Patrick Keady: Healthcare Risk Consultant
Healthcare Risk Consultant
How did you get your job?
England’s National Health Service (NHS) has been very good to me. I held a diverse range of roles in the NHS, up to Executive Director level. Then in 2006, I was attracted to a portfolio career, as Non-Executive Director and Healthcare Risk Consultant. I have now worked with 92 health and care organisations.
In 2006, I was Head of Healthcare Governance at the Strategic Health Authority (SHA) that was co-ordinating 85% of all the health services provided to the populations of Coventry, Warwickshire, Worcestershire and Herefordshire. The remaining15% of healthcare services were delivered by private healthcare providers. The SHA was one of 28 local headquarters for the NHS in England. Our SHA oversaw the health economy of 35,000 NHS employees and a budget of £2bn. Thanks to our engaged Board of Directors, the SHA consistently performed in the upper-quartile of England’s 28 SHAs. Then the Secretary of State for Health announced that the 28 would become 10. This posed a speculative risk for me, and I opted for a portfolio career as Non-Executive Director and Healthcare Risk Consultant.
Our SHA was to be merged with neighbouring SHAs in Birmingham, The Black Country, Shropshire and Staffordshire - to form the new NHS West Midlands. However, it had become clear to me, that there were very real downside risks emerging from how the three SHAs had been transferred into the embryonic NHS West Midlands. My concerns were confirmed by the Mid-Staffordshire Inquiries published in 2010 (independent) and 2013 (public).
All of this was a long way from where my working life started. I was 16 and it was during my school holidays. That was when I became a barman, a job I returned to for my next nine holidays periods. The work was exhilarating. It was all about developing real relationships with the full spectrum of people, from Members of Parliament to a cross-section of their electorate. I learned how to be flexible with customers, especially when they were inebriated!
Reading for a Degree in Chemistry, opened doors for me to work in Ireland, Germany, The Netherlands and the UK. My interest in ethnography was piqued when I noticed that each of my employers did the same things … differently. This phase in my working life was very much about listening to feedback, and learning from it too. My time at Germany’s Max Planck Society was particularly inspirational. I attribute this to their vision that “insight must precede application”. The Society has clearly remained true to it. With 29 (now 33) Nobel laureates and 15,000 peer-review papers published annually, the impact speaks for itself.
In 1991, I joined the NHS as one of their first Health and Safety Advisers employed outside London and the North West of England. Crown Immunity for health and safety at work had been removed just five months earlier. My line manager certainly welcomed the changes although some of his contemporaries needed more than just a little encouragement. I wanted to make a difference and I started with them.
While there were specific fully-funded training schemes for clinical staff, accountants and most of the managers working in the NHS at the time, there was nothing available for people like me. Instead, I developed and self-funded my own training scheme. I joined the National Association of Healthcare Safety and Risk Practitioners (1991), completed the NEBOSH Diploma (1993), the IRM Diploma (1998) and an MBA (1999).
In 1996, I received the IOSH Annual Safety and Health Practitioner Award and I decided that it was the right time for me to diversify further. By the time I became an Executive Director for Strategy and Governance, I had already diversified in to Clinical Risk Management (1994), Occupational Health (1997), General Management (1998) and Corporate Governance (2000).
What’s a typical day like as a Healthcare Risk Consultant?
Typical days today are very different to when I became a Healthcare Risk Consultant in April 2007. I used to spend 100% of my time on site with clients and at the same time, I wanted to reduce my carbon footprint. The perfect opportunity came in 2015, when the NHS introduced maximum daily rates payable to Independent Consultants. This nudged me to further review how I was working, where and how.
Today, all of my clients are comfortable with me working from home in Edinburgh. My commuting is down to 10% of what it was in 2014. I spend very little time on trains and planes, and my clients benefit from more of my time, attention and other savings too.
Working days now start at 7am, just after my partner leaves for work. I take a coffee to my desk, open my workbook and then I am in the zone. Each working day is a combination of three types of sessions: speed, strength and free-thinking.
