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Defensor McNally is a consultant orthopedic surgeon working in a sport in the UK and previously council member of the Royal College of Surgeons of England. The night Women to be super on president elect of the Medical Women's Federation only name a few of Professor Melies accolades. And they write her career Professor at now is lead on changing culture, education, exercise on apartment writing on speaking extensively only NHS health reducing complications, bias a bullying. Plus, she has 1/4 done karate black vote on incredible career. Were owner to have you here, Um, and I'm not gonna have the stage over to you. Brilliant. Thanks very much for imitation is it's lovely to stick to everybody. I'm just going to share some slides, so bear with me a moment. Oh, okay. So hopefully you can all see my slides and you can still with me. Let me know. If not So I'm going to just run through. It's a slightly random collection of sides because I'm me on, but I I was asked to talk a little bit about me, but please don't do like me. You need to do you. Um Andi? Uh so off we go. I have no conflict of interest. I need to get paid body and ingests the center of perative care. Pay my trust for half a day of my time. I get involved in lots of other things or have been involved on a voluntary basis. So I'm connected, but I don't get paid for by them. So here's me, um, in 1989 just before I qualified as a doctor. And it's fantastic job. It's fantastic being surgeon Onda. I still keep in touch with some of the people from from then, um, just very mind these people are now make fifties and they're the ones here in charge, but they developed through a different time. So you do need to, um, treatments like you? Definitely. So I'm gonna get back to that. So I've done lots of other things. That's me operating when I was pregnant on day. The little baby there, um, is now 90 was 19 yesterday on disease in Mexico traveling. So it's quite interesting going through that phase. And now I've suddenly got lows. Next time, Teo, Only time. I don't know what the time goes, but I I ought to be able to give you two different ways of my career because I'm not having to balance everything quite so much s Oh, I didn't believe it's about being pregnant when you're a surgeon. I looked into the richest Institute of Radiology, basically says that X rays are fairly safe to work with X rays because you're not getting the dose of radiation. All that kind of thing in the middle is about is breastfeeding. You can express breast milk, which teachers supply going. If you're on call a lot, which I was 19 years ago, and 20 and choose where you live. It's a bit like This is your life. This is your career. So I consultant work. I just I I was doing the foundation doctors teaching at lunchtime and I cycle back and so I could do this talk today and I'm just turning. That's my daughter's. I'm just going to say, uh, I'm just going to say no, I can't talk to her today, um, to say she's traveling safety. Um, Andi, that's my mother on. Got a problem and see how this evening she's in London. Onda Lot of people are balancing lots of things in their lives and just, you know, you kind of have to put your life into perspective. Um, but you don't have to be the one that doesn't school. Run, bring in your team. Do you use what you need? So there's my kids when we could be very rarely get it all together and same place. And after a while we started worked out and do the school run by bike lanes much, much more fun. Um, Andi? Yeah, so that's a bit more grown up on There's me with one of the kids on the right, and it was lovely being positive together with, um, there's me a guarantee that for 10 years and I was quite interesting because is the recorded decisions counsel you can see I'm writing, But now about a third of people you stand are women on far more people of color applying to be elected. Things can change and things can change within a lifetime. But you've gotta work out. What's the actual problem, brother, than what you think the problem is, you know, Is it the replying or in fact, is it because people don't apply because they think the job's too difficult for the roles too difficult. So some of it is about making the role very, very clear on going to talk to people you might want to apply or might want to do it and tell them what it's like that with the old fashioned tap on the shoulder. And so, actually, the decisions of England got quite good at it. We've just been talking about a meeting with a B m a r this morning about how we could do that with a b m a S o. We want more people to apply to be on committee, that the medical association I'm so that we get different, different way of doing business on that, my kids against, to say it's quite difficult to get for them or in the same place. And I got a website. See, lots of papers I'm talking about on my website. It's got in it. That is okay dot Okay, so this is kind of my secret about about life, really, because leadership in life kind of go together medicines very competitive. But when you're leading a T, but you've got to realize that some people just want to do a good day's work and go home for tea. Some people don't want something, really. It's low, but they're employed. They're they're they're part of your team. You've got to just go at their pace. You gotta can't have a minimum standard. And you've actually got a have rules on fairness. All that people get most annoyed if they think someone else has been treated better than that. So it's very boring for a kind of manager and or a director or something. You have to have the rules in place. You have to be