The Unique Challenges – and Opportunities – Facing Leaders of Academic Health Centers During COVID-19

Doctors wearing masks looking at tablet to assist during surgery
While the entire field of health care is responding to the unprecedented COVID-19 crisis, leaders and physicians in academic health centers face their own unique set of challenges.

Academic health systems routinely test their disaster preparedness—but nothing has fully prepared organizations for the public health crisis of the coronavirus (COVID-19) pandemic, explains Mary Finlay, lecturer in the Department of Health Policy & Management at the Harvard T.H. Chan School of Public Health and program director of the Leadership Development for Physicians in Academic Health Centers program. Between training front line workers, ramping up incident command centers, developing patient surge strategies, and addressing shortages of equipment and testing kits, leaders are being challenged on all fronts as they fight to save as many lives as possible.

Health care systems will bear the impacts of COVID-19 long beyond the first peak, especially considering the significant financial losses organizations are facing. How can leaders handle the short-term issues of the crisis, while simultaneously thinking about and planning for long-term challenges?

How Academic Health Centers are Coping Effectively

“What’s interesting about the COVID-19 crisis is that we were able to see it coming to our country before it arrived,” says Leonard Marcus, founding director of the Program for Health Care Negotiation and Conflict Resolution at the Harvard T.H. Chan School of Public Health. “We found that the leaders who have been most successful through this event were the ones who looked at what was going to be needed two weeks, a month, two months from now. They were strategic and weren’t simply concerned with what was going on today.”

He adds, “Effective leaders were able to systematically anticipate what they would need down the road. They made sure their systems were being well-managed today and knew that management needed to change. They got the systems in place so that when the difficult day came, they were ready.”

This is a tangible example of one of the key differences between management and leadership—not being solely focused on the short-term or being primarily reactive in a crisis means engaging true leadership skills. Marcus and his colleagues describe “arcs of time” to chart the sudden rise in activity, the apex when the crisis levels—such as when the number of cases hold steady and begin to decline—and the descent of the arc. The end of one arc leads to the next arc of time, as the crisis reaches a new phase. “Leaders chart these dynamics so they can anticipate what will come next and then plan for it, guiding its execution.”

“We found that the leaders who have been most successful through this event were the ones who looked at what was going to be needed two weeks, a month, two months from now. They were strategic and weren’t simply concerned with what was going on today.”

For example, health care leaders have been developing plans and practices to segregate COVID-19 patients from patients not suffering from the disease. This will restore the public’s confidence, a key factor in advancing the repopulation of clinical settings. They also have to prepare for the possibility of another wave of COVID-19 patients in the future. How will they prepare for the contingencies of each arc of time, integrating lessons learned from what came before?

“Leaders are looking at the best ways to adapt now and in the future. How will your department be different? How will you train residents differently? What will be the demands of the post-COVID-19 world and what can we do now to prepare for it?” Marcus says.

How Medical Leaders Can Apply Leadership and Management Skills to COVID-19 Response

In short, Marcus observes, “Leadership matters.” The coronavirus itself poses many unknowns. “It is up to leaders to ask the tough questions and then provide guidance for others on how to jump-start operations while providing a safe and healthy environment for all who depend on the health care system.” There are several points upon which to focus:

  • Offer quick, effective training: Untrained doctors and staff who wanted to assist with COVID-19 needed quick instruction and acclimation to new teams. This kind of quick action is essential, says Marcus. “If you have a task in front of you and you need a group of people, how do you recruit the right ones so you can effectively, efficiently, and systematically get the job done?”
  • Coordinate the right leadership team: Particularly for a crisis of this scale, Finlay says, “Who do you need around the table in the command center to understand the current situation and to ask all the right questions: What do we know? What don’t we know? What do we need to do, and who will be responsible for what actions?”
  • Take a multidimensional view: It is critical to consider all stakeholders, including patients, families, providers, suppliers, the broader community, as well as local and national authorities.
  • Look at preparedness differently: What lessons can be learned? What new methodologies can be applied? Telehealth and working from home are two tools that professionals have successfully leveraged during COVID-19. How could they be useful in the future?
  • Discuss tough ethical choices: Thorny moral decisions during medical treatment ideally must be resolved before health care workers are forced to make tragic choices, says Marcus. “What if we have three patients and only two ventilators? Leaders must take responsibility for providing proper guidance and support when these thorny choices present at the front lines.”
  • Take care of the team: This should be a top priority, to keep employees safe, supported, and informed.
  • Address mental health needs: Taking care of the mental health of a workforce, including post-traumatic stress syndrome, is critical. This includes ensuring emotional support after the compelling obligations of the first arc of time and, with that, the overload of patients that many front line health providers faced and will face.
  • Manage oneself: All eyes will be on leaders in this situation, and they will need to take care of their own well-being in order to show up for others who depend on that leadership.

Once the crisis is over, leaders of academic health centers should use it as an opportunity to reflect, learn, and identify both best practices and gaps in their operations. This will ensure the organization will emerge from the crisis even stronger and better prepared for whatever the future holds.

Harvard T.H. Chan School of Public Health offers Leadership Development for Physicians in Academic Health Centers, a leadership development program for physicians in administrative positions in academic health centers.