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How to lead during COVID


A pandemic has challenged health care leaders like never before. Here’s how to get your team through it.

Nothing tests someone’s leadership abilities like a crisis, and the COVID pandemic has pushed health care leaders to extremes they could have never imagined. Shortages of PPE, massive revenue losses, and a general fear of the unknowns about the virus challenged leaders at every level. From the smallest practice to the largest health care system, leaders had to navigate their teams forward while trying to keep everyone safe, and many lacked the training they needed to succeed.

Christopher O.L.H. Porter, Ph.D, professor of management at the Indiana University Kelley School of Business and the physician MBA program faculty chair, spoke with Medical Economics about crisis leadership and what effect COVID has had on managers.

Editor’s note: The transcript has been edited for clarity and brevity.

Medical Economics: What specific leadership challenges have emerged from the COVID-19 crisis?

Porter: One of the most basic ones is this completely changed the way we do work. The way we interact with one another, has been flipped upside down. We've gotten closer to our coworkers, in some respects, even though we're in many cases are more distant from them. But we've also seen changes in the way that people relate to their employers and what they expect from their employers. And that's really created some strain.

Medical Economics: Are there common mistakes you see leaders making during the pandemic?

Porter: Part of the answer goes back to some of the challenges that leaders are facing. You have to understand that organizations have gotten increasingly more complex as a result of COVID. The goals that organizations are pursuing and that people within the organizations are pursuing have changed quite a bit. Organizations are worried and focused on survival in ways that they didn't think about in the past, employees are worried about their safety and their health and the safety of their families in ways that they never thought they would have to when they went into their profession. So those are not addressing the fact that there are these divergent goals to do a good job at work, but at the same time, stay safe and stay healthy, is certainly a mistake that some leaders have made.

Leaders have also made mistakes by not addressing the emotional toll that this pandemic has had on their employees. The challenges that people are facing at work are certainly spilling over into what's happening in their lives outside of work, and so leaders have to address that. Another mistake that a lot of leaders have made has been inaction. You can't sit back on the sidelines and let this pandemic happen. You've got to act, you've got to be swift, you've got to be decisive. To the extent that leaders have been dishonest with people, and not been upfront about the nature of the threats, and the plan for dealing with the threats, that's certainly a huge mistake. Leaders have also failed to explicitly look for opportunities to learn throughout this crisis and assure their employees that they are going to do what's necessary to avoid repeats of some of the problems they're currently experiencing. That's certainly a mistake. But I would be remiss if I didn't point out that one of the biggest mistakes that leaders have made as it relates to this pandemic is not anticipating this pandemic. A good leader is always thinking ahead. A good leader is always asking what's the worst that could happen? What should we be prepared for, and trying to think outside of the box. And if healthcare organizations found themselves in the midst of this pandemic and did not have a plan for how they would deal with a potential pandemic, then that mistake is a tough one to recover from.

Medical Economics: Are there questions leaders should be asking themselves during the COVID crisis?

Porter: One is, what are we doing well, so they can build on those successes. But they've got to be honest, and they've got to ask themselves, what they're not doing so well so they can find opportunities for improvement. Again, it's so important to make sure that you're not repeating the mistakes of the past. It's also important for leaders to ask what their staffs need. It's always interesting to me—I work with lots of leaders and potential physician leaders in our physician MBA program—and many physicians make the assumption that they’re leaders simply by the very nature of the jobs that they do. And it's true, that they are oftentimes looked at as leaders and they take charge dealing with medical emergencies and crises. One of the things that they oftentimes overlook though, is the importance of dealing with the people who work with them, supporting them, encouraging them, motivating them. And that's a problem. Leaders should be asking themselves, what needs do their people have that they haven't addressed that they could potentially address?

Medical Economics: How important is it to have a leadership team to help you during a crisis?

Porter: Having a leadership team in place during a crisis is critical. If you think about it, how often do we get it right when we go at it alone? Rarely do leaders find success when they're working in isolation; you really do have to have a group of people around you who support you, and who can help you make the best decisions. This crisis pointed out that there are too many things for leaders to do for them to try to handle it alone, so they should not work in isolation for that reason. And then the other thing that's important to keep in mind is that good ideas are distributed throughout the population. Leaders should not be seen as the sole source of ideas and remedies and solutions. You put people in place around you who can help you get where you need to go.

Medical Economics: What's the best way to build a team with the appropriate skill set and diversity during COVID?

Porter: COVID has presented some unique challenges for developing, forming, and cultivating teams that are likely to be successful, but a lot of what we know about good team formation and development, we've known for a long time, and it will certainly apply to this crisis. It's certainly important for leaders to gather the people who they trust and put those people on their teams. But I think even though it's counterintuitive, I think it's also important for leaders to make sure that some of the people on the team are not necessarily the people they're the closest to, but the people who can be candid with them. That way they can avoid blind spots in their thinking and in their decision-making. I also think that it's of the utmost importance that leaders make sure that their teams consist of people from all levels of the organization. And I think this is especially important in a crisis situation, because it's oftentimes the people who are in the trenches that know what's working and what's not working, and can see problems that are on the horizon.

