Lessons in leadership from healthcare’s pandemic response

Covid-19 impacted every corner of the world, leaving no sector of the economy untouched – operationally, commercially, financially, and strategically. It presented business leaders with challenges few had foreseen, and to which all had to respond.

Nowhere were those leadership pressures felt more acutely than in healthcare. As the pandemic broke, and the world raced to understand this new virus, the sector had to treat and care for people safely, and design and lead universal public health communications. Healthcare leaders had a critical responsibility – all while experiencing the same uncertainty, dislocation and fear as the rest of us.

As we move into the next phase of the pandemic, healthcare businesses are reflecting on the last two years, digesting the trauma of the pandemic’s peaks and its human cost, and exploring what can be learnt from two years of rapid innovation and leadership through sustained pressure.

Over the past few months, I’ve been catching up with executive, non-executive and clinical leaders from across UK health and care, to discuss their experiences and unpick what we can all learn about leading through long-term crises from healthcare’s response to that extraordinary period.

1 | Organisations can be turned upside down in a fortnight

The pandemic taught us that transformational change can take days, not years.

Covid-19 was a catalyst for much-needed digital adoption. We saw organisations introduce video consultations, online bookings and virtual visits to care homes at scale, while telehealth services like Accurx scaled up exponentially. In a race to limit in-person contact, what were previously small-scale pilots were adopted en masse – in some cases overnight. In parallel, new operational models and pathways sprung up, across outpatient services, around surgical hubs, in the remote monitoring of residents of care homes.

The lesson here is clear: transformation at scale and at pace is more than possible. Waiting too long to modernise a business is unnecessary.

During the pandemic we saw organisations introduce video consultations, online bookings and virtual visits to care homes at scale.

2 | Crises require clear and human leadership – and different styles of communication

The very nature of leadership changed during the pandemic. In healthcare, through uncertainty and fear, teams needed clarity, authenticity, and considered communication. “I felt a responsibility to bring a sense of calm to the situation,” said Dame Jackie Daniel, Chief Executive at Newcastle upon Tyne Hospitals, which treated the UK’s first Covid-19 patients. “People were looking to us to provide leadership in the purest sense of the word.”

Many of those I spoke with discussed leaving a traditional leadership approach behind. “We were speaking to emotions, hearts, and minds,” reflected Dame Alwen Williams, Group Chief Executive at Barts Health.

Collaboration across and within organisations became more and more important. “I developed a different cadence with senior clinicians,” reflected Jackie. “Early on, none of us knew what we were dealing with, so we held meetings multiple times a day – at some peaks, ten times a day. There was a real attitude of: we don’t know what we’re facing, we need our collective brains.”

“Early on, none of us knew what we were dealing with, so we held meetings multiple times a day – at some peaks, ten times a day. There was a real attitude of: we don’t know what we’re facing, we need our collective brains.” Dame Jackie Daniel, Chief Executive at Newcastle upon Tyne Hospitals

Tactically, the pace and media of communication shifted. Sir David Behan, Chair of care home group HC-One, described “shortening lines of communication, closing the gap between information coming in and it reaching our colleagues.”

Leaders across sectors will recall faster, more regular communication with their colleagues. Many organisations – in healthcare and beyond – increased the pace of communication, introducing webinars, blogs, video messages and newsletters to give leaders a platform to address their entire company.

Whilst some elements of a “command”-style of leadership remained necessary through the escalating pace of the response, Barts Health’s communication approach became “command and engage”, rather than “command and control”. This enabled colleagues in the business to innovate and respond to the crisis at divisional or site level, by devolving decision-making through clearly defined workstreams and oversight, while group leadership made priority decisions. In particular, organisations looked to clinical leaders and members of staff to co-design new operational models, treatment plans and pathways of care – many of which have succeeded and remained in place.

During the pandemic Barts Health’s communication approach became “command and engage” rather than “command and control”

3 | You need an inclusive, diverse and psychologically safe organisation to handle a crisis well

The pandemic was only weeks old when it became clear how disproportionately heavy its burden – of infection, severe disease and mortality – was on black and ethnic minority communities. In healthcare, that greater mortality risk was linked not only to colleagues’ individual health status but to systemic factors, including around the roles people occupied and the levels of PPE to which they had access.

The reality and iniquity of unequal mortality risks became public in the UK as the Black Lives Matter protests and conversations ignited – confronting the NHS with the horrifying consequences of racial inequality and a burning platform for a response.

Many of the leaders we spoke with are recognised for having prioritised inclusivity, diversity and inclusion in their organisations prior to 2020 – but the events of summer and autumn 2020 brought urgency and a powerful impetus. At Barts Health, innovating to improve inclusion became the priority: recognising there was no blueprint, the organisation brought the quality improvement methodologies colleagues were using to drive collaboration and innovation to bear on inclusion.

As the importance of collaboration became clearer, so did the value of inclusive and safe cultures. They are a prerequisite to sustaining a strong and sustained crisis response, and to building back afterwards.

4 | Have your house in order before a crisis hits

The businesses best equipped to deal with the crisis were the ones that could build on strong foundations – from a digital infrastructure, emergency preparedness, team or values perspective.

