Fiona Shield is a UK-based pioneering speech and language therapist, workforce strategist, executive coach, and, most recently, entrepreneur.
Fiona worked in a number of multidisciplinary settings as a speech and language therapist during the 1980s and ’90s, specialising in adults who had experienced loss of language following brain injury. Her initial foray into speech and language therapy (SLT) research involved investigating the impact of short-term auditory memory training on patients with dysphasia, to determine its impact on their comprehension and expressive language ability.
While leading a multidisciplinary community rehab team—”we blurred lots of boundaries and constantly explored the meaning of ‘integrated’ and ‘interdisciplinary’ working”—Fiona helped to create the new health care role of rehabilitation assistant. This led to a year as director of a research project during 2000-2001, investigating the potential for a new health and social care role for older people.
She has held key leadership positions in the area of workforce change and development across the West Midlands from 2001, culminating in her appointment as Head of Organisational Development and Leadership in 2011 for a large integrated community trust in Staffordshire.
In 2018, Fiona assessed her transferable soft skills and decided to transition her career by going into business as a personal coach and mentor. Career transition is a pivotal step that many AHPs consider, and one that presents a lot of challenges.
We spoke to Fiona recently about her pioneering work in SLT, the evolution of her business idea, her decision to transform her career, and what true leadership means to her.
Let’s talk about your professional journey from working as a speech and language therapist to your roles involved in workforce change
I started life as a speech and language therapist, and I think like a lot of AHPs, you realise that the outside world doesn’t really understand what you do. When I first qualified, a speech and language therapist was often described as the ‘white coated elocution teacher’, and this was the worst possible way of describing us; it doesn’t start to capture the range and complexity of what speech and language therapy is about!
I specialised very early on in neurological conditions, i.e., head injury and stroke. I can remember in my first year of working, a consultant geriatrician saying to me, ‘Oh, speech therapy doesn’t work. Once the patient is dysphasic, after stroke, they’re always dysphasic’. When you’re a newly qualified professional, and you are very passionate and excited about what you have to offer, to have someone very senior tell you that is quite devastating.
I was very driven from early on in my career, to prove to myself and my profession, that we could have an impact. This led me into wanting to do some research, and I decided to study for a master’s degree. This is going to really age me—but I didn’t actually have a degree in speech therapy. When I trained it was still a diploma, I think I was the last year of diploma students at Central School of Speech and Drama, as it then became a degree. So, to be accepted by a university do a master’s without a first degree, was tricky!
I had formulated a plan to investigate the impact of short-term auditory memory training with my patients with dysphasia to see if this had any impact on their comprehension and expressive language ability.
I had to do this all in my own time. There was very little support within my department, and my managers didn’t understand why I wanted to do a master’s degree. To obtain sone financial support I applied to the local Health Authority where I was interviewed by a board of professors and doctors. They were all very eminent people, and said, ‘yes, you can have that money Fiona, but “auditory memory”… we want you to go and work with somebody at a university who is doing cochlear implants in guinea pigs’. The only connection with cochlear implants and guinea pigs was the word ‘auditory’ so I knew they had little understanding of what I was doing or what it meant! Fortunately, I was redirected to the psychology department where I was able to complete my research. It took quite a few years, and I had two children during that time!
My move away from pure SLT came about because I really did want to change things and make a difference. I was lucky enough to spend five years leading a multi-disciplinary community rehab team and this enabled me to gain a better understanding of the systems within the National Health Service (NHS) and start to influence a more patient-orientated way of working.
I took a year’s secondment from this team leader role and had the pleasure of working with Professor Pam Enderby and Susan Nancarrow at Sheffield University. This was an opportunity to look into the efficacy of a new role for older people, i.e., one that blurred the traditional professional boundaries and was designed more around the needs of older patients.
Following this I moved into the area of workforce change and development, with strategic posts working across a wider community and with some national-level responsibilities. This led to my growing interest in organisational change and development. My final role within the NHS was as Head of OD and Leadership.
Are there any moments in your career that stand out in terms of making a difference to community or care outcomes?
I was quite frustrated as a speech language therapist when what I could and couldn’t do were tightly defined. Working in stroke units, if my patient was lying in bed and I needed to sit them up, I had to go and find an OT or a physio or a nurse to do that for me, which I thought was not good practice for a team player. I felt that I should have competencies in essential manual handling for my patients, but where I worked, and within my profession there was no encouragement to step outside the boundaries of what was regarded as “SLT”.