seen to be sticking into thumb. And the problem is, is medics. We always think, Oh, if I worked a little bit hard or, you know, I could be a bit better, But actually, sometimes you just need to be very clear about what you want someone else to do. You know, You going to organize this arm? I get this kind of you tell him what you tell him a deadline and then get back to them before they haven't done it, that kind of thing. But you need to support people that are managing their life completely different from you. So you need to have that minimum expectation, because if you set them to higher standard, that's when they they worry. There's something I heard recently called Universal positive for Ms Belt Universal positive regard. Try not to jump to the conclusion that they're doing something badly because of a certain thing. You got to kind of just assume they're trying to do their best. That a positive positivity. So I was laid off of a fist in the colon surgeons about avoiding unconscious bias. Now, in fact, you can't avoid unconscious bias. But people make assumptions all the time about what? What people are gonna be like. If you go to our CSE and Geodon, you go okay for a slash study. You get loads of things that I've been involved in writing that I think are important on the four slash careers. If you want a surgeon, they got her lips and tips, and it's a fantastic job, but it's quite congested on. The big thing is, we all think that we're trying to do our best, and if we try, the heart will do even better. But actually your brains that work that they mostly it's fast thinking. You work in patterns with short cuts and biases, and you're slow, sensible brain. You actually have to concentrate to get going. So just it's very good to have patterns and repetitive stuff I can operate without really thinking about it and then suddenly have to slow down and you really concentrated. But you know, I'm so patterns are good, but sometimes you're linking up the wrong things on. That's where unconscious bias comes in, that people think a certain type of person is going to do something a certain type of way and generally speaking that they often do. But you can't assume that for individual. And there's all sorts of things written about unconscious. But I put that up there so you get some kind of science. But feel free to press print screen and then paste into a word document so that you can you can say this things you like, like So yeah, so something benevolent, biased. I was. I went for a role once on day one. I asked the person, You haven't given it to me. They said, Oh, well, we thought you might you be enough sick. We thought you might go off sick again, so we didn't give it to you, and it's like that's actually illegal, But I didn't say that's illegal. That they were trying to be kind to see would be into sometimes people's people's motivations or okay, but they need a re educating about how the world works. It's not them to make that assumption because I missed the opportunity, which meant that I wasn't ready to get future opportunities. So that probably unconscious bias is that if it if it can be interpreted bullying because brilliant have a victim, feels that people are treated differently, they might interpret that is bullying. And if it affects how we select that is unfair, d motivates people, then you end up with the good people not applying for the things they might be brilliant up. I'm so this is what I'm talking to surgeons and other senior people. I say Think about how to avoid your BIS or how to work around thumb, try and be positive. Put yourself in the shoes that have. They have bad jokes, work out when your triggers are when you get really stressed with people and slow down new If you know it's always When the new doctors talk, the first week of August. Have a try and get the clinic, which is Try and get into work on you. Do something to stop that tiny proportion of time messing up your whole relationship with that personal that team on got a fake it sometimes just smile. Just sometimes you gotta not say what's in your head. Will not do what You just have your own personal minimum standard and some things don't change even though you think they should on. But just cause many people are at that stage in their life. But I haven't kind of started having kids or thought about something. It does. Things do change. In my opinion, men and women are the most different of the age of around 29 because that's the peak age for having babies. It's also the peak age when people are trying for higher training. Actually, registrar in there surgical specialties and they've done their course surgical training. They're applying to the restaurant, and fact that problem is, actually, you are physiologically different if you are pregnant at that time or just had a baby. But that phase lost a very short time in a career, and but people can't can't see beyond it. The people can't see beyond it. The people selecting or planning training programs can't see beyond it on. We really ought to grow up and accept that it's a phase off life. Um, I wrote a paper 10 years ago about how competitive surgeries. I'm just put this up here just to say that this this showed that women do want to do surgery because of the time he was. I wouldn't just don't want to do it, you know. But also the 29% prides core training, but only half the percentage of those applying to hire training. We're winning. They drop. So something's putting People are for they're not supporting people to continue on it, I think, is that critical phase of just not be able to see beyond. So that's why so small interventions to improve things for a few people having