Days start and end with ‘speed’ sessions. These take up to one hour each. This is where I complete a group of simple tasks, such as giving brief advice to clients on the phone or skype, diary planning, responding to emails, booking train tickets, paying bills and so on.
In 2015, I became the first Certified Fellow of the IRM to work in Health and Care. It is the ‘strength’ sessions that keep me strong as a Certified Fellow of the IRM and Chartered Safety Practitioner. Strength sessions are forward-looking and they last for up to two hours. If I finish in less than two hours, then my reward is a coffee, or a brief walk and sometimes both. Strength work includes planning for Board meetings, coaching clients, running webinars, organizing seminars, drafting articles and presentations, researching legal rules and guidelines, reading key reports and documents, writing proposals, and so on. Strength work keeps me up to date on new developments too.
Then there are the free-thinking sessions. This is where I am most creative. When presented with problems that seem particularly challenging, it is the free-thinking sessions that makes them so much more malleable. I find time to write up my own work and ideas during strength sessions. Free thinking is vital to me. It is one of the reasons I opted for a portfolio career as Non-Executive Director and Independent Consultant. After almost ten years, free-thinking is the main reason I still love my work.
What do you enjoy most about your job?
I enjoy helping clients make real differences. But here’s the thing. They want to make real differences, but not to the detriment of their careers. After all, they have invested decades of time to get to where they are. The tension is real and I fully understand where they are coming from. I help them take considered risks by identifying the most appropriate options that will entice them do what is best for patients, their organization and themselves.
I choose the most appropriate time to challenge clients, while always respecting what matters most to them. I carefully choose when to speak, when to listen and when to respond to their challenges – this helps me pinpoint what matters most to them. You could say it is all about soft skills. Maybe it is emotional thinking. I’m not sure, but it works.
For me, my job is all about delivering what I agree to do, and more - provided it is ethical, legal and in the interests of patients, the client organization and the client. I enjoy opening new, unexpected avenues to help clients enhance their management of risk. I guide them on how to manage risk better and of course, I highlight the associated assurances along the way too.
As you might expect, clients are not particularly interested in my knowledge and experience. They are not interested in comprehensive advice either. All they want, is what matters most to them. They want advice that in their eyes is pragmatic, value-added and delivered on time. I enjoy doing just that.
What are the challenges?
There are a few niggles. Objectives are the main one. They are a particular issue when I am nudging healthcare professionals and specialist risk professionals - in information governance, patient safety, financial risk, occupational safety & health and other risk silos - to express how their individual efforts contribute to - or take from - the objectives for their speciality, their organization or their health economy. In the vast majority of cases, healthcare professionals and specialist risk professionals are simply unable to do this well. Perhaps it is a symptom of opaque organizational objectives agreed by their Boards of Directors.
The other niggle, is giving information to clients - information they do not want to hear. When working with large firms of Solicitors for example, I am often asked to advise on the relevance of specific guidance to their clients. Sometimes my response is not what they want to hear. But I find that explaining the rationale in terms acceptable to both groups, works well for all concerned. This usually leads to repeat business too.
I was approached by a group of 400 GPs to help them identify a response to the 4% per annum increase in visits from patients. My conclusion was that the GPs needed to focus more on what they do best and to delegate everything else. Fewer GPs were needed (not more), provided they diverted up to 40% of their workload to physiotherapists and mental health practitioners, together with a short list of other interventions. I sourced and put them in touch with GPs elsewhere in England, GPs who allow patients to self-assess on-line and GPs, who had come up with a neat quality-intensive and cost-effective alternative to locums. The recommendations were accepted in full and implemented.
In what way are your IRM qualifications relevant?
The IRM Diploma opened lots of doors for me. By the late-1990s, I was one of the first 10 IRM Diplomates employed in the NHS’s workforce of 1,300,000. Having the IRM Diploma and risk management experience, was the deciding factor in all of the last three job-offers I received, before I opted to leave NHS employment in early 2007.
NHS Doctors, Nurses and Allied Health Professionals care for all patients, based on clinical need. Some people working outside the NHS seem to think they live in the ‘real-world’ and that NHS staff do not. In my view, clinical health professionals work in the much more challenging ‘surreal world’ with the full spectrum of competing, conflicting and sometimes unachievable aspirations and demands from patients, their loved ones, the media, politicians and more. The good news for all healthcare providers (public and private) is that the IRM qualifications offer a robust structure to make sense of this.
