Welcome to Transformational Thinking for Health Leaders. I'm Dr. Fiona Day, Master Practitioner Coach and Chartered Coaching Psychologist. This is a podcast that will help you meet your most complex leadership challenges and transform your perspectives, helping you to become a more effective and creative leader with a deeper understanding of yourself and your own world of work.

Reza Jarral is a primary care doctor who's passionate about democratising wellbeing for underserved populations. He's an NHS-trained GP and is currently based in New Zealand where he holds several roles including Chief Medical Officer at Care HQ and Clinical Director at ProCare, where he has facilitated the delivery of $750 million in public-funded community services since 2022. He is an affiliated scholar at the Centre for Digital Health at Stanford University, a postgraduate lecturer at Tech Futures Lab and a clinical entrepreneur at Bridgewater Ventures New Zealand.

In August 2025, Reza joins the Commonwealth Fund in New York as a Harkness Fellow in Healthcare Policy and Practice, which is an amazing piece of news. So congratulations, Reza, and welcome to Transformational Thinking for Health Leaders. Thank you so much for that kind introduction, Fiona.

So Reza, tell us about your journey from a self-described nervous medical student to leading several interdisciplinary organisations as an emerging leader and then to America as a Harkness Fellow. Well, it's been quite a journey and I think it's important to talk about a lack of confidence because not all leaders are born leaders. And I started as perhaps not the most studious undergraduate at Imperial College, but when I started clinical medicine, I already felt my calling, as I was called to deliver better impact for my patients.

And that was where I found my niche, where I was working with high-needs groups. So I started off in deprived communities in inner-city London. I've delivered care with agencies in sub-Saharan Africa.

And here in New Zealand, I've worked with a high-needs group, particularly the indigenous population in Auckland. And that really put me on a path towards leadership as I embarked on this growth mindset where I worked on my confidence and on my leadership and my ability to enact change within organisations and really tackled some of the bugbears that I had, which were mainly public speaking and communicating in front of groups to the point where I'm now able to engage in advocacy on behalf of my patients at the population level. I've been on live radio.

I've spoken to politicians and engaged with a high-level policy audience. So for me, over the past five to ten years, it's very much been about serving my patients. And it was that clinical exposure that was the catalyst towards leadership.

So it has been an amazing journey for you. And like you say, leaders aren't born, are they? It is something that you work towards. It's the journey of a lifetime. 

You never fully get there. It's something that we're always working towards. And I love how you refer there to growth mindset and your ability to keep learning and growing and moving towards where you want to go and how that's led you to then be able to work at the level that you're working at.

And I'm curious about where you're going to go from here too, but we'll come back to that. And so moving from the UK to New Zealand as a GP must have been quite a big transition too. And then once you got there, you moved into health technology and clinical leadership.

So just tell us a little bit about that specific time in your career, would you, please? Yeah. So pretty quickly after I completed GP training, within about six months, I made the move to New Zealand. And I'll be honest, it was just to follow a girl at the time who is now my wife.

So there was no real drive for me. There was mainly just to support my partner in her career. But what I found myself was in a clinical situation where I was relatively isolated from my family and from my colleagues.

So I had to start from scratch all over again in a new country. And it was a bit of a difficult time adjusting to practicing in a new country without your friends or your support networks. And sometimes I think it's the challenges that lead to great successes.

Sometimes you have to go through dark periods in your life or your career in order to have some really great moments. So I took the opportunity back in 2017, 2018 to think about what I wanted to do for the world and what my contribution would be. And I looked at that Japanese concept of ikigai, where you think about what you're passionate about, but also that overlapping Venn diagram of what you are competent at, what the world needs, and of course, what's viable in the sense that what you could be paid to do.

And for me, the no-brainer was health technology. I've always loved tech. I've built computers and done programming and made video games as a kid.

And as a doctor, I could see the impact of health technology being incrementally more impactful on my patients on an exponential level in the next 10, 20, 30 years. So I felt like if I was going to harness the potential benefits of technology for my patients, then I should be in a leadership position in order to guide the fair, safe, equitable delivery of that technology. And I also looked at the horizon and thought, well, there's risk of the digital divide getting bigger if I'm not involved and if we leave great innovations purely to private industry and don't see the benefits in public health care, then we could see a very two-tiered society.

So that led me on a whole pivot where I continued to practice medicine and primary care, but I also started to engage in health technology. And that was a really interesting journey, starting off from an entrepreneurial mindset, then going to a clinical leadership position, and then more into the future looking towards health policy. So it's really interesting as to how you, obviously it's very different, I guess, working in a different country clinically, like you say, but then how you kind of combine your interests with your passion and also your interests in democratising wellbeing and underserved populations and kind of being part of making sure that health technology was available to all and that didn't kind of cause additional health inequalities first and recognising that you had to then become a clinical leader yourself in order to have the kind of impact at scale that you were looking for as well.

That's a great story. Thank you for sharing that. And since you've been in New Zealand then, you know, in recent years, you've been working at the largest funder and provider of primary care.

So tell us a bit about this and what you've been doing during this role. Pleasure. So I've had the privilege of being the inaugural clinical director for health equity and strategic development at Procare.

