Dr. Theresa Jacques on leading in the ICU on the pandemic frontline

‘It took lion’s strength’: Dr Theresa Jacques on being a leader in the ICU on the pandemic frontline

Dr. Theresa Jacques

Associate Professor Theresa Jacques has been a leader on the frontline of the Covid-19 pandemic in the Intensive Care Unit at The St George Hospital, a role she says took “lion’s strength”, patience and understanding.

Yet, amongst her team, she describes how there was still a “joy of working together.”

Dr Jacques has recently retired, but has had a career of varying leadership roles within the healthcare system, and has been acknowledged through awards like Westpac 100 Women of Influence and Top 50 Women in NSW Public Sector.

She was the Director of Intensive Care at The St George Hospital and experienced the first-hand clinical implications of the Covid-19 virus. 

Pandemic preparedness was vital to the acute response and hospital management that Dr Jacques worked through during Covid and she regards her efforts to “future proof”, the ICU in advance of the pandemic as one of her biggest leadership contributions. 

As Head of ICU and Chair of the Medical Staff Council at St George – before significant mention of Covid-19 entered into the news — Dr Jacques engaged senior medical staff and the hospital’s local community to rapidly rebuild the ageing infrastructure of the ICU and other acute services. She was met with opposition and doubt at all levels and yet, in 2017, the new ICU at St. George opened with an isolatable ward and single rooms that were fit and ready for the upcoming pandemic in 2020.

Of course, Dr Jacques couldn’t have seen into the future to know just how imperative her leadership would turn out to be, she simply had an unwavering determination to deliver the improved facilities she felt her patients deserved. 

To hear Dr Jacques reflect upon this leadership and her experiences over the last 2 years, you can register for the upcoming event, Women in Leadership and the Covid-19 Response, put on by Franklin Women, where Women’s Agenda co-founder, Angela Priestley, will be in conversation with Jacques and four other women who’ve led on the COVID response.

Below, Dr Jacques shares some of the most rewarding parts of her work in the ICU, the importance of women in leadership positions and her advice for women looking to make big things happen.

Congratulations on your retirement as Head of Department in May 2021! What has been most rewarding about working in and mentoring others in the ICU of the hospital?

32 years is a long time so I’ve seen 100’s of my trainees go on to bigger and better things. They are scattered globally. Many stay in contact and seek support and advice on the challenges they face : getting jobs, balancing work with home life, deciding to start a family…. Not so long ago a female trainee originally from overseas and faced struggles to settle in Australia, rang me several years after working directly with me to thank me for support and mentorship during her training years and ongoing support culminating in her finding the job of “her dreams. The happiness in her voice, her recollections of our conversations and her passion for ICU, these joys are my biggest reward.

Can you describe how and why you called on your networks to enact change for women in the Intensive Care Unit (ICU)?

Over the years I have used my personal networks to assist younger female staff gain more senior employment or take on senior leadership roles or undertake training or attend scientific meetings. The latter two usually involved financial support through funds I’d managed to squirrel away in trust accounts for that purpose. A few years ago, pre-pandemic, Dr Nhi Nguyen and I started the Women In Intensive Care NSW network, with an emphasis on having fun, getting some life skill experts to speak to us, and catching up with colleagues to share experiences. It was eye opening and one realised one was not alone in covert gender bias experiences. WIN is now more formal and under the national society (ANZICS) umbrella.

During the pandemic I participated in the ICU community of practice network, a fantastic support network for ICU’s across NSW. This network is led by women, Dr Nhi Nguyen and Ms Linda Williams. Their care and support for struggling ICU;s has been fantastic. I have observed an increasing confidence and comfort of male ICU directors ( the majority)  in female leadership through the pandemic. Through this network and my personal contacts I was able to raise concerns about the quality and supply of PPE equipment. Locally, I had the confidence to speak up about tiring rosters where others did not feel so comfortable. 

