Dr David Barrett, Programme Director for the MSc in Healthcare Leadership, explains how the COVID-19 pandemic has highlighted the importance of leadership and management in healthcare, and how we can find leaders in all areas of healthcare provision.
COVID-19 as a 'wicked' problem
The COVID-19 pandemic is widely viewed as a ‘wicked’ problem (Schiefloe, 2021) – one that has wide-ranging implications for multiple parts of society, in which one response may have unintended consequences elsewhere, and where there are few (if any) ‘right or wrong’ decisions – only ‘better or worse’ (climate change is another example of an ongoing wicked problem).
We have seen the ‘wickedness’ of COVID-19 throughout the crisis: for example, societal lockdowns may reduce spread of infection, but have catastrophic consequences for economies, for businesses, and for the mental health and wellbeing of many.
Wicked problems are complex, fast-moving and impact on organisations within multiple sectors. The response therefore needs to be coordinated, coherent and consistent across these different parts of society.
We have seen extraordinary efforts from all healthcare workers to deal with the ‘sub-crises’ that have punctuated the course of the pandemic, from shortages of personal protective equipment, to extreme pressure on critical care bed availability, the need to expedite vaccine roll-out and managing the possible impact of virus variants.
The responses to these challenges have required coordination, planning and implementation at pace, which is where we have seen the importance of healthcare leadership come to the fore.
Where do we find healthcare leaders?
Leadership in healthcare can be found in all areas. There are some who lead because it is a specific element of their role – these could include Medical Directors, Chief Executives, Lead Nurses, Laboratory Managers or Team Leaders, and could be seen as formal leaders.
However, there are many within healthcare who may not hold a formal position of authority but whose leadership qualities emerge through their behaviours, their actions, and their interactions with others – so-called informal leaders (Pielstick, 2000).
Leaders are found at different levels of healthcare systems, whether ‘Macro’ (e.g. setting healthcare policy or coordinating global and national responses), ‘Meso’ (Healthcare organisation or community level) or ‘Micro’ (individual clinical teams and patient interactions) (World Health Organization, 2002).
We also find leaders within different disciplines and with different ‘badges’ – such as clinical leaders, medical leaders, scientific leaders, nurse leaders, organisational leaders, policy leaders and even political leaders – all contributing to the COVID-19 response.
Healthcare leaders can be found across disciplines.
The challenges of COVID-19 (and how leaders have met them)
Whether formal or informal, wherever they sit within the system, and whatever their discipline, healthcare leaders have displayed incredible skills, innovation and resilience throughout the pandemic.
They have had to demonstrate creativity and flexibility to deal with having to “make faster decisions, with more information, and less clarity” (Lobdell et al, 2020). They have had to protect the health and wellbeing of their staff and patients, whilst adapting to the requirements of rapidly changing circumstances, policy and clinical evidence.
So how have they got through this? In his reflection on leadership during the early stages of the pandemic, James Stoller highlighted how key drivers of success during this period included proactivity, adaptabilty, clear communication, and attempting to instill a sense of optimism, even when challenges seem insurmountable (Stoller, 2020).
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The importance of management in times of crisis
In addition to these characteristics of successful leadership, it is important to not overlook the need for management throughout this crisis.
Visionary, inspirational and proactive leadership has been critical to the COVID-19 response, but in the midst of a pandemic, people also crave tangible outcomes – sufficient PPE, a high-quality test and trace system, efficient utilisation of limited hospital bed capacity, rapid roll-out of vaccinations – that derive to a large extent from effective management.
Where leadership stops and management starts (or vice versa) has always been a cause of lengthy academic discussion, and is encapsulated by Warren Bennis’s ‘12 differences’ between the roles (culminating in the oft-quoted statement that “The manager does things right; the leader does the right thing” (Bennis, 1989; p7)).
Regardless of the differences between the two roles, the challenges of this pandemic have required our managers to lead, and our leaders to manage.
COVID-19 as a catalyst for change
A cornerstone of leadership and management is the implementation of change. Crises such as COVID-19 act as powerful catalysts for change, with leaders needing to innovate and take risks, and their followers more accepting of new ideas, practices and systems.
John Kotter – an authority on the process of implementing change – has long highlighted that prerequisites of successful change are a sense of urgency and low levels of organisational and individual complacency (Kotter, 2008).
Healthcare has never before been through a period where the sense of urgency was so high and feelings of complacency so low, and we have seen the impact of this in the pace with which changes in practice have been implemented successfully.
As we move out of the pandemic, leaders will have the opportunity to review changes that were made, identify those that will bring long-term benefit, and embed these in normal practice.
Kalina (2020) highlighted how, post-pandemic, healthcare can continue to benefit from the enhancements in remote working, greater acceptance of technological solutions, reduced reliance on physical estate, and more effective utilisation of resources.
Learning the lessons of COVID-19 to build better healthcare in the long-term
COVID-19 has killed millions, affected billions and cost trillions. It has touched all parts of the globe and had an impact on healthcare, on society and on the economy that will be felt for decades to come. Like all things though, this pandemic will pass.
As we move through the coming years, healthcare leaders will need to focus on supporting colleagues, organisations and systems as they recover from an unprecedented period of pressure. However, they will also benefit from working with teams who are more accepting of change, more resilient, and more able to rise to whatever challenges they face in the future.
Ahern S, Loh E (2020) Leadership during the COVID-19 pandemic: building and sustaining trust in times of uncertainty BMJ Leader Published Online First: 30 September 2020. doi: 10.1136/leader-2020-000271
Bennis W (1989) Managing the dream: Leadership in the 21st Century. Journal of Organisational Change Management 2(1): 6-10
Kalina P (2020) Resilient and inclusive healthcare leadership: Black Swans, COVID‐19, and beyond. The International Journal of Health Planning and Management. 2020; 35: 1611– 1613. https://doi.org/10.1002/hpm.2983
Kotter JP (2008) A sense of urgency. Massachusetts, Harvard Business Press Lobdell KW et al (2020) Improving Health Care Leadership in the Covid-19 Era. NEJM Catalyst: Innovations in Care Delivery. June 4th 2020: doi: 10.1056/CAT.20-0225
Pielstick CD (2000) Formal vs. Informal Leading: A Comparative Analysis. Journal of Leadership Studies. 7(3):99-114. doi:10.1177/107179190000700307
Schiefloe PM (2021) The Corona crisis: a wicked problem. Scandinavian Journal of Public Health. 49(1):5-8. doi:10.1177/1403494820970767
Stoller J. K. (2020). Reflections on leadership in the time of COVID-19. BMJ Leader https://doi.org/10.1136/leader-2020-000244
World Health Organization (2002) Innovative care for chronic conditions: Building blocks for action. Available from: https://www.who.int/chp/knowledge/publications/iccc_ch2.pdf