Health care workers currently face challenges that are more intense than usual during the coronavirus (COVID-19) pandemic. The medical field is no stranger to crises, but COVID-19 has caused, in many cases, a profoundly heightened environment — extending not just to the professional but to the personal lives of employees, leaders, partners, and patients.
“It’s so wide-scale that we cannot ignore it anymore. What’s being asked of people, especially in health care, is so extreme,” says Louise Weed, program director of the Leadership Strategies for Evolving Health Care Executives program and a practice transformation specialist at the Harvard Medical School Center for Primary Care. “I worked with practices that literally redesigned their health delivery systems in a week. We are asking people to take on big work, change the way they practice, and flip everything on its head, really quickly.”
But, as with other crises and high-stress situations, this can also be an important time to take stock and understand the importance of an interdisciplinary team. What should leaders be looking to do right now, both in the short- and long-term?
Strong Leaders Build Strong Teams During COVID-19
Much like their employees, health care leaders and managers are very likely exhausted already, experiencing their own burnout. The first step would be to acknowledge their energy levels and find ways to recharge, even if it’s small steps.
“The temptation is just to run on fumes, but we make worse decisions and build worse systems when we do that,” says Weed. “Now that we know this is for the long haul, the fumes aren’t going to last us. Where are the pauses people can take and ask for help, just so they can come back to the problem and be strong leaders?”
With that said, it’s not solely the responsibility of a leader to be resilient through a crisis. Resilience, which is defined as emotional toughness, has been studied as a predictor of success for individuals in stressful situations. It has several predictive factors that indicate who will have the quality; heightened confidence in one’s abilities, disciplined routines, and support from social and family environments can be important factors. With that said, resiliency can also be a learned, developed quality with the right practice.
Thus, a strong leader can build a strong team by seeking out and also cultivating resilience — so in a time of high stress like during the COVID-19 pandemic, the leader doesn’t have to shoulder every responsibility, but can instead delegate to responsible employees. It’s also a way for employers to care for themselves and prevent burnout. Says Weed, “Once you see your team ecosystem work beyond you, then you think more clearly as a leader about what you specifically need to be doing.”
I worked with practices that literally redesigned their health delivery systems in a week. We are asking people to take on big work, change the way they practice, and flip everything on its head, really quickly.
Creating Organizational Resilience Mid-Pandemic
Building a resilient team, department, or organization requires work. Firstly, it involves ridding oneself of the notion that resilience can only be developed or practiced by individuals—an assumption that puts too much pressure on a single person for good performance. Team resilience, or resilience practiced across coworkers and incentivized by a leader, can be created through attitudes and approaches.
One important example is helping all employees in a team work collectively through failure, which can be particularly tough in health care considering the enormity of medical decisions on patients. So instead, leaders can train how to handle failure in low-stakes situations so that the tools can be available in times of greater stress.
Another approach is incentivizing work-life boundaries and self-care among all workers, which is yet another challenging area in this field. Because stressful medical emergencies can happen without warning (especially right now), the impulse for team members is to drop everything and put one’s energy behind helping patients. Since this happens over and over again, it’s not a surprise that health care is plagued by individual and collective burnout. Self-care behavior has to be learned.
“Taking a vacation or saying I’m burning out is actually an investment in the community you’re serving. If you burn out and leave, now you can’t give anything to the community,” Weed explains. It’s worth noting, though, that these systems must be both explicit and non-explicit: that there must be the right cultural environment for workers to be empowered to ask for what they need. Resilience doesn’t occur out of nowhere. It can be learned, and then the muscle needs to be flexed.
It’s also worth noting that resilient people can particularly suffer from burnout because they’re focused on control and action. In a crisis of this size and longevity, that can lead to profound exhaustion. “We need to reframe resilience away from ‘I can shoulder it all,’ to: ‘I ask for help when I need it.’ ‘I ask for feedback.’ ‘I work on communication.’ Resilient people work through issues with other people,” says Weed.
We need to reframe resilience away from “I can shoulder it all,” to: “I ask for help when I need it.” Resilient people work through issues with other people.
COVID-19 Shows That Resilience Requires Equity
COVID-19 has also exposed the inequities in our work — particularly for caretakers, where work often falls on women and people of color. Workplaces aren’t necessarily designed with families in mind, particularly now with limited childcare, increased care for aging parents, and the necessity for remote work and learning among other heightened challenges.
“We need to, as leaders, go back and reconsider these systems,” says Weed. “We’re seeing people leaving jobs — we’re already in an unemployment crisis, but we’re also on the edge of a workforce crisis. It’s unmanageable.”
Thus, health care leaders need to be thinking about inequitable work cultures and societies. What systems and supports can they put in place to help lift their employees’ load, particularly right now in this time of crisis? What are procedures and policies that set people up to fail that can be changed? It’s also a time to think about equity across racial and socioeconomic lines, especially ones that are impacted during the pandemic.
“This is a time for leaders to think about: what does it take for people to show up to work? And is it an equal amount of work and energy? What are the changes we can make or at a minimum acknowledge to help move us to a more sustainable workplace?” Weed says.
Understanding Organizational Limitations in a Pandemic or Crisis
This is a real moment for health care to look critically at itself; yet it’s also important to recognize that many structures and systems exist outside the purview of a single leader. Payment and referral structures, for example, as well as health care laws, are far beyond the ability of an organization to control, yet they too must also be actively managed — especially in a heightened state like this one.
“The system isn’t designed for our health care workers. You’re there because you care, everything’s an emergency, you’re exhausted, and you’re failing because there’s no way to succeed,” says Weed.
Which means, ultimately, that leaders need to ask themselves right now: what can I change? How can I lift up voices that are marginalized? How do I make it easier to be resilient? Even in a fee-for-service world, where quantity of care is most important to long-term solvency, how do I build for long-term team sustainability while still making sure we stay busy? And: what do I need, and who do I need around me?
None of this is attainable without self-awareness and vulnerability, understanding one’s own strengths and weaknesses. It sounds like a counterintuitive thing to ask of a resilient, empowered leader, yet it could conceivably be the most important aspect of leadership in a high-stakes situation like COVID-19.
As Weed puts it: “Resilience starts with you. Understand who you are as a leader to build people up around you, and you can’t know that until you know yourself first.”
Harvard T.H. Chan School of Public Health offers Leadership Strategies for Evolving Health Care Executives, which focuses on skill building in the critical areas of leadership and management development, conflict resolution, operational analysis, employee management, and quality management.