difficulties make a massive contribution to retention of starve Later, we also found that women who do apply was statistically significantly more likely to be appointed than men because I need a really good ones would apply on for you guys. You want to apply something competitive, Focus on the real hurdles. What is it? Is the interview. Is it an election? Focus on the bits of the boxes that you need to improve that kind of thing. Just you almost need to sit down and really focus on work out what? What, where your gaps are that you have different ways of filling them. Talk to people. Ask a voice, but you don't have to take it. I'm just saying that you know these people that live fifties we did used to operate or night that operating to be done, and we did. It did turn you into a slightly angry kind of person, so just be aware of that. And it all changed in 1996 when things report the National Conference inquiry into patient outcome of death that patients get a better result if you don't operate out of ours. And suddenly we had list during the day for emergency work, which also met, the surgeons started to get some sleep on. Do everything is done in a team and it's in a team, you know, the daytime team. So there isn't an excuse anymore on, but everything is done in teams. Andi, all specialties done in teams know specialty should require you to work on the 48 hours a week, so it's kind of opened up or specialties. But the problem is, lots of people don't know that because the last time they did surgery was in 1919, 4 and they thought, You have to be a certain way, but you don't have to be a certain way. I just think we got a curriculum for surgery on the osteo see? And you don't you don't You can't force that study for everybody is gonna be a doctor. This is the minimum. You need to be a surgeon, really just saying, I know it's very focused on gender, but, hey, someone has always made it, but they've made it with his kind of male leadership style. That's Margaret Thatcher is our first female prime minister in the UK without all male cabinet, she didn't really change things for other people. I was saying before, unless you got a tiny gap. Unless you get people supported to be a little little job stretching roles at the middle management phase, you haven't got people to just let from later, so we do need to support, promote and that kind of thing are people. Are we due to push ourselves for words if we don't think we're quite good enough? Actually, you got a picture. Somebody being worse than your in that role and actually some of the things they can do. Of course I could do that on I'm actually a rubbish role model thing. Is Miranda in the jacket? She was not registrar. She worked part time, had to train part time, had two Children and is now full time consultant. She's amazing, so you can do it. You don't need to do to sleep fast thing. We kind of think the end it. Jesse's about health. But it's not about treating things about fixing things, and we need to change so that it's more about prevention things and patients that always want choice. They want you to be the leader, as it were on. We could talk about inequalities and healthiest. Is your chance of getting circulation disease depending? What post Koji Livin on? It's a dose dependent curve so we could improve health a great deal by improving conditions. People live from working on some of the other things I've done is I was laid off the furthest from the health inequalities for me And tell me, medical real Courreges about trying to improve people, doing exercises, part off treatment, and it does prevent multiple conditions. So there we are, preventing dementia, 30% reduction in risk of dementia. If you exercise 150 minutes a week, why doesn't everybody do that? Doesn't everybody knew that? Reduce your chance of bowel counts of 45% and these are dose dependent curves again, up to about an hour days. So that was a brilliant thing, because it could have we got a big group in in the room on be kind of trying to collaborate on. Writing a document is is lovely and you get people, you know, reedited or doing their section and pulling the back to look at the whole thing. So I really enjoy that kind of thing. And we did A bit of comes around it. There's me in the daily mail. We who because actually all of those conditions are very common on down. Put the line in about aged 60 on. This is a number of medical problems that people have by age, and it goes up and, uh, put up with aged adult to be social deprivation on. Before that, you need doctors to deal with that level of complexity. It kind of gets messy. And when I'm talking to other people, when you're trying to get changed to happen, you have to think about where what other people's priorities are. So the little great it's here is how has the individual patient, you know, percentages were. 3% of patients are responsible for the area of the curve, 45% of the cost of hospitals. So if I'm talking to politicians or a hospital managers, I say if we do this, it can save money on dialysis or they don't. And again, I've I've written that other stuff about trying to get the population more active to reduce the need for social care. Um, again, that's quite interesting bringing people together doing that. But behave, behavior change isn't just about the individual changing. It's about putting in systems like Cyclones play Park so that people can do make the right choice, giving a little bit of information on then the culture make it normal for their culture and normal for their family getting their partners involved. You know that kind of thing? Um, because actually, the NHS should be about prevention, because it's