Dominique Allwood reflects on her Sciana experience, what she is learning about systems leadership, and her first few months as CEO of Imperial College Health Partners
Dominique Allwood is the chief executive officer of Imperial College Health Partners, a Health Innovation Network (HIN) in the United Kingdom, covering a population of almost three million. She is also director of population health at Imperial College Healthcare NHS Trust, one of the biggest hospitals in England. She has nearly 20 years of experience in healthcare as a doctor, working in public health and healthcare leadership and management. Dominique works with leaders, organisations, and systems to tackle the complex challenges of improving population health, reducing inequalities and inequity, and improving and innovating care. She is interested in both the "what" and "how" of achieving change.
Dominique holds several additional roles within the UK and internationally, including associate editor of BMJ Leader Journal, honorary senior clinical lecturer at Imperial College London, and board member of The Patient Revolution, based in the U.S. She also holds an MPH and an MBA. Dominique is a member of Sciana's sixth cohort.
Sciana Network: How have your first few months or weeks been in your new role [as CEO of Imperial College Health Partners]? Are there already lessons that you've learned concerning leadership?
Dominique Allwood: I'm very impatient; I like to be good at stuff straight away and know what I'm doing, and I'm in my first role as a chief executive. But I feel very energised about what the organisation is there to do, the fantastic talent in the organisation, and the ability to work with partners to solve big challenges in health through innovation.
It's a partnership organisation across healthcare provider organisations in Northwest London, to find, test, and scale innovation. We work closely with the payer organisation in Northwest London and our leading academic partners. We have a large, linked data set and commercial partners based in the area, so we've got all the assets of a world-class innovation ecosystem.
It's quite humbling to see what you can deliver with a relatively small organisation, and I think that's because you leverage the resources to work in partnership and collaboration with others.
In terms of lessons for leadership, I'm focusing a lot on clarity of purpose, helping individuals who work within [the] organisation and partners connect to that.
We're going through a lot of change and transformation in the NHS, and whilst the external environment is quite turbulent, it's even more important to be clear about our purpose and mission, especially as a system partner to different organisations in [the] service of our patients and communities.
It's hard when you work in a hybrid way, but it's important to work out how to be present, to deeply listen to our partner[s] and staff who have been through a lot of change.
SN: What key insights or shifts in thinking have emerged from your collaboration with other Fellows in the cohort, and how are you integrating those into your current work at ICHP?
DA: I started this programme partway through getting my new role. It's been interesting to see the "before and after". This cohort was specifically around systems leadership for new ways of thinking about health and wellbeing. It was almost as if there was a premonition that I may take on a new role. There definitely wasn't!
I remember talking with colleagues in Sciana meeting two, having just come out of the interview process. But in meeting one, this job wasn't even on my radar. And yet I'm now sitting right in the middle of a very archetypal systems leadership role where I'm leading place-based innovation through diverse stakeholders. I have partners, members, and stakeholders at different levels of the system across healthcare, academia, and industry. My organisation is leading both hyperlocal innovation through to supporting [the] development of national innovation policy via our national network. And this programme has taught me so much about systems leadership—tackling complex challenges, different actors with varied agendas, the role of advocacy, working beyond traditional power and more.
I think what's also been helpful from the programme is to understand some of the cross-country differences and good practice that I've been able to draw on. We had an interesting All Cohort meeting in Copenhagen a few months ago. One of the sessions was on the power of public and private partnerships. I'm thinking about that through the work that I do because my organisation sits at that intersection of [the] commercial, private sector, and public sector.
I'm also thinking about how to build teams of diverse people, and through our Sciana Challenge topic of innovative ways to tackle childhood obesity through systems leadership. How do we work on a shared challenge that is complex, that's emerging, that we're not clear on the outset where it's going to go?
So, there have been many levels of learning in this programme, and I'm actively being able to apply those into my work now in my new role, too.
SN: As a leader and mentor advocating for equity and inclusion, what strategies have you found most effective in nurturing diverse leadership in the health system?
DA: I'm very passionate about this topic. I think it's partly because I have been the beneficiary of this myself. I'm a diverse woman leader, stepping into leadership spaces that have sometimes traditionally been occupied by people who look different, sound different to me, and have different backgrounds.
My parents never completed their university degrees. I was one of the only people in my school to ever do medicine. Even within medicine, I've taken an unusual career path, and I'm one of a few public health physicians to work in healthcare leadership improvement and innovation roles.
I haven't had lots of footsteps to follow in or family or connections to have benefited from earlier in my career. Working out who could provide some mentorship and really see me and support me has been really helpful and impactful in spurring me on. I've had a lot of support and help, and I want to pass it on and do the same for other people.
The main way of doing that has been for me somewhat intentional and through the lens of sponsorship. My story often resonates with people, and I try to be generous with my time, but where possible, it's about being intentional to pick people that I want to support from underrepresented backgrounds.
Other things that I do more broadly in my day-to-day work [are] trying to think about how we embed DIE meaningfully in our work, including who we recruit, but also the behaviours and cultures we want to create in organisations.
I'm lucky that I've now taken over running an organisation that it is something that I can directly steer the tone around. I think diverse leadership is one of the biggest success factors or things that will determine the success of a team, ultimately an organisation, and the success of its mission.
SN: You co-lead an international collaboration on kindness and healthcare. In what ways do you see kindness as a strategic asset in systems leadership?
