E125 Minister John Haggie on Physician Leadership and Being Minister of Health during COVID19

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Chad Ball  00:12

Welcome to the Cold Steel podcast, hosted by Ameer Farooq and myself, Chad Ball. We consider it an absolute privilege to bring you guests from around the world who are truly experts in their craft. Our mission is to offer you a combination of not only masterclasses on clinical surgery topics, but also insights into achieving personal growth, productivity, and fulfillment as both a surgeon and perhaps more importantly, as a human.

Ameer Farooq  00:43

We had the unique opportunity on this episode to speak with the Honorable Minister John Haggie. Dr. Haggie is a general surgeon who spent his career in Newfoundland and Labrador. And at the end of his career as a general surgeon, went on to become elected as a member of the House of Assembly in 2015. He was appointed to be the Minister of Health at that time, and has continued to serve in that portfolio ever since. We spoke to him on this episode about his fascinating life story, his thoughts on leadership and the role of physicians in politics, and about his favourite book, "Shogun".

Chad Ball  01:17

Could you tell us about where you grew up and what your training pathway looked like and how you got to where you are now?

John Haggie  01:23

Yeah, sure. It's a kind of convoluted route. I was born in Manchester in the UK, a Boomer and went to high school and went to medical school there. It was at a time when there was a big expansion of the health care system, the National Health Service, and training local high school students to practise locally was the aim of the day. And it's a theme that has cycled around and certainly is popular in Newfoundland and Labrador at the moment, again, as a topic. I went to medical school in Manchester, was direct entry from high school in those days, that was not at all unusual; in actual fact, was probably the norm. I qualified there, and then did a series of rotational jobs around Manchester and the south side of Manchester, with the idea of getting my fellowship of the English College, which I got sort of four or five years in. And then the UK system at that time was much more of an apprenticeship-style thing. And I moved around the northwest of England a little bit in a fairly localized area, went out into Cheshire and Crewe, and then ended up switching streams and going down the academic surgical route at the University of Liverpool. And it was there that I realized that probably wasn't the best suited fit for me. I was much more inclined to the practical rather than the research, although I had done a PhD. But in the end, I kind of looked around. And because of the way the job market was in the UK, I looked, and English was the only language I was really fluent in. I applied for a couple of jobs in Canada. One was in northern Ontario, and one was with what was then Grenfell Regional Health Services in St. Anthony in Newfoundland. And they got back to me first and I moved.

Ameer Farooq  03:31

Tremendously fascinating life story. I think one of the most important questions we have to ask you, of course, is which football team do you support? Are you a Man[chester] United fan? Are you a Man[chester] City fan? Are you a Liverpool fan?

John Haggie  03:43

Well, you know, it's interesting, and sometimes depending on the people you're with and how vigorously they pursue football, you have to be careful how you answer that. But I grew up in a household that supported Manchester City; United were the come-from-aways; they weren't a real working-man's team, a real Manchester team; they were imports from afar. And I grew up not far from Maine Road, which was then the home of Manchester City. So when anybody asks me now that's kind of where I land.

Ameer Farooq  04:12

Yeah, so you're a true supporter before their more recent success. That's fantastic.

John Haggie  04:12

Oh, yeah [laughs]. They weren't successful at all when I was a lad.

Ameer Farooq  04:14

No kidding. So you moved to Newfoundland in 1983 and you told us about some of the motivations for that. What was that experience like coming from the UK and coming to Newfoundland and into a very different environment? What was that experience like?

John Haggie  04:44

Well, actually, it was in the 90s. I arrived in St. Anthony just after the cod left. It was the start of the moratorium in Newfoundland and Labrador, which was a huge social and economic upheaval for the whole province, but particularly around the St. Anthony basin and the Northern Peninsula, which was where the facility I was in was based. It was a regional facility. It was supposed to provide health care for Labrador except for Labrador West and the Northern Peninsula down as far as Bartletts Harbour. Smaller community: 3500. I'd lived in what was, I thought, a fairly small, rural community in the UK, but the population there was 35 000. So it was quite the difference, but it was a very hospitable move. It was pleasant. The work was stimulating. It was certainly different. What appealed to me was the true generalist aspect of it, which fitted with the kind of apprenticeship training I'd had. So there was a real mix of cases and you were never sure what would come through the door next or land at the airport from off the coast. And that I really enjoyed. I had three very young daughters at the time. And after a while, my wife and I sort of looked and felt that maybe because of them and their changing interests, it might be better if we're in a larger centre. So in '97, we moved to, for me to work, in Gander in the centre of the island. And we lived in a smaller community called Appleton and that combination was super, it worked very well for 18 years, until 2014. And then, again, family changes. So, [we] moved into Gander proper, had a small house built there. And then changed streams; I decided on a retirement gig.

