Research Viewpoints: Guidance for health care leaders during the recovery stage of COVID-19

Published Aug 9, 2021

Background

The COVID-19 pandemic is the greatest global test of health leadership of our generation. It has challenged health care leaders across the globe, as few jurisdictions were prepared to manage this crisis effectively. Even as populations are getting vaccinated in increasing numbers, international herd immunity is expected to take longer to reach than at first anticipated.

The high-stakes nature of this global crisis and the unique challenges it presents for leaders highlight the need for clear guidance on how to navigate this stage of the pandemic. This evidence-based consensus statement provides a leadership framework—key actions that leaders can take—to navigate the recovery stage of the COVID-19 pandemic safely and smoothly.

The framework was co-created by 32 experts in a variety of professional and/or academic fields who are involved in various aspects of health leadership, health care, public health, and related fields. They based their framework on a search of the literature and a multi-step structured dialogue on the topic. In writing their consensus report, they completed six rounds of feedback, revisions, and synthesis.

What ideas are the researchers presenting?

According to the authors, leaders face unique challenges during the recovery stage of the pandemic. Among other things, they must balance competing priorities, maintain staff engagement and motivation, and avoid burnout. This stage also offers unprecedented opportunities on which that leaders can capitalize.

In this consensus report, the authors present a framework that includes corresponding capabilities for each action and reflection questions to help leaders assess their own leadership and organizational capacity.

The authors classify the leadership imperatives into six categories, as described below:

• People focus 
  
  • Acknowledge and celebrate the dedication, resilience and achievements of staff.
  • Gauge stress levels among staff, understand their challenges, solicit their feedback and foster their well-being and resilience.
• Environmental scan (present and future focus)
  
  • Develop a clear understanding of the current local and global context of the crisis by identifying reliable sources of information and key experts to help guide decisions and policymaking.
  • Use systems thinking and informed projections to understand which changes in the landscape are likely to be temporary versus permanent.
• Learning and preparation (past and future focus)
  
  • Actively prepare for future emergencies by analyzing and examining performance during the earlier stages of the pandemic at the individual, departmental, organizational, and inter-organizational levels.
  • Ensure that the needed resources (human, technological, and material) are in place, including a reliable supply chain.
• Recalibrating, optimizing and organizing (present focus)
  
  • Reassess priorities explicitly and regularly, and inspire people with meaning and purpose by explicitly communicating the constants—what is not changing, despite the volatility.
  • Critically reexamine conditions for top performance (team, organizational, and system) in collaboration with staff.
  • Manage the backlog of paused services and consider making improvements while also avoiding burnout and moral distress.
• Envisioning (future focus)
  
  • Capitalize on and commit to sustaining lessons learned, successful innovations, collaborations, and coalitions.
  • Foster a culture where people feel safe to propose new ideas and to innovate spontaneously without seeking permission, while remaining coordinated and aligned with strategy.
• Crisis communication
  
  • Provide and engage in regular, clear and unambiguous communication with staff and stakeholders in a way that engenders trust and confidence.
  • Provide safety information and recommendations to government, other organizations, staff and the community to improve equitable and integrated care and emergency preparedness system wide.

How can this information be used?

This report provides a model for leaders in the health and public health sectors that can guide them through the post-emergency stage of the COVID-19 pandemic. This report also could be useful in building organizational resilience, capacity, innovation, and emergency preparedness.

What future research is recommended?

The authors note that it would be beneficial to validate their framework in other global contexts, including other sectors.

