Clinical Lead, Google Health UK

Whilst I really enjoyed what I did, and I really enjoyed geriatric medicine in particular, I couldn't see what was going to be different for the next 35 years. I'd just turned 30. I had a whole load of time ahead of me until I retired, and it felt like I would be doing the same thing every day. And it was in the era, I think, before there were really obvious career paths for medics doing different things. It kind of felt that you did medicine and you stayed in it, other than maybe going into research — and that wasn't a path at that stage I wanted to do.

So I made a decision. I got some career coaching, decided to do an MBA, which I did in Sydney and Chicago, and then took stock of where I'd go next. And where I ended up was moving back to the UK and into healthcare consulting. I started at a small public sector consultancy in London, and then after three or four years I moved to Ernst & Young, where I joined their healthcare practice. From 2012 onwards I was a partner there, leading the healthcare consulting business across the UK, and then more latterly the health and life sciences business across the UK and Ireland.

I was really happy. For me it was a great combination of my skills — I had my clinical background, which meant I could go into hospitals or primary care trusts and hold proper conversations with clinicians, but I could also bring the consulting skills to that and really drive some transformation. I loved my time there. And then, a bit like that moment earlier in my career, I was on this path where nothing was going to change. I was doing well, moving up the ladder — when I got a call somewhat out of the blue from somebody at Google saying, there's this role, a director of Google Health in the UK.

It's a great job — lots going on from Google into the NHS, and there's this role for a clinician to provide clinical oversight, but also to corral everything Google is doing across the NHS to make sure we're driving the best that we can as an organisation. And I said, oh, that's super interesting, I'll reach out to my network and see if there's anybody who's interested. And this person said, no, they want to speak to you — which was really surprising. I remember at one point in my consulting career we were having a meeting with Google, and I thought, that's so far from anything I could ever do. They're young entrepreneurs, they're so clever, they've got this whole set of skills I could never dream of. And then suddenly I'm being invited to apply for a role with them.

So I sat with it for a bit, managed my imposter syndrome over the course of a week or so, chatted with my husband — because it felt like quite a big life decision at that stage of my career — and then stepped off into the unknown. That was just over a year ago that I went through the interview process, and I was successful. I joined Google in April 2021. So I've been with the business for just under a year now, and I have two main roles. One, I'm the clinical lead into our Health AI business, which is where all of our diagnostic and imaging tools driven by AI algorithms are developed. And then I have this broader NHS role where I work with colleagues from Fitbit, YouTube, Google Health and Cloud, to really join up and drive the best of what Google can bring to the NHS.

That's a great question. I talked about the imposter syndrome side of things, and I'll come back to that. So there was somebody at Google Health at the time who I had previously worked with. And my predecessor at Google Health, Dom King, had left a few months previously. The organisation had gone through a fairly tumultuous couple of years with the merger of DeepMind Health — as Google Health used to be, when it was just a UK-based organisation — with bits of Google in Palo Alto, so Google Brain, bits of Nest. They'd all been smushed together into Google Health, and I think that had gone through quite a lot of growing pains: how do you bring different cultures together? There'd been quite a lot of attrition and turnover and products being sunsetted.

What was needed at that point was somebody to come in and steady the ship — a grown-up to provide some leadership and some calm on the London side, whilst making sure we were integrating properly as an organisation. Because we weren't really a London side and a Palo Alto side; we were a single Google Health organisation. So the person I used to work with recommended me, because he saw that I had some of those characteristics — being more on the business side than the technology side. And it was something I really tussled with, actually, because how can my skill set possibly be good enough for Google, where you've got all these amazing engineers and product people? What can I bring? I'd listen to people rattle off their working CVs as they introduced themselves and slowly sink into my chair a little bit more.

But my reflection on that is: in order for businesses to be successful, they need lots of different sorts of skills. Whilst I'm never going to be an expert in machine learning and coding clever things like a lot of my colleagues, what I can bring is a decade or more of leadership and delivery, and also an understanding of the NHS. A lot of our work is about trying to drive transformation in the NHS, and we're not always adept at speaking to people there to say, what are your pain points? What do you actually need? We tend to go, this is probably what they need — and then find it doesn't quite fit. So there was just a moment in time where the skills I bring were really critical for that next stage Google was going through: transitioning from a teenager organisation into a slightly more mature one. It needed those business skills and a steadying hand to calm things down, particularly here in the UK.

