Lesley Watts, the Chief Executive of Chelsea and Westminster Hospital NHS Foundation Trust
Question: You started out your career in health care as a nurse. What do you think you brought from nursing into your administrative roles?
Lesley Watts: I would say I'm pretty resilient, having had to navigate the difficult infrastructure, behaviours, and culture at that time. I understand clinicians at a deeper level. I also learned a great deal about team work. And a sense of fun.
Q: Can you give an example of how you have applied some of those learnings in your role as Chief Executive?
Watts: So for instance, there's a ward here that when I came to the organisation was absolutely on the top of the 'worry list' wards. But it's one of our best-performing wards now and has done a huge amount of innovative work around dementia and end-of-life care. But that was driven by an honest discussion with the team and some of the key individuals who weren't performing as highly. We were able to invigorate them towards making improvements.
Q: A common reaction might be to remove the underperforming individuals from the ward. But yet you worked with them to turn it around and become one of the top performing wards. Would you say that's representative of a particular leadership style?
Watts: I think that you should value people who are trying, but recognise that people don't always get it right, and people can become tired. But if they're trying, I think there's something about going with it. Deliberate poor performance, people who aren't trying, or the people who don't want to be here, I'm pretty clear—don't be here. Go. I say that even from induction.
We talk about how one of our key values is being 'unfailingly kind.' I talk about what that might mean. This is a pretty hard job, and my take is, if you really want to be here doing this job, then stay. Most people are trying hard, I find. People don't suddenly stop trying or suddenly become not quite so good. When that does happen, it's usually over a period of time when people need a bit of respite and support. And you need to find ways of doing that.
Q: How does the 'Fab Change Week' play into all this?
Watts: That was a way of celebrating improvements and innovations a bit more visibly. It's a way of recognising the great things we do. For instance, we did a great piece of work in our hand therapy unit, where they developed an app to help patients remember what exercises to do at home. We launched that at the start of Fab Change Week. Patients and our consultant surgeons came in for the launch. It was really, really nice. There are a number of these types of innovations here, and it's something we like to celebrate.
Q: Do you see any downsides to fast-acting innovation?
Watts: I think there's the risk of being over positive about some of the changes you make. One of the things that I talk about, particularly to more junior staff, is that sometimes you make mistakes. When that happens, you've got to be prepared to say, 'we thought this would be the result, but we got it wrong. So let's rethink it and start again'. Sometimes I think staff need to understand that getting it wrong is just as much a valued way of learning as always getting it right. In fact, often you will learn quite a lot more from getting stuff wrong than when you get it right.
Q: Switching gears a bit, what did you learn from also working at a Clinical Commissioning Group?
Watts: What 40 years in health care tells you is that the infrastructure of health is something that politicians spend their life pondering and thinking about how they could make it better. Potentially one of the ways that they could make it better is by not changing it quite so often. So if you look at what allows change to happen, it's often sustainability of leadership and sustainability of the care model, whatever it is. It allows time to build relationships and trust, which allows that change to take place.
Q: As I think about it, most of the hospital Trusts that we've studied that are doing interesting things tend to have longer than average lasting Chief Executives. How do you feel about being a Chief Executive in that context?
Watts: On a personal basis, pretty relaxed about it, honestly. One of the joys of having spent many years in the NHS is that you worry a bit less. And you're potentially allowed freedoms that others aren't, because you've become more well-known around the system. But by being reasonably resilient and by performing well in whatever environment you're in—be it in the commissioning or provider arena—that allows some respite for staff to get on and do their job.
So my advice to younger colleagues is to make your mistakes now. Do your learning now. Don't be in a rush to get to a Chief Exec's job, not least of all because the average life expectancy of a Chief Exec in the NHS isn't massive. So make sure to do work that makes you feel that you understand the business and that you know what it is you're setting out to achieve.
Q: What would make you say, 'at this point I've had enough, and I need to be done?'
Watts: Once I could see that I had built a sustainable organisation where the staff felt confident to do the job they're doing. And that the team below me would be able to take the organisation. Succession planning has always been in my mind, and I feel it's something that you owe an organisation.
When I left Hertfordshire, it was a very strong organisation. And it maintained that—I would expect it to. We don't build an organisation around individuals. It's about making sure people understand what makes an organisation run efficiently day in and day out, whether you're there or not. And making sure you put time and effort into developing strengths. Further, identifying and working on the challenges for each member of your staff, but doing that in an environment that is friendly and fun.
Q: What specifically do you do to support succession planning?
Watts: We have a systematic approach to assessing objectives and individual performance. And as part of that, we look at where individuals want to go in their career and what we might need to do to support them to get there. The more they think about that, and the more prepared you are for your appraisal and performance review, the better we are able to help you. For the more senior team, as well as doing that, I meet with them on nearly a weekly basis to discuss three questions: What am I doing now? What am I doing in the medium-term? And what am I interested in for the long-term?
