Do you have any leadership messages for the readership?

Non-clinical challenges have been harder to deal with. The answer is going to be incredible diplomacy and taking on board everybody’s views and different approaches to dealing with this COVID-19 crisis.

Tell us a bit about your leadership role, has it changed as a result of the pandemic?

My role involves learning about healthcare in different cultures and countries; it is massively rewarding. I have people I call friends from most European countries now. There is a real pleasure in being enabled to progress in a certain field of medicine where we can implement changes across a large population.

The challenges of the role: politics can be problematic. There is often disagreement or division between groups of representatives, usually between different disciplines from the same country. As chair, you have to be incredibly diplomatic. It is easy to do or say the wrong thing and deeply upset some individuals or cultures with what you have said. It is easy to forget that the culture of resuscitation in the UK is multidisciplinary, whereas elsewhere it may be considered the expertise of single medical specialities. There are also potential tensions with other international resuscitation organisations.

I do not think these existing tensions have changed during the pandemic. The UK has been hit hard by COVID-19 and we have come down heavily on the side of safety for the healthcare worker. We want to make sure our workers have airborne precaution PPE before starting resuscitation. At present, other countries are perhaps thinking that we are going to lose more people by delaying resuscitation. They perhaps have considered the risk to healthcare workers to be less.

The process of drawing consensus is rewarding but can be challenging; whenever there is a lack of high certainty science, there are different viewpoints. You can end up with opposed opinion on all sorts of issues. There is less argument in the presence of high-quality trials. It is important to weigh up the pros and cons not just of the science but also other international issues, like drug availability or cultural differences regarding resuscitation.

COVID-19 has had an impact on the ethics of resuscitation. We were keen in the UK to emphasise that we will be providing the same resuscitation care while acknowledging that in the absence of reversible causes we should advise ceasing resuscitation attempts early on. This perspective was unacceptable in different societies and other countries have taken different approaches. As chair, I have to incorporate these viewpoints and allow for diverse opinion when determining the consensus.

As editor of a journal, my work has changed: I have been making a lot more desk rejections. There has been an explosion in papers related to COVID-19 and a lot have been appearing in the public domain without peer review. We have to be careful to avoid promotion of papers, which may be misleading and may cause harm. It is important that journal editors do have a responsibility; we rely on each other and our reviewers to pick up on any issues.

What events in your past experience are most informing your leadership in this pandemic?

Resuscitation is a multidisciplinary specialty. Everybody is at least equal and in many cases paramedics and nurses are far more experienced than other groups. The ability to work with this group is incredibly helpful when it comes to working in the COVID-19 situation. I think the ability to plan with and understand those individuals is important. When have we ever seen things like online conferencing with hundreds of professionals involved? Nurses, trainee doctors, consultants, student nurses all joining in. It is a great example of working together as a group from different backgrounds. It is very impressive to witness.

I have been cognisant of using a diplomatic approach to bring people forward rather than a top-down approach to leadership. The other principle I follow is to lead by doing. I am still front line in ICU and Anaesthesia. It is important to me to have that clinical experience and put it into context.

I have never had formal leadership training; I believe I did a 2-day management course shortly before becoming a consultant. These are skills I have learnt on the job. In most cases for these organisations, you are selected by the group rather than putting yourself forward. You have got to have the right qualities to start with. If someone is perceived as having an aggressive stance they have less chance of being selected to lead in the first place.

What are you finding the biggest challenges?

We have to adapt. I think the development of healthcare is accelerating at incredible speed because of this enforced adoption of technology in the way that we work. COVID-19 has shut down all income to our small organisation and we do not have huge amounts of reserves. The real problem is working with industry who previously supported the organisation but are now being asked to work with a business model where they are being invited to invest in online offerings. It is clear that companies do not see the same benefit from this as they do from face-to-face contact. What we are trying to agree on is how much industry is able to contribute, given the smaller costs of exhibiting online. Our point of view is that if industry can contribute to support the online experience by raising the profile of the discipline, this is in the interests of everyone involved.

I think as far as education (in the NHS) goes we are already changing and delivering a lot online. People may say it is not as much fun or they do not learn as well that way but there are advantages: it is easier to share materials, in some cases, people are more able to speak up in this new interface. I think there will be good things to come out of it.

