Covid-19: the flu jab is now a critical leadership issue

Acknowledging what is being termed the ‘double danger’ of flu and coronavirus this winter - particularly following new Public Health England research[1] showing those with flu and Covid-19 are at greater risk of severe illness and death - Professor Mayur Lakhani and Dr Tony Berendt discuss the need for doctors to take a strategic approach with the effective vaccine we have against flu, and lead from every level and sector of the NHS, over the coming weeks.

Professor Mayur Lakhani, FMLM Chair, GP and CCG Lead 

My experience as a working GP in Leicester compels me to change mindsets and encourage everyone to take flu as seriously as we do childhood immunisations or cancer screening. After all, it is a highly contagious disease that claims a great number of lives each year. [2]

There are additional challenges this year – more eligible patients, more ambitious targets, greater infection prevention measures and social distancing, as well as vulnerable patients who are worried and concerned about visiting a surgery.

We also need to be concerned for staff – keeping them safe from seasonal flu while working with patients towards service restoration, recovery and reset is crucial.

I have been asking medical leaders to get behind flu vaccination as never before, to make the step change in vaccination coverage, by: leading the way and having the vaccine; being an ambassador and promoting the vaccine –  to patients as well as health and care workers; being thorough in utilising the available data and contacting patients in the target groups; and by making every contact count in offering the vaccine to those eligible.

This is also a major opportunity to start tackling health inequalities – as a working GP, I see the inverse care law in action every flu season, where the people most in need of flu vaccination are often the least likely to receive it. So, we need to overcome every barrier possible to ensure the most vulnerable and at-risk patients (and all staff) get the vaccination. In Leicester, during the Covid lockdown, we have utilised those with skills in other languages to get into the heart of local communities. With the flu vaccination, we need to reach out to those communities who do not generally engage with healthcare or mainstream media.

This is the year to be creative and innovative and apply the kind of leadership that overcomes all possible barriers.

Dr Anthony Berendt, FMLM Senior Fellow, Executive Coach in Leadership Development and former Executive Medical Director 

I am often asked, by doctors at all stages of their career, how they can start developing leadership skills. It is an understandable question but one that demonstrates a misunderstanding that once put right, can unlock a lifetime of leadership. And as we reflect on 2020 being ‘the year above all years’ when we need high rates of uptake of flu vaccine – ahead of the second UK surge of the SARS-CoV-2 pandemic – this is a good moment to expose that misunderstanding.

In a profession like medicine that is still largely hierarchical, power mostly resides in more senior individuals; partly because they have more clinical knowledge, skills and experience, which as clinicians, we ignore at our patients’ peril. But also partly because once people have power, they tend to keep it, through a combination of the opportunity their power gives them to get more (resources and influence), and the things those without power cede to the powerful, through coercion or unconscious assent.

There are many ways to think about power, including the different ways it is taken for granted; so we talk about personal power, position power, expert power, role power. This is not an exhaustive list, but it helps us to think about how someone with role power might still struggle to influence someone with a lot of expert power, or in a hierarchy, position power. And how they also might struggle if, for whatever reason, they have difficulty making the most of their personal power in a way that influences others effectively.

So, what is the misunderstanding, and what does this have to do with flu immunisation?

The misunderstanding is to assume that leadership can only be exercised through positional power, and that until you have a position – with power given by someone else – you cannot lead.

But with flu immunisation, you can lead without a formal position, at whatever level you are working in a hierarchy. You can choose to follow leaders who are promoting vaccine uptake. You can visibly have the vaccine yourself. You can initiate discussions with colleagues who do not want the vaccine and persuade and influence, one conversation at a time. Each of those conversations is a chance to exercise and develop what Steve Radcliffe calls your “leadership muscle”.[3] You can find out who is running immunisation in your part of your organisation and offer them support or practical help. You can get your colleagues doing the same and think of creative and fun ways to promote the message and get more colleagues immunised. At every opportunity you can think about how to influence helpfully, curiously, kindly, compassionately.

You can do all of this without positional power. And if you are challenged by others, in a “who do you think you are?” way, the answer is simple…you are a person working in healthcare, wanting to protect patients, colleagues and the sustainability of your service in whatever way you can; and right now, getting everyone immunised against flu is the best way to do that. Understanding that you can be an advocate for everyone’s safety gives you a role, and legitimate power in that particular role, just as it empowers you to challenge unsafe clinical practice or to remind someone to practice good hand hygiene.

Leadership opportunities are all around you and its best not to be too choosy…take them, run with them, demonstrate and develop your fitness to lead, and more opportunities will come.

[1] https://www.gov.uk/government/news/record-numbers-offered-flu-vaccine-as-those-with-flu-and-covid-19-more-likely-to-die

[2] Public Health England estimate an average of 17,000 deaths annually from flu between 2014/15 and 2018/19.

[3] Radcliffe, S. Leadership Plain and Simple, Financial Times Series (second edition, 2012)