54. Mary Salama - connecting across boundaries

I’m so excited to be talking to my good friend Mary Salama, a wonderful consultant paediatrician in Birmingham. 

Mary is one of my absolute faves - a lovely, warm person, who makes extraordinary things happen, rather than just talking about what needs to change.

And to do that for children and young people, has to be the very best thing! 

Driven by frustration and a deep understanding of the need to improve healthcare systems, Mary focuses on human factors and connecting across boundaries.

Mary is leading the way with coproduction and empowering young people, including enabling them to present community research to clinicians at the Royal College of Paediatrics and Clinical Health.

 Lemon lightbulbs 🍋💡🍋

• Be curious and furious about bringing real action
• Children with clinically complex needs need to go home rather than staying in hospital, if non-medical factors are holding them back – find a way to make it happen
• Listen deeply, learning the language and drivers people are using
• The Canal and Powering Up projects are EXCELLENT examples of coproduction - enabling young people to share their ideas about the future of health care
• Coproduction must be authentic,  starting with relationship building and creating the conditions for people to  feel safe to discuss difficult topics
• Learning from Excellence is powerful
• Networking leads to meaningful connections and potential solutions to share challenges
• Witnessing positive connections can give people hope and inspire ripples and action, way beyond the original conversations
• Use all platforms to amplify the best ideas within the NHS and save people from re-inventing the wheel
• Break out of tribal silos!
• Use creativity to make your voice heard - pink hats, lemons or whatever it takes! #JFDI and don’t forget to have fun!
• Lyse Edwards talks about a Harry Potter version of Whose Shoes; Mary talks of a Mary Poppins toolkit!
• Hold an #IntentionalCoffee with someone who inspires you   ☕☕️

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I tweet as @WhoseShoes and @WildCardWS and am on Instagram as @WildCardWS.

Please recommend 'Wild Card - Whose Shoes' to others who enjoy hearing passionate people talk about their experiences of improving health care.

Transcript

Mary Salama FINAL

Sun, Apr 28, 2024 10:29AM • 52:22

SUMMARY KEYWORDS

work, talking, children, connecting, language, create, mary, nhs, terms, birmingham, bit, connection, podcast, shoes, powering, event, royal college, learn, lovely, day

SPEAKERS

Gill Phillips, Mary Salama 

Gill Phillips  00:11

My name is Gill Phillips and I'm the creator of Whose Shoes a popular approach to coproduction. I was named as an HSJ 100 Wild Card and wants to help give a voice to others, talking about their experiences and ideas. I love chatting with people from all sorts of different perspectives, walking in their shoes. If you are interested in the future of health care, and like to hear what other people think, or perhaps even contribute at some point, Wild Card Whose Shoes is for you. So hello, and welcome to another episode of The Wild Card Whose Shoes podcast. Yay. This episode has been a long time coming. But I'm so excited to be talking to my good friend, Mary Salama, a wonderful consultant paediatrician in Birmingham. Mary is one of my absolute faves in terms of a really lovely, warm person who makes extraordinary things happen, rather than just talking about what needs to change. And to do that for children and young people has to be the very best thing. Mary will be talking about the work that she does with children with clinically complex needs, including and I love this, enabling them to go home rather than staying in hospita if non-medical factors such as availability of equipment are holding them back. She will be talking about the fabulous work she's doing through Powering Up and the Canals project. And I'll be chipping in because I was beyond thrilled to be invited along to join her a couple of weeks ago at the wonderful coproduction event she held in Birmingham, listening to young people share their views about the future of health care. We will be talking about our co-founded hashtag #IntentionalCoffee, our own special way of bringing people together and having great conversations, which all started when we first met in a coffee queue. Coproduction, learning from excellence, pink hats, deep listening, building relationships and having fun. So grab a coffee, find a quiet space, and meet my friend Mary.

 Mary Salama  02:28

So Gill, I'm so so thrilled to be here, talking about all of these things and so much more with you. As you know, I'm a paediatrician, but I think when I dig deep, my main drive is around improvement. And my drive for that is around being annoyed. So a lot of the things that we will talk about have been driven through a sense of frustration and a tipping point around making things better for both the patient in front of me or the person in front of me, but also the wider people in the system.

 Gill Phillips  03:05

Brilliant.

Mary Salama  03:07

I've got a real interest in human factors, which is how humans interact with their systems. And I think when you look at the problems that we're facing in the NHS, and particularly around children in the NHS, then actually you need to draw on different ways of thinking to try and make things better.

Gill Phillips  03:27

So important, and already I mean, you knew this would happens … I love connecting people through the podcast, that I've got this, just feeling that it's all about people and it doesn't matter really whether you're talking about a particular topic or a particular group of people. So coincidentally, my last podcast that I've just recorded is with Angela Catley, and a completely different topic when I get old, but she's got this lovely concept that she picked up I think from a conference recently and I think you'll love it Mary - furiosity - so that's when curious comes together with furious and that's exactly how you started, so that’s amazing. So you've got a bit of furiosity. 