The IRM qualifications’ narrative is that downside risks can be prevented or managed. Some healthcare specialties find risk management less intuitive than others. This is because their patients must be predominantly unwell before they can help for example, Intensive Care Medicine and Psychiatry. But the narrative is much more intuitive for healthcare professionals working with patients who are predominantly well - such as professionals in Public Health and Obstetrics.
What would you say to others thinking about joining IRM as a member?
Just do it! If you thought risk registers and board assurance frameworks were as good as it gets, then prepare to be amazed.
Joining the IRM gives you the sim-card to be part of the World’s community of leading-edge qualified risk professionals. You will have lots of opportunities, such as joining location-specific and industry-specific networks in the UK, Europe, Middle East, Africa, Caribbean and further afield. And if you are interested in Health and Care, then I welcome you to join the Health and Care special interest group. Contact me on LinkedIn (www.linkedin.com/in/patrickkeady), Twitter (@QualityRiskMgt) to find out more.
The IRM is the longest established professional body in enterprise risk management and professional qualifications are it’s unique niche. The qualifications are very well regarded and good value for money too. The beauty of the IRM qualifications is that they will help you appreciate the full impact that enterprise risk management has, when done well.
How has your role developed and what are your career ambitions? Has being linked to the IRM helped?
I am a Non-Executive Director at the IRM. This role is particularly enjoyable and invigorating. My ambition is to grow my portfolio of Non-Executive Director roles, particularly in professional bodies and healthcare.
I was a Non-Executive Director on the Board of the World’s only Chartered body for safety and health practitioners (IOSH) between November 2008 and November 2014. After ten years in the role, the then Chief Executive retired a few months before I was elected Chair of the Board. Highlights during my time as Chair included the creation of a completely new Executive Team, sponsoring a 360 degree review of the Board resulting in more independent NEDs joining the Board, setting precedent in areas where it did not already exist, and keeping the Board working together during a time of significant change.
A few months after standing down as Chair of the Board, all of my Non-Executive Director colleagues fedback on my performance – they told me they always trusted what I said and that it would be said diplomatically, that I communicated clearly and consistently, that I was resourceful and that I delegated appropriately. They added that my approach helped them make decisions that were challenging and at the same time, necessary.
Set your lifetime objective
What is more important to you. Being physically and mentally able to spend 100% of the rest of your life doing what you want to do, and when you want to do it? Or are you content to settle for something closer to 0%? Then decide on how you can best achieve what is most important to you.
Look outside your silo
As Healthcare Risk Professionals, we need to fully understand what is promoting and inhibiting objectives in specialities, organisations and health economies. To do this well, we need to look outside our usual sources of knowledge. Every day, I keep up-to-date with the usual Healthcare information sources. For a more rounded perspectives on what is in the news, I read three different dailys - the Independent (London), Glasgow Herald and Irish Times. Continuing to look outside your silo will help you have a more informed perspective. With enhanced insights, you can contribute so much more.
Don’t expect too much from healthcare
On average, the overall impact of healthcare on individuals is just 10-15%. Rather than having unrealistic expectations of what healthcare can do for you, focus instead on the high-impact determinants - your social and environmental circumstances (20%) and the personal decisions you make about how you live your life (50%). Getting this 70% right will significantly delay your need for the 10-15%. Genes are the remaining 20%.
You will have set-backs. We all do! But hang on in there. Focus on a time in the future when the set-backs are no longer there. Know your conscious biases. Discover your unconscious ones. Gravitate towards the biases that help you most and stay away from those that are counter-productive.
You are just one individual in a team of talented people. You have strengths. But your colleagues have more strengths than you do. You have to respect their strengths before they will respect yours. Relationships matter, they are as important as getting the job done.
Be open and direct
Watch and listen carefully, but retain the courage of your conviction. Be open and honest with your line manager or client. Tell them how they are doing. They need to know. They might even thank you for it!