Making health innovation real: what leadership looks like in practice

By Maxine Mackintosh and Jemima Kola-Abodunde

OHT London marked International Women’s Day 2026 a little early this year at Hale House with a conversation on what leadership actually looks like when you are trying to make innovation and change happen in practice in the complex, messy world of health!

Before the event began, members of the OHT community were already fizzing and reflecting on that question with a smattering of whiteboards around the room, which invited people to share thoughts on leadership, work, advice to their younger selves, and what sustains them during difficult periods. The responses were a mix of useful, honest and pretty hilarious - Alongside reflections on trust, honesty, and vulnerability were reminders of the importance of long walks, music, family, chocolate, raving, good coffee and alcohol to get us through the tough times!

The panel, chaired by me (Jemima!) brought together Jessica Schrouff, Director of Responsible AI at GSK; Rachel Murphy, Founder of The Grafter; and Kerrie Jones, CEO and Founder of Orri Eating Disorder Clinics.

Together, we explored the often invisible work behind innovation: the judgement, persistence, courage, and relational skill required to build something that is not only new, but also useful, trusted, and adopted.

For those of you who couldn’t be there, we’ve done a wee write-up with our takeaways!

Innovation is often less about invention than about intervention

From the outside, change can appear strategic and well-managed, but from the inside… boy-oh-boy…it’s usually contested, imperfect, and perilously uncomfortable!

Rachel described her experience leading patient-facing transformation in the NHS, where she inherited a governance structure of 10 boards involving around 120 people, with limited benefit in terms of actual delivery. One of the first decisions she and her team made was to simplify that structure, creating a smaller board with clearer representation and a clearer purpose. The change created friction, but it also created the conditions for progress. That example was part of a broader message that in established systems, innovation is not always about adding more activity, more process, or more infrastructure. Often, it requires removing complexity or challenging legacy structures to simplify them in order to make some sort of action possible. Rachel reflected that, at times, this meant having to “rattle some cages”, and what it meant to not always be popular and likeable in the face of such decisions.

Kerrie offered a different but complementary example. At the start of Covid, the model her organisation had been built around became untenable almost overnight - a situation probably resonant with many of us! Her team paused, regrouped, and built a virtual day care model in only seven days (yes - that’s seven days kids). What mattered in her account, however, was not only the speed of the pivot but what then happened in the aftermath i.e. that of building trust amongst users, gathering evidence, and continuing to make the case for the model to the board after the initial urgency had subsided. Kerrie shared that they now have data showing virtual day care has slightly outperformed in-person day care in some settings, yet the case for this delivery model is sometimes still met with friction.

That little anecdote for us flagged an insight that innovation is often not something big and disruptive, but looks more like iteration, that involves testing a new model, learning from it, and generating the evidence needed to sustain it…And then running the marathon long after you’d expected to keep the innovative spark and momentum going.

Leadership often means acting before we have certainty 

A second theme was the relationship between courage and leadership. Not courage in the abstract, but the practical reality of making difficult decisions, and especially speaking up when it is inconvenient (and maybe most often, continuing before confidence has fully caught up).

Kerrie spoke about the importance of standing “with the courage of your conviction,” particularly when a decision is right but unlikely to be universally welcomed. She also offered a phrase that we’ve all walked away with a little bit burned in our memory which is sometimes… just sometimes you simply have to “eat fear.”

Rachel reflected on how different leadership feels now compared with her 20-year-old self, and how much confidence has come not from innate assurance, but from repetition, experience, and years of doing uncomfortable things, including public speaking (oh the irony of saying this from a panel eh?!). 

What we particularly liked about this part of the conversation was its real lack of performance. No one suggested that resilience suddenly appears fully formed, or that effective leaders are always certain. Instead, the panellists described leadership as something developed through practice. Confidence grows. Judgement improves. And really our capacity to tolerate discomfort strengthens over time.