The biggest thing, in any organisation, is people. People are our biggest asset at Google. People were our biggest asset at EY. People are the biggest asset in the NHS. There are very few organisations where that isn't the case — particularly in professional services or service delivery, or even in product organisations, because you've got people needing to design and build those products. If you don't invest time in those people, you end up in all sorts of difficulty.

So the biggest thing I did at the beginning was — and it was really hard, I have to say — leaving a job in a pandemic is really easy; joining a new organisation in a pandemic is really hard. One day I was sitting at this desk where I'm talking to you from now, and the next day I was sitting at the same desk, just with a different screen, because it had been given to me by Google rather than EY. Nothing had changed, but everything had changed. And a lot of the skills you use as a senior person are quite intangible — the softer skills of having those two-minute conversations at the beginning of meetings where you find out a little bit about somebody's personal life, rather than getting straight into the transactional stuff. It's really hard to do that over video.

But despite that, I spent a lot of time getting to know people and listening, understanding how the organisation worked, not trying to do anything different or radical. Google is a really big organisation that has its culture, and I'm not going to come in and change that — nor did I want to. What was needed was somebody prepared to build a sense of community, particularly here on the London side. We're 150, 160-odd people who are the legacy Google Health business here in the UK. And to set a vision for what we could do as a team with the NHS.

That's basically been my big thing: set the vision, repeat the vision, talk to people, get them engaged with it, make it feel like something they're invested in and want to work towards. It's not a quick fix, and it's taken a lot of time, but it's beginning to pay off. I had a town hall a couple of weeks ago for the London team and we've had amazing feedback — that after a year and a half of remote working, nearly two years now, people can finally feel a sense of where we're going and what our mission is.

The other thing is working really hard to set a culture. During the pandemic we'd got quite lazy about things like working into the evenings, because there was nothing else to do. We work a lot with Pacific time, eight hours behind, so we were working into the evenings a lot, and people's lives were getting really disrupted — and they didn't feel empowered to say, this isn't okay. So I've tried to set a culture where you don't have to give a reason for saying, I want to stop work at six or seven or whatever time is right for you. You don't have to have kids to feed — you could just want to go and watch a movie on your own, that's fine. But setting some boundaries, and role-modelling that, is a really important part of what we do.

And then the final bit would be showing you've got some credibility out in the market. We've had some really exciting things happen that we've been able to celebrate as a team. One would be a tool we launched called Vaccine Search Insights, which our public and environmental health team built. It looks at searches on our platform for vaccine information — both positive and negative sentiment — and you can correlate that to vaccination activity, working with the UK Health Security Agency on that. That's been a big win for us, and we were able to do it because I had relationships with people there from my prior life. Those very visible win moments have helped build that credibility.

I think they'd say she's a very honest person who wears her heart on her sleeve. I'm not very good at hiding what I'm feeling — how do I say that without making myself sound like some emotional sob? I want people to know the truth and where things are going. So I'm a very open leader, I think; one who's willing to listen and to share and collaborate. Yeah, I think that's what people would say about me.

It's such a good question. And I'm just going to pull you up on one thing — I don't think we're not normal people, or that normal people who work nine-to-five are different to us. Different people do different things. I am enormously privileged that I was clever enough to go through school, get good O-levels and A-levels and a good degree and an MBA, and I had the support of my parents all the way through. So I'm absolutely aware I come from a really privileged place that got me to where I am — notwithstanding I've also worked really hard to get here.

But I get exactly what you're saying: we're privileged to be doing jobs like we do. I won't speak for medicine particularly, because I know hours are such a controversial thing there — not least the consultant contract. But for me, both at EY and at Google, my perspective was always: I'm paid really well, I enjoy my job, and I'm really fortunate to be doing something that gets me out of bed in the morning and excites me. So yes, I'm absolutely prepared to work in a different way, perhaps, to somebody who has a contract that says you start at nine and finish at five. However, I still think there's an importance to boundaries and navigating that work-life balance regardless. I have a ten- and a nine-year-old and a husband, and I want to spend time with them. If I'm working every evening, then that's a bit rubbish.