it's crazy, but not, um, I think I've gone through that. So some of it is rephrasing the message, listening to where people are out. So you know, you're nice. People go what people to be healthy, less pollution, the other we can't afford. Not to it. It's a kind of different. You sometimes sell things differently in different people. I didn't NBA because I was doing quite a management stuff on D. What I learned about that really is if you think you're doing leadership, actually have to do some management you have to do. The management, I think, is the basics. The human resources, the finance, the keeping, the system going, predicting problems, risk management and things. And you have to have some. You have to be ready to do that to put your systems in place on Do you have to? It's not all about being here, okay? It's about So I got kinda calm heresies because it's different. What other people think. We need diversity. We need challenge. We need if you got a project thinking if it goes wrong, What? Why we'll have to be need to talk about talk to who's gonna be affected, get them to be part of the solution. Pretend like you're listening. And then if someone decides something you don't agree with but his decision of the meeting, you don't go in back from about it late. I've done some other things about what we should call junior doctors on what we should call them his doctors, because it's doing a good job of work on the ones in training, medical doctors and post graduate training. So patients know that they're not training. They're not students, so, but again, it's kind of listening to people's ideas what the patients want. Um, heresy kind of number two. You don't need to be strong. You can ask. You could say Please. You can see you think you can say I'm sorry I didn't get it right. That's okay, Ondas about getting not just the quality which is giving people the same thing, but equity giving people what they need to do, the best they can do in their job. And then actually the reality is that people who have stuff, get given more stuff. So we need to kind of focus that alli ship, that active bystander of the people. You've been given a bad deal in the past on pushing more opportunities there. Weight on. It's about people, money and time on down for me. When I'm talking to other people, I put this lineup other people kind of my age because people sometimes think you could be perfect and you can't. You've got to use your team because everybody at some point of having a bad day and we need your team to put you through. There's only 168 hours in a week. On the record is urgent. Get into organizations that of failing on down and found 54% have problems with nutrition management, so this is not well taught, and it's not well done, so any of you could probably do it better if you concentrate on how to do it and listen to people and quite clear on. I've helped with some allegations of bullying. It's with this volume conscious buys a booklet on gets the people. They don't realize they're doing it. That's the problem because they're so you're busy trying to have achieved a high standard agent we know is the part. They haven't explained what I host and it means or they haven't got a minimum standard. So we need to set up some minimum standards and listening a bit more. So I tell them that. But listen to the team say story. That kind of thing is really, really important. You know, like a party. You've got to say what the start time is and what you expect. You can't just expect people to know it straight on, but people need to be taught. This is not the way human brains work, and the probably quality of diversity is there. Different quality means making sure everybody has an opportunity. But diversity means if somebody's on your team, you take them two aside and see what you need to be addressed. And it might be they got to drop the kids at school or certain nurses don't talk to them because they don't realize how senior they are or something that might be something that's holding the back that you can fix with them or help that or something that might be something, and you're allowed to ask, Um, we need to give people skills on how to share a meeting and stuff, So it's almost, I think they're the opposite. I'm just saying it's fasting because actually, we do stuff because it triggers they mean and serotonin, you need to be on the team. That's really good, but we need to give people those little little mini rewards for doing stuff. I was very ill. I had a stem cell transplant two years ago. I'm not operating part time, so if that's given me a a different view on things, having that invisible disability for a while and there's some things we can't see, But if you get it right for someone with a disability, you could get it right for everyone. That kind of what you need to do your job, the best that minimal standing aspirations. So now I'm just going to fly through my slides. I think I'm gonna run out of time, so but the thing that exercise get to moving message or you don't you, Kate, to get information about how to talk to patients without shaving them. We've got um, you can change culture on behavior. It's quite easy to do, but you need people to be on side on that. Have lots of, you know, photo opportunity is lots of stuff in the paper. That's the women and surgery conference with the babies. We got that out best. The people that are surgery, women different have thie information. So I've made lots of leaflets for patients and for people going through surgery, have respect for others of yourself. Onda put in some data, so we did a project about doctor's assistant. So it's training up. We've been health care