This was also reflected by some audience questions later in the session where we covered failure, recovery, and resilience. One particularly spicy question we have to give some airtime to because we loved it so much , was whether resilience is sometimes simply a more acceptable term, or even an imposed term, for making people absorb dysfunction. We’ll leave that one with you to ponder…

You do not need formal power to lead, but you do need strategic fluency

Jessica brought the discussion into territory that felt especially familiar to many in the room either working in complex matrix organisations, policy roles, or who are more junior in their careers: what does it mean to lead work that matters when you are not the CEO, do not control the budget, or are operating in an area that may be under-resourced relative to its importance? It’s all about influencing baby… (our words not hers, she was much more eloquent than that!).

She described trying to build work around fairness in healthcare AI with “zero resources,” while persuading colleagues across a large organisation that the issue deserved serious attention. Her reflections pointed to a critical feature of leadership that is often undervalued which is this ability to translate and rally and influence.

The examples she gave were that the arguments that resonate with researchers are not always the one that persuades senior decision-makers. Leadership, in this context, is not simply about holding the right position, but often about understanding the priorities, pressures, and incentives of different audiences and making the case accordingly, without losing sight of the underlying principle.

That may have been one of the most practical ideas of the evening. Conviction matters, but so does adaptability. Important work rarely advances on principle alone, and moves when leaders can read the room, build coalitions, and make the work legible to the people whose support is required and then be the chugging force in the background to make sure it progresses through the sea of “No’s”. 

Jessica also spoke openly about being one of very few women in technical spaces, and about the importance of support from other women and from communities in navigating that experience. The role of networks, solidarity, and peer support in sustaining people whose work is both strategically important and institutionally difficult was a big part of her leadership journey! Yay for communities!

Ethics and equity are not constraints on innovation = they are tests of it

The panel also addressed one of the central tensions in health innovation, and a topic which is very close to OHT’s heart, which is that of equity. What happens when urgency, delivery, and scale come up against ethics, equity, and safety?

Rachel reflected on discussions about access to digital health records in the NHS app, and the need to think seriously about domestic abuse. At one stage, she recalled, there were conversations that risked minimising the issue on the basis that it affected only a small percentage of people. Whilst many of us have been in those discussions, her reminder to the room was that it is so important to always remember that those so-called “edge cases” are actual people, and the consequences of poor design are real.

Kerrie made a similar point from a clinical perspective, emphasising the importance of maintaining integrity when working with vulnerable people. Jessica was equally clear that fairness was not something she was prepared to treat as secondary, even where institutional incentives did not naturally reward it.

One thing that comes up a lot in OHT rooms is that ethics is not as a theoretical overlay, but as a core leadership responsibility. However, in practice, ethical leadership means exercising judgement under pressure, recognising where harm may fall, and accepting that silence or inaction also carries consequences, but often doing that from a position that can feel either anti-innovation, or really quite lonely.

Leadership also requires perspective

The conversation also touched on self-care, though in a way that avoided easy prescriptions (lest we forget the good coffee and raving advice from our whiteboards!). None of the panellists offered a polished formula for balance (doh!), but instead they spoke honestly about the strain that can come with leadership, particularly when building something new or carrying significant responsibility.

A reflection we’ve had is that such questions on “tech-bro”-like panels are often met with self-optimisation-like responses, but this panel was far from that. Our panel talked about support, self-awareness and the ability to maintain proportion in the midst of pressure.

Kerrie captured that idea memorably when she said, “Relax, nothing is under control.” Whilst it was definitely a funny moment, it was also an important reminder that leadership is really not the art of mastering every possible variable, but more often, it is the capacity to stay clear-headed, act with integrity, and keep moving in the face of uncertainty.

So pulling it all together

So… how do we summarise all of this!? In health innovation, leadership appears to involve several things at once: simplifying where systems have become unnecessarily complex; making decisions without perfect certainty; adapting your language for different audiences; holding firm on ethics and equity; and continuing through resistance and risk in the face of ambiguity.

A huge thanks to Jessica Schrouff, Rachel Murphy, and Kerrie Jones for a rich and generous discussion, and to everyone who joined us and helped shape the conversation!