Women in healthcare leadership: Harnessing purpose, passion, and perseverance to change health outcomes

Sally Lewis

National Clinical Director for VBHC

Women in healthcare leadership: Harnessing purpose, passion, and perseverance to change health outcomes

13 April 2022 | 7min

Quick Takes

  • Taking a purpose-driven approach to tackling some of healthcare’s largest issues could be the key to success

  • It’s vital to be bold enough to ask questions and patient enough to listen to the answers

  • Never let self-doubt get in the way of the pursuit of a larger goal

Sally Lewis, a General Practitioner (GP) and National Clinical Lead for value-based healthcare (VBHC) in Wales, has spent her career, as part of the women in healthcare leadership, asking questions and paying close attention to the answers so she can better understand how to improve health outcomes and ensure the most impactful use of limited resources. 

Like many women, it’s the pursuit of a clear purpose, rather than a desire to gain more seniority, that motivates Sally. Under her leadership, Wales is now recognized as one of the leading countries when it comes to embedding VBHC.1 

In our third interview of this short series exploring how women in healthcare leadership are changing the face of healthcare, Sally Lewis explains why asking questions and actively listening to the answers have been instrumental in changing the way healthcare is delivered in Wales.

VBHC: The unexpected solution

Sally Lewis is a restless soul. But hers is a soul that is driven by a clear purpose – to improve health equity and outcomes whilst keeping healthcare spending under control. It’s an ambitious goal, and she’s not alone in trying to reach this lofty objective.

Across the globe, institutions, healthcare system architects, physicians, nurses, and patient groups are calling for a new way of delivering healthcare. They are broadly aligned that the needs and wishes of those receiving care and treatment should be central to this new healthcare delivery model. Equally important is a more informed approach when it comes to deciding how to use and allocate finite resources. 

“We are seeing a technology revolution that includes new treatments for new diseases that we never had before. There is a limitless potential to spend more and more, but we are seeing smaller and smaller quantifiable gains in terms of outcomes. We have an absolute duty to ensure that what we spend on health improves outcomes,” Sally says.

Sally, a GP for more than 20 years and policy advisor for VBHC at both a regional and national level, has spent most of her professional life in Wales. Early in her career, she recognized that the healthcare system was not set up to help people reach their individual health goals. Nor was it designed to address health inequity and optimize healthcare budgets. Science was changing, medicines were changing, and people’s priorities were changing, but the post-World War II healthcare system seemed stuck in a by-gone era.

“As a GP, I could see that resources were not going to where they needed to go to improve patients’ lives,” Sally says as she describes how she unwittingly became part of a growing group of people advocating for the concept that is now commonly referred to as value-based healthcare.

“Many of us working in healthcare had for a long time a sense that all was not well,” she explains. “I was thinking about the allocation of resources and how to improve outcomes long before I had heard the term value-based healthcare. I didn’t plan to go on a mission to pursue value-based healthcare. In fact, I had no plan. This has been an evolution. It has been all about solving problems from the grassroots up,” she says. 

Resistance to change

Resistance to change

VBHC first started to take off as a philosophy when Michael Porter and Elisabeth Teisberg wrote their now-famous book, Redefining Healthcare, in 2006. It was their answer to a conundrum facing the U.S. healthcare system: how to improve health outcomes whilst gaining control of ever-increasing healthcare costs.

Despite its popularity – the US dilemma is shared across many countries – it’s a concept that has proven stubbornly difficult to implement for a number of reasons, chief amongst them incentive systems that continue to reward healthcare providers and institutions for the interventions they perform, such as operations, rather than the outcomes achieved.

Over the last two decades, Sally has bucked the trend, successfully spearheading the implementation of VBHC in Wales. Today, Wales is internationally recognized as one of the leading countries when it comes to implementing value-based healthcare,1 and Sally’s voice is one that is frequently included in the global discourse.

The value of cake

“I returned to a practice in the Welsh Valleys from Bournemouth in England in 2005. I observed healthcare delivery and the difference between Wales and Bournemouth – some things were better, some things were worse. I began emailing the Health Board and asking a lot of questions. I was just trying to make things better,” Sally says.

Her efforts to improve healthcare were recognized and Sally began her career in medical management as a clinical director for the newly formed Integrated Health board and joined the women in healthcare leadership. 

“I was asked to apply. But I hesitated because I didn’t feel I was qualified, but then someone pointed out to me that there really was no training pathway for a post in medical management. So, I applied, got the job and this is when I began to learn how the health board worked,” Sally says.

A few years later, when the Aneurin Bevan University Health Board was looking for an Assistant Medical Director for VBHC, it was Sally they turned to. She was given a year to develop a VBHC strategy.

“The start was a bit of a slow burn. I spent a lot of time buying colleagues cake. I had a lot of conversations and I listened. The first priority was to learn what others had to say and what their experiences were – it was not to make anyone do anything. When the time to act came, I had a lot of friends and allies, and this made it possible for me to gain support for the three things that needed to change.

“We first needed to transfer money from low value to high-value areas. Next, we had to identify possible patient-reported outcomes measures. And finally, we had to buy patient-facing technology. If I hadn’t secured support for any one of these things, I would have resigned,” Sally says.

Together with her colleague, Adele Cahill, Sally built up a small team and grew her network.

“We had local, national, and international conversations. We knew we were in it for the long haul, so we made sure to celebrate the small wins,” Sally says.

In 2018, Sally was tasked with doing it all again. This time on a national level as National Clinical Lead for Value-Based and Prudent Healthcare in Wales, and the charge was just as great.

“One of the problems is that most systems are designed for a different set of needs. Technological advances have rescued people from death, but they have not necessarily returned them to full health. We need to flip from rescue mode to support mode. We have allowed repeated crises in the population to lead to burdening the acute healthcare sector. This is something we definitely saw during the pandemic,” Sally says. 

Healthcare in a post pandemic world

Healthcare in a post-pandemic world

The huge backlog of demand for care that was postponed during the pandemic is creating huge issues for patients, physicians, and the healthcare system. However, this could present an opportunity when it comes to further embedding the value-based approach and expanding use of important patient-facing technologies, such as apps, online booking systems, and improved sharing of data.

“There are some great lessons to be learned from the vaccines program. During our rollout here in Wales, we were able to collect some very helpful data regarding low uptake in certain areas. We were then able to bring this intelligence to our operational teams and develop new strategies to convince the harder-to-reach groups,” says Sally, who hopes that COVID will prompt a total system reset and encourage greater use of patient-reported outcome measures to direct resources to where they are needed most.

It’s clear there is still much to be done, but with Sally at the helm, Wales is surely well placed to emerge stronger from the pandemic. Her focus, quiet determination, and her ability to listen to and act upon others’ perspectives are qualities all healthcare systems should be valuing right now.

Want to find out more about women in healthcare leadership? Then check out the other articles in this series with Brigitte Nolet as she explains how COVID has unexpectedly opened more opportunities for women in healthcare leadership and Jo Halliday as she gives us an insight into the benefits of being a woman in a leadership position in a very male dominated industry.

Sally Lewis is a GP and has front-line experience in primary care at its most challenging. She entered a career in medical management in 2011 and was appointed as Assistant Medical Director for value-based care in the Aneurin Bevan University Health Board in 2014. Since 2018, Sally has been leading the national value-based healthcare program in Wales which is now part of the World Economic Forum’s Global Coalition for VBHC. She is an Honorary Professor at Swansea School of Medicine.


  1. Life Science Hub Wales. (2020). Article available from https://lshubwales.com/news/how-wales-leading-way-value-based-health-care [Accessed March 2022]

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