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Hello I’m Domhnall MacAuley and welcome to this BMJLeader Conversation. Today I’m talking to Jan Frich. Jan you’ve a remarkable career from Clinical Neurologist to a Senior Executive in hospital and health authority. Tell us about that journey and how you move from being a clinician to being such senior administrator in healthcare.
Jan Frich: Well, thank you Domhnall. It’s been a quite a journey and I think it started for me with a particular interest in patient experience of care. Basically, I was very interested in trying to understand what was important for patients. So, the first thing I did after having done my internship was to do a Masters of Medical Anthropology in London, to try to understand more the social and cultural aspects of how people dealt with their illness and risk. I started medical school in 1990, the same year the Human Genome Project started, so I was quite heavily influenced by thoughts on genetic risk. So, I wrote my PhD thesis on how to communicate about risk with patients, basically because I felt that was one of the challenges I met as a clinician – trying to talk about statistics and probabilities, and trying to figure out how this can be said in a meaningful way. And, from that starting point, I started working doing a specialization in neurology and started working with neurogenetic conditions and muscular diseases. And for almost 10 years I worked a National Center for Huntington’s Disease, which has been a main interest of mine. I became increasingly aware of the systems that framed the clinical realities that I experienced and I started studying Health Administration. I became more and more interested in leadership and management and for many years, I combined my job as a clinician with being a professor at the University of Oslo, teaching leadership and management. And then in 2017 this opportunity came up to take on a role as a senior leader in the regional health authority that contracts hospitals and owns hospitals. My idea was to try to have an impact on medical care and try to do my best. So, after a two year long pandemic, after five years in that position, I felt the need to get back to patients, to get back to where it all happens. And then I took on this job as a CEO for a general hospital, so I’ve been in that role since August 2023.
DMacA: I’m really intrigued by your interest in medical anthropology. That’s so unusual. Tell me more about that, and what you learned, and what you experienced, and what it brought to your career.
JF: As a young doctor I felt the need to understand more. I felt the need to try to broaden my “toolbox” and one of the things I learned was that there is potentially a gap between the clinical world, the medical world, and the world that people live in, or they experience, and think about their illnesses. One of the insights that I got from studying perceptions of risk was that people reasoned about their own risk in ways that I hadn’t learned about in medical school. We learned statistics, we learned averages, we learned predictions, but what I found was that, in terms of genetic risk, people would often refer to their family histories, they would reason like this: They would, for example, say – my father got this when he was in his mid 50s but he smoked and he did not exercise as much as I did, so let’s say my risk is that I would probably get trouble in the mid 60s. It’s a more analogical way of trying to make sense of uncertainties and I think just trying to understand the world of patients and that those worlds may differ. Some patients are probably quite statistical in their reasoning. But, it’s the clinician’s job to try to accommodate, and try to understand, what’s important because, if you don’t talk the same language, if you don’t understand each other, any attempts to try to install treatment would be difficult. So, this was one of the insights that I learned from doing this Master’s program. I also learned about issues like shame, guilt, things that we didn’t learn so much about medical school. And also how people try to make sense of their illness in different ways. So I think it broadened my “toolbox”, broadened my perspectives on what we’re doing and what’s important to people.
DMacA: I’m looking at two ends of a spectrum, the clinician-epidemiologist-statistician at one end and the humanities at the other. But it’s triangular because there’s a third component to your career, and that’s business administration. Tell me about that training.
JF: I think it basically started with huge frustration. As a clinician I wasn’t prepared, I didn’t understand how this system was designed. We had wards being shut down because the economy was bad and I didn’t have a clue about why these things happened so that really motivated me to try to understand more how these services are financed, what are the expectations in terms of legal requirements etc. So after many years as a clinician I also realized that you could be a medical clinician trying to lead in a reasonable way and that engaging in leadership is also one aspect of being a doctor. You work at a different level. So, I’ve invented this concept to try to give myself that sort of identity – I’m now a “Health Systems Doctor”. I’m a doctor for Health Systems- trying to do reasonable things in health systems but acknowledging that, where the rubber hits the ground is where the clinicians meets patients. And my job is trying to do the best I can to make those meetings as good as possible.
