Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

On Call with… Nadeem Moghal, Class of 1989

01 February 2018

"The experience of cancer has confirmed why I do what I do, and why I work the way I work."

Nadeem Moghal Q&A with Dr Moghal, Class of 1989, Medical Director, Barking, Havering and Redbridge University Hospitals, UK.

GROWING UP
My family and I escaped Uganda in 1972. I was 9. My father was politically active. We were refugees from the Idi Amin regime. We left in a rush, and were to catch a flight to Canada but we missed it and ended up in London. We heard then that we had just missed the ransacking of our home by the military - it was a close call. We had to rebuild our lives. We were welcome and unwelcome. That experience informed my perspective on life. A refugee, an immigrant, it took me decades to accept Britain as my home. I did not feel rooted until I had my own family. I was sent to boarding school, positively and negatively adding to the life experiences. When I arrived in Dublin, at RCSI, I genuinely felt I belonged. I still feel at home there - it's calming, welcoming and it's where I met my wife, Gertrud, who happens to be German, also an 1989 RCSI alumnus.

YOUR ROLE IN A NUTSHELL
I am the medical director of a large hospital group spread over several sites, the Barking, Havering and Redbridge University Hospitals. I am responsible for leading and directing the medical workforce, assuring standards of care through accountability of conduct, capability and performance.

TYPICAL DAY
No day is the same. I post my diary to Twitter every day. [Tweet Nadeem: @Nadeem_Moghal]. I'm a public servant so I believe being transparent and being social-media active is a positive thing. I am not allowed to use Snapchat, say my children.

 

 Nadeem 1989 1

Nadeem (far right) with Gertrud (second from left) and classmates at 2016 RCSI Reception in House of Lords

YOUR CAREER IS VERY MUCH FOCUSED ON CREATING POSITIVE CHANGE?
I went into medicine to care for patients and their families. It gives me the greatest buzz. But, I learned that I am also able to effect change on a larger scale. Doing an MBA was a fundamentally different journey but, as well as helping me acquire new skills, it helped me develop a new perspective. Time spent learning from the Institute of Healthcare Improvement in the US was a turning point. My job here is about achieving the best clinical standards, patient safety, clinical governance. Within this hospital group, my priority is to rebuild an organisation that is rooted in learning, I want to bring training and education up to date and prioritise research and innovation as well as enabling and normalising the skills of quality improvement.

DO YOU BELIEVE IN LEARNING FROM MISTAKES?
I believe we must learn from error and harm. By supporting staff, yet holding them to account, and intervening when necessary, we can give patients consistently safe, high quality, compassionate care.

IS THIS NEW FOR THE NHS?
The NHS is an extraordinary institution. I know that from working in it and, most recently, from my experience of being a patient. The NHS remains a reflection of this country's attitude to justice and to equality. But, it needs to build a 21st-century workforce. Look at how patients access knowledge now. Patients go online to get a diagnosis. They consult videos for their care. There are seemingly cheaper but effective alternatives to doctors. There are physician-associates and expert advanced care nurse practitioners, and consultations available online. Artificial intelligence will challenge us all, soon. Our patients are driving need, demand and change, and we must respond.

YOU WERE A PATIENT?
Yes, in 2017, I took a cancer sabbatical. It reaffirmed my view of the NHS. My experience as a patient made me feel very fortunate; I did not have to worry about access to treatment or bills or insurance. Cancer is a highly emotive condition. I climbed into the lifeboat, captained and crewed by truly excellent professionals. Being a doctor did not afford me any more strength or sense of advantage but I have become less accepting of the injustices that have always defined my work. The experience of cancer has confirmed why I do what I do, and why I work the way I work.

DID IT REINFORCE YOUR VIEW THAT IMPROVEMENT METHODOLOGY IS IMPORTANT?
It is possible to undo thinking and build new thinking by engagement on a day-to-day basis. I think there are two key measures of performance: (1) reviews by patients of their experience and (2) the patient-reported clinical outcomes. Both are important but the latter is key: a procedure - say a knee replacement - may go well from the surgical point of view but it is the patient who can tell us if it was worthwhile, if their quality of life is improved.

DOES THE EDUCATION SYSTEM BREED THE RIGHT KIND OF PHYSICIAN TO MEET THE NEEDS OF PATIENTS NOW?
The new generation absorb knowledge differently - they are not "all or nothing" but are determined to achieve a work life balance. More are time-sensitive, less vocationally focused. As an employer we need to create a workplace that understands their needs. I believe the way we recruit doctors is overly focused on academic achievement: I would prefer an educational model that included philosophy, literature and history, understanding the human condition. I am doctor. I am a patient. I am a person.

HOT TOPIC IN HEALTHCARE?
I believe there is institutional racism in hospitals. I work in the most diverse part of Britain. Every nationality in the world is here; the staff are hugely diverse. But racism is a daily occurrence. The staff deal with it and don't raise it as an issue, but our duty as an organisation is to deal with it so that staff do not enable a racist decision out of fear or in response to threat. There has been an upsurge in this challenge since the Brexit vote. As a society we have revealed a very real problem.

 1989

Class of 1989

LOOKING BACK
They say the best times are student days. So true. Ups and downs. Many more ups. The downs made bearable and resolved by fabulous friends that have endured over the decades. Lemke, also Class of 1989, is godfather to one of our children. Geoff, who is the glue that has kept a lot of our Class connected over the years, is seemingly godfather to all our children; he passed on the medical degree and career but surely deserves an honorary title! Posting in our 1989 Facebook group reveals how badly I am aging; all the rest still look like they did at graduation!

Thank you Dr Moghal

'On Call' is our new alumni interview series in which alumni supply the answers to our searching questions. If you have any comments, feedback, or would like to be put in contact with Dr Moghal please email alumni@rcsi.ie - or find him on Twitter @Nadeem_Moghal