Reflections on Leadership during the COVID-19 crisis

Reflections on COVID-19: What I learned from the pandemic crisis in healthcare.. #covid #healthcareleadership #crisiscommunications

As an expert , I saw it coming and yet I didn’t.?While I had a degree in emerging infectious diseases and I had taught emerging infectious diseases for public health and medical students for years , I too was taken aback. What would come to be known as SARS-CoV2 was a respiratory virus, not spread through close contact like Ebola. If there was ever an inkling in our global environment this could be locally contained, the virus was laughing at us. At my last conference before the shelter in place order in San Francisco, my clinical laboratory collaborator and I were lecturing on molecular diagnostics for SARS-coV-2 and the role of diagnostics in infectious diseases management. Our organization,had just experienced the first community acquired case in the United States the week prior. All the big tech companies had canceled their meetings. San Francisco was eerily quiet, restaurants and bars empty.?Little did people know what was coming. In hindsight, the “retrospectoscope” is 20/20. It was already there.

As the crisis unfolded, I learned a few lessons.

1.????Crisis leadership is not day to day leadership, requiring a different perspective and mindset

2.????Communication can make or break teams, particularly in times of crisis. Sometimes it has to break first, but lessons can be learned.

3.????Engagement of the whole organization needs to be from the ground up not just top down.

I summarize my thoughts on these three points below on crisis leadership.

When that first case hit so close to home, our new CEO had been in office around 9 months and our Dean for only 6 months.?Our CEO is a transformational and disruptive leader, who came in with ambitious goals to elevate ambulatory operations and focus on virtual care and the “hospital at home”. Our new Dean was tasked with revamping the medical student curriculum with a focus on diversity and equity. They had just started their journey as leaders, and culture change takes time.

It initially felt like there was a disconnect between the frontline healthcare professionals and the highest-level leaders-employees’ day to day needs became the frontline's primary concern over leadership’s broader strategy.?This was to be expected in a crisis environment .?Thus, there was an opportunity for a ground up approach to leadership.

Those of us on the frontlines are well suited to crisis leadership. In fact, in matrixed academic healthcare settings the frontline clinicians have a lot of autonomy and arguably could be considered the true decision makers.?Operating in teams, many of which are newly formed and change daily, taking charge, and making quick decisions with limited information are hallmarks of emergency medicine.?One example was securing PPE for frontline safety.

Exceptional leaders need to develop and communicate vision, and loyalty is slow to establish and quick to lose. Our organization benefits from great expertise and motivation, where physicians and nurses on the frontlines can lead culture change and focus on day to day needs while leaders at the top focus on transformation and global strategy.?

Lessons learned from COVID-19 t with continued confused public messaging are that communication from the top should be crystal clear and unified, while lines need to be open to allow conversation so the frontline understands and can execute the strategy.?

The frontline are the true decision makers in a matrixed academic healthcare system who can facilitate strategy execution. Collaboration and communication in large matrixed organizations will always be a challenge but should be part of the overall organizational strategy not just in crisis times but in periods of stability and growth.