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Editorial / E
´ditorial
Crisis Leadership During
and Following COVID-19
Bruce B. Forster, MSc, MD
1
,
Michael N. Patlas, MD, FRCPC, FASER, FCAR, FSAR
2
,
and Frank J. Lexa, MD, MBA
3
The pessimist complains about the wind.
The optimist expects it to change.
The leader adjusts the sails.
—John Maxwell
With over 43 000 cases in Canada, and >2200 deaths, and
throughout the world, >2.7 million cases and 200 000 deaths at
the time of writing, there is little doubt that the SARS-CoV-2
pandemic would qualify as a crisis of a ‘‘landscape’’ scale. The
latter term is used to describe a crisis of enormous scale that
spreads exceedingly quickly, leading to a feeling of loss of
control, disorientation, and severe emotional disturbance.
1
Most of us have never experienced such disruptive times, and
never has good leadership been more important. But what con-
stitutes effective leadership during such a crisis?
Firstly, leadership is not confined to those at the top of the
organizational chart; we all lead every day, be it at home, in our
communities, or within our profession, so such skills apply to
us all. The first step is summed up nicely by the expression,
‘‘Failing to prepare is preparing to fail.’’ The great leader
anticipates and plans for significant disruptions. Clearly, this
does not so much apply to COVID-19 as it is already upon us,
but it is a good reminder for radiology departments to create
disaster plan for mass casualties given the central role that
imaging plays in diagnosis and management. Collaboration
with emergency department and trauma surgery through dili-
gent planning and running of simulations is paramount in opti-
mal preparation, as is acquisition of personal protective
equipment (PPE), which relies on modeling the need and com-
munication to health authorities and government.
During a crisis, more than ever, it is paramount that leaders
avoid a top-down style of leadership. Assemble a network of
teams, empower others, and promote open discussions, in
which creative ideas can be exchanged without fear of repri-
sal.
2
Be aware, as so aptly demonstrated by this pandemic, that
conditions can change rapidly. Be flexible to new directions as
conditions change, but be wary of ‘‘analysis paralysis.’’ It is
more important to act decisively and swiftly, then to always
‘‘get it right.’’ Maintain your equilibrium during these rapidly
changing times.
3
Don’t let your emotions overwhelm you dur-
ing what could be described as an ‘‘administrative code blue.’’
Remember the advice to pilots: during a crisis, be it a fire, or
mechanical issues, ‘‘just fly the plane.’’ In our case, the equiv-
alent would be ‘‘just look after the patient’’—secondary issues
must fall lower in priority. But remember to not just react but
rather strategize a proactive long-term strategy in anticipation
of, for example, radiologist/technologist quarantine due to
exposure, or managing PPE shortage.
Transparency is such an important principle in crisis manage-
ment. Leaders need to provide clarity on what they know and what
they don’t. Regular, accurate communication is essential during
such a crisis and mitigates the risk of rumors and misinformation
being spread, much like the chatter in the cabin of an airliner as it
sits on the tarmac for many minutes with no explanation. With
COVID-19, the understanding of who to screen (and how) before
what procedures changes regularly and is a source of anxiety
which clear evidence-based updates can reduce. Leaders are con-
stantly scrutinized for tone, words chosen, and body language, so
be mindful, and also be realistic, but optimistic whenever possible.
An engaged leader who ‘‘walks the walk’’ with their unit
engenders respect,
4
whether sharing equally in the income
reduction during the crisis or volunteering for patient screening
at hospital entrances. The demonstration of empathy is critical
in crises in which human tragedy is frequent. And the leader
should model the importance of self-care, ensuring they are
match-fit for the challenges by ensuring adequate sleep, good
nutrition, and adequate exercise.
Finally, the recovery phase after a crisis most certainly
demands strong leadership. Balancing the safety of patients and
health care workers with the value-add that medical imaging
and intervention provides in diagnosis and treatment planning
requires an iterative process with feedback loops that instruct
next steps. And with a pandemic such as COVID-19, it is
possible that all of the above principles, with lessons learned,
may be applied again in case of recurrent outbreaks.
1
Department of Radiology, Faculty of Medicine, University of British Columbia,
Vancouver, British Columbia, Canada
2
Department of Radiology, McMaster University, Hamilton, Ontario, Canada
3
American College of Radiology, Reston, VA, USA
Corresponding Author:
Michael N. Patlas, MD, FRCPC, FASER, FCAR, FSAR, Department of Radiology,
McMaster University, 237 Barton St E., Hamilton, Ontario, Canada L8L 2X2.
Email: eic@car.ca
Canadian Association of
Radiologists’ Journal
1-2
ªThe Author(s) 2020
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/0846537120926752
journals.sagepub.com/home/caj
A great leader helps individuals believe in themselves and
contribute to an achievement that they thought not possible if
acting alone. A landscape crisis such as the SARS CoV-2
pandemic is a global crisis such as we have never seen. But with
principles of great leadership in mind, the radiology community
can ‘‘adjust the sails’’ and help steer the medicalcommunity back
to the safe haven of quality, timely, and evidence-based care.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, author-
ship, and/or publication of this article.
References
1. Howitt AM, Leonard HB. Against Desperate Peril: High Perfor-
mance in Emergency Preparedness and Response, in ‘Communic-
able Crises: Prevention, Response, and Recovery in the Global
Arena’. Collins D, ed. Information Age Publishing; 2007.
2. D’Auria G, DeSmet A. Leadership in a crisis: Responding to cor-
onavirus outbreak and future challenges. 2020. https://www.mckin
sey.com/business-functions/organization/our-insights/leadership-
in-a-crisis-responding-to-the-coronavirus-outbreak-and-future-
challenges. Accessed April 23, 2020.
3. Lexa FJ. Leading in a crisis, part 2: succeeding in battle. J Am Coll
Radiol. 2009;6(10):671-672.
4. Lexa FJ. Leading in a crisis, part 1. J Am Coll Radiol. 2009;6(7):
521-522.
2Canadian Association of Radiologists’ Journal XX(X)