Mary Salama  04:09

I love that word. And I think I'll nick that. Thanks, Angela. I think frustration can be quite a negative kind of connotated word but actually, I think the drive to change and the curiosity about why things are so frustrating is brilliant. So yes. Furiousity!

Gill Phillips  04:30

I knew you’d love that one.

Mary Salama  04:32

So, so I think riffing on curiosity, I think you you end up seeing things from a different perspective, which is very much the Whose Shoes ethos and it's around bringing people together that might see a problem from a different perspective and curating solutions or lemon light bulbs through those connections. And I think when I started my journey, it very much started as a child of parents who were sick and seeing health system from maybe a slightly different lens. My dad was an obstetrician. And so I spent a lot of time living in hospital accommodation, but also interacting with staff members as part of my childhood. So bleeping my dad through the theatre coordinator to, you know, ask him if I could go out, and going in to do ward rounds with him on Christmas Day and kind of doing terrible carol singing actually. So moments like that really connect you with the idea of the NHS and ideal of the NHS. And I think that's why I wanted to do medicine, because it was very much working together to make people better and well, and I really love that idea. I think as you journey through, what you then see is that you can't do that, as well as you might want to. And there are lots of different reasons for that. And I think that's what drives a lot of the work that I do. So I think in my early years as a consultant, one of the things that I became really interested in is how we improve care for children who had lots of different teams involved who were kind of a bit stuck in the system. So I did a lot of cardiology as a trainee, and although the patients on the cardiology ward and their families got excellent cardiology management, the holistic care was sometimes patchy. And I wanted to make that better. So that started off a journey with others to look at solutions for children with medical complexity. And it's really interesting, and you see this a lot that people are furious ... furiosit … How do you say that?

Gill Phillips  04:38

I guess they have to be curious and furious.

Mary Salama  05:08

Yeah, curious. Yeah. So basically, people are curious and furious about the same things at the same time. So what you'll find is that there will be a change, because there's things that change across the country in similar ways. And people have that same reaction. And I think part of what I'd like to talk to you about is how we how we channel that and connect them together, because we're better together, and we are better collaborating, especially when it comes to really tricky problems. So what I've found with the journey with the children with complexity is that people were curious and curious about it at the same time for many different disciplines, from a nursing perspective, from an management perspective. And we ended up coming together and looking at the solution of creating a team that would then look at this problem. And that's grown over the last 10 years, and done some work that has been presented at national scale and actually segwayed into, again, other people's journeys around the furious and curious to create a co Lab, which is the CO lab Partnership, which is a space really for people, key stakeholders, including parents, front and foremost, to come together to try and look at improving care for children with complexity. And I think that was really fortuitous, because that was where #IntentionalCoffee was made, really, with our talk that we had to create together for the online virtual COVID style conference that we were running. I think that journey of sessions talking to you about the content that we were thinking about presenting really sparks off the idea around intentionality of connection. And that idea that actually, that kind of deliberation and that deliberate creation of space, to be able to connect with somebody who you feel would help you open more referrals in terms of the work stream that you're going down.

Gill Phillips  05:08

Yeah, that's, that's so interesting. Mary ... I think you've naturally ... I was hoping that you'd pick up on your incredibly interesting background as a child, which, inevitably, in this podcast, you can only touch upon compared with some of the learning that I've had in terms of your experiences as a child and how that shaped you. I find that fascinating. And what you were saying there was naturally more through, I think our shared interest, the curiosity in people's stories, that everybody's got a story, and to see how people have ended up where they are, and those very formative experiences they've had. And the whole holistic approach that I think is very much what's brought us together. 

Mary Salama  09:03

Yeah

Gill Phillips  09:04

Better together. And CoLab, I think when I first heard the story of of Colab, and as I understand it, it is curiosity for children. Isn't it?

Mary Salama  09:59

Yeah

Gill Phillips  09:59

The group of people that's come together - that special group - and I was just so thrilled to be invited to open, I think, the Colab conference ...

Mary Salama  10:09

We did, yeah ...

Gill Phillips  10:09

Yeah. I was asked to be perhaps a bit of a motivational speaker ...  what the story was, so for people listening, so we don't just go off on one Mary, because we can do that ...

Mary Salama  10:09

(laughter)

 Gill Phillips  10:13

...   time ... that, when I sa  w the draft programme, and I'd got the first 20 minutes, and I saw, Oh, my goodness, my friend, Mary Salama has got the next 20 minutes. And we got together and said, "Well, how about if we kind of blend it as rather than just a talk, and then you talking more about the practice that we just get together? And we've got, hey, we've got Mary, we've got 40 minutes, we can do something with 40 minutes ..."

Mary Salama  10:47

(laughter)

 Gill Phillips  10:49

And then bringing in Jo Minford at the end, which was my dream, really ...

Mary Salama  10:53

Yeah. 

Gill Phillips  10:53

So, in terms of intentional coffee, that was quite a story really

Mary Salama  10:57

No, it was lovely. And I think you touched on a couple of points that really are the golden thread. So the intentional coffee, obviously, is important. But it's also that, that perspectives and blending, and actually, you're not having parallel perspectives. So you're not not bringing things in in a, sort of, listed agenda, but trying to really dig deeper to then combine them. And I think unless you go deeper, you won't be able to combine authentically. And I think that's, that's the kind of thing that you see in your coproduction events in the way the gamification of that coproduction is, is really important. Because what it does is create connections outside the topic in ways that then enable you to feel safe enough to open up and really share.

