Interview with Josh Allison – Co-founder of The HCG (The Healthcare Consulting Group)

Dr Josh Allison studied medicine at Imperial College London before setting up The Healthcare Consulting Group (The HCG) with his co-founder, Dr Vikram Palit. Though he spends the majority of his time in quality improvement and service re-design, Dr Allison also maintains his clinical practice as an Emergency Department Registrar in a large London teaching hospital.

Tell me a little bit about what the HCG does.

DR JOSH ALLISON: The Healthcare Consulting Group is a clinician-led consulting firm that specialises in service improvement, training, and digital health implementation. We work with public and private healthcare organisations to accelerate change but with one key difference – our interventions, project teams and advisors are all clinically-led. Our team is made up of clinicians who have an in-depth understanding of operations and service delivery, front-line clinical experience and relevant training in management to unite teams towards a shared goal.

Although the conversation may start in the board room you’re much more likely to find us working with staff on the ward, in the operating theatre, the outpatient clinics, or in GP practices.

Tell me a little bit about you and your co-founder’s backgrounds and your consultants.

DR JOSH ALLISON: I am a clinician trained at Imperial College London. I still practice part-time as an Emergency Department Registrar and my co-founder, Vikram, is an Australian paediatrician who now works in London.  We both moved into NHS management roles driven by a frustration with the inefficiencies of our working environments effecting both patients and staff, and a genuine desire to improve the situation.  From these perspectives we’ve been able to lead teams making system-wide changes to clinical workflows and operational processes, to cost improvement and shaping board level strategy.

We support other clinicians from all disciplines to join us in improving the service we provide.  I would say 95% of the people we work with, the consultants we have, are also clinicians. Our focus is on clinical engagement and sustainable change for which we employ a variety of quality improvement strategies.

And are all your clinicians still practicing or are some of them just consulting?

DR JOSH ALLISON: Our consultants are dually trained in medicine and also healthcare management. We also have a group of associates, generally bright young doctors who are currently working in clinical practice but have had substantial experience with the big consulting firms.

I’m sure your readers know there’s a big drain of doctors leaving medicine.  Some are moving to practice in countries with more forgiving healthcare systems. Others are leaving clinical practice altogether and moving into more lucrative industries such as management consultancy. We’re really trying to pull these clinicians back from general management consultancy into the healthcare environment. The NHS despite its main criticisms is a fantastic organisation, and these are the people we need, with the expertise and the knowledge to bring it into the 21st century. When you combine clinicians who have worked in the front-line, who understand the procedures and the people, and who understand management speak – well that is a powerful combination.

So healthcare consulting is quite a broad term used for anything related to health from Pharmaceuticals to advising the NHS – what does the HCG specialise in?

DR JOSH ALLISON: We support, instigate and accelerate clinically-led change at all levels.  Our three main branches are consulting, training and technology.

As consultants we may work with a Trust to tackle a specific problem they’re facing e.g. referrals being lost due to outdated referral pathways, theatre inefficiency or temporary staffing costs hampering investment in other areas of workforce. 

With training, we offer workforce development by up-skilling staff in quality improvement methodology that allows them to enact effective changes themselves.  We provide this training within the NHS, private healthcare organisations as well as for universities running Healthcare Management and MBA programmes. 

And finally we work with Trusts and SME’s (small and medium sized enterprises) to accelerate the adoption of transformation digital technologies in healthcare.  We play a role in design, implementation and engagement with digital tools.

How do you think the NHS compares to other healthcare systems at integrating innovative technology?

DR JOSH ALLISON: I would start by saying there is a lot going on and if you are interested in innovation and digital health, the NHS is fast becoming an enabler. 

NHS digital, NHS Improvement and the Academic Health Science Networks (AHSN’s) to name a few, are doing some amazing work supporting SME’s, integrating technologies into their transformation projects and digitally supporting Trusts towards becoming paperless. We’ve also got the digital health accelerators, giving start-ups and SMEs a platform to directly implement their services and technologies to the NHS. Think Babylon’s innovative ‘GP at hand service.’

Overall, I think there is a lot of investment and goodwill, particularly from the current Secretary of Health (Matt Hancock) to support digital health in the NHS, but we still have a long way to go. One of the main difficulties is the process of scoping the market for what is available, and then appraising these digital innovations to make sure they actually work – that they improve patient outcomes.

But we are definitely moving in the right direction.

As a medic going into business, what has it been like and what are the challenges that you faced being a doctor doing something outside of medicine?

DR JOSH ALLISON: I’ve received a whole range of opinions about my career, from mostly well-meaning doctors. In the medical world most of your peers, your mentors and supervisors will be doctors who have never done anything else but follow the traditional training route.  Understandably there is some resistance from often very senior doctors, if a trainee chooses to leave clinical training.  

But the shift towards clinical leadership is here. As operational and financial pressures increase in the NHS and wider health environment, we are having to think more progressively and creatively about how we deliver healthcare. And we need clinicians who are trained in change management and operations to be able to lead large-scale and transformational improvement work. We are increasingly looking for people who contribute in a different way. 

I think we are at the beginning of generational change, as programmes like the Darzi Fellowship and the National Medical Director’s Programme, continue to attract hundreds of enthusiastic and talented junior doctors. And at the same time, hundreds more are leaving or taking time off training, and opting for something different in their careers.

For me, the work I am doing combining my clinical experience with service improvement is incredibly fulfilling.  It’s a cliché but “you can save as many lives wearing a suit as when wearing scrubs.”

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