“to create the connection from research to translation to transformation of health care and to help coordinate ecosystems that do not always work well together.”
Dr Jean-Frédéric Levesque is the Chief Executive of the NSW Agency for Clinical Innovation, and the Deputy Secretary, Clinical Innovation and Research at the NSW Ministry of Health.
He is an Adjunct Professor at the Centre for Primary Health Care and Equity at the University of New South Wales. He has authored more than 160 peer reviewed publications and his seminal research on healthcare access and inequity has been cited more than 3,000 times.
Jean-Frédéric Levesque has a Medical Degree, a Masters in Community Health and a Doctorate in Public Health from the Université de Montréal, Canada. He brings extensive leadership in healthcare systems analysis and improvement, combining experience in clinical practice in refugee health and tropical medicine, in clinical governance and in academic research.
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“I come from a small, community in northeastern Quebec, very near Labrador. It’s a community called Port-Cartier. It’s a little mining town of 5-6000 people about 12 hours drive from Montreal. It’s a fairly remote place and in winter it is sometimes difficult to access. But its also beautiful, placed between the ocean and the Laurentian Mountains. A beautiful place to grow up.”
Hello. I’m Domhnall MacAuley and welcome to MedicsVoices.com where we talk to the key opinion leaders in health and medicine around the world. Today, we’re in New South Wales in Australia and I’m speaking to Jean-Frederic Lévesque.
It’s a very long way from northern Quebec to New South Wales. Let’s take you back to the very beginning. Where did it all begin?
Jean-Frédéric Levesque: I come from a small, community in northeastern Quebec, very near Labrador. It’s a community called Port-Cartier. It’s a little mining town of 5-6000 people about 12 hours drive from Montreal. It’s a fairly remote place and in winter it is sometimes difficult to access. But its also beautiful, placed between the ocean and the Laurentian Mountains. A beautiful place to grow up.
DMacA: Tell us about growing up, school, and what stimulated you to do medicine?
J-F L: Medicine came a bit later in my life. I probably grew up oblivious to what I would eventually do. I was passionate about ice hockey, playing hockey all the time at the local rink and outdoors in the streets with my friends. Even when the school was closed because of the very cold temperatures or storms, we would be outside on the street playing hockey and pretending to be Wayne Gretzky and all of our idols. I grew up really close to nature. I was not quite sure what I would do in the future but I was always interested in learning and knowing about things which eventually brought me to science with medicine as an option towards the end of high school. Before that, I was open to lots of potential options.
DMacA: Let’s talk about this transition from high school. You went to university in Montreal. Tell us about medical school.
J-F L: Medical school was fantastic. I was young and I feel that I was not sufficiently mature as a person to be studying medicine and seeing patients. I was part of a program where we moved very quickly in the hospital interviewing patients, not doing medical stuff but, starting to learn to interact with people.
There were, of course, fantastic friendships, very long hours of study, and I was someone that wanted to do very well. I was a very dedicated student but I was also very involved in the international health group which led me to do some placements in India, expanding my horizon and gradually helping me to find the area of health and medicine that I would become passionate about. For me, medical school was an intense time of study but also of really good friendships and growing as a person.
“… l learned a lot about methods and became passionate about research.” It’s funny because, I still remember that in medical school, one of my colleagues had been very interested in clinical trials and research and, my first reaction was… how boring. And now the reality is that I lead clinical innovation and research in New South Wales and it has taken me to places where I didn’t think I would go.”
DMacA: Tell us about these placements, because that clearly widened your international horizons.
J-F L: There is a background to the story because before starting medicine I took some time off and travelled to India and Nepal. This came about because I was supposed to participate in the Canadian national junior badminton championship that year but I got injured. I was in a sports medicine program in college. So instead of having a full term dedicated to the badminton championship before starting university, I ended up with a bit of time on my hands. I spoke to my elder brother and he suggested going to Asia and spending a bit of time there. I had just come back from a month in Mexico again, trying to explore the world, etc. I flew to Nepal, did some trekking, travelled across north India and then came back to Montreal to start medicine. I decided very quickly that I wanted to continue to do this. I was really interested in going to Africa and to explore a new continent, new countries, new cultures. But, because I already had that experience in India, an older classmate who had just come back from India talked about this fantastic place, Tamil Nadu, where you could provide care for the indigenous populations of South India. So, I thought, Africa can wait, I’m going back to India. And I travelled with my very close friend Chris and we had a fantastic experience traveling from small village to small village, helping doctors to provide mobile clinics in very remote villages in South India and exposed to indigenous cultures that I had never heard about before. It was a fantastic experience at 21 years old.