Gill Phillips  11:53

That's interesting and I think ... and I'm sure you'd feel the same ... that you could have kind of just gut feeling that something works, and then you try it out a little bit, quite timid. And then "Whoa, that really did work!" And then you can, the next time be a little bit bolder with it and a little bit more confident, perhaps. So, I've found in terms of connecting ... and certainly with the Whose Shoes workshops now ... And you know, we try and get people if they want to, to make a pledge about what they individually can do to make a difference. And I've pretty much discovered that whatever anybody says, I can add some value through networking. So somebody who's perhaps already doing that, or somebody that I think they'd just connect with, and what was it the event that you were at Mary, where we had the conversation, the amazing conversation about British Sign Language? 

Mary Salama  12:43

Yeah, yep. Yeah, it was beautiful. 

Gill Phillips  12:46

It really was beautiful. Somebody on one table, basically doing all they could to support people who were deaf, or with a hearing impairment in a healthcare setting. And genuinely from the heart, that was their passion, and feeling a little bit lost and alone. And I just asked the direct question, "Do you think there's anyone that could help you with this?", and they said, "No". And then, on the very next table, one of the participants of the event, started actually signing live, and was desperate to be the next person to speak and those two people connected. And then suddenly, you've got a buddy, who's passionate about the same thing as you. And I've got no idea where that will go. But when I saw those two people connect, and actually have a hug on the day, I thought, there's a little spark happening there that's pretty special. And, you can't plan for these things,

Mary Salama  13:42

You can't, and the thing is that actually, even if the spark goes absolutely nowhere in terms of outputs and data, actually, that spark in and of itself is an outcome. And I was quite struck about.... so I was listening to your initial podcast around the idea of wellness and health, and you know, that whole looking after your staff, and actually a lot of wellness, we know from many studies and interventions really centres around connection, when you look at BlueZone communities or you look at teams that work well, actually they're connected and connection is vital to that feeling of happiness and belonging and, and leads to much more than just that momentary feeling. 

Gill Phillips  14:31

Yes. 

Mary Salama  14:32

So I think creating the connection is really important, just for the generation of energy that happens in that moment.

Gill Phillips  14:43

Yeah, and perhaps even for other people to witness that. 

Mary Salama  14:46

Yes. 

Gill Phillips  14:47

You don't know what spin offs there might be around the room, you know, that it's not to do with that particular conversation, or those two people connecting, but other people I think sometimes see possibilities. 

Mary Salama  14:58

Yeah

Gill Phillips  14:59

And people get quite stuck I think with how difficult things are at the moment in life and in the healthcare system, and you can feel a bit hopeless. And I think anything that gives people hope, anything that gives them something to think, "Well, that happened, you know, I can perhaps do do something" is quite powerful. 

Mary Salama  15:19

I agree. I think the warmth spreads and, a bit like the light bulbs, you know, that actually you have little light bulbs going and that creates a sense of, sort of warm and safe and positive and all of the things that we associate with light. And I think another place where I, I have experienced that and do every year is the Learning from Excellence conference. So I, I use that as my wellness time, I have to say, so I booked that every year, and go for some life-reaffirming positivity. And I think that's the kind of thing that can create this kind of movement forward in a more positive way.

Gill Phillips  16:04

Yeah. Yeah. Brilliant.

Mary Salama  16:07

Have you ever been here?

Gill Phillips  16:09

No. I haven't. I've only been to ... So it's Adrian Plunkett isn't it, that is one of your champions, and I've joined one or two of his online sessions. And just the whole concept of learning from excellence, I find is so obviously positive, rather than blaming everybody, and ... it's refreshing I can see, you know, I love the idea that you go along, to just reaffirm and and meet positive people. And I think that was my experience as well, when we first met at the Q community event, that I hadn't been to a Q community event before. And like, everywhere I turned, there seemed to be people who've got interesting stories, people who are wanting to make change. And I think it sounds it's a similar experience in that. It just makes you go away feeling fired up rather than flattened. 

Mary Salama  17:01

Yes. I think that is true, JoGille. And I think both Adrian and Emma, his wife, who work on the learning from excellence, are really just quietly positive. So yes, I'm not quite so quiet. And I think it's really authentic, that calm, quiet positivity. 

Gill Phillips  17:24

Yes .

Mary Salama  17:25

And also a well thought out positivity, it's not a brash reactionary, you know, everything is all some kind of Legoland kind of positivity, you know.

Gill Phillips  17:35

Or superficial. 

Mary Salama  17:36

Superficial. It's very deep. So one of the things that I've learned from watching Adrian and Emma and their wider, amazing LFE team work is that it's really authentic. And I really want to emulate that in the kind of work that I do - that it needs to be authentic coproduction, and that you need to really be able to hear difficult things, and feel safe discussing them. And I think that needs work on building relationships and building the roots and deepening the roots together as a team to then authentically coproduce together.