So where I've got to — and everybody has to find the pattern that's right for them — is that at Google, because a lot of our team are over in Palo Alto, we often have quieter mornings. Rather than starting at eight, which I'd do at EY, I now start at nine, nine-thirty. So I get to drop my kids at school, which I'd never done before — for me that's a massive bonus. I get the morning time where I don't have to be thinking about work. Then Monday to Thursday I aim to finish by seven, because then my kids and I can have dinner together and I can put them to bed. And if I need to do a little bit in the evening — laptop on my lap while the telly's on in the background — then I will. If something's urgent, I'll jump on a call. It was the same at EY: if we had an important deliverable or a bid to write, sometimes you have to work evenings and weekends. But it's about setting the norms and then being prepared to flex for the unexpected. It's when the unexpected becomes routine, and every day you're doing calls at nine in the evening, that you need to reassess whether that's right. For me, cutting off at seven Monday to Thursday, and earlier on a Friday, those are my basic boundaries — and then if I need to flex, I will.

It's a good question. I was doing medicine in my 20s and early 30s, and your hours are defined for you to an extent, aren't they — you're on a shift system or a rota. So it's hard to say. But in consulting, I think there is a culture of quite silly hours, and an attitude of, I can get on if I'm doing all these hours and seem to do all these hours. One of the really important things there for leaders is role-modelling good behaviour. When I was a partner at EY, and now a director at Google, I would never expect my teams to work silly hours if I'm not prepared to work them alongside them. You shouldn't have that model of the juniors doing all the hours while the bosses sit at home kicking back, smoking cigars. So there's something about role-modelling as a leader that gives permission to your teams to work in more moderated, manageable ways than perhaps previously, where as a junior going up through consulting you were expected to work every hour that God sends.

So, underpinning it — if I hadn't been approached, would I have gone looking for a new job? Probably not. I was 50 at the time. I had another ten years before I'd have been asked to retire from EY, because partners retire at 60. In my head I was probably there for the long run and saw my future ahead of me.

Interestingly, within a short while of being approached — and I did mull it over for about a week before doing anything — I remember saying to my husband, the minute I start this process I'm inexorably on the way out of EY. Because you sort of have to become disloyal to start an interview process with someone else; you have to surface all the reasons you might want to leave, and then they become real. So even if I didn't get the Google job, I was aware I'd probably then be looking for other things. But what crystallised quite quickly in my thinking was that going and doing something else felt relatively low-risk. I'd join Google, and even if it wasn't what I thought it was going to be — and being honest, it hasn't been quite what I thought — even if it wasn't in a bad way, I'd get through a year, maybe go and look for something else, and then you've got 18 months on your CV, and that's probably okay. You'll have got the brand and learned some stuff.

So I thought, this gives me the opportunity to exit a career I'm really good at, but in quite a low-risk way — and if I wanted to, I could probably go back, because I wasn't leaving EY to go to a competitor. I was leaving to do something really different. So I actually left on pretty good terms. Within days of leaving I knew I would never go back — it's been quite a liberating thing. I really enjoyed my time in consulting, but moving into a product-based business where you can actually have something that makes an immediate impact, rather than doing things by influence, which is the consulting model, was enormously exciting. Plus, it made me realise: if I could succeed at Google, I could succeed anywhere. I have no idea how long I'll be at Google. It's been a year, I'm extraordinarily happy, I'm learning lots, I'm adding value, I know my place and what I can do. But if that finishes in two years and I stop learning and I'm no longer adding value, I know I can go and get a job — in a startup or a scale-up, or working for a venture capital fund, or as a CEO of a portfolio company. The fact of moving has given me a load of confidence that I can do other things.

