reason to come to Oxford was the extreme talent base and focus on transforming how medicine will be practiced in the next five to 10 years.
Q: So you'd arrived to a large organisation that has all of the potential talent to be very innovative and a long history of innovation. How did you approach your first six months on the job?
Holthof: One of the first issues I confronted was around long-term investments: How do we make the right investments in buildings, which usually last more than 40 years? In particular, how do you develop the physical estate of a new life sciences campus? We had to develop a master plan with the university, with the hospital, and with the local authority, focused on what a life sciences campus will look like 40 years from now.
We now have a master plan that's being approved by the local planners, which is building on the success of Oxford over the past 800 years around the concept of colleges or dedicated buildings that create a diverse community.
We decided that we didn't want a huge building but rather a number of buildings with 250 to 500 people who are multidisciplinary—because that's where the innovation will occur, whether that's cell therapy or nanotechnology. And we also want to make sure they're embedded into the actual delivery of care.
Q: Another big challenge on your radar when you arrived, of course, is that NHS resources are under pressure. How has that impacted your ability to be as innovative as you would like?
Holthof: Well, both the academic medical centre and the university were concerned about budget pressures. That's the main reason for why the university and the trust have created a new legal entity called Oxford University Clinic, which will allow innovation that could not take place otherwise. It will diversify the sources of funding so that we also have more private funding available for research, teaching, and care delivery, and allow us to invest in innovations that otherwise the NHS or public spending would not.
It's one of my achievements since I came to Oxford that I'm proud of. We've now signed a lease in London for developing a clinic in partnership with Mayo Clinic. So we're trying to stay at the forefront of innovation by diversifying the amount of funding and the type of funding we get.
Q: More broadly, what has been your experience with the NHS? Strengths, weaknesses, opportunities?
Holthof: The strength definitely is that the NHS produces a lot of measurement and metrics; I don't know many other systems where so many metrics are readily available around quality, safety, and operational indicators. Eventually we hope to have longitudinal records for patients, which then could be used for population health and also for developing registers for research and improving the care delivered. And we have some very strong analytical groups that can help us mine the data, analyse the data, and see what we can learn from it.
Also—and this is more a policy question—providing universal access to patients in a tax-funded system is great for population health. On the flip side, if you're an individual who wants to seek the best care even if it isn't yet evidence-based—and if you're willing to pay for it—then this is not the best system.
Q: So we've talked about the path that brought you to Oxford and your experience here so far. Let's talk about the future. What do you expect to change in health care across the next three to five years?
Holthof: I would say artificial intelligence. That transformation is already underway. We've already rolled out an application in all of our hospitals that uses a database of more than 30 million vital signs to predict which patients are going to get sick. And it already impacts medicine today: The sickest patients are seen first, and we therefore avoid admissions to intensive care. We signed a deal with Drayson Technologies to commercialise this technology within the NHS and globally.
A second example is imaging, where we're seeing that artificial intelligence can accelerate the reporting of normal scans. I expect these technologies will be commercialised and scaled up in the next three to five years.
More broadly, new technologies will help us find the fundamental cause of diseases. Right now, often we don't know the real underlying reason for a disease, and so we call it 'congestive heart failure', or 'lung cancer'. With better diagnostic capability, you can identify the root cause and come up with more targeted therapies that will improve outcomes.
Q: And looking even further into your crystal ball, when you leave Oxford at some point, what would you like people to say about you and what you've achieved?
Holthof: That I've made a difference in allowing Oxford to stay at the top of innovation. Oxford has a reputation of being a very innovative hub, and we need to make sure we remain at the top. I'd like to contribute to a change that allows us to remain at the top of innovation.
Balance and gratitude
Q: I know we're running out of time, and there are millions more questions I could ask you—but let's take a step back and talk about how you manage your personal life. How do you find balance in your life?
Holthof: For me, balance is very important. I have quite a lot of passions outside of health care, like mountaineering in both winter and summer. And those are for me the moments of reflection, relaxation, and inspiration.
My other passion is cycling. I do cycle into work every day. But I also love cycling in the Cotswolds and explore the countryside on a bike.
Q: And to wrap up, what would you say you're most grateful for?
Holthof: Good health. Being in a job like this one, you just come across so many friends and family who don't have good health, and you realise how valuable good health is.