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Profile: Krystyna Ruskiewicz, Managing Director, Space-4 Consulting

Having the time and space to think is a valuable commodity and one that many senior executives may feel is in short supply. Yet Krystyna Ruszkiewicz, managing director of human resources and organisational consultancy Space-4 Consulting, which specialises in the NHS, believes it is vital. 

“Leaders don’t get a lot of time to think innovatively. The work I do is all about creating space for organisations or individuals to think about what they’re doing and why they are doing it. That’s why we’re called Space-4, even though it can sound like a construction company,” she laughs.   

A former NHS human resources director – she describes her last two jobs in the service, at the Chelsea and Westminster trust and before that at the Royal Marsden, as “the two best HR jobs in London” – Krystyna has been working as a consultant for the past ten years.

Her move out of the NHS coincided with the then Labour government’s work on developing new models of care within the service, including independent treatment centres (ISTCs) and initially working with a firm bidding to build and run ISTCs.

“Creating a completely new organisation is not something that you often get to do. A number of these new initiatives don’t set out to achieve what they are meant to be achieve but have unintended consequences when they change practice in other areas. The ISTC programme’s focus on surgical care changed the way the NHS thought about the market.”

Krystyna stresses that change does not have to be about organisational structure. With the acute sector currently facing turbulent times, with hospital chains and an increasing number of mergers and acquisitions being mooted in the sector, she is equally clear that tinkering with organisational structures will not solve a health economy’s deep rooted problems.

“There are ways in which one organisation can support and mentor another - especially those in leadership roles - that doesn’t have to go into the transactional side of who employs who. Very often in health we get so tied up in the transactional processes and we take our eye off what is possible,” she says.

However Krystyna adds that despite recent moves to rid the NHS of a great deal of its structural hierarchies, with the dissolving of strategic health authorities, too often, an organisational  focus on structures and transactions still gets in the way of “what really matters”. 

“My intention was always to help people respond rather than react. Often this means working with the leadership team of a newly created organisation, often as a result of bringing two organisations together. The important thing from the outset is not to use the language of integration and merger when what is actually happening is an acquisition. If it’s an acquisition call it that from the outset. “

Regardless of the nature of the work Krystyna does with those in leadership positions, there are key issues she addresses with each.

“What’s important to them? What motivates them? It’s always interesting to explore what people think about leadership,” she adds.  “If they do think about the sort of leader they admire it doesn’t matter so who they are, what is more interesting is exploring why they admire them. What is more worrying is if they haven’t thought about it or acknowledged what a responsibility being a leader is.”

And she is adamant that organisations need to understand and be clear about what they are setting out to achieve and to temper their message accordingly.
“Language is so important. Everything we do is ruled by the words that we use. How do people talk about their organisation, do they say ‘we’ or ‘they’? If they are referring to the organisation in the third person then there’s going to be a disconnect. Any organisation can have issues but it is about creating a positive narrative and it is the job of the chief executive to do that,” she says.


Andrew Liles - transition from acute Trust CEO to Partner in a health care consultancy

After 10 years as an acute Trust CEO, and 20 years after completing the NHS management training scheme, l left the direct employ of the NHS last autumn to create a health care consultancy with a close colleague.  The last 9 months have flown by, I’ve worked with a wide range of clients on interesting assignments, learnt new skills, gained new knowledge, and feel just as committed to and as much a part of the NHS as I did before.

A major part of the success of my move to this new role has been my relationship with my business partner Paul.  He was a management trainee the year after me and we worked together in our early jobs as general managers and then directors.  As I moved into CEO roles, Paul moved into health consultancy and for the past 5 years had worked successfully as an independent consultant.  He was the go-to person for a range of providers and commissioners in the south east and London for help with strategy, planning and important business cases.  He led the production of my last Trust’s successful FT application integrated business plan.  As his reputation and demand grew he decided to find a partner to help build the business and that is where I came in.  One year after we talked about joining forces we launched Consilium Partners.