Gill Phillips  18:21

Yeah. And that really resonates with me, because it's funny how things sometimes come full circle. So in terms of why I jumped ship from my day job to set up Whose Shoes and try and actually listen to people, and not just tick boxes. In my case, what was personalised care, I felt that nobody really knew. And we needed to discover that by talking to people. And then fast forward 16 years as it is now. And at worst, I can feel that somebody feels they perhaps ought to have' one of those Whose Shoes things' because they've been told to 'do coproduction'. And they really don't understand the deep preparation, relationship building, making people feel valued from the very beginning. Coproduction starts way before the actual event. And that's what makes the success rather than just ... a tick box, which could be called a Whose Shoes event, and you have one of those things and you hope it all turns out as well as the event that you perhaps saw on a film or something. And I think that relationship building, people can tell whether it's genuine. People know whether you're really listening to them for themselves, or for your own agenda.

Mary Salama  19:38

I do agree. And actually, I think there's a risk to doing it when you haven't done that groundwork. And the risk is ...

Gill Phillips  19:45

It can be dangerous. 

Mary Salama  19:47

It can be dangerous , yes. And dangerous for clinicians and dangerous for families and patients with lived experience. I think you have to be very careful about how you go about that and I know you do a lot of work, thinking about it and planning it and identifying the people and managing things on the day. And I think it would be lovely to have that as a kind of toolkit or I don't want to say toolkit because that makes it all very regimented. But almost like a ... like a Mary Poppins bag or something, you know that you have a, you know, a bag of things that you kind of pull out if you need them. You know, if you need a light bulb, you'll I mean, there are people, generationally that won't know what I'm talking about at all. 

 (Laughter)

Mary Salama  20:35

But please, go and watch Mary Poppins until ... oh, it's been remade, hasn't it? So maybe, maybe actually, they do.

Gill Phillips  20:45

So that really links up, you know, I'm working with Lyse Edwards, in particular at Midlands Partnership Foundation Trust. And she always uses as her example, the Harry Potter version of Whose Shoes

Gill Phillips  20:57

We're doing some bespoke work together. And in terms of the different scenarios and poems and so on, then, we need to develop another little subset of cards. And she describes it to people like the 'Harry Potter version of Trivial Pursuits' I think is her phrase. So you've now brought Mary Poppins in? So we've got ...

Mary Salama  20:57

Oh nice!

(Laughter) 

Gill Phillips  21:05

... it's much more fun than a toolkit. 

Mary Salama  21:20

Well, yeah, and, and I think, I think it speaks to your whole ethos, which is around being creative around how we have those conversations. And I mean, that's what happened recently with another person I really want to mention. And hopefully, you'll get a chance to chat to her in more detail, but Guddi Singh has been incredible at galvanizing change. And so she's a paediatrician interested in public health, who has led ... created and led, the well being and Health Action movement within the paediatric arena, which is around reducing inequalities for young people. And I think it speaks to what you talked about, the tribal Q community positivity, because she put in a Q Exchange bid for powering up, which is coproducing solutions to help inequality with young people. And so I'd put in a separate bid for the Canal project, which is kind of similar, but it is centered around Birmingham. So improving health for children of Birmingham by creating connections in the same ways that the canals connect people together within the city. And so drawing on that parallel, I'd put in a bid and then saw her bid, which was obviously a lot better and sparklier. And, you know ... it was really good. So I emailed her and said, "Look, we're kind of asking for the same, you know, what about we join forces?" And I don't know if she thought initially I was mad, but we had a couple of intentional coffees ...

 (Laughter)

 Mary Salama  22:47

And connected around that. And from there has grown this Powering Up, dual site, London - Birmingham, in collaboration with the Canal team here, and a couple of other people. So Amy McLean, Lisa Van Geyzel, here in Birmingham. And so we've created this connection, which has then led to more connections and ultimately led to last week, a huge explosion of pink at the Royal College of Paediatrics and Child Health. So we had done work with schools in Birmingham, facilitated by public health and community partnership working through Amy McLean and bought 70 children from secondary schools in Birmingham to the Children's Hospital to present their community research on topics around mental health vaccination, performance enhancing drugs, diets, access to healthcare information, loads of really interesting things. And so they came and presented to a load of clinicians and then got to discuss at panel some of the issues that they were facing, were able to ask questions to Matt Boazman, who's the CEO of Birmingham Children's Hospital, Marion Gibbon, who's in charge of public health in the city for young people, and also Guddi Singh, and that was really amazing as an event. And at that event, I know you were there. So it'd be lovely to hear your perspective actually, hear how that went in terms of coproduction marks out of 10?