My dream job was when I had an opportunity to run a community rehab team, and the beauty of this was that I and my team, which was multi-professional, could start to look at how we could all put our patients right at the centre of our practice. It was about goals and outcomes that our patients wanted—even when these didn’t quite match those recommended by the therapists! To achieve this, as a team, we identified competencies that we all needed, and organised in-house training so that as a team we could work together, more seamlessly, around the needs of our patients. We blurred lots of boundaries and constantly explored the meaning of ‘integrated’ and ‘interdisciplinary’ working.
How did you create the rehabilitation assistant role?
Each member of the team had their own professional lead, so the physiotherapist reported into physiotherapy, the occupational therapist into occupational therapy, and myself into speech therapy, but actually working as a team, we weren’t always working quite to the same boundaries—I would transfer a patient into a chair, or onto a toilet, because my team had taught me to do that.
That made sense for me, but working as a speech and language therapist that probably still wouldn’t have been approved of, so it was a little bit risky. I think that in terms of being pioneering, what we successfully created was the role of a rehabilitation assistant.
These roles are well established now but in 1995 they were few and far between. It was a new role that we felt would fully enhance the patient experience and ensure that their wants and needs were kept at the centre of what we offered. My workforce budget for the Rehabilitation team included some OT, physio and SLT assistants. Instead of recruiting to these uni-professional roles we turned them all into a team of rehabilitation assistants who worked across the different disciplines and was the key worker for our patients.
They kept us therapists on our toes by reminding us about what was important for the patient, which at times differed from our professional intent. An example that stayed with me was when a rehabilitation assistant told me, as an SLT, that my patient with dysphasia following a cerebrovascular accident was more concerned with his mobility and that this should be the main focus of intervention at this time. When he could mobilise enough to join the day room in his nursing home, then SLT and communication would be more relevant and the patient would be more receptive. This was very true for this patient and was a great example of keeping the patient’s priorities in focus.
And would you call them allied health support workers nowadays?
Possibly, although in the rehabilitation team we also had some nursing, psychology and social work input, not just allied health.
The problem was, within the trust where I worked, nobody quite knew how they would fit in and they weren’t allowed to join a professional body. We even went to meet with the AHP professional bodies in London: SLT, OT, physio and nursing to ask if they would recognise and offer some support for the role of a rehabilitation assistant. The Colleges all said that if we could demonstrate that more than 50% of their time was spent doing tasks associated with one profession, then they could join that professional body—the problem for us was that we didn’t measure their activity in terms of the profession. It was about what the patients’ needed and that didn’t always translate into a specific discipline.
That was quite an interesting time, and there were a lot of eyebrows raised about the way we were working and what we were doing. I had a lot of autonomy, a lot of freedom, but at the same time, the model we were working towards didn’t really exist. So, we formed a national network of community rehabilitation teams, and that put us in touch with other teams doing similar things to us, all trying to work in an interdisciplinary, integrated style.
Not long after this the concept and models of integrated community teams began to take off and with it the long-standing challenge of integrating health and social care.
How did you pivot from the NHS to coaching and mentoring?
After leading the rehab team, I moved into strategic work, because I really wanted to make a difference, I wanted to change things—and unfortunately you often let go of your clinical work when you do this, because there isn’t time to do both.
I started to take on roles across the wider region around modernisation and change, role redesign, that kind of thing, and from there, I ended up in the world of organisational development (OD). By the latter part of my career, I was Head of Organisational Development and Leadership in a big community trust. So that role was strategic, yes, but what I absolutely loved was the opportunity to work one-to-one with staff to support their personal development. At this time, I completed coaching and OD practitioner qualifications.
All my team were qualified coaches—as a member of the OD team, this was important as the demand for coaching for staff at all levels was increasing. For me, this helped to make up for the fact that I was no longer working face-to-face with patients. Working one-to-one with staff to help them cope with change, or find a way of coping with an issue, took me back to my therapy days. My motivation for my job was hugely enhanced by having this time as a coach and it compensated for the challenging strategic meetings that I also needed to attend.
What do you find is the most rewarding aspect of coaching?
I just absolutely love that part of my work. My mother would say to me when I was in Workforce and OD roles, ‘Why did you stop being a speech therapist? I understood what you did then, now I haven’t a clue what you do!’. I guess the answer is a lot of us leave our clinical roles behind as we become more strategic and move into roles where we feel we can influence and make improvements. It’s also true to say that AHPs have a diverse and interesting skill mix that is transferable to other roles. As an SLT I cared passionately about our ability to communicate, and this is just as much of an issue working at senior and executive levels when you want to be heard and understood!