Chad Ball  06:46

[laughs] "Gig" might be an underestimate of your "retirement voyage." You know, clearly we all work in different environments and you've had the really neat privilege of working in a number of different ones. How did working in that initial St. Anthony, and then subsequently, Gander region, shape your view as not only a surgeon, but also a person? How did it impact you?

John Haggie  07:16

Well, I think several things happened. One was, I got involved in medical advocacy, while incidentally, and it was purely by accident. The person who had been elected to represent the district on the Newfoundland and Labrador Medical Association (NLMA) didn't like the travel. For me, looking at it slightly differently. I was the only other elected person in that area having been elected as president of the medical staff. And so they offered it to me on the basis that they were looking for anyone who'd say yes. And again, wanting to find out more about how things worked, I did say yes and embarked on a different path for extracurricular work, which I found immensely absorbing and interesting, because it taught me an awful lot, I thought, about how the system worked. I got a real surprise, in many respects, when I found myself in this portfolio 20 odd years later, to realize that that was an illusion and I only knew how bits of it worked. Again, that made you think about things in a different way. You've got the detail of surgery, you've got the challenge of the individual patient, putting his stitches in the right place, because I was still a stitcher not a stapler, although the stapler was a great tool for certain cases. And then in contrast, my out-of-hours activities were around strategic and policy discussions. I really enjoyed those. And I realize that makes me a bit strange, but it was me.

Chad Ball  08:59

I don't think we think that makes you strange at all. It's a talent and it's a skill and you've clearly had that talent for a long time - a few decades now - and you've certainly matured it into a pretty impressive leadership voyage. You correct me if I'm wrong, but I remember you as the CMA president in about 2010-2011. How did that come about? And how did that impact your thought process and your voyage?

John Haggie  09:30

Well, it's really been a matter of being in the right place at the right time. I served on the Board of the NLMA, got interested in public relations and government relations while I was there, ended up in the executive and then ended up being nominated and elected president the NLMA. Then what happened was, there was the first doctor strike in job action in a province since Heaven only knows when. And that gave me a profile amongst my own colleagues. And then, fortuitously, I'd served a little bit of time on CMA in government relation, political action committee, health policy and economics kind of spheres. And then the rotation as it were, for CMA president came around to Newfoundland and Labrador. So we had a very vigorous election campaign, which was really the first campaign I ever fought between myself and three other colleagues here, who had a background in medical advocacy. And I won that election. And then was installed as CMA President 2011 to 2012. So you have a year as president elect, president, and then past president. And that was fascinating, too, because that showed me a completely different view of health care from the national stage. It got me into the Ottawa bubble. It was an interesting and instructive exercise, because there is that bubble effect in Ottawa. And there is that bubble effect in politics, when the House sits, you find yourself in need of going back, in my case, to the NLMA when I was with the CMA and then in terms of the district now, as a minister, you need to go back to your own district to reconnect, and fact check some of the things you think you understand about what's going on while you've been inside the bubble. But it was a really interesting exercise. And that got me interested in politics in general. And I got into discussions with my local MP; he and I shared flights on the way back at the end of the parliamentary week or the work week I had with CMA. I got to see every province in this country and it was an amazing privilege to do that. I think I was the first CMA president to do a real rural and remote tour for the President's tour. I went around the top of the country. I went around Northern BC and Alberta and Nunavut and Cambridge Bay. I think I was the first CMA President to visit Labrador, while an incumbent, and great privilege and fascinating. It was like a masterclass in health care management, health care organization.

Ameer Farooq  12:26

You came somewhat as an outsider; you came from the UK to Canada and then worked your way into medical politics and then really made a big transition into the national and provincial stage on a more broad side level and became elected and now have been serving a role as a minister. I wonder, do you think that your outsider role has allowed you to see things in a bit of a different way and with a different light? And is that part of the motivation for you to get into politics in that you could perhaps see things in a bit of a different way than perhaps people who had  always lived in that system? Do you think that has played a role in your motivation to get involved with leadership in politics?