Gill Phillips  24:19

Oh, well, I was just so thrilled to be invited. I really wasn't ... I didn't know what to expect. I definitely expected there to be more just, you know, people coming along to an event. I didn't realize it'd be such a small number really, of people who weren't the young people in the schools actually participating. So as I say, I was really thrilled to be invited along. I was blown away really by the authenticity and the innovation, I think in terms of inviting young people from schools to come along, and they'd had the chance to do their research projects. And they all came onstage to report about it. And I could see that ... I mean, honestly, at that age, I would have been absolutely terrified. And I could see that some of them were, but they still did it nonetheless. And I think the confidence and the just self esteem that they could get from that, there's so many spin off values for children beyond the actual event and the topic and what they're actually doing through to one guy who I thought, should have been on The Apprentice. He said ... 

Mary Salama  25:33

That's Srei, That's Srei ...

Gill Phillips  25:33

Yeah?

Mary Salama  25:33

Yeah, I'm gonna tell you about him in a minute

Gill Phillips  25:40

He gave his name. And "I'd like to introduce you to my team. In fact, they could introduce themselves..."  and, you know, all of them had their place in terms of what they'd got to say, and the level of confidence and the ... what they probably were getting from the opportunity as I say, beyond, you know, the actual topic and the subject of that day. I thought to give them the opportunity to ask questions to the panel, of, as you say, very senior people, was extraordinary. And then I was blown away by the actual questions that they asked. And I think young people ask, really, real questions. They weren't easy questions. They were challenging questions. And I thought for Matt, your chief executive, to put himself in that position ... That's ... that's vulnerability, isn't it? For someone as senior as that to be on stage live, answering young people's questions ... I thought the whole event was really amazing. And then ... now, the other bits in terms of stories that you don't get is ...  for me on that day, I got a chance for the first time to meet you and Guddi Singh together. Whereas I'd obviously meant you separately before; to feel the energy and start to get into the 'pink hats' movement, to sit next to one of your amazing clinicians, a haematologist. And we actually discovered that we'd got some personal connections ... to meet Marian from public health, and possibly she might be a future podcast guest. We're both into poems. Definitely Guddi Singh, I'd love to have on the podcast, I think this could very much build this conversation, to chat to some of the young people even you know, you've got all these different conversations and connections happening behind the scenes, I think it was a very special day. So well done!

Mary Salama  27:32

Oh we were so thrilled to have you with us. And I'm really hoping, as part of Powering Up, what we want to do is create content that we can then share and use to amplify the message from young people. And so we had One-to-one Productions, Judy and Dean coming to film it. ... all the way from up north. And so hopefully, we'll have some sound bites and some videos to share about the day and use that to further enhance the spirit of Powering Up. I think one of the things that came from that ... so you, you touched on a couple of things. So our panel were amazing, really authentic, really real. So Matt was brilliant. Marian and Guddi ... . I mean, Guddi just says it how it is. And Marian was really open and honest and responsive. So we were really lucky with our panel. 

Gill Phillips  28:25

Definitely.

Mary Salama  28:26

 And I think it was really interesting, because I think it was either one of the young people or one of the panel, asked me why pink and we hadn't really had a chance to think about it. But actually, pink is quite a bright colour. And it's difficult to ignore. And I think from that conversation, what then happened ... you're talking about ripple effects ... is we then ... I went home and ordered six more hats, from Hens R Us or whatever. And we then took them to the Royal College meeting. So the paediatric national group is called the Royal College of Paediatrics and Child Health and they meet every year and this year then met in Birmingham. last week. And we were able to take that very group. So Srei ... he wants to be barrister actually. And all the young people, five of them came up and presented on stage in a massive auditorium to a load of paediatricians and they did the same presentation on their community research around performance enhancing drugs. And on stage was the President of our Royal College of Paediatrics and gave him a little certificate. It was brilliant. It was so amazing. 

Gill Phillips  29:37

It sounds amazing. 

Mary Salama  29:39

Yeah, it was and and we then did a workshop with them later on in in the Royal College meeting. And there were loads of really quite young paediatricians and medical students ranging up to some really influential paediatricians. You know, a couple from London, Amanda Watson from CCC, so some really good sort of movers and shakers of both present and future hopefully. And, and Doug Simkiss was there from Birmingham. So we had loads of really amazing people in the room. And these young people were able to share their stories in the Powering Up session, and everyone got a selfie with a pink hat and Rhea Berman, who's our young person that's leading a lot of this work was also there and was able to tell her story. So it was a really blended approach. And I think it speaks to that idea of just having a little bit of fun injected, and the thing you were saying around the Harry Potter Trivial Pursuit, well, actually, pink hats bring people together, because actually, you can't ignore a pink hat. Everyone was asking about the pink hats. There's a story behind them. The young people wore them, the President of the Royal College wore them, you know, the staff, I think wanted to take them home afterwards ...

Gill Phillips  30:56

(Laughter)

 Mary Salama  30:56

We had to retrieve them. So I think there is that thing around just making things fun and joyful and creating connections in a positive way. And I think that's really got to be key.

Gill Phillips  31:09

So if we come together at the event, we can have a colour clash, because I'll have the lemons and you'll have the absolutely shocking pink.

Mary Salama  31:18

Well, I think there's nothing wrong with that, Gill, we can have pink and ... pink and yellow.

Gill Phillips  31:25

People will notice us, won't they? They will. 

