Thoughts on Adaptive Leadership During the COVID-19 Pandemic

by Edward L. Baker MD, MPH; Robert Irwin, MA; and Gene Matthews, JD


As public health leaders around the globe work to provide leadership in these challenging times, each day will present new or recurring leadership challenges. Some lessons learned from prior outbreaks may serve as useful guideposts. However, the coronavirus outbreak has, in important respects, presented unprecedented challenges. Therefore, leaders will draw on wisdom from prior experiences while learning, in real time, lessons from today.

In this post, we suggest that, by focusing on a few elements of leadership practice, public health leaders, particularly those in state and local health agencies, may find ways to prioritize actions and thereby better serve those in our communities through a greater clarity of mission and purpose. We also suggest leaders should consider the practices of adaptive leadership as offered by Heifetz, Linsky, and colleagues as they deal with challenges that are not clear-cut or easy to identify. They offer a set of practices (below) which may be helpful including “maintaining disciplined attention.”

Adaptive Leadership – Leader Behaviors

  1. Get on the Balcony
  2. Identify the Adaptive Challenge
  3. Regulate Distress
  4. Maintain disciplined attention
  5. Give the Work Back to the People
  6. Protect Leadership Voices from Below

One aspect of adaptive public health leadership is for leaders to focus attention (their own and that of others) on 4 central elements of leadership practice in these times. Although these 4 areas may not include everything to be considered, we submit these as a starting point to be used to structure consideration of a range of issues. These elements are 1) situational awareness, 2) decision making, 3) communication, and 4) energy. In each area, we suggest that leaders should focus on asking the right questions rather than having all the answers*.

*Baker EL, Gilkey R. Asking Better Questions – A Core Leadership Skill. J Public Health Management and Practice. In press. 2020.

Situational Awareness

Public health epidemiologists are schooled in the techniques of monitoring case counts, risk factors and other aspects of monitoring the course of a disease outbreak. All of this is critical to the process of framing the response. In addition to the epidemiologic approach to situational awareness, there are other components of situational awareness.

First, monitoring the status of the public health system at the local, state and national levels is critical. For example, the state of laboratory capacity across the nation has received laser-like attention. Other aspects of the public health system that are central to this response includes public health agency informatics capacity and communication capacity, particularly at the local and state levels. Thus, situational awareness should include monitoring of key system status indicators, such as the 10 Essential Public Health Services, as a component of situational awareness.

Further, as public health and the healthcare system work together in these times, public health agencies will need to enhance awareness of the status of capacity in health care facilities. As capacity evolves over coming weeks, public health leaders will be called on to address conditions and concerns regarding health care delivery. Thus, a greater awareness of health care system capacity will be needed.

So, in these times, situational awareness for public health leaders may be enhanced by focusing on a few questions:

  1. What is the status of the coronavirus epidemic from an epidemiologic perspective?
  2. What is the state of the public health system’s capacity and capability to respond to the epidemic?
  3. What is the capacity of the health care system (especially at the community level) to provide needed care?
  4. In a state or local health agency, what are other state or local government agencies doing?

Decision Making

In times of stress, the process of sound decision making can suffer. A preoccupation with events may lead to a short-term focus and a reactive posture.

All too often the process of decision making may concentrate exclusively on data (which changes hourly) and recent events (another type of data). As a result, leaders fail to take a longer view and adopt a broader perspective incorporating not only data, information, and knowledge, but also cultivating wisdom.

So, how might public health leaders expand the decision-making process and make wiser decisions? A few questions may be of value:

  1. How is our prevailing mindset interfering with our ability to both question our assumptions and encourage alternative perspectives?
  2. In what ways are we fostering systems and procedures to better “look around corners” and anticipate events more effectively?
  3. How are we encouraging a few wise individuals to serve as “participant observers” to “get on the balcony” and observe our decision-making processes and provide real time feedback?
  4. How are we seeking to uncover what we don’t know and also identify what may be unknowable?

Communication

Communication has now become the central science/tool of public health practice (in contrast to the central role of epidemiology in the past). In these times particularly, local public health leaders serve as a credible and trusted voice to address the needs of the public for meaningful, empathetic, consistent, and factual communications.  A few questions may be useful:

  1. As I communicate with others (my staff, my colleagues, local elected officials, and the public), what do they really need to hear? This question contrasts with the frequent mindset which asks “What do I need to say?”
  2. Am I then tailoring communication to meet the specific needs of the audience?
  3. What is the strategic intent of our communication?
  4. How is my communication helping to prepare others for what lies ahead?

Energy

In public health emergencies, the collective energy of the public health workforce (along with that of the healthcare workforce) will be drained and stretched to the limit. As a result, public health leaders will be called on to monitor their own energy level and that of team members. The current situation appears to be “more of a marathon than a sprint”. In light of that challenge, public health leaders may want to ask a few questions. We suggest that part of doing so requires the leader to separate out issues into 3 categories: 1) “must do”, 2) “good to do” and 3) “nice to do.”

A few questions related to energy preservation include:

  1. To what extend am I focusing the finite energy of my team on those “must do” priorities in a daily morning meeting to assemble and plan together?
  2. In what ways am I modeling self-care and encouraging others to do so?
  3. What systems are in place to monitor burnout and other signs of energy depletion and then to act accordingly?
  4. To what extent are we reaching out to those with expertise and experience in dealing with public health crises to supplement staff capacity?

Conclusion

The crucial work of public health is generally conducted in the shadows. The COVID-19 crisis thrusts that work and the public health leaders that guide it into the full light of day. Leaders face increased risks with heightened exposure. But with increased risk comes increased opportunity. By focusing attention on better situational awareness, wise decision making, improved communications and optimal energy management, public health leaders have the opportunity as rarely before to prevent disease and save lives.  

Many of our nation’s political and scientific leaders have likened the coronavirus crisis to fighting a war.  As Sir Winston Churchill said during a war more than 75 years ago, “Never let a good crisis go to waste.”

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Edward L. Baker, MD, MPH, a former Assistant Surgeon General in the US Public Health Service and former Director of CDC’s Public Health Practice Program Office, currently serves as Adjunct Professor in Health Policy and Management at UNC. He teaches a course on the theory and practice of leadership in the School of Public Health’s DrPH program and an online course on Designing and Managing Public Health Information Systems through the Public Health Informatics Institute in Atlanta. Dr. Baker also serves as an adjunct Professor at Harvard Chan School of Public Health in the Department of Environmental Health. [Full bio.]

Robert Irwin, MA, is a public health consultant, a former Senior Advisor in the Influenza Coordination Unit of the Centers for Disease Control and Prevention, and a former Senior Program Analyst and Special Assistant in the Washington, DC, office of the CDC Director. He has also served as Director, Special Initiatives, at the Association of State and Territorial Health Officials in Washington, DC. He currently serves as vice chair of the board of trustees of Memorial Hospital, a critical access hospital in North Conway, New Hampshire.

Gene Matthews, JD, is a senior investigator at the NC Institute for Public Health, where he conducts legal research and provides technical assistance to public health practitioners on legal topics. He is also the Director of the Southeastern Regional Center of the Network for Public Health Law (sponsored by the Robert Wood Johnson Foundation), which provides legal assistance on a variety of public health topics, enabling practitioners, lawyers and policymakers to apply the law to pressing public health issues.

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