So Procare is, I guess, like a funding for primary care services, a meso-level organisation within New Zealand's health system. And we cover primary care services for 850,000 people, including New Zealand's highest enrolled population of indigenous Maori people, Pacific Islanders and Asian population. So the challenges when it comes to tackling health equity gaps and promoting wellbeing across the board are really strong, but the opportunities to use the strength of a large organisation to deliver those population health goals is also really great.

And one of the fun things that I've been involved in at Procare is collaborative data sharing to drive precise population health initiatives to local communities. And I've been able to share, you know, our vast amounts of longitudinal data with local partners to drive house-to-house vaccination initiatives across COVID. And then at the national level, we were able to engage in research with the World Health Organisation to validate international tools for barriers to vaccination, validate them in the local context.

And that was a really fun trial to be a part of. And then internationally, we've been able to use our data as part of the global vaccine data network to promote the safety of immunisations and to tackle disinformation. So a lot of it has been about using that platform for impact for clinical research and innovation, but there's always been that focus on health equity.

That's really interesting work, isn't it, and how you've been then kind of getting involved in trials and how you've been using data and kind of this kind of collaborative cross-sector working that's kind of moving a little bit into kind of global health and learning around some of the public health interventions that you've been describing there. So it must be really exciting for you to have been taken part in all of that and I'm sure really impactful as well. And Care HQ then, this is a social impact focused telemedical platform and you've been growing that and using that in telehealth.

So could you tell us a little bit about that? And I believe you've also may have received an award, haven't you, around this? So yeah, tell us about that, if you would. Yeah, yeah. So New Zealand was probably about four to five years behind the UK when it came to telehealth adoption.

The sector was relatively reticent to it for various reasons, but as we all knew, the pandemic accelerated many digital adoption modalities and telehealth really took off in New Zealand. Over that time, I led the delivery of a national telehealth service that was designed to bridge unmet need and support primary care services, but crucially do that in a positive way without tackling the capitation payment mechanism, so without disenfranchising patients from their local doctor or undermining their local doctor by taking away their source of revenue. So we were very much there to serve the sector but also to serve patients and we were asked by the Ministry of Health to digitally engage high needs groups who typically don't use telehealth.

So that initiative was fun to be a part of. We designed a digital gateway that simplified access to a pool of telemedical services and simplified the payment as well. We also did some digital education material with cartoons and videos that we filmed with local communities and posters.

And then we launched the service and we saw a massive growth and uptake from our target audience, which were indigenous Maori people in New Zealand, Pacific Islanders, and socioeconomic quintile four and five, so the poorest people in our communities, up to 16 times. So that was a huge success. We saw great patient experience measures and outcome measures.

We presented our data and we were really grateful to receive the CIO Award and Digital Transformation Award that year. The service has since scaled quite significantly, so we've delivered over 120,000 consultations. And we've expanded subsidised care for high needs groups, including homeless communities, rural communities, aged care facilities.

And, you know, we're just getting started. There's a bright future for Care HQ. And that's a great story, isn't it, really, about how you use technology with these kind of underserved populations or perhaps have harder to access in terms of for them to be able to access telehealth.

And you've really kind of used that kind of mission that you had, that you'd set all of those years before around health equity and kind of really sort of seeing that draw fruit, I guess, and kind of happen in real life. And it's really inspiring to hear that because I was assistive technology lead in one of my public health consultant jobs. And when I arrived, there was a cupboard full of kit sitting in the cupboard.

And so kind of actually getting it out and getting it used, there's such a big gap, isn't there, between the kind of ordering the kit and it being used in practice and then particularly being used in a health inequalities context. So, yeah, really very well done for doing that. And I love how you described how you used the community in that and the cartoons and the videos.

That sounds like really great work that you were doing there. And I guess kind of sensing real thread of values for you in terms of how you lead. Reza, what would you say kind of are your own values and where they fit in terms of your own kind of professional compass here? Yeah, Fiona, there's a really beautiful proverb in Samoan, and I won't pronounce it in Samoan, but the translation is that the pathway to leadership is through service.

And I think that very much sums up my approach to leadership. I'm there to serve and enable the best possible outcomes with the tools available to me. And part of that value and that mission I think comes from my journey and my parents' journey and their parents' journey.

Both of my grandparents were born in small villages in the Punjab, and they came from a very difficult background. And from that humble beginning where my grandmothers were both illiterate and married off in their early teens, my parents were able to give me an enormous privilege to go to medical school and study in the UK. So I feel very much that my pathway to leadership is through service to support those who otherwise wouldn't be supported, and that's very much been the mission and the vision behind what I do.

In terms of the practical delivery of leadership in the clinical context, obviously my goal is to enable my teams to thrive and give them what they need to do what they do and reduce the barriers that they have in their daily life but also provide them with a sense of strategic vision and purpose. And I think it's really important as a leader to role model some of the activities and the values that you want to be seen across your team. So for me, there's lots of learning in leadership.

