In Conversation with Helen Higham

Hi Helen, Congratulations on the Frederic Hewitt Lectureship, how do you feel about the award?

Delighted is the easy answer! But more seriously - this is the 75th anniversary of the inaugural Frederic Hewitt Lecture. I'm the first woman to receive it, and one of my mentors, Pierre Foëx (Emeritus Nuffield Professor of Anaesthetics), won it exactly 30 years ago. Considering his influence on my career there's a really nice synchronicity there that felt pretty special on a personal level.

There can be times in anyone's career when you think, ‘oh, I haven’t made any progress, how have I got here?’ An award like the Lectureship forces you to take a moment, and look back, and you suddenly see the huge advances that we've made in OxSTaR (Oxford Simulation, Teaching and Research team) both in teaching and research. It feels extremely positive to exist in this space right now, because suddenly there's significant traction for the kind of things that we do in both simulation-based education and healthcare systems safety.

Why do you think you’re the first woman since 1950 to receive Frederick Hewitt Lectureship? 

I think that where the Frederic Hewitt Lectureship is concerned, it's about having an opportunity to show a sustained and innovative contribution in a certain field, and I think that as ever, where women in medicine are concerned, that ability to balance work and life remains a challenge, so sustaining a contribution can be difficult.

I feel very proud of the fact that I'm the first woman to have achieved it, but also perhaps a little surprised, because as a specialty we are at least half women now. Our focus on flexible working has been exemplary:  we offer less than full time opportunities in anaesthesia and we think very carefully about how we structure our postgraduate training programme to support flexibility in clinical training. As a consultant in anaesthesia, there are also opportunities to consider less than full time working. I chose that route to make sure that I had the necessary time both to be with my family but also to be able to develop and drive OxSTaR in in the way that I have.

On the subject of equality, you also have a role in NDCN as co-chair of the EDI working group. What drew you to that?

I feel so strongly about being a good teacher and that necessarily involves getting interested in the people that are around you. I have had experience of family and friends with disabilities and observed over the years, the challenges that they have faced, and it felt like an opportunity to do something very positive around EDI in the department. We have a very inclusive collaborative outlook within NDCN with all sorts of amazing people and the opportunities to do something translational are very clear in this area - you can make a difference quite quickly and we have.

Let’s talk about your career path, as you HAVE clinical, educational and academic roles. 

I'll start with my clinical career: it's very exciting when you start out in medical school and you see the vast array of different opportunities but when I went into anaesthetics then suddenly there was a light bulb moment of ‘yes, this is my gang, this is where I feel I'm useful and I'm making a difference to patient care’ and that's been the case ever since.

What's evolved alongside my clinical career is the education and research. I always loved teaching. I come from a family of teachers so it was quite natural for me to think about teaching as an opportunity within medicine. It evolved as a result of my being an anaesthetist into the use of simulation to train healthcare professionals and teams and then latterly into an exciting programme of research in clinical education and healthcare systems safety.

What drew you to anaesthetics? What was that light bulb moment?

Firstly, the immediacy of your involvement with patients: a patient comes into the hospital with a problem that requires a surgical intervention and we are there to support them on that journey. You start when you meet them in the preoperative phase, when a patient is perhaps very scared about what's going to happen to them. They don't know what the outcome is going to be and they're frightened of giving up control to another person. Within that very short period of time I have to build a relationship that encourages the patient to trust me, to care for them whilst they are under the anaesthetic, and to bring them safely out of the surgery. That's immensely rewarding.

Then there’s the holistic approach to the system that anaesthetists naturally apply to patients. We think about humans as a set of complex systems that work together as a functioning whole. It's the same thing for the healthcare system that we exist in: there are a lot of different departments and people that might care for a patient. All of them interact and human factors is the discipline that, in simple terms, aims to design work systems that make it easy for healthcare professionals to do their jobs safely and efficiently. And that's the approach we take to looking at modelling healthcare systems and how we make them better.

Tell us more about OxSTAR and how that has grown?

I’ve had so much support over the years from the department. I'd been a consultant for a few years, and we were doing simulation training at the Kadoorie Centre in the John Radcliffe but it became apparent that we needed more space. When Irene Tracy and Henry McQuay took on the joint roles of the Nuffield Chair of Anaesthetic Science and the Nuffield Chair of Clinical Anaesthesia, they both said ‘look, we need to expand this. It's a natural USP for anaesthesia. It's what we do’.

So, at the end of 2007 we opened the doors to OxSTaR, the University’s first simulation centre, and the programmes began in 2008 with medical students and foundation doctors. Since then, consecutive heads of department have been fantastically supportive and now we have a new Nuffield Professor of Anaesthetics so watch this space!

It was so obvious to me why simulation is important, but at that stage I had no clue how it was going to expand. It has built up through momentum, passion and enthusiasm.