assistance to do, take blood tests and fill out um, in tasks we want in the world For that, put them putting the percentages in helps. Then people are on your keep rolling because this is about leadership. It's that gap. You've got the innovator to got the early adopters they on. Then there's a gap. Before everyone takes it on, you've got to do everything you can to pull people so that it seems like the best thing to do. And for that you need your numbers and your project on your plan to carry on on your complaints. Do you listen because on be fair on diff people are behaving badly. You can stop them in the moment. You don't have to go through the whole taking two HR thing if they will change. Uh, people have. These is the bad things. Don't do this. This is leadership. Don't seem bad. Attendant at Superior. Avoid stuff. Anyone who wants to do surgery go go to the operating theater, but in advance, check out what kit they used to. You can look it up online if you use Smith, and Nephew will strike her. Google the operative techniques so you can know what better kit comes next. It's It's not that difficult, like falling a recipe. Check it when you're applying for something. Is it something you apply for? Is it something going to be elected? You have to appeal to the wider group with your election statement. You know, I'm just trying to ahead demand things. If you're going for a paid job, particularly demand things to help like that mean assistant and get some skills about human resources. Finance. There's this and quite simple things that to get your systems in place, we're gonna be a manager. Um, but your system and they, um, have your CV ready? Um, people talk about coaching, um, mentoring. But often it's in your head already. You just need permission. Andi, do ask for advice, but you don't have to take it. This is quite busy, but it's about work out how systems work. So if there's a secretary taking minutes, you can send them an email going. This is what I said in the meeting. Can you put this in the minutes? And they love you because you've put it already in the minutes like you understand everything you know, Look up, moving medicine. They'll put it in straight into the minutes, and people weren't. They will see the minutes she's going to work out when you need to get your papers in advance so that it's about your agenda. Know there's a chair in meetings. Question forward. There's something about in the volume unconscious bias working, you using the room. How long each item to take that kind of thing? Be aware of projects failed. Just be professional with people. It's not their fault. Don't think don't have to happen straight away. Some best projects is when it's worked elsewhere, going to visit as a team on working out what really makes it work if they've got a secret ingredient like receptionist, that or something. Emails. Don't assume someone sitting there waiting for your email. Be really clear with dates, times that kind of thing. Time management. Just work out twice. We've got to get my car. I know tedx because I just thought, you know you can just save it. But at the time I wake me. Do your really boring stuff. Parenting Fork. It's 40. Many are booking set teacher training days off. It's just you and that one special. Keep it with the other ones were still in school, so you can do something special that always remember that Make time for you. Use your extra adults grandparents' and stuff because teenagers are really difficult you need. They need someone else to talk to you. When they cross review eso use everybody. Use everybody. You're entitled to be there. You been appointed. Everyone's got different skills. Welcome them. Say your point, Onda. I've done the leadership management thing when, Yeah, this is that Just a charming even Think if you were employing people to do a task you've got add on the on costs to the organizations. It always costs a little bit more on. If you're taking on a project, you need to add on a bit of time of the extra stuff that takes when you forget your password or something. Do you make time to listen to how your partners day was? Because a lot of people that think they're too busy and you're never too busy osseous and you don't really care for study, join a trade union because you never know when life is going to mess up on your gonna need it. Medical Women's Federation told UK BMA that kind of thing about teams C popped order UK is really good for teachable moment. Getting people ready for surgery. Working teams across the better health benefits of active travel outweigh the risk by 10 to 1. Just saying stages there. These the road crashes in East Born, and we need more people to be respectful around people. So I can I feel like I'm being bullied when I go out on my bike. Sometimes it's only just for a little bit getting to the next traffic jam they mess up of Cymbalta order. You can do the cooking up your interest in the anesthetics or anyone getting through surgery. My last life story. Never run. Work out what you want to do. See, it's got an adult UK. Ask me on Twitter if you like to come to you about so planes. But it's about listen about making professional that slow down at the right thing on. But I'm kind of stick to your values that was mentioned the last session on I'm going to stop sharing on Thank you very much. Oh, thank you so much. That was a waste of stopped, er, but lots of really helpful tips and on life inside and the outside of method. And thank you so much, Professor. Right now, like for joining us for taking time out of your really busy schedule to join this event and share your story. And we'll really appreciate it. You. Thank you. Thank you.