The Importance of Values and Making Waves

As part of International Womens Day 2024, our CEO, Sue Holden, looks back on her career journey, the challenges, the learning and the importance of values-based leadership.

After working in the library for 18 months, a colleague took me to one side and said ‘Sue, I really can’t see you doing this job for the rest of your life, what do you like doing?’.

I thought about the question and realised I was quite practical, and I couldn’t imagine doing something that was solely theoretical, so I replied and said ‘well, my Mum’s an Auxiliary Nurse and our next-door neighbour is a Sister in theatre, so I suppose I have an interest in health’.

Sure enough, the librarian helped Sue apply for nurse training and she was accepted onto the course.

Throughout the training it became clear to me that I wasn’t the most compliant of people. I always had lots of questions about things and that, in equal measure, was welcomed and caused some irritation – depending on who I was working with. Some people really liked the questions and interest I had, others didn’t.

During my second year of training, I witnessed some care which I thought was wholly unacceptable and I spoke up about it. I wrote a long letter detailing the things that were wrong on my placement ward, I posted it and went on holiday for three weeks. When I came back the letter had caused some issues and I found myself in hot water, the resulting fallout was unexpected from my perspective and surprised me – from the ward sister being moved to another area and the ward was removed from a training ward, to being told I had to complete the rest of my training in peripheral hospitals, and I’d be lucky to get a job at the end of my training.

I was a good student nurse, and I did well in my placements, but when I finished, I could only manage to get a job working the night shift in a surgical unit. This was as a direct consequence of what I did twelve months prior. It taught me that even though we may do the right thing, the consequences cannot be predicted.

You see, at that time, freedom to speak wasn’t a thing. In my naivety, I thought I had done a good thing, and while it was good for the patients, was it the right way to go about it? Probably not, however, we learn.

It was at this point in Sue’s life that she decided to focus on becoming a midwife where she began her training in a different hospital and went on to deliver 800+ babies and gain a new set of skills.

I loved it. It was such a privilege to be involved in care at such a special and intimate time in people’s lives.

Once again, I was well known for asking questions and wanting to try different things. One of the skills I learnt working at the library was speed reading; I read fast, and I retain information quickly. Despite not being very academic, I’ve always had a thirst for information and learning. And I’ve always preferred learning about the practical application first, and then the theory.

I gained a lot of experience during that time to enhance my own learning by working in the community as well as in the hospital. Five years after qualifying as a midwife, I found myself applying for the job of Delivery Suite Leader. The role was advertised externally, so I went through the recruitment process, and I was offered it. A group of senior midwives put a complaint in as they thought the interview process was flawed, as somebody from their own group who had been acting into the role didn’t get it. I had a lot of time for this midwife and respected her clinical skills, but what really hit home to me was how the service had become more about what worked for the midwives, than what necessarily worked for the women.

I was asked by the Director of Midwifery if I wanted to take the post up, given the level of concern that had been expressed, and I said, ‘bring it on’. It reinforced my belief that we were stuck in certain ways and the leadership and service wasn’t where it needed to be.

I had to win my peers over and show I knew what I was doing and that I was credible – not just from a clinical point of view, but as a leader. During my time as Delivery suite leader and Supervisor of Midwives, we did some innovative things like setting up an after-birth concern service and I always maintained carrying a caseload even when I was promoted to the senior management team.

One day, I was caring for a lady who was high-risk as she had previously given birth to a still-born baby. I’d put a lot of time into this patient with antenatal care and she went into labour in the early hours on a Monday morning, so I went with her. At the same time, a management meeting was due to take place, so I sent my apologies. I had a phone call with my director who told me ‘You’re paid to be a manager, not just a midwife, this is important’, to which I replied with ‘it’s not as important as being a midwife’. That afternoon, I resigned.

As you can imagine, it wasn’t the first time we had shared a difference of opinion. But my values were such that my first duty was as a midwife and a manager second, and I felt strongly about this – and knew we weren’t going to resolve it anytime soon.

I found myself driving home thinking, I’ve jacked my job in, I’m a single parent and I had no job to go to.

Luckily, Sue had recently completed a master’s in education and was teaching a course about maternity issues at a local university on a part-time basis. It was at this time she applied for a role as Education and Research Facilitator for the Northern Yorkshire region.

I didn’t expect to get that role, even to the extent where I didn’t know where Durham was. So, when I was shortlisted, I had a look on the map and realised it was quite a long way, away. To my surprise, I was offered it. I found this role interesting as having just completed my masters’ dissertation, which was based on a service I had implemented and the evaluation of it, I thought so many people undertake further degrees and may never use the research – it just sits on a shelf.