In what ways did you see women’s leadership in the Australian COVID-19 response become vital to better community health outcomes?

I again refer to the Ministry of Health ICU Community of Practice leadership. Nhi and her team at the Agency for Clinical Innovation (ACI) are the key to the ICU response to Covid. They are the link between us and administration and politicians. And with Omicron b4 &5 ramping up their work is not done. They remain after so long approachable, understanding and action oriented. 

The Nurse Leaders subgroup of the ACI ICU executive, led by women, was a network established well before the pandemic. Their organisational skills are exceptional. They supported smaller ICU’s through the busiest times of the pandemic, sharing protocols, nursing workforce support and education. I have no doubt they were pivotal in the success of the NSW ICU Covid response. 

Another example of great female leadership at a local level comes to mind. Our Director of Medical Services is female, and has military training. She has had to work round the clock solving the unsolvable. She has engaged senior medical staff who have willingly “pitched in”, she has supported the hospital wellness initiative and in spite of lurching from meeting to meeting always manages to get back to individuals. Her weekly bulletins to staff are comprehensive and human. She knows maintaining our health workforce is vital for community outcomes.

Have you seen the pandemic change typical leadership hierarchies for women who want to have their innovative ideas heard and acted upon?

There have been opportunities for women to step quickly into newly created pandemic response leadership positions in NSW. There is no doubt in my mind that the daily appearance before the media of a woman, Dr Kerry Chant, NSW Chief Medical Officer, patiently answering questions and providing advice during the height of activity, has helped the public adjust to more women in leadership roles. Her daily appearances became reassuring and were quickly reinstated after protests when they were stopped for a short period.  

While making big impacts for others by managing clinical cases and hospital protocols, what steps, if any, did you take to prioritise your own health and mental wellbeing?

Working in the Covid area caused me great anxiety. I feared for my family when they could not get access to vaccines. I was isolated from them for a period including 2 weeks over Christmas 2020 and New Year 2021 due to a Covid exposure. Thank goodness for “whats app”. Coping strategies included never missing my morning latte and exercise. Something I stuck with throughout was attending “boot camp” at Bronte Beach – watching the sunrise while doing virtually supervised kettle bells and skipping ropes was sustaining. A group of women around 60 years old (The Goldies!) supported each other, at a distance,  to turn up and exercise. In fact. I think I was a more regular attender during lock down as I didn’t want to let the Goldies down! 

What have you learned about yourself and your leadership style over the past couple years?

In addition to the pandemic I was going through a transition from head of Department to senior clinician. I had to stop trying to “fix things” for everyone and support others in finding solutions. I’m empathic and picked up on staff distress in the Covid pod. I enjoy helping trainees in ICU and in spite of all the Covid challenges I love my clinical work. With the various leadership roles I’ve had I can consider “the big picture” and understand the challenges of health care provision across the state. When the pressure was extreme I learnt more about what my “triggers” were and worked hard at letting them “go through to the keeper”. I suffered moral distress when I couldn’t do what I would normally do for patients and their families. I didn’t realise how tired I was until I went on long service leave. The first month was devoted to recovering from the exhaustion and getting back to living normally. Exhaustion, anxiety and burnout are increasing among health care workers as the Covid pandemic continues.

What advice would you give other women looking to push past stereotypes and become leaders in the health and medical research sector?

Keep pushing, don’t get angry or dwell on the still occurring unconscious bias but call it out tactfully when you come upon it, have at least one mentor and preferably more to cover the various aspects of your career and life. And undertake leadership courses too – there are some great ones e.g. Harvard Mediation and Negotiation, Dealing with difficult people, The ASUM Executive Leadership for Women course. Don’t be afraid to acknowledge you can’t do/be everything and let some things go. But never let go of your “me time” and never feel guilty about spoiling yourself from time to time. Now my children are adults, I realise how proud and tolerant they are of their mum so don’t worry so much about the impact of your ambitions on yours– include them!

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