DA: I've been very fortunate to lead this movement with a wonderful group of people. A key part of that leadership group is a previous Sciana Fellow: Bob Klaber, who was in Cohort 2. We've had a number of realisations that it's both what you do and how you do things in healthcare that's important, and we have often spent much less time focused on the how. One of the things that we feel is really important is about the role of kindness and some of the related pro-social terms of compassion and empathy within health care,
It is an important part of the building blocks for helping to build psychological safety, which is crucial for trust and high-performing teams, creating environments that help empower people, help them to collaborate, innovate, and create safety to fail fast and learn.
There is this brilliant movement that we created, which centres on key conversations such as how we meaningfully cultivate kindness and measure it. We've now got over 1,400 people who are part of the wider extended group. People dial into from all over the world. We have people getting up in the middle of the night from Australasia.
It really embodies the fact that people are thinking that this should not be a "nice to have" and is often an under-focused part of the workplace, especially in the current context of resource constraints. It's very tempting to have conversations that focus on working people harder, working people more productively, and taking money out of the system.
I also joined the Board of The Patient Revolution to try and tackle some of this. Prof. Victor Montori has taught me a lot about how fractured the system is—people are not resources, and patients are not widgets. As leaders, we need to ask ourselves what's the culture we want to create in these organisations? Care at the heart of what we're trying to do, and doing that through kindness is really important.
SN: Your work focuses on equity and population health. Can you share a recent example where your leadership directly contributed to reducing health inequalities, and what lessons can be applied more?
DA: One of the things that I did in my role as director of population health at Imperial College Healthcare Trust was help lead the development of our health and equity framework focused on how we improve health, wealth, and wellbeing and equity for our local population in Northwest London. We are one of the largest hospital providers in the NHS in England, and we had a strapline of a mission vision, which was "Better health for life".
Hospitals are not just "repair shops for sick people". I was trying to help the organisation understand how to focus on health.
We started with things that the organisation can control. If you start to look at the characteristics of those people not attending appointments in the outpatient clinic, they often come from the most underserved populations, so we've done quite a bit of work to understand that better and then put some improvements in place.
But at a more macro level, we've been looking at our role as an anchor institution and how we can improve health through tackling social determinants of health—the causes of the causes. We are doing a lot of work around employment in the local community—people in deprived communities who wouldn't ordinarily access roles in our hospital.
More broadly, we've been trying to get people to think more systematically about using change methods to do this kind of work, thinking about data, but also thinking about stories, and how we really understand the needs of the populations and are clear on who they are. Trying to narrow that gap so that we have a focus, a disproportionate focus on those who need it most.
SN: Reflecting on your experience as both a mentor and a leader, what advice would you give to emerging leaders?
DA: I am thinking about this in relation to when I [was] "emerging". Some of the most important experiences I had were going on formal leadership development training, but that wasn't just about taught programmes. I had an amazing transformational fellowship experience that went beyond "teaching".
I think there's something special about learning alongside people who are at the similar places in their careers, but they come from different backgrounds and disciplines. Some of the richest learning was through my peers. Understanding others' views of the world, and how does that help me understand what I'm trying to do? Not everyone will be fortunate enough to go on fellowship programmes, but finding ways to draw on the experiences of peers through a leadership lens can be very powerful.
Many people who will read this probably have taken tests or questionnaires: what do you value, and what are your values? One of the things that comes up highest for me is around learning. I'm really interested in meeting people from different backgrounds, disciplines, and different sectors beyond health. I think we have a huge amount to learn from other industries and sectors where we're trying to tackle the challenges. I would encourage those interested in leadership to have a ferocious thirst for learning!
I think another thing that's been a thread through my work has been seeking out mentors, people who will support me, challenge me, and signpost me. So, I would advise everyone to find mentors—you can be greedy and have more than one! That's been an important part of what I've done.
The final advice would be [that] there is no "right" journey or path, and to not worry about what you think you're supposed to do. I've been struck by how much I've noticed in my career some common threads, but I've joined those threads through different roles and taken advantage of things that wouldn't be on a traditional linear career path.
SN: What is your Sciana experience over time, and what are you looking to achieve by the final meeting in November?
DA: I think it potentially could be an overused word, but I definitely think it's been inspirational: the people I've met as participants, the advisors who bring all of this wealth of experience, [and] the speakers have all extended my thinking. I think the setting is breathtaking, and it gives this chance to really stop and be still and reflective. In such a hurried and busy world, I need to force myself to slow down. To borrow a phrase from The Patient Revolution, I've enjoyed the amount of "unhurried conversations" I've had.
My experience so far has been built on a spirit of openness, generosity, and a commitment from people who want to learn and also try to think differently. It's been a chance to really reflect honestly about work, life, and ambitions. That's been really helpful for me to think about how I can bring some of those practices and revelations into my work.
Ultimately, this is a network and a programme built on collaboration, that's really important for taking those pieces of learning and transferring them into my workplace. I'm thinking about how we pass the baton on to the next cohort and be a good steward of this community. I'm also thinking about the need to go back and make sure I put my learning into action. So, that's definitely on my mind whenever I'm here.
By November, in the final meeting for our cohort, we will have completed our Sciana Challenge. One lesson of systems leadership is that the work is never done. I am also keen that I keep a relationship with the people who are in this group. They've become a peer network but also friends. So, actually, I don't [see] the programme as the end; it's just the beginning of the next stage of the journey.
The whole experience has been amazing, and I'm keen to stay part of the Salzburg Global family and think about how I plug into all the opportunities.
It's such a privilege to do this programme that I'd like to think that this time horizon is beyond November. Hopefully, we will have achieved our challenge. I would have squeezed all the juice out of all of the residential programmes and of my fellow participants to help me do my job really well and to have a big impact on the work that I do.