You asked when we were setting this up about my reflections and advice I might have — and being willing to make a move even when it feels a bit risky is a really important one, because it's rarely not going to work. You're always going to enhance your CV, learn new skills, and it sets you up with the confidence to move again. A lot of what all of us are about is learning and improving, and moving to Google has allowed me to do that in spades.

It's a really good question. There are some bits of my career I look back on with such happiness and fondness. There were definitely bits of my junior doctor years that — despite the one-in-four rotas — were the happiest days. I look back and think about how you'd do the Saturday morning through to Monday six o'clock, then go straight to the pub and drink a few pints, then go home and sleep for a bit, get up and do a Tuesday overnight into Wednesday. We survived on a diet of alcohol, cigarettes and terrible food in the mess. But they were champion days, because of the camaraderie, the team you worked with, the relationships, the stories, the memories.

Then when I moved on to do my membership concurrently, those were the less happy days — they really make you train for your membership whilst working all the hours, and make you pay for it, and all the practice. That was my least favourite time. And then I loved my MBA. The 18 months of my MBA were probably some of the happiest days. Partly because I came in as a doctor — there were lots of financial consultants who already knew a lot of the stuff, and I was this completely virgin brain who knew nothing. I remember my first day, in an accounting class, doing debits and credits, and people were putting up their hands talking about depreciation and amortisation, and I didn't know what the words meant. I went home and cried, going, why have I done this? Everybody's so clever. Then I realised they were the accountants, and they were just showing off. You'd do five subjects each term for ten weeks — know nothing at the beginning, go on this really steep learning curve, and just as you began to plateau you'd take an exam, stop, and do five new subjects. That was tremendous, because of the stimulation and the academic rigour.

There are bits of my consulting career I see as highlights and bits as lowlights. And this last year has been a roller-coaster, not least because of the pandemic and learning the ropes at a new place — but I'd definitely put it as a highlight. So, to answer your question about whether things plateau or change: I think each bit of your career will have highlights and lowlights, and it's about seizing those highlights and understanding what it was about that bit that made you excited. When I was doing medicine, it was about the team — those halcyon junior doctor days, the sense of camaraderie. That's been a consistent feature: I'm happiest when I'm working with a team I enjoy, and who I can coach or be coached by. My MBA was great because I was learning a lot, so I know I'm best in an environment that's fast-paced and where you're being asked to solve problems. As you develop your career, it's about really understanding what you're good at and what gets you out of bed and excites you. If you can find the overlap of those in a job, then you've found the pot at the end of the rainbow.

It's a great question. We've had lots of clinicians at various stages come into consulting over the years who've lasted six, nine, twelve months and then gone, this isn't right for me. And it's crystallised for them that being a surgeon or anaesthetist or a GP was right — they just needed to go and make sure by testing something else. I'm not sure there's something specific in a personality that does it.

The reason I left medicine — I think I'd always known deep down, even as I was going to medical school, that medicine wasn't for me long-term. I was doing sciences at A-level, and my school was very much: if you're doing sciences, you either go off and do natural sciences at Oxbridge or you go into medical school. Those were the two career options the careers people pushed you down. So I ended up in this career path almost by accident, as opposed to having a massive dream all my life to be a doctor. I made a couple of tentative moves to do other things along the way and felt guilty, because I'd spent a lot of time and my parents had invested in me. So it took me quite a long time to make that move. I don't think it's about personality types — I think it's about thinking about what gets you out of bed in the morning and what you're good at. There are careers within medicine and outside of it where different people will flourish.

When I left medicine, I didn't miss reading blood results, or putting in a central line, or any of that. I really missed my old people that I'd looked after. I didn't do geriatrics by mistake. People said to me, if you want to leave medicine, why don't you go and do a more exciting branch like cardiothoracic surgery? And I'd say, no, no, you don't get it — I did geriatrics because I really, really enjoyed looking after old people. I'd find myself engineering my way into conversations — I'd get onto a bus and sit next to Elsie, or whoever, the old lady with her shopping trolley, and start a conversation. She'd look at me like, who's this mad woman coming to talk to me? But I'd find my fixes of old people along the way to fill that gap. So I definitely missed that bit of medicine.