We planned our new company carefully.  We spent time talking about what we each wanted from it and what success would look like.  Our passion and commitment for the NHS drove the design of the company – we look for assignments where you can work with good people and where there is a need and commitment to deliver change or improvement.  We wanted to offer a different kind of consultancy experience – in which we work with the client to be clear on what they want to achieve and design a bespoke plan or approach that achieves it.  And we do the work ourselves and to our highest possible standard.

We’ve had some great assignments in our first 9 months, including the following.  We are supporting two of the Vanguard sites implementing the new models of care in the Five Year Forward View.  I am the lead advisor in a large system transformation programme for the care of older people across 4 CCGs and 4 Local Authorities.  I have worked with a Teaching Hospital Trust to redesign their planning processes and produce an integrated Annual Plan.  I am working with the GPs on a CCG Governing Body to redesign clinical leadership roles and processes to make them more effective.  I am working with three acute Trust CEO’s to explore and scope the potential for clinical and non-clinical collaboration and, we are now working on an implementation plan.

I like the work lifestyle with this new role.  It is varied and interesting.  You get to work with good people on the things that are important to them.  About half of the week I’m working at home and half out working with clients.  Paul and I talk everyday and meet regularly.  To do this role well you need to be flexible – you have a big responsibility to your clients and you need to do everything you can to meet their needs and timescales.  Sometimes this means working really hard and Paul and I will be working in the evenings and maybe the weekend to get something done on time.  The quality of our work is important to us – we’re building our reputation by making sure that the service and product we give the client is high quality.  A job well done is very rewarding.

At Christmas, the Royal Holloway University of London made me a Visiting Professor in Health Care Management.  This is a small, but important adjunct to our work to build Consilium Partners.  We’re exploring how we can work with academics to respond to the needs of the NHS and our clients and have just put forward a joint bid with the Computer Science and Psychology departments to model an urgent care system.   It is early days, but has the potential for us to be able to broaden and strengthen the support we can give the NHS.  It will make us different to most other companies.  I also chair the advisory board for the Management School and teach on the MBA course.

People ask me if I miss being a CEO, and more specifically if I miss my last Trust, Ashford and St Peter’s Hospitals.  The answer is no and yes.  I enjoyed being a CEO and always thought it was a privilege to be able to do it – but after 10 years I was ready for a change.  I do miss being part of the large and vital human enterprise that is Ashford and St Peter’s.  The good news is that they’re going from strength to strength – my Chief Nurse is now the CEO, they were inspected by the CQC in December and given a Good rating and have just won the National Care Quality Award by CHKS.

Paul and I are now looking at how we can build on a successful start and increase our capability and capacity to support clients.  We have a good group of like-minded Associates that we can count on when we need a particular skill and we are currently looking to appoint a Management Consultant to work alongside us.  We’re very conscious that building the company needs as much careful thought as starting it required.  Whatever we do has to fit in with our original values and motivation and has to give the support that our clients want and need. If you would like to find out more please view the candidate brief on www.acertus.co.uk/candidates/vacancies or call Linda McCue on 07958 032839, confidential and informal enquiries are welcomed.

Andrew Liles

From NHS to private sector, profile of Michelle Ford by Emma Dent

Profile of Michelle Ford, Director of Business Development, Medical Services

By Emma Dent

As a former nurse, midwife and health visitor, Michelle Ford once assumed her career would unfold in an acute hospital setting. What her career has actually seen to date has been a succession of roles largely based in primary care that track not just the NHS and the third sector but also the commercial sector. In themselves they track the recent history of how commissioning and procurement in the NHS has evolved and features both commissioner and provider roles.    

“After 15 years working in a clinical setting I took a move into community based work, working for the then primary care trust with deprived and vulnerable communities in Hastings in Sussex,” says Michelle. “I then became a Sure Start director in Chatham in Kent, which taught me a lot about stakeholder engagement and partnerships and working with both health and social care.”

After three years in that post, which was local authority funded, Michelle went back into the NHS in 2007 as head of commissioning at Shepway PCT in Kent.

“Working with partnerships and on service redesign was an eye opener, about what did and didn’t work. Being a commissioner then was about block contracts at cost and value, with no targets. We knew very little about outcomes, or about contracting. In the last eight years the NHS has been through quite a turnaround in those terms. We are now commissioning with far more expectations.”

