Post-Pandemic Leadership Challenges
Although the pandemic is not over, thus far the hospital case loads have been fairly level in most parts of the United States, so it is time for leaders to start thinking “Now what?” As a CNN story dated 24 March put it:
“Burned out medical staff suffering from trauma and in some cases PTSD, the erosion of public trust in hospitals, and frustration over… [vaccine supply] …are just some of the problems reported in a new report on US hospitals released by the Department of Health and Human Services Inspector General Wednesday.
Hospitals reported challenges largely related to the ongoing intensity of having to deal with Covid for a year. That has them grappling with challenges that were brought on by Covid, but also exacerbated longstanding challenges in healthcare delivery, staffing, financial stability…”
The article quotes hospital administrators talking about staff mental health, but usually from a “medical” perspective. I am reminded of the maxim I learned from military psychiatrists treating soldiers with combat-induced dysfunction. The basic thrust is what the patient was experiencing is a normal reaction to an abnormal situation, not a sign of individual dysfunction. The best treatment has been shown to be returning the soldier to his/her unit as quickly as possible, and encouraging soldiers to acknowledge the stress. Front-line medical personnel have been in combat for more than a year, and everyone has been affected in some way. Rebuilding individual capacity means restoring unit capacity, where the bonds of shared experience can give them the chance to recover.
One of the most important issues is to find ways to allow grief to be expressed. All physicians and nurses who work with critically ill patients have rituals they use to deal with the emotional impact of patient deaths—actual and anticipated. The volume of pandemic patients and its attendant isolation disrupted those rituals for patients, family, and providers, and everyone has suffered as a result. So, leadership lesson number one: healthcare is, and always will be, about people. The challenge is to build systems of care that support individual and organizational resiliency, which probably does not include maximizing economic “efficiency.” The myth of the market is that all costs are known and measurable. In the pandemic we have good evidence that not all costs are known and not all can be measured.
The second leadership lesson: science is necessary but not sufficient for progress. How many times have you heard a political leader say “we are following the science?” Have you seen much difference in human behavior in states where leaders say they are following the science? I haven’t been impressed that it has had much impact. Now don’t misunderstand. The development of a safe, effective vaccine within a year of the first appearance of the virus is a tremendous scientific success, which is why it is necessary, but not enough. I have previously discussed vaccine hesitancy as an exemplar of the limitations we face improving medical care. The tendency to write off people who reject our conclusions, of whatever sort, seems particularly evident just now. So, the leadership challenge is to define the basis upon which healthcare organizations are to act. Given that so many “facts” are being accepted/rejected makes this challenging. Personally, I have always thought of the practice of medicine as a moral enterprise with a social contract between the physician to operate with respect for the patient’s autonomy and standing as another human being and, in return, the patient to respect me and my advice, whether they take it or not. I think the commercialization of medicine has undermined the social compact in ways that may make restoring this difficult, if not impossible. Nonetheless, I think it is essential a common basis for action be restored.
The third lesson from the pandemic: we are all in this together. In times of stress, we tend to turn inward, and the advice to “socially distance” has meant isolation from “the other.” Combined with the tendency to scapegoat others who are not like “us,” we have seen the dangers of this normal reaction. So, the leadership challenge is to think more broadly. Many healthcare organizations have had their finances seriously harmed by the pandemic, so it is natural to look inward. But I want to suggest successful survivors will figure out how to reach outward. Private organizations need public organizations, like health departments, and vice-versa. Cooperating with other organizations has been essential in dealing with the pandemic, and we need to continue this afterwards.
The fourth lesson is that “the way we do things around here” has been broken. I have suggested some of our people-centered rituals need to be restored, but that does not mean things have to go back to the past. We know many of our previous practices did not serve anyone—patient, provider, or payer, but were simply relics of the past. The leadership challenge, then, is to maintain the organizational flexibility used to deal with the pandemic and resist the reinstitution of bureaucracy. The time frame to exploit this flexibility is short—the urge to reimpose “order” is strong and will reassert itself quickly. What parts of your organization are now the detritus of the years and need to be jettisoned? What new things have you learned to do that need to be exploited, yes, even institutionalized, in the future? What things were jettisoned in the midst of the pandemic that have caused unintended damage and need to be restored? These are tough questions, and the time to come up with answers is short. Now is the time, while we continue to vaccinate and treat those who don’t.
6 April 2021
 Holmes K. A Year Fighting a Global Pandemic Leaves US Hospitals in Shambles, New Report Finds. 24 March 2021. Accessed at https://www.cnn.com/2021/03/24/health/hhs-oig-pandemic-hospitals-report/.
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