But when you look at what you can do from a more macro level — yes, it's a bit abstract, but there's a lot more than just "change management," which is a terrible consulting term. When I look at what we're doing at Google — how Fitbits can be used in the pre-hospital space, or managing long-term conditions in a different way, keeping patients out of hospital and well for longer. When I look at what colleagues at YouTube are doing, driving really high-quality, authoritative health content so that if you search for, say, back pain, the first things that come up are accredited information. When I look at the fact we've got an algorithm that can read mammograms as efficiently and effectively as a radiologist — how do we integrate that into clinical workflow to free radiologists up to do other things? We've got a million women who missed their mammograms during lockdown, so anything we can do to speed that backlog getting back to normal. Those things don't feel abstract and change-management-y to me. They feel very real and very important, and to be part of delivering them is such a privilege. It's a different thing to the day-to-day of dealing with Elsie and Doug on your ward round — but what we're doing is helping Elsie and Doug and the rest of the ward round, just in a different way.

That's right. There are clearly product teams building things all the time, and it's a balance of seeing what's needed from a consumer or clinician perspective versus what's being created — because we've got clever people thinking of clever solutions, and you bring those two things together. I guess we have three priorities. One is the consumer: what tools can we put in the hands of consumers to improve their health? Think about Google's overall mission — to organise the world's information and make it more helpful. Health information is a really big part of that. So the things I mentioned — organising YouTube information, organising information around skin complaints or whatever. And Fitbit's another great example, helping consumers manage or access their health information in a different way.

The second is clinicians, in the broadest sense — people working in the health space. How do we provide tools to help them deliver better care? And the third is community: how do we enhance what happens from a public health perspective? Some of that vaccine search insights work, or the community mobility reports we did during COVID showing where people were moving to and the impact lockdowns were having. We've also got a lot of work going on in lower- and middle-income settings, looking at how you drive high-quality public health initiatives at scale, helping health teams organise data and get access to clinical information better. So we sit with that as our frame, and my job as a clinician is to help bring the clinical prioritisation — making sure what we're doing has the most impact from a clinical perspective, but also from a system perspective.

That's right. As you can imagine, we aren't short of approaches from people saying, we'd like to collaborate with you. And we'd love to work with as many people as we possibly can — we've had amazing collaborations with Moorfields and Imperial and Royal Free here in the UK, and Mayo and Stanford in the US, and increasingly into lower- and middle-income settings. So there is something about prioritising because things won't have enough clinical impact. The other thing is remembering that one of Google's missions is about helping the world organise its information better, so we like things that can be done at scale — how do you impact millions, or billions, of users? We have twelve products across Google now used by over a billion users each — Gmail, Maps, YouTube, search. Health is slightly different, but there are still areas where you can get into the millions. So it's both clinical utility and scale of impact.

It's such a good question, and space definitely has an impact. Office space is really interesting. I'm increasingly spending time in our offices in Pancras Square, now we're beginning to exit the back end of the pandemic, and I have to say I'm loving being back in a physical setting. The major difference that strikes me between Google offices and EY offices is there's more exposed pipework at Google — and I'm not sure that's the thing that leads to an innovative culture. There's a lot of thinking going on from our real estate and workspace teams about how to change the office now we're moving into this hybrid world — some people at home a couple of days a week, some in the office. How do we change the way we collaborate without losing that spark of innovation? I think Google will be at the forefront of that, and other tech companies too.

But the biggest thing is about giving people permission to be innovative. It's in the culture. Google is a completely flat structure — it's not hierarchical, people's levels and grades aren't written anywhere. You could be having a conversation with somebody four grades lower than you and not know it, because their area of expertise is so different to yours that you lose that levelling. It doesn't matter that I'm a director. So there's something about setting that culture from the top, and it filters down. There's also something about hiring the right people. The hiring process for Google is remarkably robust — a series of interviews where you're assessed against a set of characteristics, and it's tough. I have to remind myself of that, having spent my first nine months crippled by imposter syndrome. I remind myself on a daily basis that I got through that same interview process as everybody else, so I do deserve to be here. So it's about hiring the right people, the right attitude in managers to allow innovation, and then a bit of how we work in the setting that really drives that.