DMacA: That certainly widened your horizon. But I’m interested in this fork in the road where you could have been a sports medicine doctor. Tell us about that.
J-F L: It’s interesting but it was never really truly on the cards. I was passionate about sport and I still am. I still play ice hockey here in Australia and it’s always been part of my life. But I was interested in different dimensions of medicine and very quickly realized that I was interested in how medicine works as a system. It came it came gradually, of course, but every time I did placements during my training and later during my residency, I was looking at things and thinking, maybe we can do this differently. I was always very interested in new treatments and how they would disrupt the way we provided care. And that has been a driving force. So, sports medicine was never really contemplated. I did think about surgery for a while, and I was interested in so many different things that I think life could have ended up being very different. But, at some point, it became clear that my skillset was driving me to think more about systems, clinical innovation, and to dedicate my career to trying to improve healthcare and health systems.
DMacA: When you graduated you did some clinical jobs, but you also did a Master’s degree in Community Health, and then you did a PhD. Take us through those.
J-F L: The Master’s was actually part of my residency program. I had to do it to obtain my Royal College certification. I was working as a clinician at the refugee clinic, and it just made sense to use that clinical setting as a place where I would do my project. I studied the acceptance of the screening test for tuberculosis which is, of course, a sensitive topic.
When refugees arrive in new countries, they’re a very vulnerable population and you want to strike the right balance between offering them a service that will help their health, but in a way that will not jeopardize their refugee pathway, because, of course, you want to do the best for them as human beings. That sometimes means that you have to compromise what could be achieved from a health perspective because if they don’t accept a treatment, you’ve lost the relationships entirely. We studied the factors that enable refugee claimants to accept the screening test, working with a fantastic group of committed clinicians who were also very good friends. And, we published that study. Then what happened is that I became very passionate about scientific methods, wanted to learn more, and as part of my residency program, I committed to do a PhD.
I still wanted to go to Africa but again, the same thing happened. When I started to talk to potential supervisors, they said, “Well, you’ve got that experience in India. You’ve been a few times, you understand the culture. We’ve got this fantastic project in Kerala, in South India. And, you know, we already have a local team. You could go there and do your PhD in Kerala.” It was a fantastic opportunity and I committed to a PhD, where I studied inequalities and access in urban south India. What I did was to assess how people accessed health care for chronic conditions and infectious diseases in different types of settings, both in the slums as well as more formalized settings, and trying to understand how the healthcare system, both formal and informal, was responding to the needs of the people living in in urban settings in South India. It was a fantastic experience and again, l learned a lot about methods and became passionate about research. It’s funny because, I still remember that in medical school, one of my colleagues had been very interested in clinical trials and research and, my first reaction was… how boring. And now the reality is that I lead clinical innovation and research in New South Wales and it has taken me to places where I didn’t think I would go.
“I gave it all of my time and effort for probably a full decade of commitment to primary care research. That led to amazing projects, amazing comparative projects on primary care around the world and that’s also where I made lifelong friends. It’s a beautiful field in terms of the people that commit to that field of research.”
DMacA: Before we go to Australia, we have to talk about your enormous contribution to primary care in Canada, because your colleagues speak very highly of what you achieved.
J-F L: Primary care was probably my first really committed area of investigation. I finished my PhD and my residency program and then started work in Montreal. I became very involved in a team that had just received a mandate to study primary care reforms in Quebec. That was at the time of the establishment of the family medicine groups in Quebec and at a time where in Ontario there were lots of different new models of provision of service delivery in primary care. When I was recruited to be part of that team they pointed out that primary care was a priority topic and they needed good evidence for decision makers to guide primary care reform. I thought that was really important, very relevant, and a way that we can make a difference for people. Access to primary care remains a really tricky issue in different countries. Looking at those different investments in Quebec, new models and new ways to provide team based care, I thought, let’s give it a go. I was really lucky to be mentored by Raynald Pineault other colleagues and being embedded in a team that had a strong methodological background and a clear commitment to do research that would be used both by clinicians and by policymakers.
That was very formative because you can do research for the sake of developing knowledge and that’s very important as there are so many areas of health and health care where we still need that pure knowledge development but, the essence of that team was that we were so close to decision makers, politicians, and clinicians working in those settings in trying to implement those new models. Our researchers worked with those people making the connection between research and the clinical practice. And that was very rewarding. I gave it all of my time and effort for probably a full decade of commitment to primary care research. That led to amazing projects, amazing comparative projects on primary care around the world and that’s also where I made lifelong friends. It’s a beautiful field in terms of the people that commit to that field of research.