So, for me, coaching is something which is a very natural follow-on from being a speech and language therapist. It’s different, you are no longer the ‘expert’ giving advice. Instead you have a privileged opportunity to be with someone, to create a space and time for them to think and for them to discover more about themselves, so that they can make the best decisions.
What does leadership in allied health mean to you?
The thing about working in small professions that are not always widely understood outside of that profession, is that you are constantly having to check that people do understand what you do. AHP leaders must be excellent advocates for their particular profession and for each other.
The other thing is the need to recognise just how skilled AHPs are, and I don’t just mean the competencies associated with their profession. In addition to this, AHPs have a huge resource of generalisable softer skills. For me this was the reminder that if I could help people to communicate, because that is my job as a speech and language therapist, then surely I could communicate with a board at trust level and do strategic work. However it took me a long time to realise that I was trained to communicate so why not use that skill to communicate with directors and influential people who could really change things!
I’m not advocating, at all, that every AHP should step away from pure clinical practice but for those who do choose to step outside, it’s having that confidence to know that they have important transferable skills to take with them.
Could you tell me about the founding of Ikenga Coaching?
I had an opportunity to leave my NHS role during a merger of trusts. I was at NHS retirement age, so the timing was right, however I wasn’t ready to finish work. Instead, this became an opportunity to do something different and do something I felt passionately about.
I knew I never wanted to write another board paper, but I did want to coach people. So, I stepped out of my NHS role and I set up my own business which, after much soul searching and revisiting my personal values and beliefs, I named Ikenga. Any marketing person will tell you it’s a really bad title for a business, because it doesn’t tell anybody what I do. But it was a personal journey at this point.
The word Ikenga is African and means Positivity, Achievement, Success—I had battles with people who do branding and marketing who said, ‘Can’t you call it Fiona Shield Coaching?’ But it was a personal thing that the message behind the word ‘Ikenga’ reminds me of my values, and it reminds me of what I wanted my business to be about.
I put myself on a marketing course; one of the problems of working in the NHS is that I haven’t a clue about money. Anyone who’s as old as me will know, speech therapists, as we were originally, weren’t allowed to advertise at all. We weren’t allowed to see patients privately who we had seen in the NHS, even if they asked us. I therefore had my share of self-limiting beliefs about what I could, should, ought to, do to establish my business.
It was clear that I would need some support and new skills in business, particularly in marketing and finance. My next steps therefore were to invest some time (and money!) in acquiring these business skills.
My marketing course, that was designed by coaches for coaches, emphasised the importance of identifying my ‘Ideal Client’. I resisted this like mad because I felt that I could coach so many different types of people, age, gender, background, etc. However, once I settled on choosing an ideal client, I realised that this is exactly who I want to coach!
Although we don’t tend to share our personal journeys with our clients in coaching, it does help to have trodden a similar path and have a natural empathy. I know I have credibility with my clients who are (usually) health, social care, and other public sector or academic staff who are approaching retirement.
People in this group usually find there is plenty of financial advice about pensions, etc available. I remember being invited to pension talks as soon as I hit 50! However, no-one seems to talk about the psychological and emotional impact of giving up your career, your profession and taking off that badge that provides your identity every day. Believe me this is huge for many people and especially those who have given their all to their profession, burnt midnight oil and really cared about making a difference.
So, this is the focus for my coaching practice. I’m really enjoying both experiencing retirement myself and also studying, reading the literature and growing my understanding of this important life transition and life change.
And what advice would you have for other AHPs and allied health leaders who are seeking to move into entrepreneurship?
- Revisit your values—what is important to you, what motivates you and gets you out of bed!
- Identify your target audience. It is very important that you speak to these people in your marketing, so you do need to know who they are.
- Recognise what new (or rusty) skills you need and be honest with yourself about the skills that you don’t have. In my case, it was marketing and finance. Other people might have slightly different skills that they feel they’re lacking in, depending on what the business is that they’re doing. I think it’s actually about investing in yourself and being prepared to fill those knowledge/skills gaps.
But what I think is really important is that a lot of us have done a lot of personal development, and leadership development, and actually, the tools we have in our toolbox are virtually the same. Most business tools are the same as the leadership tools, and if you’ve done a leadership course, the chances are, you’ve got a box of tools somewhere. So just dust them off and discover how they can help you now with your business.
View Fiona’s website | Follow Fiona on LinkedIn | We host a number of career forums and communities of practice that provide discussion around career transition and entrepreneurship for allied health professionals. Please visit the Allied Health Academy to find out more.