A couple of things. One is: don't lead people on — make decisions early. There's nothing worse than projects drifting and resources being slowly cut because people aren't prepared to say, we should stop this. So there's something about being decisive early if you can see something's not working. And then, honesty is the other thing. Don't try to flim-flam around the reasons. This hasn't worked, for this set of reasons; this is why we're doing this; here's the impact on you, and here's how we're going to make things work for you going forwards, even though this thing hasn't worked out. Those would be the two things I'd say.

There are always going to be people who abreact to that style. One of the other parts of being a leader is being able to read a room and work out how to flex your style and the way you're communicating. So there's something incumbent on me to set the tone and get that right. But my experience has been that people prefer honesty. And maybe I'm still one of those memes, right — maybe when I think I'm being honest I'm saying the thing on the left-hand side, and I know people will interpret it as the bit on the right-hand side. I don't know. But I've never really had a bad experience of it. I think people would much rather hear from an authentic leader than somebody who doesn't feel authentic.

I was thinking about this before we started the call. When I was going for partner, I had a sponsor — one of the senior partners sponsoring me through. And he said to me: treat every meeting you go to, whether it's a beer with somebody on a Thursday evening or whatever, as if it's the most important pitch you're ever going to do and your career depends on it. So prepare for it. That really stuck with me. I'm probably not as assiduous now as I was back then — or maybe I've just become more practised at it. But his big thing was: spend half an hour, or 15 minutes, beforehand thinking, what are the outcomes I want from this? What are the three things I want to get across? If things get derailed, how am I going to bring them back on track? It's the thing that's helped me be as successful as anything else I've ever been taught.

It's the bit of coaching I give to everybody, particularly as you're moving from a junior level up into being a manager. There's a real change: as a more junior person you get given tasks, you go away and do them. And then when you become a manager, you suddenly have to craft the ideas yourself and convince people of them, and figure out how to put them into action. Being able to communicate that in a succinct, precise way is really important. So preparation is utterly key. Also — don't write long emails. Write emails with bullet points and the thing you want to get across. People won't read long emails.

It'll depend on the meeting. Definitely make sure you know who's going to be in it and what they do ahead of time — that almost goes without saying, but perhaps it doesn't, and that's why meetings don't go well. Thinking of it from a consulting lens: if you're going into a meeting where you're trying to gather information, ask yourself, what am I trying to achieve here? What are the one or two absolute things that if I walk out without, my manager will say, why did you bother going? So plan out the meeting, think about the timing, how you're going to ask for that information.

If you're going in to transmit — to read out some outputs — make sure you've prepared your story. Telling stories is really important. Whatever career you're in, being able to tell a story to get information across is a skill valuable beyond measure. Lots of people do slide presentations where they just put a load of information on the slides and talk over it, and the slides say different things to the voiceover, and as an audience you're sat there going, what's going on, I can't get it. So it's being really prepared in how you're transmitting the information and the messages you're trying to get across.

I've got a meeting later today with an external partner about a collaboration we might do in low- and middle-income settings. My preparation has been to do a pre-meet with one of their team to find out their priorities. I've prepped the two people coming with me from my side, we've written some slides, we've got an agenda, and we know the three quite low-level things we want to come out of it — and if we get more, that's brilliant. But it's really clear. That's the sort of thing I mean by preparation.

When you sent through the question about book recommendations, I've been staring at my bookshelf behind me thinking about the books I like to read most. I was going to talk about Indian literature, because A Suitable Boy is my favourite book of all time — I've read it many, many times — and Rohinton Mistry is another author I love. In terms of resources that are helpful for work, probably less so. I'm not a prolific user of management books. I've learned my way through by practical means rather than academic means. I was thinking back to my MBA the other day, and having whittered on to you about how brilliant it was — can I remember anything from it? Not really. Do I still have any of the textbooks? A couple. But at the time it was clearly really important, if that makes sense.

[Susan's cat walks in, meowing] Apologies if that's being heard in the background.

Thank you.