DMacA: Those comparative projects are very important so tell us about the people you worked with and the models that you created.
J-F L: There were, of course, a lot of collaborations across Canada. I worked with Brian Hutchison from Ontario , Sabrina Wong from British Columbia , Mylaine Breton from Quebec and a lot of different people from different provinces. There were lots of comparative studies of those reforms because all the Canadian Provinces had embarked on significant transformation in how care was provided in primary care. That led very quickly to connections with researchers from the US, researchers from Australia and the UK. Grant Russell and Mark Harris in Australia are some of my very close colleagues and, in the US, Ben Crabtree and Will Miller were my main collaborators. In the UK, I did a lot of work with, but mostly I have to say, received mentorship from Martin Roland . His is a very good colleague and someone who has influenced my career significantly. That led to studies where we were not just assessing primary care reforms and new models but trying to understand how the context in each different country influenced the way clinicians were working, and how those new models would influence that practice. This was, again, a really rewarding experience. That then led to studies where we didn’t want to just study those emerging models but we started to work with decision makers to promote new models and to pilot and trial them because we could see that the primary care reforms had achieved quite a lot in terms of implementing new generic ways to organize a clinical practice and generate ways to organize pathways for patients. There were subgroups that still faced significant problems in access to health care and we had to think about innovative models, things that had not been tried yet. We were a group of researchers trying to do this across different countries throughout the world which was a very rewarding experience.
“The goal was to create the connection from research to translation to transformation of health care and to help coordinate ecosystems that do not always work well together. Everybody’s heard how treatments and innovations may take up to 14 years to become embedded in clinical practice, and this is an attempt to integrate different organizations and mandates in New South Wales in a way that aligns their work so that we bridge those gaps.”
DMacA: You certainly had an international flavour to your work, which then brought you to Australia. Tell us about that move.
J-F L: Australia came because of one of the collaborations that we had established. I was working with Grant Russell and Mark Harris, but also Jane Gunn from the University of Melbourne. During one of the sessions that we had as part of this research project, Jane asked me if I would you be interested to do a sabbatical in Australia? “We’ve got this project, which is a collaboration between University of Melbourne and a local decision making body and I think that you could help us with this” she said. I spoke to my family about it and we thought that it would be a great experience. I submitted a proposal to Jane and we were welcomed at University of Melbourne for a year long sabbatical. During part of that time I brought my family to Melbourne to live for a few months. Our kids were, at the time, in second year of high school and last year of primary school so it was quite formative for my son and my daughter and, overall, it turned out to be a really good experience for the family. We came back to Montreal with everybody going back to their previous schools, previous jobs, friends and family etc. But, it didn’t take long before I received a call from a head-hunter, saying that they were looking for someone to lead a health information agency in New South Wales and that my name had been mentioned. Our first response was to say no, that we’ve done Australia. But they called again and as a family, we started to have conversations about what this could mean, and we decided to go. I was appointed chief executive of the Bureau of Health Information in New South Wales, which was great experience. Sydney was very different from Melbourne but is an absolutely beautiful place and we still live here. And, that’s how we got to be in Australia.
DMacA: Tell us about your current job which sounds really exciting.
J-F L: My current job is a dual role. It’s quite innovative in its own way. After close to five years as the chief executive of the Bureau of Health Information, I was offered the opportunity to lead an organization called the Agency for Clinical Innovation (ACI). Like the Bureau of Health Information the ACI is an organization that we call the ‘Pillar Agency’. It’s an organization at arms length from the ministry. Its role is to lead clinical engagement across a broad range of medical professions with allied health and nursing involvement. We’ve got 42 clinical networks that span the state and we work with them at designing, piloting and implementing at scale innovations in health care. Those innovations are about new technologies but also about new ways to work, new pharmacological therapies and, increasingly, advanced therapies like Car-T cell therapies for cancer, for example. I started that role in 2017 and I’m still the chief executive of the Agency for Clinical Innovation so I’ve been eight years in the role but, over the last three years, I’ve also been asked to combine in this role with a new role being established in New South Wales, the role of Deputy Secretary for Clinical Innovation and Research. The goal was to create the connection from research to translation to transformation of health care and to help coordinate ecosystems that do not always work well together. Everybody’s heard how treatments and innovations may take up to 14 years to become embedded in clinical practice, and this is an attempt to integrate different organizations and mandates in New South Wales in a way that aligns their work so that we bridge those gaps. At the same time the goal was not to simply to merge them all into one very big monolithic structure that wouldn’t, perhaps, be as agile and as creative and innovative as we would like. So, we kept the Agency for Clinical Innovation in place and we brought the Office for Health and Medical Research within a division of the ministry that I now lead. My role now is to orchestrate those connections and work with the system to ensure those innovations are used in clinical practice. It’s a fantastic role, and I feel blessed to be able to do that. I work with clinicians from all parts of medicine and healthcare, as diverse as surgery, oncology, respiratory medicine, and primary care and we have programs in all those different areas working with clinicians at trying to improve care for the population of New South Wales. We aim to contribute to implementation science and knowledge and try to share that experience and expertise with colleagues from other States and in other countries. It’s a bit of a challenge, of course, because I lead both a ministry department and I lead an organization that is at arm’s length of that structure. But, we’ve been innovative in the way that we’ve established things and it’s working out well.
