In conversation with Dr Nnenna Osuji, CEO at North Middlesex University Hospital NHS Trust

Dr Nnenna Osuji is CEO at North Middlesex University Hospital NHS Trust. In this interview, she shares her advice for creating trust through developing psychological safety and shares a chief executive’s take on what to look for in a chair of the board.

What put you on the road to becoming a CEO?

Just after my fourth child, I reached an inflection point about what to do next. I wanted to be challenged more. So, when I was recommended for a medical leadership role, I jumped at the opportunity. The rest, though not intentional, just followed.

As CEO, are there any golden rules that you follow?

I sleep every night with a clear conscience. There are a few things that are especially important in allowing me to do that. The first one is courage; the second is to never be complicit by my silence; and the third is to be as compassionate as I can be. If I go to work everyday and know that I’ve done my level best, that I have been as courageous and compassionate as I could reasonably be, and that I haven’t been silent when something has been done or said that should not have happened, then I can sleep soundly at night.

I remember being told by someone when I became medical director – and it has stayed with me – that I must be prepared to walk away from my job in order for me to do it well. That, I think, is all about having red lines – I know where my moral compass starts and where it ends; I know where I’m comfortable going and where I’m not comfortable going, and that has been the guiding principle of my leadership.

“I must be prepared to walk away from my job in order for me to do it well.”

If you could make a single change to make executive teams more effective, what would it be?

Trust - formed from a commonality of purpose is essential in providing the cohesion and mutual support you need when managing teams. When this is the case, you don’t need to waste time and energy on managing personal agendas as it’s evidently clear why everyone is there. For boards where this is their foundation, the ability of its members to be psychologically safe enough to be curious and to probe by asking challenging questions respectfully is enhanced, and the organisation benefits.

How do you create that trust?

I wouldn’t say I’ve perfected it; rather, I’m running experiments! One core aspect is that we have “humble enquiry” as our guiding principle. Beyond that, some examples of things I’ve tried are:

• I invest considerably in executive team development with a strong facilitator who takes us through exercises that create discomfort and encourage us to start thinking about being vulnerable together.
• Whilst our executive team meetings are quite operational, we also have extended time together to choose a topic and talk it through to arrive at a strategic solution for the entire Trust; this topic can come from, say, one of the executive’s portfolios, and it can be helpful to get wider perspectives.
• Recently, I asked the executives to present each other’s reports at our executive team meeting – for example, the Director of HR presented the quality report. This made them engage with the papers in a way they hadn’t before – and although I’m sure they hated me for it, I’m also sure that it’s a worthwhile exercise in building up our cross-awareness. We haven’t done it at a board meeting, though!

As a CEO, what do you most value in a chair of the board?

All in all, I’ve worked with five chairs. The most important thing I have come to appreciate is a shared sense of strong values, which align with those of the organisation. When you’re coming into a CEO role, I have found it helpful to have person-centred conversations with the chair around where you’ve come from, where you’re going, and what drives you. This gives you a sense of those values and gives a sign as to how firmly they will stand beside you when difficult decisions need to be taken.

“The most important thing I have come to appreciate is a shared sense of strong values, which align with those of the organisation.”

What I have come to appreciate in my chair is the ability to lay the groundwork and begin facilitating support for decisions that need to be made for the medium- and long-term. As a CEO, you are periodically altogether consumed by the running of the organisation and managing stakeholders, so having a chair who can help you when your back is against the wall is massively helpful. In addition to this, I think it can be powerful for the chair to be a recognised and visible symbol who is active in the organisation.