Any particular surprises?

From an academic viewpoint, the explosion in papers submitted in relation to COVID-19 is staggering. I have never led a large RCT, but they are complex. It takes years to set these trials up but to have achieved this in a few weeks is very impressive. A few months ago, we never thought we would be managing critical care patients in day surgery theatres and trying to cope. The surprise was how well people worked together despite unbelievably challenging circumstances.

My personal surprise was to find that the only right thing to do was to return to the on-call rota after coming off it 3 months prior to the pandemic. I suppose I am surprised just by how long it is going to take us to get back to normality and other work, particularly in anaesthetics and critical care. It never dawned on me that the economic consequences would be such as they are. I look at my neighbours or my colleagues furloughed from the ERC, or those who are not lucky enough to be able to come to work and talk to their colleagues. While we have had a few downsides trying to deal with COVID-19, for me, they are balanced by being able to work, coming to see our friends and colleagues. If you think about everyone else, we are pretty well off actually, aside from the financial security of being a healthcare professional. Of course, there is risk to our health but I think with the right precautions,the risks of working as a healthcare professional are minimised, but the risks from the mental state of losing a job are arguably far worse.

Are you seeing any behaviours from colleagues that encourage you?

I have seen more compassion in the last 3 months than I have seen in years. Nurses, physiotherapists, doctors working together to push a bed out of the back door to ICU, so a family can see their loved one for the first time in weeks. That took commitment.

How do we maintain kindness and compassion?

I think probably the biggest experience of this has come from looking after the individuals whose lives have been shattered. It is the people we employed running the offices in Belgium. Trying to deal with that situation using an online chat interface, where there are 10 faces looking out at you, they have all been furloughed and they realise as we discussed things that they may be made redundant. That is a pretty terrible experience. You can see the emotional impact that is having.

It may be that I am a bit hard-nosed but I have not seen directly challenging clinical work conditions except for in the critical care setting when we were in the day surgery unit. Working without enough light in the room, trying to communicate awful news to families via a phone. That was stressful and I know that affected both doctors and nurses quite badly. I think it is important to know that we need to be sensitive to that fact when we work together.

I suspect it comes down to us adapting rather than walking away because it is too unbearable. We are learning to communicate. In the past, I would never want to communicate over the phone with a family to give them bad news about a family member who was about to die. To do that, I felt, was awful. I could count on my hand the number of times I have done that in my entire career. Whereas, now it is almost the norm. Families are quite understanding and that has changed the way I think about things. We will look back to the time before and think that was fantastic, but we are never going back to it.

Any guiding principles or ideas that you find helpful?

I think we do the things we do because we enjoy them. To pretend we do it for the greater good would be misleading. It is a nice consequence of doing the things we enjoy. It is a privilege.

I had a strong mentor in my career, a person called Peter Baskett who sadly died about 12 years ago. He was a resuscitation expert, a consultant in Anaesthesia and Intensive Care in Bristol. He was a world leader in resuscitation and so many of the opportunities that I have been given are a direct consequence of my relationship with him. We also worked together in motorsport on events such as the British Grand Prix. He was very much a leader he would hold the attention of the room, every time. As a motivator, he was unparalleled. He continued leading life support courses and was editor in-chief of the journal (Resuscitation) until just before he died. I said I never did a leadership course but he is where I got a lot of it from.

Some people talk the talk, whereas Peter always got stuck in, whatever the risk, he had to be up there at the front. He would take people with him because he would not tell people what to do, but he would always be the one to do the first draft, putting the hard work in. He also had a strong play ethic, which also takes people with you. Those are qualities I have tried hard to follow.

What are you looking for from your leaders?

I think the thing I look for in my leaders is the truth. The difference between respecting someone or not is the truth. I am generally not supportive of politicians because I think they are extremely clever people who can spin the truth in a way that can mislead. They may do it with good intent, but I do not like that approach. I prefer strong leaders to say it how it is and work for solutions on that basis, rather than trying to spin a story when that is a lie. I think our leaders at our hospital have been very honest with us when things were not looking great. I think that has helped people get through, a lot of us were expecting far worse than what we have seen so far, although I would rather not hedge my bets. I hope the honesty principle is one that I follow.