DMacA: This brings us very nicely to talk about your Harkness Fellowship which clearly was inspiring.
JF: Yes, I had the opportunity to become a Harkness Fellow with the Commonwealth Fund in the US in 2013-14. I spent the year based at Yale School of Public Health and studied leadership in Health Systems and how leadership was developed, or the systems initiatives and programs to develop leadership capacity. I soon realized that you could think about leadership in two distinct ways: You could think about this as developing individual leaders or, you could think about leadership development as developing a capacity within a system. Leadership development can be both, but I think you need both perspectives to build strong organizations that have a commitment and a sense of direction and leadership. I had the opportunity to travel around, talk with people in major health systems in the US, and basically embed myself and ask…How do you know, how do you do this, how do you target different professional groups. For example, should you see doctors as a special case or should they be part of development initiatives for everyone. There are a lot of questions in this field and one of the insights is that, so far, the leadership component hasn’t been very big in professional in medical and health education, nursing education, and I think we need to have initiatives and programs in place to build that capacity for clinicians. You just can’t take it for granted, you need to have something in place to strengthen your systems.
DMacA: Which brings me to one of those key questions. I guess it applies to clinical leadership as well as anywhere else. Are leaders born are made?
JF: That’s the classic question. I think the correct answer would, perhaps, be both. But, for the most part, leaders are made. There are some personality traits you can associate with leadership capacity and potential, but I think what the literature says is that around 80 percent of it all is based on actually learning and doing and reflecting. It’s a capacity you can develop and build.
DMacA: Let me talk to you about something slightly different. It’s still within the business of communication and leadership and that’s your role as editor of the Norwegian Medical Journal. That was an unusual turn in the road of your career. Do you think we’re doing a good job in medical communication?
JF: My role was being a medical editor for a couple of years in the Norwegian Medical Journal. It was almost 15 years ago and it was an important part of my career. To communicate and disseminate knowledge and, to reflect on what that knowledge means, is an important role for medical journals. What does this mean in this particular context, the local health system context, the Norwegian Healthcare System? I think International journals are very important but I also see the importance of having national or local journals debating and discussing. Today we have a lot more information available than we could dream of. We communicate a lot but I think we have to communicate wisely. We have to frame messages and frame knowledge. It’s a difficult question to respond to I think but having an ongoing dialogue over new insights is really important for a society.
DMacA: Thinking back on all the different components of your career and looking at how these all come together, my final question is, where to next?
JF: I haven’t thought so much about that. I’ve just taken on this role and there’s a lot of things to do here so, I have no other plans other than just trying to do my job the best I can at this hospital. It’s a prestigious hospital, it’s on the Newsweek list of world’s best hospitals, and we need to ensure that we keep the good reputation, keep the high quality, and then strengthen our system so that we can meet the future.
DMacA: Jan, it’s been an absolute pleasure talking to you and thank you for sharing so much of your life and experience with us. And I’ve learned a new term and a new career and that’s that of the “Health Systems Doctor”.
Dr. Jan Frich
Jan Frich is a Norwegian medical doctor, graduated from University of Oslo, who is trained as a Neurologist, with a special interest in neurogenetic conditions such as Huntingtons disease and neuromuscular diseases. In August 2023 he became the CEO of Diakonhjemmet Hospital, a non-profit general deaconess hospital in Oslo. Dr. Frich holds a Master’s degree in Medical Anthropology from Brunel University London and is Master in Health Administration from University of Oslo. From 2018 until 2022 he was Chief Medical Officer of a regional health authority responsible for specialist health services for a population of 3.1 million people in Norway. Dr. Frich is Adjunct Professor of health management and leadership at University of Oslo. In the academic year 2013/2014 he was Visiting Professor at the Yale School of Public Health and the Norwegian Commonwealth Fund’s Harkness Fellow in Health Policy and Practice. He serves as Associate Editor in BMJ Leader.
Declaration of interests
I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.
Professor Domhnall MacAuley
Domhnall MacAuley currently serves on the International Editorial Board for BMJ Leader.
Declaration of interests
I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.