Newcastle Hospitals, for example, had just finished implementing an electronic patient record programme before the crisis hit. As well as enabling remote monitoring and virtual consultations, this investment also equipped the trust with a dataset that enabled it to undertake critical predictive modelling.

More broadly, Alwen Williams described how being underpinned by strong values of care and compassion meant that Barts wasn’t “diminished” by the emergency response to the crisis, despite the pressures of Covid’s second wave hitting Barts Health early and particularly hard. Recalling one particular night, in which more than a thousand re-trained and re-deployed colleagues supported Covid patients, Alwen reflected that “what spoke to the human spirit, was ‘let’s collaborate for the good of our communities and patients’.”

While the pandemic clearly demonstrated the power of uniting an organisation around a common goal, that effort happened most readily, and with the greatest impact, in organisations that went into 2020 with strong values and a clear vision – and good IT.

5 | Don’t press stop on everything

During the emergency response, healthcare organisations prioritised Covid and emergency medicine, pausing many aspects of their longer-term operations. Their strategic agenda also narrowed, to focus on responding to Covid above all else.

The best performing organisations, though, retained bandwidth for a few very high-priority areas unrelated to the pandemic. This, I was told multiple times in my conversations with leaders, proved critical to rebuilding the business as the pandemic drew on.

Continuing with research and redevelopment projects, for example, or major capital development plans, was not only important in sustaining growth and the continuation of care post-Covid, but also in allowing organisations to see ahead, building back after the pandemic with focus, positivity and drive.

If something is strategically critical to the organisation, it needs to remain on the agenda, even through crisis.

6 | Seize the moment for innovation

Without exception, every healthcare leader I spoke with for this column commented on the pace and nature of innovation during the pandemic.

“Innovation was fueled by a ‘what do we have to lose?’ attitude,” reflected Karen Kirkham, who was the Senior Clinical Advisor in the NHS’s Primary Care Transformation Programme during Covid and is now Chief Medical Officer at Deloitte. The urgency of the situation was “rocket fuel for different ways of working”, including greater collaboration between colleagues.

The pandemic also “changed attitudes to risk”, commented Alwen Williams. “Having to be less risk averse brought out innovation and teamwork. We learnt a lot about how we can work differently.” She noted one particular example: “For years at Barts, there had been discussions around new arrangements for transitional care in our maternity ward, but it had never got off the ground. Once Covid hit, the obstetricians quickly took the lead and rapidly transformed the process.”

 “Having to be less risk averse brought out innovation and teamwork. We learnt a lot about how we can work differently.” Dame Alwen Williams, Group Chief Executive at Barts Health. 

Of course, operating at a Covid-19-level of urgency is not sustainable. But the scale of innovation – much of which has been sustained beyond Covid – speaks to the success of increased collaboration, and of leadership unleashing clinical and operational expertise close to an organisation’s point of service. Moreover, by adjusting attitudes to risk, we saw organisations bring in new technologies; hospitals adapt outdated operating models; trusts cut the time of ethics approvals; researchers speed up their processes, and leaders make critical decisions at a never-before-seen pace.

7 | Invest in your people – in wellbeing, and beyond

The experience of healthcare colleagues through the pandemic shone a stark light on the importance of employee wellbeing.

Across the sector, Healthcare professionals worked through crisis and emergency, through exhaustion and change, and under significant emotional pressure. Many were retrained and redeployed, working away from their areas of expertise, and many lived away from their families. Leaders have spoken about working to support colleagues through the deaths of their patients, their own colleagues, all the while operating at a pitch of huge intensity, covering shortfalls while demand escalated unpredictably.

The Chair of one London hospital described redeploying its clinical psychologists to provide internal support during the first wave, and quickly realising that these should become permanent fixtures. The hospital then created health and wellbeing hubs and worked with individuals and teams on the importance of psychological safety.

“Staff who feel valued and engaged give their best,” said David Behan, reflecting on the need for compassionate leadership. “The pandemic reinforced for me the value of being able to look at an issue from the perspective of other people and to walk in their shoes. When people say they’re exhausted, it’s not my place to say they’re not.”

Happily, this focus on emotional literacy has been carried through into the next phases of the pandemic. It was interesting to hear from another CEO about the impact of the pandemic on current employee development processes, for example. “Formerly the conversations we were having about professional development were quite transactional,” they told me. “Now, they’re much more personal, about how people feel and what it is that gets in the way of doing a really good job.”

Crucially, no amount of wellbeing support will be enough if your workforce is under unsustainable pressure. In healthcare, the pre-pandemic shortage of medical professionals has been compounded since Covid, and the labour crunch in the consumer-facing sectors is slowing recovery across multiple sectors. Ensuring that colleagues feel supported, emotionally as well as professionally, is a critical part of recruitment and retention – but having them in place in the first place must be the priority.

The toll of the pandemic on healthcare colleagues was exacerbated by high vacancy rates before Covid struck. Other sectors would do well to learn the lesson that an over-stretched workforce is far more vulnerable to burn-out in a crisis.

It’s said that a wise person learns from experience, and a wiser one learns from the experience of others. I’m confident that the hard-won expertise of NHS leaders will be a source of inspiration, not only to healthcare companies in the next crisis, but to every business for years to come.

hatty.cadman@thembsgroup.co.uk | @TheMBSGroup