We now have 12 core members of the team and about 100 peripatetic faculty from different specialties that dip in and out. Plus of course, a research group, 5 DPhil students, two DM students and a bunch of master students, which is more than I could have dreamed of! We've now delivered training to over 30,000 healthcare professionals in this country alone, in the NHS, most of those in Oxford, obviously, but some coming from other hospitals and nationally.

Can you explain more about simulation in healthcare and how it is a natural fit with anaesthesia?

Simulation has been used in healthcare since the early 1990s, but anaesthesia was a natural home for it because of the nature of the work we do. We look after the most critically unwell people in the hospital, and when things go wrong it happens quickly, and you need to be trained to respond in the moment and  adapt to your patient’s needs. Simulation offers a safe space to practise in real time for both anaesthetists and the teams in which we work.

Participants in simulation scenarios can feel very stressed when they're in the room caring for a simulated patient and people are observing them. It's that same feeling you get when you see a patient who is rapidly deteriorating in front of you on the ward and that’s what we're trying to mimic, to give people a chance to see how they respond in stressful circumstances and learn from it.

To this day I have never had anyone leave the simulation centre and say that was a complete waste of my time. It makes an immediate difference to their confidence and competence. We also know that it makes a difference to their behaviour in the workplace, so they are better performing doctors and nurses when they leave the centre than they were when they came in. That feels extremely positive.

So it's not just about the technical skills, it's about managing the emotional and the psychological aspect of it as well?

Oh, absolutely. It's what we call  'non-technical skills'. They're often referred to as soft skills but they’re not! What we know about the evolution of safety incidents in healthcare is that it’s not technical skills that let us down it’s our ability to communicate clearly in a high-pressure moment or lead a team collaboratively So they're actually the hardest skills.

We do teach technical skills - lumbar puncture, siting of chest drains, defibrillation etc.- but we recognise that the most important skills in the workplace relate to how we behave within our teams because no healthcare professional works in isolation. We're always in a team of some sort and it's vitally important that we have that collaborative approach and really excellent, safety critical communication techniques.

What are you most proud of at OxSTAR?

I'm most proud of our people. We have an amazing team which is just getting better and stronger. But I would have to say that it's our response in the pandemic that really stands out for me and was probably the moment where the value of what we do really became very obvious.

Anaesthesia was one of the specialties that stepped up to the plate in the pandemic. We immediately pivoted our roles to go back to being intensive care doctors, doctors that went to do intubations, doctors that were roving on the wards, supporting patients in respiratory difficulty and we embraced that challenge quite naturally I think because, by nature, we tend to be quite comfortable with risk. It's a part of our job.

I wanted to make all of our learning materials free to access for everybody, to share what we knew about managing patients with COVID with everybody and Kevin Talbot was very supportive of this. We developed posters for the steps you take to put on your PPE and take it off safely; we made over 90 training films; we trained people in the SIM Centre, we went out and about in the critical care areas to deliver training to staff. We had over 50,000 new users on the website as a result of what we did, and our reach became global, there was a point at which we got to Greenland! We also had some lovely feedback from colleagues in the Philippines and Laos. This felt very positive considering the pressure that we were under.

OxSTAR has clearly moved beyond just anaesthesia now,  What's next?

We always had a vision that first and foremost we wanted to get a reputation for the high quality of our teaching. But the R in our name is for research and there's a reason for that. We're in an academic department and I always wanted to offer opportunities for healthcare professionals from any background to come in and learn how to do research and to focus on those very translational areas  in clinical education and healthcare system safety that we feel so strongly about. There’s a huge amount of opportunity here. We've developed collaborations across the University, with experimental psychology and engineering science, looking at improving decision making in any clinical context and the use of AI to improve healthcare systems safety.

Also very excitingly, Bruce Biccard is joining us as the new Nuffield Chair of Anaesthetics. He has a passion for global anaesthesia, and we want to drive research in that field building on work that Hilary Edgcombe is already doing.

But to the point about our work in safety not just being about anaesthetics, the last three publications that we're particularly proud of came from applying systems thinking in a clinical research facility, to the challenging problem of antimicrobial resistance and to safety incident analysis in any healthcare setting. None of that is anaesthetics and for me, that's exciting!

And what’s next for you?

I've touched on the importance of that holistic approach both to our patients but also to the work system in which we exist. But it's more than that. It's about understanding the sorts of methods we can use to analyse and improve the work system that now excite me particularly and that have been absolutely at the heart of developments in the anaesthetics curriculum, but also in the sorts of research that you see in anaesthetic journals and it's great to be a part of that community. Of course, my ultimate goal is to encourage more researchers to join us and to drive improvements that really make a difference to patient care and outcomes.

Hopefully it won’t be another 75 years before a woman is awarded the Frederic Hewitt Lectureship!