by Edward Baker, MD, MPH; P. K. (Ken) Keen, MA; and Roderick Gilkey, PhD
In a prior column, we offered questions that leaders should be asking as they provide leadership through the challenges of the COVID pandemic. In this column, we build on the prior framework to offer guiding principles and best practices leading to concrete actions that leaders can take. We also emphasize the value of ongoing learning during the pandemic response to improve the response and to help prepare public health for future crises. Since crisis leadership in other situations may provide useful insights, we draw upon the massive response to the 2010 earthquake in Haiti during which one of us (KK) led the overall US and multination humanitarian response. Another coauthor (RG) participated with Gen. Keen in the recovery efforts in Haiti, where they developed leadership support and programs. In this column, we will offer specific strategies and tactics which served in the response to the Haiti earthquake that seem applicable to the COVID response.
Crisis Leadership — Guiding Principles
During the COVID pandemic (as in Haiti), leaders must define their current situation and reality, both within their organization and externally. Using what they know to be fact, and what they believe to be true (assumptions), leaders must quickly develop a plan of action with priorities. Leaders must articulate often the vision and plan of action (strategy, objectives, tactics, and priorities). In Haiti, the vision was to save lives and mitigate the suffering of the Haitian people. Everything was tied to that vision.
Achieving Situational Awareness
Guiding principles: In order to develop strategy, objectives, tactics, and priorities, leaders must develop situational awareness such that they can make informed decisions and communicate effectively. In the public health arena, situational awareness should include not only epidemiologic analyses and projections but also an awareness of the capacity of the health system, the actions of other organizations, and the societal and political context in which public health is practiced.
Best Practices:
- Find ways each day to get out and engage with those on the front line and leaders engaged in the fight.
- Collect information by listening, asking powerful questions, and challenging assumptions.
- Ask open-ended questions. Do not ask “yes” or “no” questions. Ask “why” and “what they think” about a decision or direction that was given.*
- Recognize staff efforts and the “heroes” of the week.
- Identify a person and a process to help manage and prioritize information flow, particularly in dealing with email overload and other inputs.
- Monitor the epidemiology of the pandemic and utilize informatics tools and techniques to display data and information clearly for professional and public use.
- Monitor the capacity and status of the systems (eg, information and laboratory systems) that support public health practice.
- Conduct rigorous environmental scans of the societal and political environment in which public health preventive measures must play out.
- Engage in “worst case” scenario modeling while managing the public health response. Engage in “what if” exercises to uncover “blind spots” and vulnerabilities.
*Baker EL, Gilkey R. Asking Better Questions – A Core Leadership Skill. J Public Health Management and Practice. In press. 2020.
Adaptive Decision Making
Guiding Principles: During a crisis, even the most highly functioning organizations and teams know that their normal processes and practices of doing business cannot meet the demands of the current situation and new reality. To succeed they must adapt before quickly making critical decisions. In Haiti, following the earthquake, it was imperative to move quickly to save lives of those who were buried under the rubble of the earthquake or get to those who had life-threatening injuries. At times, that meant we did not have all the information we desired, so we had to operate with incomplete data or information.
In Haiti, we used what facts we had and made some assumptions. Also, there were times we needed to slow down at the operational level to speed up at the tactical. For example, when searching under the rubble of a collapsed hotel for survivors, the teams had to pause periodically to ensure they were focused in the right area by occasionally collecting information from all teams working the recovery effort. In short, we had to slow down at the operational level to ensure we took a deliberate approach to coordinate our actions and move with a unity of effort at the tactical level, in order to increase the success of finding survivors. Making decisions quickly, without total knowledge and information, is imperative but must be balanced with a continuous process of sharing information, confirming facts, and testing assumptions.
Best Practices:
- Ask yourself and your leaders, “What decisions do we need to make today or in the next 72 hours? What decisions do we need to make in the next 3 – 10 days?
- Identify the stakeholders in these decisions and how you will reach out to them. Make sure you involve the right people in the right way at the right time.
- Cultivate a climate in which mindsets are questioned and assumptions challenged by formally instituting a process. Some use the idea of a “Team B” for this.
- Establish (in advance) criteria for determining if the decision was “correct” — “How will we know that we did the right thing?” “What will success look like?”
- Avoid “wishful thinking” and “business as usual.”