She had not been in post long before a director went on long term sick leave and Michelle became director of commissioning at the PCT during the time it merged with three others to become part of Eastern and Coastal Kent PCT.

“From being at one of the smallest PCTs in the country I went to being at one of the biggest; from a population of about 120,000 to a population of about 765,000, so it was quite a change.”

In the merged organisation Michelle was the lead commissioner for the specialist services of cancer and ambulance services before becoming assistant director of contracting and procurement.

She says living in the patch she was commissioning for helped her keep a sense of accountability to local people.

“We were the purse keepers and I wanted to make a difference. But I have always wanted to make a difference; even now I am always thinking about the patients,” she says.

“But to go from purchasing to putting services out to tender [was for me] a big change. It was all about getting providers to work differently.”

However Michelle says there was often confusion in the NHS about the journey the service was going on – both culturally and in terms of service provision.

“As the NHS we need to be clear about what we wanted but commissioners were still working towards knowing what was wanted and we were still sometimes told what to do, regardless of whether it was a fit for the area. For instance, we had to procure a range of services including one of the first Darzi centres (walk in centres, known as Darzi centres after the former health minister who devised them). I didn’t know if we needed one but we were told we had to have one.”    

Later, with the emergence of clinical commissioning groups in 2012, Michelle says she knew a lot of efficiencies were due to be made, but chose not to stay and face likely redundancy – despite the redundancy package that would have come with it.

“A lot of corporate memory was lost when PCTs were wound down,” she says. “I had been in the NHS since I was 18 and waiting for redundancy would have been the easier option. But it felt immoral. Instead I was head hunted to do business development for an organisation that was carrying out an out of hour’s service that I had tendered.”

Michelle’s next move, two years later, was to be for another provider, this time a charity delivering care for people with dementia.

“I had never worked with people with dementia before and also I really wanted to see what it was like to work for a charity,” she says. “I wanted to see what the drivers for the organisation were and what the differences were between working with non-executive directors in the NHS and with charitable trustees, as the latter have no financial reward for the work they do. 

“The culture was certainly different, especially in areas such as terms and conditions for employees. Some staff had not had a pay rise in three years.”

After many years working in Kent, Michelle decided her next career move should be for a national player – and learnt a valuable lesson along the way.  

“I wanted to make a change and work in London so I joined a large private provider in a business development role. I was attracted by working for a well-recognised and large corporate organisation but it did not take long to realise that this not for me,” says Michelle.

Within this role it was apparent that I would never have been responsible for the implementation of care, and this is something that I struggled with but I had to make that move to learn that lesson. Sometimes you have to do that.”

Although the wrong one, the move helped Michelle realise that rather being in a very large organisation, what she prefers to be is “a big fish in a little pond.”

Realising she needed a new job, Michelle rang Linda McCue at executive search and selection specialists Acertus.

“By happy coincidence my current role had come in that very morning,” laughs Michelle. Now at Medical Services, whose non-emergency patient transport service vehicles will be familiar to many in the areas it serves in England and Wales. The firm also provides ambulances for critical care triage services and repatriation care.

Her role as director of business development is to “expand the business, developing new opportunities and develop business and income streams. Most patient transport services are now contracted out. Having worked as both commissioner and provider I can understand some of the cultural differences. I can understand what we can and can’t deliver – for example if the   performance indicators don’t align with the wants and needs of our patients”, she says...

"I can suggest solutions without being difficult about it,” she says.

Having been at Medical Services for less than a year, Michelle admits she misses interacting with patients and would eventually like to be a chief executive officer, perhaps in the field of palliative care or care for the elderly.

Written by Emma Dent. Emma has specialised in health policy for over ten years and is a former features editor of HSJ, a former Norwich Union Healthcare Medical Journalism award winner and a former MIND journalist of the year.

Msheireb Enrichment Centre

Not long back from a visit to Qatar where we had the time to visit the Msheireb Enrichment Centre, very interesting exhibition housing historic artifacts and explaining how how these will be incorporated into the architectural vision for Doha. We were taken around the exhibition by a very informative and friendly guide who kindly showed us the Majlis - view from this room below. Thoroughly recommended!

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