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Crisis Leadership during the COVID-19 Pandemic: A Review to Inform Policymaking
Abstract
Context: The COVID-19 pandemic has placed unprecedented stress on health care systems worldwide. The global scale of the outbreak and its unpredictable nature has put a significant leadership burden on health care leaders and decision-makers. Predefined emergency preparedness plans are no longer working. Evidence-based guidelines and crisis communication plans are insufficient. There is an increased amount of pandemic fatigue among the general population. Businesses are suffering. A financial crisis is looming. Health systems leaders need new leadership behaviors and mindsets to help them lead during the next phases of this dynamic crisis as well as in future pandemics. Despite a proliferation of perspectives on the topic, given the novelty of the situation there is no aggregated resource distilling the evidence about how to lead under crisis conditions. Objective: The aim of this paper is to systematically examine evidence from research on public health crisis leadership to determine what competencies are explicitly needed to better respond to pandemics like COVID-19. Specifically, we sought to map and assess published studies on pandemics (a) to characterize core competencies required to lead in the health sector during a pandemic, and (b) to identify contextual enablers and barriers to leading during a crisis. Methods: We conducted a rapid review using the methodological framework of Arksey and O’Malley (2005), the World Health Organization Rapid Review Guide, and the Joanna Briggs Institute 2020 guide to scoping reviews (Peters et al., 2020; Tricco et al., 2017). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-SR) guided our reporting of study findings. Data Sources: We performed a systematic and comprehensive search of MEDLINE (via Ovid), EMBASE, PsycINFO, Business Source Premier, and Canadian Business & Current Affairs for studies published between 2003 (since SARS) and July 28, 2020. Study Selection, Extraction, and Synthesis: We selected all empirical articles (quantitative, qualitative, and mixed methods) that discussed crisis leadership during a pandemic. Data Synthesis: The literature search identified 8,044 citations. A review of abstracts led to the retrieval of 749 full-text articles for assessment, of which 30 were selected for review. Conclusions: Our findings show that crisis leadership competencies commonly fall under three categories of leadership capacity: task, people, and adaptive. In pandemic-related leadership literature, task-related behaviors such as preparing and planning, establishing collaborations, and crisis communication often receive more attention. Our analysis revealed that during a crisis, people-oriented capacities and adaptive capacities are equally important for leaders to successfully lead in a dynamic situation shaped by structural, political, and cultural contextual factors.
... However, less attention has been paid to determining the preventive employee behaviors that contribute to the adoption and non-adoption of preventive employee behaviors at the workplace. At an uncertain time, organizations and leadership are the two sources to provide authentic information to their employee to adopt preventive behavior in the workplace (Sriharan et al., 2021), especially in the presence of rumors and conspiracies that hinder the factual information (Jolley & Paterson, 2020;Roozenbeek et al., 2020). Organizations speak through their action and policies (Windscheid et al., 2016), and leaders' actions and words speak of their intention and geniuses of the issue (Leroy et al., 2012). ...
... However, less attention has been paid to determining the preventive employee behaviors that contribute to the adoption and non-adoption of preventive employee behaviors at the workplace. At an uncertain time, organizations and leadership are the two sources to provide authentic information to their employee to adopt preventive behavior in the workplace (Sriharan et al., 2021), especially in the presence of rumors and conspiracies that hinder the factual information (Jolley & Paterson, 2020;Roozenbeek et al., 2020). Organizations speak through their action and policies (Windscheid et al., 2016), and leaders' actions and words speak of their intention and geniuses of the issue (Leroy et al., 2012). ...
This study utilizes Social Information Processing (SIP) theory to investigate the relationship between organizational preventive actions (substantive vs. symbolic), employee preventive behavior, the mediating role of conspiracy beliefs, and moderating role of leadership integrity in the context of Covid-19. The study explains leadership integrity as a boundary condition to facilitate or hinder the mediated relationship between organizational actions and employee preventive behavior (EPB). The hypothesized model was tested using partial least square structural equation modelling (PLS-SEM) on two-wave data collected from 281 respondents. The results revealed that substantive actions do not predict EPB directly but through conspiracy beliefs. Contrary to these, symbolic actions negatively predict EPB directly. Leadership integrity moderates the relationship between substantive actions and conspiracy beliefs, while the interaction effect with symbolic actions is not sup ported. The findings of this study caution managers to walk their talk because employees critically observe the most apparent actions, especially when management fails to practice them. The study contributes to social information processing theory by pointing to leadership integrity as a source of authenticity to curb the negative impact of symbolic actions and catalyst the effect of substantive actions on employee preventive behavior.
