Health & Care Futures
In conversation with Professor Jason Leitch

Health & Care Futures blog: February 2022

Conversations from the Heart: Leadership in Health and Care in a time of crisis - in conversation with Professor Jason Leitch, National Clinical Director of Health and Social Care Services

In our first blog, Dr Ioanna Nixon, Principal Knowledge Exchange Fellow in the Department of Management Science and Clinical Oncologist at the Beatson West of Scotland Cancer Centre, speaks to Professor Jason Leitch, National Clinical Director of Health and Social Care Services, about his experience of the pandemic, his observations and learnings and the role of leadership in a time of crisis. 

Dr Ioanna Nixon

Ioanna: Jason, a warm welcome and huge thanks for having this interview with me today.

Jason: Thanks for having me. It's an absolute pleasure!

Very pleased to hear. Your leadership role as the National Clinical Director of Health and Care services is pivotal. What is leadership to you and how would you define it?

Leadership, for me, is about bringing people with you, and a values system and collective vision of working together. I don't think it's always about leading from the front, though undoubtedly in the early days of COVID we needed some command and control and people to step up.

When I think of people I consider leaders, I think of people like Dr Don Berwick, the first president of the Institute for Healthcare Improvement. He is a gracious and generous man at the cutting edge of improvement in science and clinical systems and is enormously generous with his time.

But I could also describe a charge nurse in a ward in a Glasgow hospital, who's running a 12-hour shift with four colleagues looking after 26 cancer patients. Or the cleaner I met in a care home in Shetland who leads by example in working to protect residents and staff and families and everybody else from COVID-19. She is a leader in her workplace.

So, I don't think leadership depends on rank or hierarchy. It does depend on values and courage and a willingness to take what we would call agency, where you not only have the skill-set to lead, but you also have the courage to use that power.

Have you seen leadership emerging in any unexpected places during the pandemic crisis?

The care home in Shetland will stay with me for a long time. I went there because, although they had a very difficult start – they had some of the first infections before the disease even had a name – they've subsequently had almost no positive cases and no more deaths from COVID. So they've learned.

I also think the World Health Organization (WHO) has had a fantastic leadership journey during the pandemic. The WHO is not known for its speed and agility but has had to work with speed and agility. It has done much more public-facing broadcasting than it's ever done before. It's people like Mike Ryan, who has been at the forefront of WHO’s public face of the pandemic, and absolutely fantastic.

Not everybody gets it right all the time, including us, but our First Minister very early on made the pandemic communications a mixture of political leadership, because she leads the country, and leadership from clinicians – the Chief Medical Officer, initially Catherine Calderwood and then Professor Sir Gregor Smith, and me and others. Throughout this period we’ve tried to get our message across in a way that people would trust.

I don't think leadership depends on rank or hierarchy. It does depend on values and courage and a willingness to take what we would call agency.

You've described traits and skills like courage in a good leader. Are these different in the calm compared to periods of crisis?

I think a good leader can adapt to the situation they're given. So, if on a Tuesday night you need to decide whether to close schools on the Wednesday, that demands a level of command and control that requires you to make quick decisions and have confidence in your decisions.

In calmer times when you're thinking, “Okay, what is the strategic approach to COVID? What are we going to do about cancer care going forward?” – then a leader has to bring in a team of people to get a broad overview in order to decide the right course of action. In the end, there is still a decision to be taken – and that might be to stop some health screening programmes for Scotland, an enormously difficult decision taken at the beginning of the pandemic and something we hope never to have to do again. Or, it could on be whether we are going to vaccinate 12 to 15-year-olds in Scotland.

So I think there is variation in the way you lead particularly at times of crisis. You do need clear decisions and decision-makers who are brave and able to do that. But you also need to do it in a way that is collective, so you don’t get just groupthink and we all just agree because the First Minister says we have to agree. That's not how it's been in the private discussions in Scotland.

As a leader, how do you maintain a connection with what’s happening on the ground?

That's been particularly difficult during the pandemic because it's been inappropriate for non-clinicians to wander around COVID wards or for politicians to be seen in A&E departments. I think it's very important that people in positions like mine are as visible as possible.

It's been frustrating for me during this period. I've tried to stay connected virtually but thankfully I'm allowed out again. So, I’m aiming to visit every health board in Scotland. I went to Orkney and Shetland recently and visited care homes to meet people who had done the work and it was fantastic. I absolutely loved it. It was energising. It was moving. It also allowed me to get perspective on what some people have been through during this time. I hope to go to the Western Isles next and around the mainland of Scotland.

The other thing that has changed, of course, is during the pandemic, my front line has changed. So, I've spent a lot of time with faith and belief leaders, with sports leaders, with people who run hospitality, who run our nightclubs. Gregor, the Chief Medical Officer and I, have had to get to know a lot of other parts of the public and private sectors of Scotland. I now know how the buses work, a little bit of what it takes to run Scotland's railways and for electricity suppliers to keep the lights on.

I've had to learn what it feels like to be in a slightly different version of the front line, not just our health and care frontline. That's been really interesting, but also really challenging.

What is your leadership style?

I think that’s probably a question for others. My attempts at leadership are exactly that. I'm very happy to be making decisions, but I expect to be surrounded by people who are smarter and better than me to help and I don't micromanage at all. I'm very happy for people to make decisions. I want them to know when to escalate, when to come for help, or when to come for cover. I try to be as inclusive and open as I can. I try to be honest and I try to make it fun.

It helps if you can surround yourself with people who share your vision and optimism, though it’s still important to listen to the naysayers – in case you’re wrong, in case there is something to learn from them.

Professor Jason Leitch, National Clinical Director

Are there times you doubt yourself as a leader?

Often. Genuinely, often, particularly in the last couple of years when I've been on calls with people that I had only ever seen on TV or had to engage and give advice to people and try and work our way through this chaos. I revert to advice that my mother gave me when I was very young. And it's to tell the truth. I genuinely tell the truth in the moment.

It helps if you can surround yourself with people who share your vision and optimism, though it’s still important to listen to the naysayers – in case you’re wrong, in case there is something to learn from them.

With the knowledge and experience that you have gained during the past two years, is there anything that you would have done differently in hindsight?

I think when the history is written, they will say there were a lot of things that we could have done differently, whether that’s the difficult decisions about lockdowns, Christmas holidays, school closures, or advice to universities and colleges.

At the time, you make those choices with the best of intentions with the best available science. And remember, underneath the spokespeople like me, there is an educational advisory group, there is a professional advisory group for the clinical side, there is a vaccination information group. All trying to find consensus in real-time and that adds a layer of complexity to that decision making.

Early in the pandemic, we didn't know how transmissible the virus was in the air. We didn't know that 30% of people have it asymptomatically, we didn't know exactly which age groups and who was most vulnerable. Now, we know a huge amount more but we still don't know enough and we’re learning all the time while still trying to mitigate the harms from this virus.

Ioanna: Thanks for your time, Jason.

Jason: Thank you. It has been an absolute pleasure.

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