About the authors

Jaason M. Geerts,¹ Donna Kinnair,² Paul Taheri,³ Ajit Abraham,⁴ Joonmo Ahn,⁵ Rifat Atun,⁶ Lorena Barberia,⁷ Nigel J. Best,⁸ Rakhi Dandona,⁹ Adeel Abbas Dhahri,¹⁰ Louise Emilsson,¹¹ Julian R. Free,¹² Michael Gardam,¹³ William H. Geerts,¹⁴ Chikwe Ihekweazu,¹⁵ Shanthi Johnson,¹⁶ Allison Kooijman,¹⁷ Alika T. Lafontaine,¹⁸ Eyal Leshem,¹⁹ Caroline Lidstone-Jones,²⁰ Erwin Loh,²¹ Oscar Lyons,²² Khalid Ali Fouda Neel,²³ Peter S. Nyasulu,²⁴ Oliver Razum,²⁵ Hélène Sabourin,²⁶ Jackie Schleifer Taylor,²⁷ Hamid Sharifi,²⁸ Vicky Stergiopoulos,²⁹ Brett Sutton,³⁰ Zunyou Wu,³¹ Marc Bilodeau³²

1. Research and Leadership Development, Canadian College of Health Leaders, Ottawa, Ontario, Canada; Bayes Business School, University of London, London, United Kingdom
2. Royal College of Nursing, Marylebone, London, United Kingdom
3. Yale School of Medicine, New Haven, Connecticut, USA
4. Barts Health NHS Trust, Royal Hospital, London, United Kingdom; Staff College: Leadership in Healthcare, London, United Kingdom
5. Department of Public Administration, Korea University, Seoul, Republic of Korea
6. Global Health Systems, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
7. Department of Political Science, University of São Paulo, São Paulo, Brazil; Solidarity Research Network for Public Policies and Society, Observatorio COVID-19 Brazil
8. United Nations Mission in South Sudan, UN House, Juba, South Sudan
9. Public Health Foundation of India, Gurugram, India; Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
10. Royal Infirmary Hospital Edinburgh, Edinburgh, United Kingdom
11. Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Vårdcentralen Värmlands Nysäter and Centre for Clinical Research, County Council of Värmland, Värmland, Sweden; Medicine and Health, Örebro University, Örebro, Sweden
12. University of Lincoln, Brayford Pool, Lincoln, United Kingdom
13. Chief Executive Officer, Health PEI, Charlottetown, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
14. Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
15. Nigeria Centre for Disease Control, Jabi, Abuja, Nigeria
16. School of Public Health, University of Alberta, Edmonton, Alberta, Canada
17. World Health Organization Patients for Patient Safety, Geneva, Switzerland; Patients for Patient Safety Canada, Edmonton, Alberta, Canada
18. Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada; Canadian Medical Association, First Nations Health Authority, Indigenous Physicians Association of Canada, West Vancouver, British Columbia, Canada
19. Institute for Travel and Tropical Medicine, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel; School of Medicine, Tel Aviv University, Tel Aviv, Israel
20. Indigenous Primary Health Care Council, Toronto, Ontario, Canada
21. Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia; St Vincent’s Health Australia, East Melbourne, Australia
22. Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Headington, Oxford, United Kingdom
23. College of medicine, King Saud University, Riyadh, Saudi Arabia
24. Division of Epidemiology & Biostatistics, Department of Global Health, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
25. School of Public Health, Bielefeld University, Bielefeld, Germany
26. Canadian Association of Occupational Therapists, Nepean, Ontario, Canada; Organizations for Health Action, Ottawa, Ontario, Canada
27. London Health Sciences Centre, London, Ontario, Canada; Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
28. HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
29. Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
30. Department of Health, Melbourne, Victoria, Australia; Monash University School of Public Health and Preventive Medicine, Melbourne, Australia
31. China Center for Disease Control and Prevention, Beijing, China (Wu); Division of HIV Prevention, National Center for AIDS/STD Control and Prevention, Beijing, China; Department of Epidemiology, UCLA Fielding School of Public Health, University of California, Los Angeles, USA
32. Surgeon General, Canadian Armed Forces, Ottawa, Ontario, Canada 

Acknowledgements

This knowledge exchange activity is supported by Evidence Exchange Network (EENet), which is part of the Provincial System Support Program at the Centre for Addiction and Mental Health - “CAMH”). EENet has been made possible through a financial contribution from the Ministry of Health (“MOH”). The views expressed herein do not necessarily represent the views of either MOH or of CAMH.

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