Any good team to help with crisis management should be diverse in the sense that you pull from people from throughout the organization, and then the other thing that I would recommend leaders do in terms of their thoughts about team composition, is make sure that they're engaging in the sort of boundary spanning that we know actually helps teams to be successful. So in other words, all of my sources of information shouldn't necessarily reside from within the organization. I, as a leader, should be able to look out at other organizations who were dealing with the same problems that I'm dealing with, and look to them for insights about what's working and what's not working.

Medical Economics: Why is it important to monitor the staff’s emotional needs during a crisis? And what effect should that have on your response?

Porter: Well, as it relates to people's emotional needs, and the need for leaders to pay attention to those emotional needs, we know that when people are suffering at work, that can have an impact on their performance. And we also know that what happens at work doesn't necessarily stay at work. There's an interesting interface between what happens at work and what happens in non-work settings. And we oftentimes see spillover of both positive and negative events that happen at work when we have successes at work that can affect us outside of work, as well as when we're in the midst of defeats and losses at work that spills over and affects us at home as well. And that can tend to be too much for employees, which again leads to things like burnout, high levels of stress, and it can undermine their performance, it can cause them to be more susceptible to making mistakes, and then ultimately, it can affect turnover.

Medical Economics: How should physician leaders balance achieving normal day-to-day organizational goals and just getting through the COVID crisis?

Porter: This is a tough one. There is a balancing act, but it can be done successfully. Part of what has to happen is that organizations need to have a team that focuses on the now, the present, but they also have to have a team in place that's going to focus on what life's going to look like after this crisis. Perhaps those teams are separate teams, but they do communicate with one another. Survival is certainly paramount. As I mentioned earlier, organizations that never would have thought that they would have to worry about their survival, all of a sudden are wondering if they're going to be around in 2021 and 2022. So survival has got to be at the forefront of leaders’ minds and crisis management teams minds—how do you just simply get through this crisis. But at the same time, I think it's critical that leaders articulate a future vision of what a future is going to look like; employees need to hear that they know that they're in the midst of a crisis now, but they need to know there's something good on the other side.

Medical Economics: Is effective planning possible during COVID when so many things are changing on a daily basis?

Porter: This is another one that's extremely tough. But it is possible to plan for a future post-COVID. One of the things that has to happen is you have to look at examples from outside of your organization and what people are doing well, and sort of envision what that future might look like. At this point, there's not a leader of a health care organization who shouldn't be thinking about their future and making some plans about that future. And so as we look at trends—different states can see what's coming, hospitals can see what's coming—and they can start making some plans in terms of their equipment and their people.

Medical Economics: Are there communication strategies that work best during a crisis that leaders should be employing?

Porter: There are several effective communication strategies that I think good leaders should be utilizing right now. I think it's important for leaders to be present, and to be timely. This is not the time for leaders to be not seen by their employees. You've got to be around; you've got to be there. It’s critically important that leaders are honest and don't spin. Employees are savvy enough to see through spin, and we're in a time where a lot of employees don't know who to trust. Again, they're getting closer to coworkers, because they're going through this external threat, and they're going through it together. But leaders who aren't around are leaders who are not going to be trusted by those employees.

It's also important to make sure that you're communicating a plan of action, and thinking about and talking about what the future is going to look like. People need to hear that there's a future for their organization, especially at a time where so many people are experiencing layoffs within health care. So talking about a future, a future that includes that employee, would be incredibly important. Certainly leaders need to be sensitive to everybody who's affected, and they need to make sure that they're focusing on those who are affected and not themselves. It's also critical that when you are talking to your employees, you're doing the best you can to articulate a message that's consistent, and not with conflicting ideas, and give them consistent information.

I would also say that it's really important to understand that because of the emotional toll that this crisis is having on employees who are in the trenches, all those frontline workers, that information has to be delivered in bite-sized chunks. I think it would be detrimental to you to present for an hour to a group of people who are emotionally exhausted. You've got to break things up into meaningful, but digestible, chunks of information. And the other thing I would add is that it's important that leaders don't make excuses for their organizations. Don't make excuses for themselves and don't make excuses for their actions. They need to just simply focus on what the future is going to look like and how they're going to be better as a result of getting through this crisis.

Medical Economics: How should leaders communicate bad news during COVID, which could range from having to layoff colleagues to the death of a co-worker?

Porter: It's a sad question to have to answer, but that's the reality of this crisis. When you're delivering bad news, whether it's about the state of the organization, whether it's about coworkers, it's important to make sure that you're truthful. Again, spin is one of the worst things that a leader could do in a crisis situation because you just undermine trust among employees. So I certainly think that being truthful is important. But while you're presenting unfortunate or disappointing news, it's important to make sure that your vision is one that's positive and that you're sharing that with your employees as well.

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Jennifer N. Lee, MD, FAAFP
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health