Healthcare leadership in times of crisis

COVID-19 was one of the biggest crises faced by the healthcare industry in recent years. It tested healthcare systems, governments and political leaders worldwide. And to everyone’s surprise, everyone fell short, and there were massive deficits in communication, flexibility, preparedness and even leadership.

The pandemic not only threatened people’s lives worldwide but also impacted economies, people’s privacy and freedom. Each country responded differently to the crisis, thanks to failing global supply chains, the spread of misinformation from the media, and political players trying to one-up each other.

Combined, all this impacted how the healthcare industry responded to the COVID-19 pandemic. Healthcare professionals faced ethical dilemmas, and they were under a great deal of emotional stress. Nevertheless, the pandemic has allowed healthcare organizations to learn from their mistakes and work to face future challenges in a much-improved way.

Effective leadership in times of crisis

During times of crisis, such as the COVID-19 pandemic, the importance of strong healthcare leadership becomes apparent. The decisions made by healthcare leaders can have an overwhelming impact on the outcomes of the crisis. Effective healthcare administrators are key in guiding their organizations through uncertain and challenging times, making informed decisions and ensuring the safety and wellbeing of patients and healthcare workers.

Politicians may not support the tough decisions required in the crisis as it may affect their political careers. It might be most challenging if the mortality rates are high and the effectiveness of the treatment options is not guaranteed. To overcome the politicians’ shortcomings, healthcare administrators need to be proactive in their roles and make the best possible decisions for the safety of everyone.

Decision making lies at the core of good crisis leadership. Leaders must make the right decisions at the right time, even if those decisions are difficult and unpopular. Their ability to effectively communicate these decisions and convince their workforce and constituents of their rationale is paramount. Setting clear goals, establishing optimal communication channels and ensuring progress in the planned direction are key components of effective crisis leadership.

Leaders must be willing to take risks and make timely decisions in the face of uncertainty, as it may be the only opportunity for success. They must first recognize and accurately assess the problem to make the right decisions. This may involve utilizing risk management tools, such as likelihood/severity matrices, to evaluate the potential consequences. Decision making must incorporate the best available evidence. However, most people naturally delay decisions or downplay the magnitude of problems due to cognitive biases.

One case considered to be a case of good leadership and crisis communication was New Zealand’s response to the COVID-19 pandemic. The government provided its population with a clear, stepwise plan to address the pandemic. Former Prime Minister Jacinda Ardern’s leadership and effective communication contributed to minimal deaths from Covid in the country and her own overwhelming victory in the country’s general election 2020. This showcases the importance of clear communication and setting expectations during a crisis.

Another critical skill for effective healthcare administrators is situational awareness. It is an ongoing process that requires continuous analysis of the environment and circumstances. As Helmuth von Moltke famously said: “No battle plan survives contact with the enemy.” Healthcare leaders must adapt strategies based on new information and redirect their efforts accordingly. This type of leadership is known as ‘adaptive leadership.’ It involves anticipating future needs, articulating those needs to build understanding and support, adapting responses based on continuous learning, and being accountable and open to changes and feedback.

Mistakes are inevitable in crises, but effective healthcare leaders see them as opportunities for improvement and productive action. Instead of assigning blame, healthcare leaders must stay focused on the ultimate goal and learn from their mistakes. The population and community’s belief in healthcare professionals and leaders is critical, as a lack of trust can undermine crisis management efforts. Leaders and their situational analyses may differ, resulting in varying timing of supported decisions and measures. For example, South Korea took early and effective actions against the COVID-19 pandemic based on its experience with the Middle East Respiratory Syndrome (MERS) epidemic. At the same time, countries like the United States and Brazil reacted late and with less severity.

Caring for employees during the crisis

In times of crisis, healthcare workers face increased pressure and disruption in their personal and professional lives. Healthcare administrators and leaders must prioritize the well-being of their workforce. It involves providing guidance, training and necessary equipment for personal protection. Hospitals must revise staffing and roster models to minimize exposure and ensure sufficient availability.

Healthcare workers bear the brunt of mounting pressure within their professional environments during any crisis or situation similar to the pandemic. If the number of patients increases and there is an escalation in the risk of exposure to potential harm, frontline workers are the most at risk. Canceled holidays, extended shifts and difficulties adhering to maximum work-hour regulations become commonplace. Moreover, when fellow healthcare workers or colleagues succumb to the healthcare crisis and require medical assistance or, tragically, lose their lives, the burden on these frontline workers becomes even more pronounced.

Employers and healthcare administrators must proactively recognize their workforce’s heightened susceptibility to disease transmission. Ensuring the provision of guidance, training and personal protective equipment is pivotal in maintaining confidence and preventing cross-contamination. Additionally, healthcare administrators must reevaluate staffing and roster models during an ongoing healthcare crisis. They must plan and allocate sufficient resources in advance if the duration and impact of the crisis are uncertain. It will help safeguard the community and maintain the continuity of the service, even in the worst-case scenario. For example, healthcare leadership and administrators can tailor staff rosters to align with the epidemiological characteristics of the pandemic. It will help to mitigate critical shortages in intensive care staffing.

