Telling people what to do isn’t directing
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SFM Consulting meets John Reay, Chief Executive of London Bridge Hospital.
London Bridge hospital, situated on London’s south bank near the bridge of the same name, is one of Europe’s leading private hospitals; it has 590 staff, treats thousands of patients a year and has a turnover of £100m.
John Reay, CEO London Bridge HospitalJohn Reay, Chief Executive Officer of London Bridge Hospital, has led the hospital since December 2000, during which time it has grown rapidly, acquiring two additional buildings on site as well as creating two diagnostic centres, one in the City and one in Canary Wharf. The Healthcare Commission (now the Care Quality Commission) named London Bridge Hospital as one of the top ten UK hospitals for heart surgery. This was an outstanding accolade for the cardiac team which is made up of some of the capital’s leading surgeons and specialist medical teams. London Bridge Hospital has long had an international reputation for its high standards of cardiac medicine and to be named alongside some of London’s leading teaching hospitals was a tremendous achievement.
John, 49, served in the Royal Regiment of Fusiliers for 11 years, reaching the rank of majorand he served in Northern Ireland, Germany and Cyprus. On leaving the Army, John studied a full time MBA at Cranfield School of Management before training as a hospital manager with BUPA Hospitals Limited. He then went on to manage Parkside Hospital in Wimbledon before moving to London Bridge Hospital (LBH) in 2000. John regards his primary challenge as building the quality of the hospital’s services and letting the world know how good the doctors and staff are at the hospital: “We have demonstrably excellent outcomes and the multidisciplinary teamwork here is second to none”.
SFM: Did your time in the Royal Regiment of Fusiliers, or studying for an MBA, provide you with experiences to draw on that you wouldn’t have gained elsewhere?
JR: My military training was excellent and extremely pertinent. The army gives you excellent training in listening to people and developing your interpersonal skills. I found that running a hospital is not dissimilar to my role in the Army as, in both cases, you are dealing with a lot of professionals who know their job better than you ever will, and your job, as leader or manager, is to listen to them and facilitate solutions which give them the chance to do the best job they can. The hospital is similar to an infantry regiment – you have all these experts in different weapon systems, and they know what they’re doing, and your job is to put them in the right place, at the right time, to deliver the best possible outcome. At times, dealing with (medical) consultants is just like being a staff officer and dealing with your commanding officers! You have to get them to go in a certain direction but be mindful of their seniority at the same time.
I did an MBA which was great. It was one of the most fun years of my life, and whilst the Army was great fun, it was tremendous to have a year where I had responsibility only for myself.
When I left the army I wanted to go into business management. I knew that “business language” was very different from “military language” and this was one of the driving forces behind studying for an MBA. The other was that the Army teach you to tell people what to do, but this isn’t the only way of achieving results, and the MBA course teaches you not to tell people what to do but to be directive. I’ve subsequently found that being directive is essential working in a hospital where my job is to make the team feel that it’s their idea. So my transition year studying an MBA was time and money, my money, very well spent.
SFM: How did you move from studying a full time MBA into hospital management?
JR: I had a very good training background with Bupa. Bupa recruited me from the MBA onto what they called their Associate Manager Programme which trains you to be a hospital manager. I did my year’s training at Bupa Cambridge and Bupa Leicester where I learned how to manage a hospital by being trained to do every job. It was a full year of learning and I had to keep a diary of all my learning points. I was reviewed by my Regional Manager on a regular basis, and the General Manager, to whom I was attached, would write a report. In my second placement, Bupa Leicester, I did a very good job for my general manager setting up an MRI (magnetic resonance imaging) for him.
I heard of a great opportunity at Parkside Hospital in Wimbledon. They were looking for someone to manage the hospital. After the interviews I was offered the job at Parkside and it was hugely exciting because they sent the contract to me by courier on a Sunday. I really thought this was the bees knees – someone has paid for a courier to deliver my contract of employment on a Sunday morning. How cool was that?
SFM: Parkside Hospital was your first executive management role in healthcare and it was struggling when you took over. What did you do to turn it around?
JR: When I took over as manager at Parkside Hospital, in Wimbledon, it was a turnaround situation, and although a turnaround is very much “directive control”, in a hospital environment, the staff and consultants don’t want to feel you being too directive. They’ve got to like you and want to work with you – so it’s being directive but with velvet gloves. The consultants were really good and once they realised you were listening, and not pushing stuff on them, they really opened up and wanted to be part of the changes.
Management had changed a number of times, and the hospital had suffered as a result, so there was a lot of scope for improvement which was possible as Wimbledon and the surrounding area has a huge private medical insurance (PMI) clientele. Parkside was very much a “hips and hernias” hospital, that is a hospital that provided good, routine surgery, but to grow the hospital and extend its market it needed to offer more. I identified that building an oncology (cancer treatment) unit was the solution to grow the hospital.
SFM: You are credited with the turnaround and development of London Bridge Hospital. What was the hospital like when you joined in 2000 and what challenges faced you?
JR: LBH had been on the market for 18 months, and was in bad shape, when HCA bought it. They advertised for a CEO, I applied, as did many other London-based healthcare managers. In London you know who is managing what, and you know when the jobs are coming up so I knew who I was competing against for the role. I was lucky – I won. I joined LBH as CEO 6 months after HCA had bought it which was a promotion for me.
The previous manager had tried to go the quality route as the hospital wasn’t in a leafy environment so there was no local population. But there’s another way of looking at where your patients come from when you’ve got 350,000 commuters the other side of London Bridge, all of whom want to be seen, now, and by the best specialists.
SFM: What changes did you make that really turned LBH around?
JR: Setting up our GP Liaison department was a real winner. GP liaison liaises with GP’s, consultants, their secretaries and the patient to provide a bespoke service organising timely and convenient appointments at the hospital and its satellite centres. There are a number of private GPs that service the City commuters and I realised that courting them was a real winner. I’ve always been careful not to compete with them so have avoided doing anything like health screening, or anything else they would regard as competition. We keep off their “turf”. We are also very open with them and they know that we are talking to all of them, but at the same time they know we are trying to help them and support them.
For example, all the major private GP providers know I speak to each of them. So we have representatives from two private GP clinics that refer into LBH on the MAC (Medical Advisory Committee) which provides us with opinions from two of our major sources of referrals. We wouldn’t dare just invite one without the other. Fortunately we’re all good mature businessmen so they understand where I’m coming from: the hospital can’t survive on the back of just one private GP group. From their point of view they want to ensure that LBH is delivering what we promise, so their patients don’t turn around to them and question why they were referred to us. So getting it right with private GP’s was essential. The other real winner was creating the right environment and culture for multi-disciplinary team work.
For patients to get the best outcomes you don’t want consultants working in splendid isolation, or as self employed business people – you want “chambers” and you want groups of consultants as they deliver better healthcare. They are more consistent, they provide better cover for each other, and the patient usually ends up in the arms of the right sort of specialist, rather than being bounced around. I’ve also found they work with you better – you are no longer held to ransom because Consultant X has lost his temper and is going to walk out, because his colleagues will reason with him before he gets to me. It’s better policing. It means there’s always someone to see a patient urgently so the referring GPs, which have come to rely on us, aren’t let down. As a consequence, there are fewer and fewer times when we refer outside LBH. We still do on certain occasions. For instance, all our cardiologists go to the same cardiology conference at the same time. They go because it’s good for networking, it’s good for exchange of ideas and it’s good fun. It’s a problem we haven’t managed to resolve.
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