John Haggie  13:19

I think it has. If you look back at my involvement in medical politics in the UK, it was nonexistent. I did, again by accident, become a source of information when they changed a lot of the compensation systems in the UK in the '80s for doctors in training.  It was simply because I didn't understand it, and then because I found out, people in similar situations found it easier to come and talk to me. But when I came to Canada, I realized that whilst I spoke English, I didn't speak Canadian or Newfoundland English and words I thought had a specific meaning would be used completely differently here - some in a good way and some in a really unfortunate way. So I stopped making assumptions that I knew what was going on and tried very hard to find out what was going on by getting involved. The best way of finding out what's going on, I found, is to actually throw yourself into it. And that's kind of what I did. The more I knew, the more I realized I needed to know. And at some point, you do have some ideas where you think you can actually change the status quo in a way that will make things better - however you define better. And so that's been my motivation for going to the next step. Looking at it slightly differently has certainly helped in some of the policy and strategy discussions. You can't bring in ideas from another jurisdiction and expect them to work unchanged or unfiltered. The other thing is because of the discussions that I've had to have to try and figure things out, I've also learned that no good idea can't be made better by further discussion and input from other people. So I think that's helped me make better decisions and provide maybe a better direction for the organizations I've led or represented.

Ameer Farooq  15:20

I think that's such a profound way of looking at things and trying to understand how you can best serve the people that you've been tasked with serving. And you've been quoted as saying that Shogun is your favourite book.

John Haggie  15:37

You've been reading. Indeed, I've read it seven or eight times.

Ameer Farooq  15:43

Can you tell us a little bit about that book. Again, that's the story of this outsider, who comes into Japan and really gets incorporated into this totally different culture. Can you tell us a little bit about that book, and maybe a little bit about how that's informed your understanding of politics and leadership?

John Haggie  16:01

Well, there are several levels to it. The book has a whole layer of plots, which on first or even second read you miss. It's a very intricate book. It appeals to my interest in history. [When] I grew up, I was raised by a historian. And whilst I didn't pursue that at high school, it's kind of hobby reading for me now. The other thing is the author. The author spent four years in Changi Prison Camp in Singapore as a prisoner of the Japanese. And yet his books, of which "Shogun," I think, is the best personally, and "Tai-Pan" and "Noble House" and this kind of thing, are all very much pitched in the culture of the people who held him captive for four years and under some of the worst circumstances of any prisoners of war. I had the privilege as a resident, house officer or an intern, as you would say here, of looking after some of what we call the FEPOW - Far East Prisoners of War. And their physical health was appalling - 20 years after the war had ended - 30 years after the war ended. And yet Clavell made that book about the very good things of the military code that had nearly killed him. He, in "Shogun," seems to convey this admiration for Bushido. And it's interesting because the character of Blackthrone the pilot starts off hating the Japanese in the way that they have treated his colleagues, very much like Clavell must have, yet at the end of it, he is the only friend of the Shogun.

Chad Ball  17:55

That it's such a deep read.

John Haggie  17:57

The TV show that they made with Richard Chamberlain was a travesty and it was truly appalling.

Chad Ball  18:06

[Laughs] I'd forgotten about that until I went back and reviewed the book again. You're absolutely right. It was terrible.

John Haggie  18:11

It was hideous. You know, the best thing about it was Toshirô Mifune, who was the Shogun role in that. He probably was unknown in the UK and it didn't harm his reputation. But Richard Chamberlain was a mess.

Chad Ball  18:29

Yeah, totally. Totally. You know, one of the things that physicians often talk about and Ameer and I have talked about this theme on a number of podcasts is a flirting with or idea of getting involved in - you can use many different terms, but really politics in general - What is it about your voyage where you actually walked through that threshold? Why do you think that perhaps many physicians, who talk about doing it and might be absolutely superb contributors and candidates for some of these roles, don't actually launch themselves over that obstacle?