A lot of what I did in this role was around raising the profile of nursing research which tended to be more ethnographic and qualitative, rather than gold standard, randomized control trails that most doctors were involved in. And now when you think about women’s experience, it’s absolutely at the heart of what we should be doing.

After working in this role for a couple of years, Sue was asked to join an improvement organisation which was being set-up. This role gave Sue the opportunity to work with a variety of inspirational and leading professionals such as Helen Bevan, Maxine Connor and Jim Easton.

This was called the ‘learning alliance’ and was my first real experience of improvement tools and approaches. It was at the time of the modernisation agency and there was a real interest in how we could change the way we approached improvement. I was able to access training and spent time with many leading thinkers at the time; Jean Penny, Etienne Wenger, Paul Plsek and Malcolm Gladwell.

After 2 years I moved into a large teaching organisation as Head of Learning and within 12 months I was then appointed as Director of Corporate Development where I acquired lots of other responsibilities and a bigger team. After acquiring another organisation, I set up my own organisational development team and developed my own practice. I was interested in psychological tools and did my chartered fellowship CIPD. I completed my training and HR became part of my portfolio as well as occupational health improvement, research and education – basically everything which stuck it all together.

I was given a lot of freedom to develop the provision in the way I felt was right for the organisation thanks to Pat Crowley, Chief Executive, and his visionary ways.

It’s important to find people who share your values and it’s also important to ask for help. I like wavy lines and I’m not someone who likes to be boxed in. I think everything has possibility and as long as you keep wavy lines, you’ll find a way through. If you try and put straight lines around things, invariably it won’t work.

I had some very positive experiences throughout my 13 years in this role, but there were times when I felt some of my values were challenged and I knew it was time for me to move on.

After seeing an Improvement Director role to support Trusts in special measures, Sue felt it would be a good opportunity to use her coaching qualifications, extensive experience and deep understanding in organisational form and change.

I learnt an enormous amount over the five years as Improvement Director and worked alongside a CEO in his first CEO role, called Lance McCarthy. He went into Hinchingbrooke following the demise of ‘Circle Experiment’. He epitomised leadership based on respect and collaboration. He understood the need for perseverance even when it was difficult. I was able to support him to make some really important changes and the team which he developed over that time, was probably as good a team as I’d seen – but unfortunately due to organisational change the team was disbanded.

One important lesson I learnt was that you must understand what your own motivations are, because self-determination comes from within and there’s only so much that can come from outside when it’s out of your control – but how you are is in your control.

I’ve always worked on the basis that I believe the best in people. Often circumstances mean people don’t or can’t do what they need to do, rather than their desire or intent. And this isn’t to say I haven’t had some difficult conversations, because I have and you need to, but that can still be done with kindness.

After an NHSE restructure, I applied for the role of National Director for Intensive Support which brought together financial and quality special measures – something I advocated for, for a long time. Prior to this, I met Hugh McCaughey who was appointed as National Director for Improvement after being a Chief Executive for a fully integrated care system organisation in Ireland.

I’m clear to this day that I would never have been appointed into the National Director for Intensive Support role if it wasn’t for him and our shared values. When we talked, the matters in our minds were the same and I found him inspirational because he was kind. He supported me 100% to develop the recovery support programme and understood very early on why I felt so strongly about why the damaging ‘special measures’ label had to stop.

After developing the recovery support programme and growing it as a focus around improvement support, it seems every organisation Sue touched had as much good stuff going on in it, if not more than the areas which found themselves in the spotlight – but it was time for a change.

Hugh made the decision to retire, and I decided I wanted more flexibility, so I started to look for another job – which brought me to Aqua.

All of the stuff I’ve done throughout my career such as organisational development, leadership and improvement is brought together at Aqua. I can’t tell you how much I admire people working in the NHS because it’s so hard, at every level. We’re in a privileged position at Aqua as we can give our NHS colleagues some hope, energy, and support – because that’s what we do every day. The team and I can shape new ways of innovating, we can try new things and we can be aspirational with what we do and deliver – but most of all, it gets me closer to the parts of my career I loved, people I missed and the work I enjoy doing the most.

I believe good leaders touch your heart and give you something to aspire to, something to believe in and for me, being driven by values is incredibly important. The people who inspired me throughout my career had a depth to them and encouraged me to ask questions, try new ideas, think with a wavy mindset, and reminded me to place my values at the heart of everything I did – and will do.