Lessons I am learning
by Alice Murray
I was in Washington DC in March of 2017 when Donald Trump released ‘The American Health Care Act’, his first attempt to repeal and replace Obamacare. I was part of a small group of Harkness Fellows with exclusive access to senior US Senate policy advisors, researchers, Republican pollsters and corporate lobbyists, hearing first hand about the fascinating, and traumatic, process of healthcare reform in the US.1
The following month, I was in Tucson Arizona, speaking to surgeons who worked in a stand-alone surgical centre, off a highway, where they shared their patient reception with a laser hair removal company.
These two extremes were key highlights of a fascinating year as a Harkness fellow in Healthcare Policy and Practice in the US. The Harkness program allows international graduates to become embedded in the US, travelling the country and undertaking a piece of research that aims to advance health care for all.
I was mentored by health policy rock star and academic, Ashish Jha, Professor of Global Health at Harvard School of Public Health (16.8k Twitter followers), and Dr Thomas Lee, Professor at Harvard, ex-CMO of Brigham and Women’s Hospital in Boston, now CMO for Press-Ganey. Amongst many other incredible achievements, he is the man behind “The Strategy That Will Fix Healthcare” with Michael Porter (Harvard Business School)2. Plucked from London colorectal surgical training, I found myself travelling across 19 states in one year, visiting over 15 healthcare systems and undertaking over 60 interviews of healthcare leaders, chief quality and strategy officers as well as many surgeons. I made amazing new friends, became obsessed with exercise classes, got used to regular late night food deliveries and started writing emails with “I’m reaching out to you…”. I landed back home with a bump in Ilford, Essex to my ST5 post. I’m still learning, but here are a few of my overarching early reflections.
As a surgeon in the NHS, perhaps particularly as a woman, I had often felt I did not belong. I regularly felt uneasy in theatre coffee-room conversations about the technical details of surgical kit, I felt stifled creatively, and I had frequently been asked if I really wanted to be a surgeon. Was my undivided dedication to the specialty from the age of 16 not enough? Clearly not.
At this point I sought a different path, undertaking a colorectal research fellowship and PhD at Colombia University in New York and Imperial College, London for two years. I then applied for Harkness. My 11 companion Fellows and those leading the international programme came from diverse backgrounds across charitable organisations, clinical practice, mathematics, economics and policy. As not one of the Harkness fellows had the same experience, knowledge or abilities, yet each was individually successful. it made me think over the course of the year, what I could bring to healthcare, with my own set of skills and qualities. I am not the typical surgeon nor am I a pure academic or a policy-wonk, but I don’t need to be. I finally felt at home; authentic. Finding out how I can best contribute to the NHS and have maximum impact on patient care, is the driving force behind my ongoing development, personally and professionally.
Over the year at Harvard I worked hard on my projects, keen to please my funders and to deliver a paper, perspective or piece of work that would be highly topical and widely read. Though I continue to work on my research from that year, I am beginning to realise that the experience I had, the people I met, the talks, the interviews, the visits I undertook and the unconscious assimilation of culture, ideas and practice in the US taught me far more. From this, I hope I will continue to reap rewards over my long-term future.
While travelling across healthcare systems in America I constantly said to myself “Ooooh that’s amazing!”, “Wouldn’t it be fantastic if we did that in the NHS!” or often, “That’s terrible, thank goodness we do not do that in the UK”. What I learned was that healthy envy is a wonderful thing.3 It drove an enthusiasm in me for change in the NHS. I saw what potential there was for us to learn from across the pond (and what we must never emulate).
I returned home, back to a clinical career, but with an appetite for change, to be involved in improving NHS care beyond a one-to-one patient interaction and with new ideas, experience and confidence behind me. The NHS is sometimes very frustrating, and demoralising, with those lower down in the pecking order feeling powerless to affect high-level change, but as Sir Bruce Keogh said to me when I came back to the UK “There is no hierarchy of ideas”. Now that’s what I call an American attitude, let’s see more of it in the NHS.
Murray A Ghafur S. The American Healthcare Act decoded. In: McLellan A, ed. Health Services Journal, March 2017.
Porter ME, Thomas H. Lee. The Strategy That Will Fix Health Care. Harvard Business Review. October 2013;91(10):50-70.
Seddon N, Lee TH. Envy — A Strategy for Reform. New England Journal of Medicine. 2013;368(24):2245-2247.