John Haggie  19:09

Just on the surface, you go from maybe the third most respected profession in the world, in the country, to the second last or even the last depending on your views on used car salesmen and tax collectors. There is that. There's certainly no real incentive, in a material way, to taking this role at all. And if you are fair to everyone, nobody really likes you all the time. You will have days when you have a fan club out there, and they will not say anything. And then you'll have days when everybody really doesn't like you, particularly if you adopt a more visible leadership role as a spokesperson for a department or a minister of the Crown. I think you do have to be fairly thick skinned. Health care is not for the faint hearted, either at a senior executive management administration level, or at this kind of level, because it is so emotional. Having the surgical mentality does assist, but it's no guarantee. And my personal experience over the last six years is that the more widespread forms of social media are not kind, because they actively filter out reasonable discourse and they actively deter sensible converses. And so you can't really spend a lot of time looking at that. Those are the downsides. The upside is I work with a great bunch of civil servants, who again, could walk out the door here anytime and double or triple their salary in the private sector. And yet, they work seven days a week, some of them, with no overtime. And they're thoughtful, they're bright, they're energetic, they've been really stressed through COVID, just like everybody in health has been, but the people you work with make the job. And I think that's one of the challenges of health care. When everybody's tired, and everybody's fatigued, it is hard to go to work sometimes. And that's when the best thing you can do, as one person once said to me, "Is wake up, dress up, show up and look pleased as though you're there," because at the end of the day, as a physician, people look to you to set the tone in a crisis or on the floor, doing rounds. And similarly here. If you look as though you really want to be somewhere else, it doesn't help in the slightest and, is in actual fact, is a huge deterrent. But it's a hell of a job some days to do it.

Chad Ball  22:05

You touched just briefly on COVID-19. Ameer and I really wanted to ask you about that specifically, functioning as the Minister of Health during such a crazy historic time. What were some of the principles that you used or employed to navigate the pandemic in your province? And how did that relate nationally? And what did you learn from this whole, I imagine tremendously challenging, time period?

John Haggie  22:34

Sit and think as fast as you can. And as long as you need to. You don't know everything and the world will shift under your feet at a moment's notice. So be prepared to acknowledge that. And one of my mantra sayings has been, and continues to be, "the only constant thing about COVID was change and the need to adapt to it." We had a small but super team of public health physicians and CDC staff and such, and really and honestly, they provided stellar advice. We had premiers who were prepared to listen and acknowledge the same comments I've just made that you didn't know where you were going to go. Also between us we could come up with the ideas that there were ways off the hook, you know, vaccination was a key. We put a huge amount of effort into driving that. And the people of this province were super, because our adult vaccination rates usually suck; our pediatric ones are excellent, and would rival anywhere; but, they listened and they stepped up and our vaccination rates in adults are as good as you'll see in any jurisdiction in the world. But it was a slog. The battles are won and lost in your head; it's a question of endurance and every so often each of us needs four or five hours when you sit down, or a night where you can just have a drink with your family and just recharge a little bit. Because you've got to keep going; it's a marathon, so you've got to pace yourself. Those were the kinds of things. And we look back; I dug out Selma and had other people dig out references to the flu pandemic in Newfoundland and Labrador and there were some really good archives from Twillingate and from St. John's. A lot of the challenges that we saw revolve around masks, not so much vaccination, but certainly around masks and public health measures, and the pushback and the dynamic, the tensions there - they were repeats of 1918/1919, either here or in New York or in St. John's. There were some parallels to be drawn, but it was certainly a challenge. And the other thing was, you just need to get yourself out there and be prepared to take the knocks from the naysayers, but you've got to go out there in front of the media and you've got to recruit the media to help you, because notwithstanding social media, which we used a lot, traditional media still has a crucial role to play, particularly in the kind of long-form analyses and the long-form reads. Social media tends to find people who are oil experts one day, economists the next and then suddenly virologists the day after, so you have to learn to live with that.

Ameer Farooq  25:27

Dr. Haggie, many public health officials and people involved in health during COVID were hated. There have been a number of really good analyses about particularly public health officials in the US who actually faced a tremendous amount of hate and criticism for their rules with COVID-19. Uniquely, you actually became quite loved for the way that you handled many aspects of the pandemic. And in fact, there was this whole "Haggie-isms" type thing that was born, where people were embroidering your sayings on various things. One of my favourites is your phrase, "Please don't let them lick to handle of the shopping cart." Or, another one was, "If you swipe right on Tinder, you might get more than what you bargained for." How did you latch on to this pithy, memorable way of speaking, rather than the verbose things that we're usually used to hearing from our elected officials?