KEYWORDS conspiracy beliefs, Covid-19, employee preventive behavior, leader’s integrity, social information processing theory (SIP)
... Emergency Managers will need to show expertise in crisis leadership skills and multi-disciplinary collaboration across the entire disaster cycle (prevention, preparedness, response, recovery, rehabilitation) that transcend functional discipline-specific capabilities. [5][6][7] There are several specific areas to be addressed that can significantly enhance both capacity and capability: Multi-disciplinary collaboration: It is time to move beyond merely referring to other entities as "partners." An appreciation for the need for each stakeholder to both master their lane and work well with others should be cultivated at every level of the profession. ...
The COVID-19 Pandemic continues to be one of the most formidable public health challenges in modern history. Amidst the backdrop of new variants of the SARS CoV-2 virus, the pandemic that everyone thought would be over in a year shows little signs of abatement. Concurrently, the emergency management community globally have responded to an unprecedented number of crisis events. From March 2020 to September 2021, there have been sizeable disasters such as wildfires, hurricanes and tropical storms, earthquakes, and flooding. In addition, cyberattacks and terrorist activity have required additional manpower, management resources, and both the talent and funding to adequately study and train differently than we have to date.
Purpose
The purpose of the paper is to identify traits and behaviors of organization leaders that were deemed helpful by employees during the COVID-19 pandemic.
Design/methodology/approach
This is an exploratory qualitative study that utilized online surveys. Data from 155 participants were subjected to content analysis.
Findings
Several interrelated traits and behaviors of effective crisis leadership were identified. These were clustered into three superordinate themes – attending to the person, taking charge and showing the way forward and sustaining the spirit.
Research limitations/implications
Findings from this paper can be furthered by conducting quantitative studies to validate themes and/or test a conceptual model of effective crisis leadership. Gathering data from other populations at different points in time during the COVID-19 pandemic may also be useful.
Practical implications
A review of leadership development programs and organization norms and values is recommended in order to ensure that they are consistent with crisis leadership competencies.
Originality/value
This paper helps address the gap on follower-centered perspectives about organizational leadership responses to crises and highlights the importance of care and compassion in leading employees during difficult times.
Traumatic events such as a pandemic shatter the assumption of the workplace as a safe place. Nurses face risks of life-threatening infection, which can create psychological distress. Quality of care for infected patients depends on mental well-being of nurses which calls for research on predictors of stress among health care workers. Responding to a call for research on the effects of leadership styles on psychological distress during traumatic events, this paper uses the theoretical lens of social exchange theory and contributes to literature on relationships between inclusive leadership, psychological distress, work engagement, and self-sacrifice. Participants of this cross sectional study included 497 registered nurses from five hospitals in Wuhan. Data were collected with temporal separation through an online questionnaire. Partial least-squares structural equation modeling was used to analyze data. Results show inclusive leadership has a significant negative relationship with psychological distress. Work engagement mediates this relationship, and nurses’ self-sacrificial behavior moderates it. Findings indicate inclusive leadership style serves as a sustainable mechanism to reduce psychological distress during pandemics. It can operationalize the delivery of mental health support in real-time in work settings. Results provide empirical support for social exchange theory through high work engagement to help control psychological distress among nurses.
On 11th March 2020, the spread of the SARS-CoV-2 virus was declared a pandemic by the World Health Organisation (WHO). Approximately 5.6 million have now been infected and over 350,000 have died. This global public health crisis has since cascaded into a series of challenges for leaders around the world, threatening both the health and economy of populations. This paper attempts to compartmentalise leadership aspects, allowing a closer examination of reports and the analysis of outcomes. The authors are thus enabled to formulate a number of evidence-based recommendations on the de-escalation of restrictions.
The coronavirus disease that emerged in 2019 (COVID-19) spotlights the need for effective leadership in a crisis. Leadership research in applied psychology suggests that women tend to be preferred over men as leaders during uncertain times. We contribute to this literature by examining, in the context of COVID-19, whether states with women governors had fewer deaths than states with men governors, and why. We tested this research question with publicly available data on COVID-19 deaths in the United States as of May 5, 2020 and found that states with women governors had fewer COVID-19 deaths compared to states with men governors. Governor sex also interacted with early stay-at-home orders; states with women governors who issued these orders early had fewer deaths compared to states with men governors who did the same. To provide insight into psychological mechanisms of this relationship, we conducted a qualitative analysis of governor briefings that took place between April 1, 2020 and May 5, 2020 (251 briefings, 38 governors, 1.2 million words). Compared to men, women governors expressed more empathy and confidence in their briefings. Practical implications are discussed.