Mary Salama  31:28

Yeah, 100%. And I think I think that's about it, it's not being able to be ignored 

Gill Phillips  31:32

Yeah, I love it.

Mary Salama  31:33

Being able to advocate for your patients and being able to, you know, to say you can't, you can't ignore the lived experience, you can't ignore that idea of coproduction, because you'll miss it, you'll miss something. You won't get where you need to go without the coproduction.

Gill Phillips  31:48

Yeah. And I think something I picked up from what you said: the blended approach. Now to take that in a slightly different direction. The work that I'm doing with Midlands Partnership Foundation Trust is all about children and young people. And it goes right to the roots of children without necessarily medical ... you know, the acute needs that you deal with Mary, but mental health problems, special needs, the community aspect. And I think what we've found is that to listen to the children, listen to the parents, and just find out how difficult it is to access services. So I suppose what really interests me is just that family who are dealing with life, and they've got children and the different children might have different needs, as we all do. And some of them might be very low key needs, or some of them might be in danger of becoming more serious. And I suppose I've got this sort of gut feeling with Whose Shoes that that family doesn't really care who provides services, and even whether they're called services at all, but to have the support that they need within the community, or to be able to reach out and know where to go for help with whatever needs the children the family might have, and to see them as a holistic family unit. And I think, to sort of look across all of that work, and then you're dealing with children with very highly complex clinical needs, who could be within that same family, I just find it fascinating in terms of breaking down all of these barriers and seeing what really helps those children most. And that links me back a little bit. I think I mentioned at the beginning, just being able to send the child home. And I'm talking all over the place at the moment. But I really have been just so impressed, Mary, by the way that you can kind of get to the heart of what a family needs. And the medical term would be 'discharged'. I'd call it 'going home'. And would you like to tell us your thoughts on any of that?

Mary Salama  34:04

So so all of that speaks to ergonomics or understanding systems, and actually an understanding, framing and human factors. And I've been sort of on my journey of discovery around many of these topics. And I think the more I understand and learn, the more I see that we need to look at systems design and framing and language, and all of those things when we're thinking about problem solving. So you are totally right, we see discharge as a medical thing medically fit for discharge, socially fit for discharge equipment. We see it in those terms. And that's the language we use. And I think one of the things that you talked about was around language. So in your initial podcast, you were talking about how we, we need to talk to somebody who understands management language, translate it and I think the parallel is around actual language. So I speak a bit of Spanish a bit of Arabic If I'm talking to somebody, and they understand language better in those terms, I'll flip. Now actually, in the same way, that's what we need to do, when we're looking at where we're going. We talk about our problem in management terms, and we have to learn a little bit of management language, and they have to learn our language. And that has to be the way that we move forward together. You know, if I'm talking entrepreneurially, I'll talk about leaning in, or I'll talk about pivoting, or I'll talk about USPS or those kinds of terms, they're not medical terms, you know, when we're talking in the language of the patient, then we need to understand the language that they need, and they might think about home for your birthday, or Mother's Day, yes, or the fact that it's a religious, they want to be able to observe Ramadan, or, you know, just really little things like, it took me three years of working very hard to understand that, even though South Asian boy might have Muhammad is his first name. It's not the name he's called by he's called by second name. Yes. Which is his, you know, Muhammad is a prefix, almost like, that's the way I understand it. So actually, those are the things that we need to understand. Yes. And actually, when we are able, when I'm able, in a consultation to say, Oh, do you call him, Ibrahim, or Muhammad and they say, oh, Ibrahim, they, they get a sense that you understand them a little bit better, and you can then make that connection and move forward. And I think, in the same way, we need to understand the language of that family. And it may not be the same as the family we saw 10 minutes ago, may be completely different. Their drivers may be different, the way they're set up is different. And I think, I think the thing that our system is really bad at doing is understanding families language, and the families drivers, in the same way that we understand medical language, or even, you know, super specialist, different language, or even language of care and commissioning. So I think that process change where you put the child and the family, and we talk about putting the Child and Family centrally, but actually, what is important to them, what matters to them? What are the metrics that they need? And what are the things that make the most difference to them and actually trying to work together? To marry those two up?

Gill Phillips  37:22

Yeah, that's extraordinary. And I think you mentioned names, and there's so many different ... I think names are just so fascinating. The examples you gave and you said, it helps you understand better, but I think, again, you flip it from the family's point of view, oh, my goodness, somebody really cares, you know, someone who's so busy clinically, but they actually want to know what the preferred name is. Just something as simple as that, I think, can unleash a whole lot of feelings in terms of how that person feels valued or not, and it doesn't take a lot of time.

Mary Salama  38:00

And it is really interesting, because from the other side, if somebody does that, to me, as a service user, it makes a huge difference to  me,, somebody understands that. I don't know,  that we were facilitated when my dad was terminally ill to be able to take him to Egypt, to see the Pope and to spend time with him. And despite all the medical equipment, and all of filling in forms, and risk assessments, and all of that I was facilitated in being able to do that, because that was really important to us as a family. And I can still remember that trip, and many others. Also remember the time that was spent there. And I think that's really important. That's, that's something that I take with me. And you know, I'll never forget. But that required somebody to step outside their comfort zone, in a clinical capacity. And I think when we do that, we might not see the impact and the effects, but actually, they're there.