Communication
Guiding Principles: Leaders should seek to communicate in ways that address what the audience needs to hear, not just what the leader wants to say. That approach requires a deep understanding of the needs of the intended audience and practices that support this intent. Communicate simply and clearly the “must dos” of the situation with a clear time frame, avoiding the “good to dos” and “nice to dos.” Be clear on priorities and repeat them regularly.
Best Practices:
- In Haiti, each day we had a simple, clear message with no more than 3 points: what we had done, what we were doing, and what we were planning to do. This ‘”Daily One-Pager Communication Plan” was provided to every leader from the top to the bottom.
- Every day, the senior leader (KK) communicated the vision (save lives and mitigate suffering) on a daily “walk around leadership journey,” asking about how we were doing that today and soliciting feedback on challenges.
- In Haiti, a “Joint Inter-Agency Strategic Communication” team developed a daily “One-Pager Communication Plan” and coordinated with the media.
Energy Management
Guiding Principles: As the COVID response evolves, burn out will happen. To prevent burnout and manage energy for the long term, we advocate for the central principle that you must take care of yourself so that you can then take care of your team. We suggest that you “create a battle rhythm” enabling you to operate at a sustainable pace over time.
Best Practices:
- Leaders must “lead by example,” especially in taking care of themselves and taking care of others. Set a daily routine that allows you to re-charge, get enough sleep, eat well, get exercise (even a little helps), and mentally decompress.
- Ask your subordinate leaders what they are doing to re-charge and take care of themselves. If they are not setting a good example, help them to do so.
- Establish a concrete system to set limits on work schedules and establish rotation practices to provide relief to stressed and stretched leaders.
- Establish ways to monitor for early signs of “burnout” and actions designed to prevent it.
Seek feedback from a trusted confidant with respect to your own “energy management.”
Learning
Guiding Principles: All too often leaders immersed in a crisis may fail to take stock of daily leadership lessons. To avoid this pitfall, public health professionals have a unique opportunity to serve as “participant observers” by capturing and sharing the many lessons learned from the COVID pandemic response. The other leadership imperative is for leaders to embed learning processes and best practices to anticipate or reduce the probability and impact of future crisis. By doing so, the leader is able to both provide tactical responses to an immediate crisis while building strategic long-term capability.
Best Practices:
- Each leader should create a “COVID Leadership Diary” and use it daily.
- Do not wait until the crisis is over to reflect upon the lessons and what you can learn. Do an in-stride After Action Review (AAR) encouraging every team to ask:
- What is going well? What worked?
- What did not work?
- What did we learn?
- What do we need to do differently?
- Create a multi-functional “Tiger Team” for the organization that can produce an AAR for the overall organization with clear lessons and recommendations for the future.
- Create a process for follow-up actions based upon what recommendations the leadership accepts to implement.
Conclusion/Summary
As in the response to the Haiti earthquake (and other public health crises), we advocate for an awareness of certain guiding principles during a crisis: be informed, keep it simple, and think tactically and strategically simultaneously (eg, clear the streets immediately while building strategic partnerships for the future). These guiding principles lead to concrete actions to be taken on a daily basis to improve situational awareness, support adaptive decision making, and communicate with simplicity and clarity while managing energy for the long term. We also emphasize the importance of a systematic approach to learning from experience — both in the midst of the response and afterward. As a result of adherence to these principles and best practices, public health organizations will enhance their ability to provide essential services and to save lives. Further, by doing so, organizations that succeed in addressing the COVID pandemic leadership challenges will emerge as stronger organizations which are better positioned for whatever the future may hold.
Lieutenant General (Ret) P. K. (Ken) Keen is a native of Hyden, Kentucky. LTG (Ret) Keen is currently the Associate Dean of Leadership Development and a faculty member in Organization and Management for Emory University’s Goizueta Business School in Atlanta, Georgia. In this role, he manages a school-wide leadership development program for the MBA programs, which includes teaching crisis leadership; developing high performing teams; implementing a Coaching Fellows Program; and coaching in the Advanced Leadership Academy. [Full bio.]
Professor Roderick Gilkey holds a joint appointment at Emory University, where he serves on the faculty of the Goizueta Business School as a professor in the practice of organization and management, and the School of Medicine, where he is an associate professor of psychiatry. He is the recipient of the university’s highest teaching honor, the Emory Williams Award. Rick also serves on the faculty of Duke Corporate Education. [Full bio.]
About the Author
- Dr. Edward L. Baker, 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 an Adjunct Professor at UNC, Harvard, and Indiana University schools of public health. At UNC and Harvard, he teaches courses on the theory and practice of leadership.
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