Senior leader reflections: Jamie Walton

University Hospitals Birmingham NHS Foundation Trust runs Good Hope, Heartlands, Queen Elizabeth and Solihull hospitals, the Birmingham Chest Clinic, and Solihull community services.

I started in the NHS 10 years ago as a newly qualified graduate, out of a degree specifically focused on cardiac physiology. I started off very general, getting involved in different tests within cardiology and gaining experience across the board. We do lots of diagnostic tests within cardiology. We cover ultrasound scanning of the heart, exercise testing, ECG analysis and we look after patients with pacemakers and defibrillators. We also work in the cardiac catheterisation lab, which is a specialised theatre with X-ray cameras. In them, we can do all kinds of specialist procedures, such as insertion of heart valves, insertion of pacemakers or inserting stents into patients’ coronary arteries after a heart attack. As a physiologist or clinical scientist, our role is to assist with the specialist technologies in the procedure, monitor patients and manage emergency situations, such as cardiac arrest. As I gained experience, I became more specialised, focusing on heart rhythm problems, the electrics of the heart.

As a heart rhythm specialist, after prioritising our patients and workload for the day, I’m typically in one of two places. I could be in the cardiac catheter labs where we fit pacemakers and defibrillators. We select all the equipment that's going to be used, programme and test the devices and monitor the patients. We provide specialist knowledge and advice to the implanter. If not involved in these procedures, I am generally found in our device follow-up clinics. As clinical scientists, we take responsibility for these patients, building good long-term relationships, diagnosing clinical issues, testing the workings of the device and devising strategies to manage any issues.

During the COVID-19 pandemic, we undertook a huge project to upscale our remote monitoring services for implanted devices. All the devices we fit (pacemakers and defibrillators) have the capability to have this remote follow-up; the patients are provided with a monitor or a smartphone app, which connects wirelessly to their implanted device. The data is collected, sent across to us, and we can review it. We can follow up the patient without needing to see them in hospital. The technology has been around for 20 years, but the pandemic meant that we couldn't physically see our patients in person, so there was a real need to push this forward and maintain our ongoing care. We embarked on a huge project to get all the patients in our service onto remote monitoring, and I am pleased that we successfully did that. Now, we're trying to adapt how we use this technology day-to-day. We have around 4,500 patients under our care, and most of our routine follow-up is now done through these remote systems. Patients were a bit unsure at first but have become very supportive of it. It gives us greater capacity to see the patients who need further support. It’s been a real team effort.

As soon as patients have a pacemaker or defibrillator, they remain under lifetime care, so we follow them up on a regular basis. Clinical scientists see them with some level of autonomy, reporting back any major findings to the responsible consultant cardiologist. We see the patients, take the history, get all the diagnostic information and, quite often, suggest programming changes or other treatments that can make the patient better. More recently I have been completing a doctoral qualification, the Higher Specialist Scientific Training programme (HSST), with the aim of becoming a consultant clinical scientist. It is a fully funded, professional doctoral program which covers lots of different aspects of the job, such as leadership and management, clinical skills, education and then a clinical research project. Now in the latter stages of the course, I am conducting my own randomised controlled clinical trial, using a novel technology to improve the programming of our devices in heart failure patients. As a consultant clinical scientist, I would have my own patient caseload, taking responsibility for my own clinical service and providing advanced practice to a consultant level. These roles are new and being developed, so it is very exciting!

The NHS right now is challenging. We deal with a lot of patients who, understandably, Can be quite anxious, dealing with serious conditions, and having to wait long times for procedures. They may be struggling to get appointments to see the people they need to see. It is difficult trying to balance and prioritise our workloads, and often we can’t do everything we want to. Sometimes we take the hit of this from the patient. Speaking to them, ensuring they understand what's going on, and coming to a compromise based on priorities can be a challenge. It's about how we can make the situation better and what can we do to help them. Often, it's something that's quite small that is causing anxiety, and sometimes it can be something that we can fix, which is quite rewarding. Good communication is critical, ensuring we are listening to them and establishing the root cause; this better aids us to provide a solution. As UHB is a tertiary specialist centre, we see patients from all ends of the spectrum. Most cardiology patients are elderly, but we have a lot of young patients here, too. Being able to speak to the two different groups and understand the two different groups is challenging, but it is what makes work at UHB so rewarding!

We talk a lot about communication when we're at work, but often we don’t reflect or work on it enough. There's lots of clinical jargon in our job. How do you get that information across to the patient? How can you explain things in a way that they understand? How can you take information from them, to aid your diagnosis and build up a picture of what they need? There are so many benefits in letting patients speak, engaging with them, and trying to get to the bottom of the cause, because often there's misunderstandings. People may not necessarily understand what their symptom might be related to, so if we can break it down for them, find out their ideas and expectations, then we can agree a better plan moving forward, getting to the bottom of the problem much quicker.

To someone who wanted to work in leadership, I’d say “go for it”. Being a leader empowers you to make direct changes for the good of your service and improve care for patients. It continuously challenges you, but it is so rewarding to see the work you do make a real impact on your team and your patients. Be sure to set yourself small and realistic goals and remember that you can’t change the world in a day. However, if you have a vision and a passion to improve things, then absolutely do it and don’t give up. Sometimes you might need to adapt your approach; leadership is dynamic, and you will constantly learn and evolve. I ensure I check in on my team regularly. I speak to them on a one-to-one basis, getting to know them as a person and getting direct feedback. Get to know their strengths and weaknesses, get to know what makes them tick. Your team is essential, so treat them as individuals, respect them and support them, and they will do the same for you. I also try to keep them involved in the projects I do. This empowers them and gives them ownership in what we are doing. It makes the changes I want to make more sustainable and more effective.

As a leader, don’t be afraid to get feedback and be challenged – this is a positive thing, it makes you a better leader and builds a stronger relationship with your team.? I want to raise awareness of the healthcare science workforce. So often when people come into healthcare, looking at healthcare jobs, they consider doctors, nurses, and sometimes other allied health professional (AHP) roles, like physiotherapy or radiography. We're a workforce that not a lot of people know about, but we’re a workforce of tens of thousands of people across the UK, managing 80% of all diagnoses in hospital.

Being a healthcare scientist is very varied, and very interesting. No two days are the same. A lot of people think of healthcare scientists, and they think about pathology or more lab-based things, but this workforce encompasses so much more, like medical engineering, medical physics, prosthetics or critical care science, which people are less aware of. There is so much variety and such different roles. I work in physiological sciences, specifically cardiology, which is obviously my passion, but there are also similar roles within respiratory, vascular, neurophysiology, audiology or gastrointestinal. These roles are patient-facing, and they are very clinical, performing a range of diagnostic tests with specialist clinical knowledge. There are some incredibly exciting career opportunities in healthcare science, and we need to raise awareness of these.

If you're inspired by Jamie and want to join #teamUHB, visit our Jobs website below to see all of our current vacancies: