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Homing in on pandemic-proof healthcare leadership

December 14, 2023

Person sitting while using laptop computer with a green stethoscope nearby

Cheryl Mitchell has spent much of her career studying leadership in the complex and dynamic world of healthcare, both as a consultant and academic director of UVic’s MBA in Sustainable Innovation. In early 2020, the COVID-19 pandemic swept the world and put health systems in crisis-management mode. Mitchell saw an opportunity to take a deep dive into what works and what doesn’t for leaders trying to navigate a rapidly unfolding pandemic. One comment that Mitchell frequently heard from leaders that piqued her interest was that although the pandemic was difficult in many ways, in other ways it made the act of being a leader easier. She found this contradiction between complexity and “simplicity” fascinating.

 “So, the question was, how do you lead within the regular complexity of healthcare and then layer on a pandemic?” Mitchell says.

She and a team of seven other academics set out to unearth leadership competencies healthcare leaders need during a pandemic. To do so they analyzed 35 peer-reviewed articles on pandemics published between 2003, the year of the SARS pandemic, and December 2020. This first-of-its-kind scope review identified leadership behaviours and skills crucial for pandemic response. 

Their resulting paper, Public Health and Health Sector Crisis Leadership During Pandemics: A Review of the Medical and Business Literature, was recently named Medical Care Research and Review 2022 Article of the Year. It makes a compelling case for a shift in leadership education that melds three core competencies: task-oriented (identifying the crisis early, developing protocols and allocating resources, monitoring, communicating and collaborating,) people-oriented (effective, inspiring and empathetic,) and adaptation-oriented (making informed decisions in a rapidly evolving situation.) 

There’s more. Leaders need to understand how contextual factors – political, cultural and organizational – influence these three core competencies.

“We know we have to prepare, coordinate and collaborate. But what hasn’t been integrated is those adaptive competencies. We have to understand the work we do, the people we work with, the health system, and how things flow through that system,” Mitchell explains.

BC did well

Is it a tall order? You bet. But Mitchell says pandemics demand exceptional leadership. She gives BC good marks thanks to its Emergency Operations Centre (EOC), well-seasoned in responding to other crises such as wildfires.

“Our leaders were able to stand up this EOC structure for the pandemic. Inherent to this structure is a way of making decisions that have multiple people adding their perspectives and making rapid evidence-based decisions,” Mitchell says.

But there’s room for improvement. Our healthcare system responds well to known day-to-day crises. That’s what healthcare professionals are trained to do.

“Just imagine the degree of expertise that exists within healthcare. Many of us would stand back and watch in awe as people are mobilized quickly around something like a catastrophic car accident,” Mitchell says.

However, COVID-19 introduced two wildcards – uncertainty and the importance of system-wide collaboration that forces healthcare workers out of their professional silos.

“There was a lot we didn’t know; for example, the trajectory of the disease and exactly how it would be transmitted,” Mitchell says.

At the same time, healthcare staff had to find ways to collaborate with people they normally don’t see around the water cooler, such as policymakers, communication specialists and supply chain managers.

What we learned but didn’t apply

Twenty years ago, SARS taught us a lot, but it didn’t translate into our healthcare system and governments being as prepared as they could have been for COVID-19.

The experiences of places like Hong Kong showed that nursing homes and long-term care facilities are vulnerable to pandemics. Yet, Canada failed to bolster its long-term care infrastructure and the consequences were devastating. During the first COVID-19 wave in Canada, 80 per cent of deaths occurred among the elderly in these facilities.

Another lesson not applied was the need for a stockpile of PPE (Personal Protective Equipment) preparedness. Consequently, Canada was caught flat-footed in the global race to procure N-95 masks.

 “The first piece, is how are we ensuring that we learn from this experience in an evidence-based, purposeful way?” Mitchell asks. “The second piece, is how are we ensuring that we are building into the system the networks that allow us to collaborate and coordinate?”

The financial costs - not to mention the human costs - of not applying these lessons to future pandemics are huge. One recent study by McKinsey & Company found that pandemic policy failures added between $125 and $200 billion to annual healthcare expenditures in the United States alone.

Enlightened leadership

It wasn’t lost on Mitchell and her colleagues that while conducting their research, our healthcare system was, and continues to be, in the midst of a staffing and healthcare delivery crisis.

“How is it that you have very smart, committed, engaged and dedicated people, but that our healthcare system is struggling?” Mitchell says.

The short answer is it’s a systemic, not an individual problem. Since publishing the pandemic leadership paper, she’s been thinking a lot about big-picture change in the healthcare system. This is exactly the sort of organizational challenge that UVic’s MBA in Sustainable Innovation is addressing.

“Much of what we are discussing around healthcare is a key focus for our MBA in Sustainable Innovation,” Mitchell says.  “We bring students from a broad range of organizations, including healthcare, to develop the skills to navigate the ambiguity and uncertainty associated with what I like to call the ‘wicked problems’ found in complex, adaptive systems.”

When it comes to healthcare, she’s a fan of transformational rather than incremental organizational change. However, Mitchell points out that it’s already happening in BC with a push for team-based care, a delivery model coordinated among multiple healthcare providers and across many different settings of care.

“With our MBA, we focus on the mindset required as we reimagine not just healthcare but all organizations, the leadership and the innovation required to face the current global dynamic context, and values like sustainability and regeneration,” Mitchell says.

It’s a monumental challenge that requires monumental leadership.

—Photo credit: National Cancer Institute on Unsplash