Q: Every meeting you cover those three?
Watts: More or less. It is reasonably informal, but it has a little bit of structure to it so that we make sure that if individuals need assistance, we give it to them. Most of them have coaching on a one-to-one basis as well. For instance, today our Chief Operating Officer is with his coach for the afternoon, and those coaches are external to the hospital. I can see that progress has been made by individuals because of work that's done with their coaches.
I coach other executives outside of the hospital, and it makes me realise the value. I want people to have time to develop and enjoy the work that they're doing and not be under pressure the whole time. And there's a risk that there is constant pressure from above. I think part of my job is to protect the team from that.
Q: Coaching is a big investment to make. But it sounds like part of the reason for doing it is to give people a little bit more protection, a little more space, a little more time, is that right?
Watts: It is. And it is a big investment. I believe we get a good return on it, and I'm pretty direct about it. If I think that it's making no difference at all, then we would have a conversation about stopping the coaching. But particularly with a young team, they need to explore things, and they need some help to do that.
Q: When you said you coach other executives, what do you see? What are the areas you most frequently have to work on?
Watts: Resilience is one, actually. Often this has to do with facing up to some difficult conversations, and how we have conversations. For example, the NHS is absolutely a leaky cauldron. So if you don't want something heard, don't say it. If you do want it heard, have the courage of your convictions to say it up front, but then also allow it to be challenged. Work on not taking criticism too personally, and concentrate on the issue.
Q: Tell me your Twitter strategy. It seems pretty extensive compared to some other Chief Execs.
Watts: I absolutely recognise the need to communicate, particularly with our staff. So my Twitter strategy is really about celebrating some of what I see our staff doing day in and day out. It's an internal thank you, and showing I recognise their efforts. And to that extent, I would say it's pretty successful. The staff like it.
Q: What else do you do to be visible to your staff?
Watts: Ideally, I work on wards or in the departments.
Q: How often is this—once a month? In uniform?
Watts: Typically every single week I visit every single clinical area. And yes, I wear scrubs. I usually do pretty basic stuff. I tend to do the stuff that's heavy, like washing under the patients or stuff that's sort of messy.
Q: What's a normal day for you?
Watts: There really isn't one normal day. But we have regular meetings, like the Board meetings, exec meetings, and meetings with my own cabinet, which is a smaller group of execs. The exec meeting includes all the clinical directors and heads of service. We also have a running series of deep dives into our performance. It looks at quality improvements, staffing, and efficiency from the ward level up to overall service. In between all of those and in between the strategic pieces of work, as well as work with our external partners, then I will go out to the wards. So it takes a fair bit of commitment to do it, but it's worthwhile.
Q: What kind of impact do you think this has made with the merger between Chelsea and Westminster Hospital and West Middlesex University Hospital?
Watts: When you merge, you try and do two things, which is bring a whole organisation together, whilst at the same time allowing its component parts to still have their own history and their own identity. You need to reinforce that view, and you need to do that quite visibly, I think. And I think one of the reasons that the merger has been successful is not just my visibility but the visibility of the whole exec team.
It's also been lovely to celebrate the things that were similar between the organisations. And our value of Unfailingly Kind allows us to do that. To put this into perspective, I see every complaint that patients submit. Most of the complaints aren't about technical stuff—this is one of the safest hospitals in the country. It's about staff looking up and saying hello. About being kind. So we talk about that a lot. At induction if I ask 'who's kind in this room,' everyone will put their hand up. If I ask who is unfailingly kind, I think it would look different. When you're going nonstop on your feet all day, when your patient buzzer is going, when you've got your Chief Exec asking why something is delayed or closed, it's much harder to be kind. But you need to really think, 'what are the strategies I have to grit my teeth, put a smile on my face, and be kind to patients?'
Patients can have some pretty worrying technical care, and they will still think they've have a good experience if the staff are kind to them. And the other way around. They could have absolutely great technical care, but feel they had a terrible experience if we haven't worried to look up and smile and say hello. So we've worked really hard on that. And I think it's been embraced well across both sites.
Q: What are you grateful for?
Watts: The commitment of our staff. Every day I think about how fantastic they are. I'm grateful for my career. I don't know where else you would start out as an 18 year old without clear aspirations to now be running a teaching hospital. But somehow that's the magic of the NHS. If you work really hard in the NHS and you commit yourself to it, I think that those opportunities are absolutely out there. So I'm grateful for that.
Q: Flash forward one year, there's a press release about Chelsea and Westminster Hospital, what does it say?
Watts: I think what would really make me happy, is that it would say that we have the best retention of staff in the country. I think that's unlikely, because it's not that easy to retain staff in London, but perhaps at least highlighting that we have great retention of staff. That we continue to put patients first. And that we are recognised as being really kind to patients and that we are among the most innovative in our delivery of health care.