Gill Phillips  38:58

Yeah. And tiny things, and I can remember when I had my first baby, and I took him into work, and my mates were there, and they made a fuss. And it was lovely, and that I didn't expect the Director of Social Services, which is where I was working at the time, to come down and just say our"Ah, Gill", you know, "lovely, congratulations, let's have a look". And it took him what, five minutes out of his day, and I'm talking about that nearly 40 years later. So it can be tiny can't it, tiny examples, but things that really, really matter to the person. 

Mary Salama  39:39

And I think it's creating the space to understand that that really matters. So actually, I think in palliative care you have more time and more space. The challenge really is in acute care or A&E or you know, those those kinds of scenarios and that's where system design comes in. Because you've got to design an ability for you to see that or hear that or create the space to have that discussion. So,Gill, I think, just reflecting on everything we've talked about, I think if I had one thing that I was going to want to be highlighted, it's around the power of learning from other people and connecting across boundaries. And that has enabled me to think really differently about lots of different things, connecting across being a service user and being a service deliverer, connecting across different disciplines, connecting across totally unrelated groups of people learning from, you know, being a mum, or having to sort out with sports logistics, and transferring that to clinical practice and vice versa. And I think, I think if there was one thing that I'd want people to think about, it would be around how we in the modern world with all the noise that there is, create the space for this connection, and this learning. So if I give you an example, last week, Ken Nicholson, who's our education person in Colab, ran a workshop for paediatricians around how we improve care for children with complexity. And one of the people present was really frustrated with the time delay and getting the equipment commissioned, which led to a delay in discharge. Now, in Birmingham, we've done work on this and published it. So actually, that's work that could be visible. But in the noise of all of the work that's being done, that wasn't visible to them. And the idea is around having an equipment loan bank, and it's been running through the children with complexities discharge team for the last few years and has saved over 1000 bed days in time in hospital because you're getting children out, which is where they need to be. They need to be with their families and with their siblings and not in hospital. So that intervention has made a real difference for children in Birmingham, but we want that intervention to be able to be amplified and spread and be useful for children in Manchester, in London. ..., in the Outer Hebrides, it would be really amazing if that was spreadable. And I think that's the thing that we really face. A challenge within the NHS is how you spread the good ideas. And I think one of the things that we have is too much noise. And we almost need to learn to have, hashtag this actually, Kondo the NHS, we need to stop doing things and, and create a space to be able to share the good stuff by just getting rid of the stuff that we don't need to do or no longer do but haven't got rid of or, you know, cleaning the hard drives and just making space for you to be able to think and spread and talk about the things that are important 

Gill Phillips  42:18

That's a fantastic message and, I'm glad that you've at least touched upon that equipment work because I think tangible examples like that. And that was one that I really remembered from what I learned from the Colab talk that we did together and just hearing you speak at various events. Something like a child is stuck in hospital because because of stuff really. That's what I call it. And that's what I love about you Mary, that you will find ways around the stuff to make the really important thing - Oh my goodness, the child going home - happen. So is that example of the equipment on Fab NHS stuff?

Gill Phillips  43:13

No.   And again, it's tribal, isn't it, it's tribal

Gill Phillips  43:42

It is, it is. Because I'm a massive fan of FAB NHS stuff. I've done a podcast with Terri Porrett It's so simple, you know, collect the good stuff and put it there. But then I say at events "How many people have heard of FAB NHS stuff?" Not necessarily all that many people. So it's trying to break out of these tribal silos, whatever.

Mary Salama  44:04

Yeah, yeah. And, and some of it's about amplification. So the equipment hire was ... So we've got a family support worker, Mary Kelly, who works with Rachel Shanahan and Katherine and our team, and they created this equipment, but it wasn't me. It wasn't my idea. It was their idea. Because they see it on the ground. And they were really innovative and they got this done. And it's been amplified within our trust. But I feel like it's my responsibility to amplify it wider and and get more people to see it, but actually, that's maybe not in their arena that might be kind of, you know, tribally to paediatricians or tribally to NHS management. So it's trying to see how we can again translate something into a language that makes sense and bed days a language,  they're a currency in their language in themselves and actually ... Maybe we need to be braver about the translation and braver about overcoming the boundaries. And maybe what you need to do is create a Duolingo equivalent.

Mary Salama  44:11

Wow5, that's ... you can't just leave us hanging with a Duolingo equivalent. Expand on that just a tiny bit. What does that look like?