Background The COVID-19 pandemic has raised a wide range of challenges for health systems around the world and the National Health Service in England has been no exception. A significant proportion of infected cases require intensive care unit support and have a high mortality rate. In the early stages of the pandemic, there was neither an evidence base nor a clinical consensus on the optimal management of patients in this setting.
Interventions Responding to requests for assistance to address this evidence gap, UCLPartners, an Academic Health Science Partnership, working in collaboration with other organisations including National Institute of Health Research Applied Research Collaboration North Thames, developed a clinical academic team to synthesise clinical learning in real time. This was then disseminated using existing networks and social media to local, regional, national and international clinical teams.
Conclusion An Academic Health Science Partnership was able to respond quickly through adapting and expediting traditional methods of evidence gathering, supporting organisations to work collaboratively across their networks and so meet an urgent clinical need to the benefit of clinicians and patients.
Boin (2019) argues that in transboundary crisis management it is almost impossible to achieve centralization and coordination. This article identifies three principles through which actors in a transboundary crisis can balance centralization with autonomy while shaping coordination along the way. We reanalysed three transboundary cases: the Dutch military mission in Afghanistan, the downing of MH17 and hurricane Irma striking Sint-Maarten. The principles we found are as follows: (a) reformulating key strategic priorities, (b) flexible adaptation of crisis management protocols and (c) the emergence of multifunctional units. With these three principles, we reflect on challenges in the Dutch crisis response to the corona outbreak and propose improve- ments for progressing current crisis management efforts.
Background
In this piece, we translate insights from our study of routine coordination in the Ebola virus disease response operation by Uganda Red Cross Society (URCS) for managing long-lasting public health emergencies. We further show how these lessons are relevant to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Commonly, emergency response organisations, like the URCS or hospitals, are ill equipped to handle longer lasting emergencies. These emergencies require special measures that combine ad-hoc action, continuous awareness over longer time periods, and the collaboration of multiple actors such as the government, public health institutions and other non-governmental organisations (NGOs).
Results
From our study we can translate seven lessons learnt which are important for managing long-term public health emergencies such as pandemics: (1) centralised pooling and management of resources; (2) engagement of local communities in response efforts; (3) the need to continuously recruit and train staff; (4) the establishment of adjusted working patterns to prevent staff exhaustion; (5) cooperation of involved agencies with security for enforcing measures; (6) the revision of funding frameworks; and (7) the use of global positioning system (GPS) data to identify population movement patterns.
Conclusion
Although still speculative at this stage, we apply these lessons to the current SARS-CoV-2 pandemic. We argue that immediate action in the areas of resource pooling and control over critical resources, in the engagement of trusted and respected individuals in risk communication, in the continuous training and hiring of new staff, and in the appropriation of GPS tracking data is called for in managing SARS-CoV-2 by policy makers, NGOs and other involved agencies.
Background: The COVID-19 pandemic has highlighted health care systems’ vulnerabilities. Hospitals face increasing risk of periods of scarcity of life-sustaining resources such as ventilators for mechanical respiratory support, as has been the case in Italy as of March, 2020. The National Academy of Medicine has provided guidance on crisis standards of care, which call for the reallocation of scarce medical resources to those who will benefit most during extreme situations. Given that this will require a departure from the usual fiduciary duty of the bedside clinician, we determined and mapped potential barriers to the implementation of the guidelines from stakeholders using an implementation science framework. Methods: A protocol was created to operationalize national and state guidelines for triaging ventilators during crisis conditions. Focus groups and key informant interviews were conducted from July-September 2018 with clinicians at three acute care hospitals of an urban academic medical center. Respiratory therapists, intensivists, nursing leadership and the palliative care interdisciplinary team participated in focus groups. Key informant interviews were conducted with emergency management, respiratory therapy and emergency medicine. Subjects were presented the protocol and their reflections were elicited using a semi-structured interview guide. Data from transcripts and notes were categorized using a coding strategy based on the Theoretical Domains Framework. Results: Participants anticipated that implementing this protocol would challenge their roles and identities as clinicians including both their fiduciary duty to the patient and their decision-making autonomy. Despite this, many participants acknowledged the need for such a protocol to standardize care and minimize bias as well as to mitigate potential consequences for individual clinicians. Participants identified the question of considering patient quality of life in triage decisions as an important and unresolved ethical issue in disaster triage. Conclusion: Clinicians’ discomfort with shifting roles and obligations could pose implementation barriers for crisis standards of care.
Objective
To locate and analyze U.S. State Crisis Standards of Care (CSC) documents to determine their prevalence and quality.