“The indigenous cultures are very different as well. But, growing up in a remote community in the north east of Quebec, there were quite a few First Nation communities all around me. … And moving to a place where Aboriginal culture is extremely important I felt a very strong connection and it is something we want to continue to promote.”
DMacA: Let’s talk about something slightly different for a moment. I couldn’t think of a greater contrast than between the snowy lands of northern Quebec and the sunshine of Sydney. Tell us a little bit about the cultural and organizational differences you’ve had to adapt to.
J-F L: There are two very different countries and settings but, at the same time, they are very similar. I moved from a vast sparsely populated federated country with an indigenous culture and background and with extremes of temperatures to another one.
But they are not exactly the same. Australia and Canada do share many characteristics including extreme temperatures. It’s not the same, of course, but that connection with the climate is very important in both countries. The indigenous cultures are very different as well. But, growing up in a remote community in the north east of Quebec, there were quite a few First Nation communities all around me. I played ice hockey against some of those communities when I was a kid. And moving to a place where Aboriginal culture is extremely important I felt a very strong connection and it is something we want to continue to promote. Being in a State where we have to work with the national government, it’s not too dissimilar from a Province in Canada working with the national government and being a land of migrations with very diverse communities, all felt very similar. But, I arrived in a place where the health care system has some significant differences. In Australia, there is a private sector which has a very clear role to play and the public sector works in coordination with that sector as much as possible. In Canada, this is something that remains a topic of very active debate whereas in Australia it’s never in the news. It’s not something that people talk about that frequently although there are, of course, tensions between those sectors. It’s something that we work with here and I had to learn to understand that so that I would work in an effective way. Culturally, of course, there are similarities between Australians and Canadians. There’s no question but that there is a very welcoming feel to Australia similar to that we Canadians also offer to newcomers. I feel very welcome.
When I arrived here, I very quickly found myself on the news on radio and on TV, talking about the performance of the New South Wales healthcare system. And I felt – who am I, from northern Quebec, coming to Australia and looking at data, talking to clinicians, visiting hospitals and then saying, we’ve got issues here or this is working really well.
But the reality is that, despite my accent, everybody was absolutely understanding and I was I was told very quickly that Australia is used to accents, and yours is nice, we enjoy it, don’t worry about it. And there’s a there’s a simplicity and acceptance that I felt made it easier for us to come to Australia.
And, a little known fact- there is ice hockey in Australia. There is also snow at times and we have mountain regions where it can be cold with some snow. And of course, my family and I find different ways to reconnect with this, so that we can still enjoy some cooler weather. But it’s never quite, of course, like the Canadian winters.
DMacA: You anticipated my final question which is to ask you, how does that see chief executive of ACI relax?
J-F L: I’ve always been a musician so I’ve always kept playing music and that’s one of my go to places to relax. I’ve played classical guitar from quite a young age and this is something that has accompanied me through my life. So I play music and listen to music and that’s something that helps me to relax. But living in Australia now, there are walks on the beach with my wife which is something that we really enjoy. And walking in the beautiful mountains and forests around Sydney- the Blue Mountains are near to us. And I like to write which is also of the things that I do to relax. This all helps me to disconnect
DMacA: Jean-Frédéric, thank you very much for sharing so much of your life- your professional life and your home life with us. Thank you very much indeed. Merci à vous.
” I’ve always been a musician so I’ve always kept playing music and that’s one of my go to places to relax. I’ve played classical guitar from quite a young age and this is something that has accompanied me through my life. So I play music and listen to music and that’s something that helps me to relax. But living in Australia now, there are walks on the beach with my wife which is something that we really enjoy. And walking in the beautiful mountains and forests around Sydney- the Blue Mountains are near to us. And I like to write which is also of the things that I do to relax. This all helps me to disconnect”
Image from “Q&A – Lets Talk About the Healthcare Innovation with Dr Jean-Frédéric Levesque”https://www.youtube.com/watch?v=iFSjsVhSVuc