Mary Salama  45:23

Well, you know, so you're talking about, and maybe, maybe Hexitime is a Duolingo equivalent, because actually, what you're what you're trying to do is, you're trying to create a resource where I can learn about management speak, or I can learn about the language of social care, or I can learn about the language of housing, or local authority. So we spend time looking at this when we're looking at discharging children from hospital, getting them back home quicker, is actually how do we understand the housing system better? How do we use terms that that are key phrases or terms that they need to move forward in their processes? So for example, before we did any work with social care, I didn't know what an offer was  ... a local offer. I mean, you know, because you've got background in social care. But that was just that an offer of what ~ what's on offer? It's not, it's not a term that I understand or would use. How do you create that? Where you say, well, a local offer is X Y, Z, and it's the stuff that isn't in your induction book?  Because it's just the way we speak and the way we mean things to be. And maybe they're different in Birmingham versus Glasgow, maybe, you know, like in terms of just even within my tribe, but actually, how do we use that to translate and speak common language?

Gill Phillips  45:53

And that, that so feeds into everything I do, really? And I can be very provocative, because I'd say, Why should we need to learn all these languages? Why can't people just talk in a language that everyone understands? So you've got all these different phrases? And you've got? I mean, don't get me into acronyms. So yeah, when I do my coproduction work with the Darzi fellows, which is probably my favorite piece of work, and I've got the privilege of working with this fantastic group of healthcare professionals from right across the board each year. And I remember sitting with one group and saying, I knew there was an obstetrician around the table. So I was cheating a bit. I said, someone's come into the hospital for an IOL. Does anyone know what that is? And she said, Oh, induction of labor. And I said, Well, that's funny, because he is a man. And he's going to the eye department. And I think he thinks he wants an intra ocular lens.

 (Laughter)

 Mary Salama  47:46

So I mean, that speaks to so many things. You know, Gill. I've been teaching human factors for like, you know, 10 years or so. And actually, we talk about that we talk about language and jargon. And I think, I think your aspiration that we'd be able to drill and talk about requires time. So I think a lot of the jargon is to, is to simplify for timeliness, for efficiency. And so a lot of the things that we've created have been around improving efficiency within our systems

Mary Salama  48:17

Obviously,, yeah, each of course,

Mary Salama  48:19

including language that we use.

Mary Salama  48:21

Yeah.

Mary Salama  48:22

I'm being naughty.

Mary Salama  48:23

 No, no, no, no, I know, you know, but .... So if you're doing that, to improve efficiency, what you need to do is you need to create the space to be able to have that conversation because you can't do it at pace, you can't have those conversations at pace unless you understand the language. And I think, you know, when  I was a house officer back in the day when they were called house officers and not FY 1s, I worked in rural Dunfermline, which is in Scotland, near Carlisle,

Gill Phillips  48:53

Where my grandma comes from,

Gill Phillips  48:55

oh, really? I know, we're done family.

Mary Salama  48:57

Oh, it's beautiful. And people are lovely. And they're all farmers and they,re all really stoic. And they never complain about anything . They might be having a heart attack, but you wouldn't know and that kind of thing? Anyway, so they're lovely people. So but I'd come as a Londoner, studying in Scotland, you know, in a city then come to do this job. And I didn't understand what people were saying. I genuinely ... there were words they were using. I just didn't, I didn't understand. And so my consultant at the time, bought me a dictionary, an English Scottish dictionary, which I've still got actually I've still got it on my shelf. And, and you know what, I think that just highlights some of the things and it's the same wherever you go, you know, if you go to the Black Country, what is dinner? What is tea? You know, it's very different to what I might say, even in sort of south of Birmingham or Warwickshire or you know, London. It's a different language and unless you seek to learn and actually just asking about the language creates the connection. So I think we do need Duolingo

Gill Phillips  50:02

Yeah. And just as a very silly note to finish on ... as a child, I remember my next door neighbor, asking me if I wanted to spend a penny. And we used to have a corner shop like literally, you know, 50 yards up the road, where in those days, and it obviously shows my age, you could spend a penny and get some fruit salads, and a black jack. In  a little cone. And I was very excited and said, Yes, please. And she sent me to the toilet. So we need to understand each other's language.

Mary Salama  50:40

That's exactly it. That's a nice ... That's a nice way to finish.

Gill Phillips  50:45

So well. Thank you so much, Mary. It's been absolutely amazing talking to you. I knew we could talk all day. So I think we'd probably better stop there. But so many messages. Is there anything you want to say as a sort of final ...?

Mary Salama  50:59

I think what I what I would say to anyone is be be curious, be furious. Go outside your comfort zone, make a connection. Send an email, pick up the phone. That's the way we're going to make it better.

Gill Phillips  51:16

Brilliant. Love it, Mary. So you keep doing that, because you're doing that in spades in everything that you do. It runs through you like a stick of rock, and I'm so delighted to talk to you today. Thanks for making the time.

Mary Salama  51:29

Thank you, Gill. That was lovely. Thank you so much.

Gill Phillips  51:34

Thank you so much for listening. If you enjoyed this episode, it would be fantastic if you would leave a review and a rating as well as recommending the Wild Card - Whose Shoes podcast series to anyone who you think might find it interesting. And please subscribe. That way you get to hear when new episodes are available. I have lots more wonderful podcast guests in the pipeline. And don't forget to explore and share previous episodes. So many conversations with amazing people who are courageously sharing their stories and experiences across a very wide range of topics. I tweet as @WhoseShoes. Thank you for being on this journey with me. And let's hope that together, we can make a difference. See you next time.