Continuance of hospital services in times of crisis requires careful consideration and extensive communication. These measures will ensure that the workforce is informed and capable of effective performance. Healthcare administrators must collaborate with labor unions to prevent unnecessary opposition — this is critical as it can be particularly hazardous during such a crisis. It is imperative to emphasize that any temporary infringement upon employee rights must be justified. After the pandemic, employers must also be held accountable for their actions.

Although remote work is a viable option for most professions, working remotely in healthcare can be very challenging. Healthcare workers must be available at the frontline, and an adequate on-site workforce is essential for seamless healthcare service provision.

Healthcare professionals are at higher risk and should be allowed to work from home or assume alternative roles that minimize exposure. However, healthcare administrators must acknowledge that managing remote teams necessitates distinct management skills. It can be difficult to manage everything remotely. Maintaining efficiency and productivity requires heightened trust and potentially increased technical resources while imposing unique stresses on the remote healthcare worker. The healthcare leadership team will also need to manage the responsibility of increased technology costs. For instance, a court ruling in Switzerland mandated that employees be compensated for using their own infrastructure.

Healthcare professionals may face ethical dilemmas when they must make difficult decisions about allocating scarce resources and balancing treatment options. Doctors and nurses may find themselves in new territory in the face of a rapid admission of critically ill patients and the unavailability of resources such as hospital beds and ventilators. It is especially true for healthcare professionals working in acute care settings, such as emergency departments and intensive care units. Healthcare administrators must offer adequate training and education to professionals in these roles. In normal circumstances, healthcare professionals provide optimal care to every patient treated. However, during a pandemic or healthcare crisis, making agonizing choices regarding treatment allocation may become necessary, inevitably necessitating the denial of care to certain individuals.

Ethics and the impact on healthcare workers

Healthcare administrators and leaders must strive to uphold the four principles of medical ethics: autonomy, non-maleficence, beneficence and justice. These can also exert tremendous emotional pressure on healthcare workers.

The Swiss Academy of Medical Sciences, in collaboration with the Swiss Society of Intensive Care Medicine, published national guidelines in March 2020 to alleviate this ethical burden and uphold public confidence in medical institutions. These guidelines prioritize the potential benefit of intensive care therapy, regardless of age. These guidelines have gained widespread acceptance in practice, although they are criticized for not respecting patients’ wishes fully.

In contrast, the guidelines from Italy focus more on years of life expectancy saved. Irrespective of the strategy healthcare administrators and political leaders selected, a framework of clear and universally accepted guidelines is paramount for frontline healthcare workers. Timely communication of sound guidelines by medical and scientific societies can help prevent any misinformation spread by myriad individuals interested in conveying their agendas to the public.

Leaders must proactively offer many resources and strategies to support healthcare employees in building resilience and coping mechanisms. It starts with effective communication strategies and extends to the fast development of required guidelines by healthcare administrators. Moreover, it is necessary to set up safe and open feedback channels to foster a positive learning culture throughout healthcare organizations.

Healthcare administrators prepare for any crisis

Healthcare administration and leadership play a crucial role, particularly during healthcare crises such as a pandemic. Effective healthcare administrators are essential in navigating the challenges and complexities of these situations.

To become effective healthcare administrators, aspirants can choose a masters in health administration online degree from a reputable institution such as the University of Ottawa’s Telfer School of Management. The online Telfer EMHA is an executive-level program requiring a baccalaureate degree and at least five years of management-related work experience. This unique program at the Canadian university combines healthcare with business management. It will teach the knowledge and fundamentals of healthcare and management, which are essential for becoming a well-rounded leader and administrator in healthcare.

In the initial wave of a healthcare crisis, hospitals face an overwhelming and rapidly escalating workload. To meet the growing demand, they must swiftly mobilize all available resources, such as retired workers, students and personal protective equipment. Additionally, healthcare administrators must rapidly adapt and simplify treatment processes to ensure efficient care delivery. Healthcare organizations must focus on practical and viable solutions over perfect but time-consuming measures during critical moments.

As experienced during the COVID-19 pandemic, the virus’s global spread impacted the global supply chains. It also affected the supply of personal protective equipment, leading to its severe shortage in hospitals and among the population. While the supply chain was sufficient and efficient in meeting the demand before the pandemic, it was severely disrupted during the pandemic.

As a result, healthcare administrators must plan to maintain stockpiles of critical goods and diversify their supply chains to mitigate the risk of disruption in the future. After the first wave of a crisis passes, healthcare administrators and leaders must plan for the resumption of normal procedures in the hospital, such as elective procedures. Although some things must go back on track, healthcare organizations must also consider the potential for subsequent waves. Organizations must accurately document the strategies and measures utilized in the initial wave. This documentation will act as a blueprint for future action, especially in case of a subsequent wave. Every successful step must be integrated into a comprehensive plan to address future waves effectively.

Final thoughts

Effective healthcare administrators combine communication, leadership, management and scientific expertise to guide their communities and workforces through a crisis. Making timely decisions, communicating them transparently and honestly, and being adaptable are crucial components of successful leadership. It is imperative to recognize that the situation will evolve and change repeatedly, requiring leaders to remain agile and responsive. By embracing these principles, healthcare administrators can effectively navigate the challenges of a healthcare crisis and support their institutions and communities in overcoming adversity.