Not surprisingly, plenty has been written already about leadership in healthcare during the COVID-19 pandemic. The biggest global crisis in a generation has shaken our healthcare systems to their foundations. Operationally and strategically, the dual challenges of providing treatment for a novel virus with no known cure while suppressing an alarming R rate has tested the abilities of senior leaders to their limits.
It is right that it should be this way. Sudden crises of the scale we have seen over the past few months tend to cause chaos, confusion and panic, which only serve to accelerate collapse. When there is a sudden surge in demand for hospital beds and ventilators that simply are not available in any given location, it takes strong, effective leadership to solve the logistical problems and find the required capacity somehow.
When PPE shortages start to bite and tired, overstretched staff start to become frightened about doing their vital jobs, it takes compassionate, emotionally intelligent leadership to listen to their concerns and find a way to put them at ease.
In other words, at the height of any emergency, good leaders prove themselves by how effectively they manage to hold an organisation together in the face of collapse. They may have to make difficult decisions, think quickly and intuitively, take risks and soak up collateral damage along the way. But as long as they steer their ship through the worst of the storm, they have done their job.
No one would doubt the achievement of any hospital or medical centre executive who could claim they had done as much once the COVID-19 outbreak is (hopefully) contained. But there is a school of thought that great leadership through a crisis goes even further. The very best leaders, some would argue, are able to look at a crisis as an opportunity for meaningful reform and improvement. Rather than settle for helping their organisation survive, they look at what needs to be changed to make sure history doesn’t repeat itself.
From Resolution to Reform
We are already seeing the idea promoted that COVID-19 can be used as a launchpad to resolve some of the long-standing structural and operational deficiencies of healthcare. Global analysts McKinsey & Co come up with a typically memorable five-step pathway for leading healthcare out of the crisis — Resolve, Resilience, Return, Reimagine and Reform. The first three steps we might define as crisis management, the latter two change management to achieve lasting improvements.
The New England Journal of Medicine, meanwhile, links this more specifically to the role of healthcare leadership, arguing that COVID-19 has exposed the weaknesses in information sharing across traditional healthcare organisations. In order to avoid being caught out in the future by the resource shortages and lack of end-to-end coordination that have characterised elements of the COVID-19 response, the journal argues that healthcare leaders need to start radically restructuring services and institutions to break down silos and improve communication.
But while these might be the goals of great leadership looking through the crisis and beyond, how is it actually achieved? What traits and characteristics will make great leadership stand out and help turn potential catastrophe into long-lasting reform?
What Great Leaders Do in a Crisis
There is a very informative commentary on this topic written by Dr Bandar AlKnawy and published by the British Medical Journal. Dr AlKnawy was the CEO of the King Saud Bin Abdulaziz Medical City in Riyadh, the Saudi Arabian capital, when an outbreak of another respiratory illness caused by a coronavirus — MERS-CoV — struck the institution in 2015.
Faced with a spiralling infection rate, Dr AlKnawy took the unprecedented step of closing the entire hospital and the university campus attached to it. What is fascinating about the article is that he connects his own personal reflections on the crisis facing him with a theoretical model for effective leadership “in extremis” devised from studies of military leadership.
What stands out for me from Dr AlKnawy’s analysis is that he is able to describe specific leadership traits and behaviours at different points in a crisis response. He proposes a broad two-phase model very similar to the one I suggest McKinsey’s five steps can be divided into above. ‘Phase 1’ is the emergency response itself, containing the crisis and minimizing damage. Then, after an intermediary period of learning lessons, planning new strategies and empowering teams, ‘Phase 2’ is all about “striving for transformation”, or “making sustainable changes towards excellence.”
For any healthcare leader facing the enormous burden of the COVID-19 crisis right now, Dr AlKnawy’s commentary reads like a handbook for what visionary excellence in leadership looks like — from a man who has been there and done it. At Phase 1, dealing with the crisis itself, he urges leaders to think decisively and be prepared to take risks, urging them at the same time to leave operational details to others so they are free to think strategically and keep the big picture in mind at all times. He reminds leaders of the importance of being visible at all times at the height of a crisis, taking responsibility and offering reassurance, and of focusing on clear, consistent communication both internally and externally.
In addition, Dr AlKnawy reminds leaders that they do not have to bear the burden entirely on their own, urging them to seek help as they need it. This includes involving your own people in the decision-making process, as not only will this further build trust through transparent communication, it will also help to secure buy-in to whatever courses of action need to be taken. The best leaders, says Dr AlKnawy, are never so proud as to assume they have all the answers.
Communication skills form the crux of the behaviours and traits recommended by Dr AlKnawy through Phase 2, where the objective now is to turn the lessons learnt from the crisis into permanent and lasting change. Again, he warns leaders to listen to all perspectives and not just surround themselves with consenting voices — if you get it wrong, shutting out dissent exposes flaws in your judgement. The best leaders want to get it right even if it means being challenged and proven wrong.
Finally, Dr AlKnawy acknowledges the inevitability of meeting some resistance to change. The best leaders address that through personal example — committing fully to the principle of change and working tirelessly to promote it. Once the initial urgency of the crisis starts to fade, appetite for change is likely to dwindle amongst those who take comfort in returning to the old ways. A leader’s role is to stand firm in the assurance that there is no way back — the only path is forwards.