I think I'm very much at the emerging stage of my leadership journey, but keeping that vision to serve has always been my North Star. Leadership is about the behaviours that you demonstrate, what a camera and a microphone would see and record you doing, but the values are the guiding principle, the North Star, like you say, that underpin those micro and macro choices that we make in terms of our behaviours. And I can really hear how that service is really grounded in your own personal family history as well and how you're kind of manifesting that service in the work that you're doing.

So in terms of kind of thinking ahead then, Reza, thanks for sharing all of that, kind of moving into 2025 and going to Stanford, the intersection of digital health and behavioural science, a personal passion of mine as well. Tell us about your research and then perhaps after that we could talk about your Heartless Fellowship. Absolutely.

So I'm really excited this year to start a sabbatical period of research where I will be going to the United States to work with experts in the field of behavioural science and digital health. The drive to do this work stems from, again, my desire to advocate in the realm of technological enablement, particularly for underserved groups, but also looking at some of the key burdens that we're facing in healthcare today and non-communicable diseases, chronic diseases, some of the biggest clinical, economic and equitable challenges that we face in healthcare. So tackling that huge burden and that growing burden of chronic diseases is really important, particularly in the prevention space when it comes to healthy behaviours, eating well, moving well, smoking, alcohol, taking care of your mental health.

And in this research I'm really looking to explore where the intersection between digital modulators of behaviours might help us improve prevention in the wellbeing space. So whether it be wearables, mobile health apps, coaches, how can we utilise emerging technology to nudge people towards healthier behaviours. I think for many years healthcare has been behind industry in this respect.

Amazon, YouTube, Netflix all have a fine art of nudging us to do things that they want us to do, whether it be pushing us to add something to our basket, watching another video or another film. There are lots of sticky digital mediums that we use every day and I think my drive to action is in healthcare, why are we not using the same thinking, the same techniques in order to do good and to get better health outcomes at scale. So really lucky to be going to do that research in the US and extremely fortunate to have the support of the Commonwealth Fund with the Harkness Fellowship.

So yeah, amazing year that you got ahead of you here, haven't you? And congratulations again about the Harkness funding. So how was that for you, I suppose, the process of considering it and applying and then hearing the news? Just tell us a little bit about that if you would. Yeah, I would love to Fiona.

So I first thought about the Harkness about four years ago and it's an internationally well-known programme. It's considered a reverse road scholarship. So taking some of the highest talent in emerging healthcare leadership from around the world and typically what a country would send one individual to the United States to perform research in healthcare policy or practice.

And four years ago, when I looked at the application process, I thought that's not for me, it would be nice, but I don't do research and I'm not of the calibre that they want. I'm not a population health doctor and a public health doctor and I'm not a clinical academic scientist. But over the past four years, I've realised that if I don't do something like this, then who will? It has to be someone who is really engaged and invested in care delivery.

And I've gone from the front lines to a clinical leadership position. I've led some research myself, so now was the time to apply. The application process is very involved.

So these types of fellowships, things like the Fulbright and the Harkness typically will take around a year or more than a year from ideation to completion because you will need to go through many iterations of your documents and your proposals. You'll need to speak to dozens of stakeholders, people who have previously been successful, to understand what goes into a successful application, but also if you are successful, how to get the most out of it. And ultimately, it comes down to a high-stakes interview in front of a panel of very senior leaders, including those from the United States, and keeping your cool and sticking to your values and communicating who you are.

So I went to an in-person interview in Wellington at the Ministry of Health and I was sat at a table of the most senior healthcare leaders in our sector, including a panel from the United States, and we spent an hour talking. And two and a half hours later, I got a phone call from New York that said that I'd been selected, and it was just the most amazing feeling, Fiona. It felt like payback after years of really hard work and acknowledgement on a level that I haven't experienced before.

So if I'm honest, I'm still on the high. It's only been about six days since the announcement, so I'm still really enjoying the feeling. Yes, an incredible achievement for you, Reza, and so happy for you, and I'm sure you're going to really make the most of it and then use your learning wherever you go from here.

But congratulations, and thank you for sharing that. And like you say, it's not just the year of applying for it, it's the culmination of all of those decades of hard work that you've put in that have enabled you to have been that successful candidate at that time. And yes, really glad that they phoned you so quickly too.

That's wonderful, isn't it? They must have really wanted you to do the role. So really wish you all the best for this next chapter. It sounds, you know, things are really going to continue with that North Star around health equity that really kind of drives you and taking you in new directions.

And this is what I call serial mastery, like continuing to build on your skills and then taking them in a slightly different direction. But I really love what you just said there about if not me, then who is going to do this work? So it takes a lot of courage to put yourself out there and to put yourself through applying for something like this and to do all the things that you've done as well. So I just want to acknowledge you about that and wish you all the very best for this next chapter and into the future.

And thank you ever so much, Reza, for coming and talking with me today. Thanks so much, Fiona, and thanks again for having me. It's been a pleasure.

If you've enjoyed this podcast and would like to find out more, head over to www.fionadayconsulting.co.uk and you'll receive three hours of free CPD, the Health Career Success Programme, when you sign up to my newsletter. And there's loads of other resources to support you as a medical or public health leader on my website too. Thanks for listening.