How applying academic thinking in the workplace can help drive change within the NHS

Jack Goldsmith, who completed the Senior Leader Apprenticeship (Management for Future Leaders) programme in 2024, adopted this values-led mindset to complete a number of Work-Based Projects focused on healthcare delivery within University College London Hospitals NHS Foundation Trust. In this article, we explore the learning and impact gained from two of these projects.

“The Work-Based Projects reflected the scope of my current role at UCLH, and helped me to pinpoint the substantive changes I could make to improve the services provided by the Trust. That was really beneficial – and I’ve been able to see the impact of the confidence and communication skills I’ve gained within my workplace.”

“The Work-Based Projects reflected the scope of my current role at UCLH, and helped me to pinpoint the substantive changes I could make to improve the services provided by the Trust. That was really beneficial – and I’ve been able to see the impact of the confidence and communication skills I’ve gained within my workplace.”

This project addressed a universal issue that affects services and teams: missed appointments. Every year, UCLH delivers 1.1 million outpatient appointments to over 350,000 people. As the Strategy Implementation Manager in the Paediatric and Adolescents Division at UCLH, Jack had a unique insight into the operational functions and flaws of a frontline service.

Having remained largely unchanged since the 1940s, the model for outpatient appointments has been revolutionised since the pandemic. At UCLH, 50% of outpatient appointments are now delivered virtually. Currently, patients who miss a scheduled telephone call – due to lack of signal, clinicians running early/late, or lack of awareness about the appointment - have to wait up to a year for a new appointment. This causes frustration and delays on both sides, adds to the critical issue of waiting list backlogs, and negatively affects patient outcomes in terms of both health and trust in the NHS.

It also increases the pressure on an already over-stretched and underfunded healthcare service. A recent NHS study suggested that almost five million clinician hours could be saved if 30% of outpatient appointments moved to virtual consultations and £266 million could be saved by reducing ‘Do not attend’ rates for outpatient appointments to 2% (ZPB Associates, 2020).

Jack’s Work-Based Project proposed the introduction of virtual waiting rooms for telephone appointments, an innovation designed to prevent ‘did not attends’ (DNAs) in appointments. A Virtual Waiting Room removes much of the uncertainty from the process

and provides patients with more autonomy. Instead of waiting passively for a phone call, patients can dial in ahead of their appointment and receive updates on their waiting time before speaking to a clinician.

Jack created a prototype interface for this new system, and interviewed key stakeholders about the benefits and potential challenges of Virtual Waiting Rooms. His feasibility study found that, from a cost-benefit perspective, the introduction of this system would be a net positive due to more efficient resource allocation and shorter waiting lists. Crucially, it would also benefit patients by removing some of the barriers that prevent fast and effective care.

Jack said: “This module has changed my perception of ‘innovation’. I considered innovation to be the introduction of a new product; something different, not produced before.

"This assignment allowed me to explore a process innovation, using codified knowledge that could make an enormous, innovative change for UCLH."

The implementation of virtual waiting rooms is a prime example of how leaders can work to improve the systems they work within by building on the technologies and processes already in place. When reflecting on the project, Jack found that a positive culture of creative thinking and continued development is also something that needs to be fostered universally, so that all team members can strive to improve through innovation. “Innovation is vital to improvement; it should be creative and involve all employees throughout the organisation. Working in teams is critical to making innovation work; it requires a positive culture to ensure success. I hope to support my colleagues in the teams I work in, to help to drive this process of continuous improvement.”

The SLA programme doesn’t just empower learners to deliver practical innovations. It also encourages a holistic, values-led approach to strategic management. This reflects one of the most fundamental tenets of the NHS; to deliver high-quality patient care guided by compassion, integrity, and a commitment to equitable outcomes.

Jack’s Work-Based Project focused on concepts from philosophy, and how NHS can use these to guide organisational responses to moral challenges – particularly around Equity, Diversity and Inclusion (EDI).

He analysed three specific moral challenges to patient and staff equality: the under-representation of children from minority backgrounds in clinical trials, the recruitment and retention of a diverse workforce, and the reduction of implicit biases within the healthcare setting. This project used stakeholder mapping and engagement to analyse how Aristotelian virtues could be practically applied to address these moral challenges. “Studying virtue ethics gave me a much greater understanding of the ethical principles and how they can be used to address EDI challenges on a deeper and more sustained level. Alongside the work on corporate responsibility, I was able to better comprehend the impact of an organisation on wider society.”

As an early-career learner, Jack believes that the programme has enabled him to reflect upon and articulate his personal values. He might not have the authority to impose change, but he can certainly act as a change agent, sharing his new learning with colleagues and team members to help the NHS achieve the inclusive culture it seeks.

As the NHS struggles with chronic underfunding, poor staff retention and lack of resources, these practical and theoretical innovations can improve patient outcomes and operational efficiency. Jack is already putting this approach into practice. Within his division, he’s implementing cost improvement plans, working to ensure EDI practices are embedded and supporting a project to reduce the rate of missed appointments by 13%.

"I want to help create a more inclusive and diverse workplace, where staff and patients feel safe and able to be their authentic selves. […] This work should then be developed through promotion of EDI networks, creating safe spaces and active listeners who can support colleagues and patients at the hospital. All of this I hope will instil a more inclusive culture whereby the process of dealing with these moral challenges in EDI is a lot easier to navigate."

The Senior Leader Apprenticeship for Future Leaders is designed to equip managers with the skill-set and confidence to deliver effective and lasting change. The focus on personal growth, self-analysis and reflection, alongside knowledge sharing, is something Jack experienced during his time at Henley Business School.

“The programme has affected me more personally than I expected. There was a lot of time to reflect on my own values within the wider context of corporate responsibility and ethics. I’m now studying for a Masters in psychology, and I’ve realised how relevant the skills and knowledge gained on the SLA programme are to other career paths within healthcare. Ultimately it’s about understanding why we do this work, and why it’s important.”