John Haggie  26:34

I got myself in trouble as a resident because I used to use humour to try and defuse tense situations. It works, but the one thing I learned the very hard way, which you really had to be very careful about it, to be honest, was the first few COVID briefings that we did, I had no notes; there was no script to run this by. My poor communications director got told off once by someone for not preparing the minister adequately. But there was no prep you could do; we settled into a routine and some of these phrases just popped into my head.  I've got three daughters, I've got grandkids and teething toddlers chewing on the handles of shopping carts is just something you used to see in supermarkets and big stores. And the Tinder piece, there was a huge discussion on the Internet, of course, around that time about sexual transmission of COVID 19 and there were some really amusing comments. And I thought that was the only one that seemed to me to be fit for general consumption, because we were talking about the use of apps. And I don't know why the media went that route, but they were struggling for questions as well, because I know they used to look at their Twitter feed and their personal emails in an attempt to find material. So it just popped up organically. And I think it did help because it made you a bit more relatable, because, you're right, I dislike Government speak as much as the next person. But there are occasions when you really need to be extremely careful of even the adjective or the noun that you use in a certain circumstance. For most people, it probably isn't that crucial. But there are always groups who will be looking to see themselves in what you're talking about, not necessarily COVID, but pretty well, anything. And you have to be aware that your audience is not the general public, there is no general public, there is the public in general made up of groups with different views. And you have to try and be respectful of those. So that's why the language is often so formal, and there's a place for it, don't get me wrong. But there's also a place for a little bit of spontaneity. And I think in the early days, when everyone was looking at doom and gloom, when we had our first cluster and that kind of thing, it just kind of rolled off the tongue.

Chad Ball  29:17

Well, your humour and wit have become a national celebrity, so to speak.  I wish we had more of that in all of our interactions, it's certainly welcomed. There's no question that COVID and the current pandemic has probably been one of the biggest challenges in all of our lifetimes on the health care side. We continue to struggle in many ways, in many provinces, in particular, the province I'm in, in Alberta right now on the health care side, but I'm curious, both locally as well as nationally, where do you see Canadian health care in terms of challenges over the next say, 5 or 10 years? Where are we going and, and where do you see those speed bumps coming?

John Haggie  30:01

I think there's a splitting of approach. Back when I went into this business, for one of a better word, it was very much that technology was going to solve the problems: you needed a better diagnostic scanner, you needed a fancier cardiac surgery procedure, or you needed a different cancer drug. And those have a place; there's absolutely no doubt about it. But what has become very obvious in Canada, particularly in those provinces with an aging demographic, Alberta may be slightly different at the moment in terms of where they are, but certainly in terms of Newfoundland and Labrador, we need a rock-solid primary care provision system. And our health accord document has started as walking down that road and has really provided us with a snapshot and an analysis to put it into a cohesive package. And so really, it's kind of low-intensity, sometimes low-tech, community-level engagement with people who have chronic illnesses that is going to make the biggest difference. And long term, we've always known - but kind of pay a bit of lip service to - the issues around preventative medicine and social determinants of health, our Health Accord NL document ties all that together. And so we're looking as a government at the things outside my shop, that will make a difference. So, how do you lift people out of poverty? What's the role of minimum income guarantee? Does minimum wage work in that regard? What about housing, particularly in our more rural areas? And we have several Indigenous partners we need to work with, who we could support as they work their way through challenges, which are more noticeable than the non-Indigenous communities for sure. So I think those two threads have to be balanced, because one is very expensive, very glitzy, attracts fundraising from foundations and this kind of thing. And the other is very low key, very understated, but for my grandchildren will make more difference.

Ameer Farooq  32:18

One of the questions we try to ask all of our guests is, if you could go back in time and give yourself advice as an early career surgeon, or perhaps even as a chief resident, what advice would you give yourself?

John Haggie  32:33

Well, in surgery, I would say listen to the Team Lead on the floor. I've had three or four over the course of my career, and they have been absolutely invaluable. Keep your ears open and your mouth shut sometimes. As one of my colleagues says, "You've got two ears and one mouth." There's a message there.

Ameer Farooq  33:03

You've been listening to Cold Steel, the official podcast of the Canadian Journal of Surgery. If you've liked what you've been listening to, please leave us a review on iTunes. We'd love to hear your thoughts, comments or feedback. Send us an email at [email protected] or tweet at us @CanJSurg. Thanks again.