Methods
Following PRISMA guidelines, Google search for “allocation of scarce resources” and “crisis standards of care (CSC)” for each state. We analyzed the plans based on the 2009 Institute of Medicine (IOM) Report which provided guidance for establishing CSC for use in disaster situations, as well as the 2014 CHEST consensus statement’s 11 core topic areas.
Results
The search yielded 42 state documents and we excluded 11 that were not CSC plans. Of the 31 included plans, 13 plans were written for an “All Hazards” approach, while 18 were pandemic influenza specific. 18 had strong ethical grounding. 21 plans had integrated and ongoing community and provider engagement, education, and communication. 22 had assurances regarding legal authority and environment. 16 plans had clear indicators, triggers, and lines of responsibility. Finally, 28 had evidence-based clinical processes and operations.
Conclusion
Five plans contained all 5 IOM elements: Arizona, Colorado, Minnesota, Nevada, and Vermont. Colorado and Minnesota have “All Hazards” documents and processes for both Adult and Pediatric populations and could be considered exemplars for other states.
Methodological quality (risk of bias) assessment is an important step before study initiation usage. Therefore, accurately judging study type is the first priority, and the choosing proper tool is also important. In this review, we introduced methodological quality assessment tools for randomized controlled trial (including individual and cluster), animal study, non-randomized interventional studies (including follow-up study, controlled before-and-after study, before-after/ pre-post study, uncontrolled longitudinal study, interrupted time series study), cohort study, case-control study, cross-sectional study (including analytical and descriptive), observational case series and case reports, comparative effectiveness research, diagnostic study, health economic evaluation, prediction study (including predictor finding study, prediction model impact study, prognostic prediction model study), qualitative study, outcome measurement instruments (including patient - reported outcome measure development, content validity, structural validity, internal consistency, cross-cultural validity/ measurement invariance, reliability, measurement error, criterion validity, hypotheses testing for construct validity, and responsiveness), systematic review and meta-analysis, and clinical practice guideline. The readers of our review can distinguish the types of medical studies and choose appropriate tools. In one word, comprehensively mastering relevant knowledge and implementing more practices are basic requirements for correctly assessing the methodological quality.
Meaning making by leadership in a crisis is required to reduce uncertainty. We used analytic criteria for meaning making suggested by crisis management literature to investigate public leaders’ quotations in news coverage of a health crisis. The quotations were examined in terms of the five frame functions, which include offering a credible explanation of what happened, offering guidance, instilling hope, showing empathy, and suggesting that leaders are in control. The Middle East respiratory syndrome outbreak in South Korea was examined. As a result, the most salient frame function identified was displaying they are in control of the emergency, followed by offering guidance and explaining what happened. The salience of leaders’ meaning making disappeared in coverage by a liberal newspaper.
Background
Scoping reviews are a relatively new approach to evidence synthesis and currently there exists little guidance regarding the decision to choose between a systematic review or scoping review approach when synthesising evidence. The purpose of this article is to clearly describe the differences in indications between scoping reviews and systematic reviews and to provide guidance for when a scoping review is (and is not) appropriate.
Results
Researchers may conduct scoping reviews instead of systematic reviews where the purpose of the review is to identify knowledge gaps, scope a body of literature, clarify concepts or to investigate research conduct. While useful in their own right, scoping reviews may also be helpful precursors to systematic reviews and can be used to confirm the relevance of inclusion criteria and potential questions.
Conclusions
Scoping reviews are a useful tool in the ever increasing arsenal of evidence synthesis approaches. Although conducted for different purposes compared to systematic reviews, scoping reviews still require rigorous and transparent methods in their conduct to ensure that the results are trustworthy. Our hope is that with clear guidance available regarding whether to conduct a scoping review or a systematic review, there will be less scoping reviews being performed for inappropriate indications better served by a systematic review, and vice-versa.
Policy-makers require valid evidence to support time-sensitive decisions regarding the coverage, quality, efficiency, and equity of health systems. Systematic reviews and other types of evidence syntheses are increasingly employed to inform policy-making and produce guidance for health systems. However, the time and cost to produce a systematic review is often a barrier to its use in decision-making. Rapid reviews are a timely, and affordable approach that can provide actionable and relevant evidence to strengthen health policy and systems. This Practical Guide explores different approaches and methods for expedited synthesis of health policy and systems research, and provides guidance on how to plan, conduct, and promote the use of rapid reviews, while highlighting key challenges including their application in low- and middle-income countries. Our proposed solutions will help provide policy-makers and health systems managers with strategic evidence to make crucial decisions about health systems’ response in emergency situations, as well as in routine decision-making.
Background:
Terrorism, disease outbreaks, and other natural disasters and mass casualty events have pushed health care and public health systems to identify and refine emergency preparedness protocols for disaster response. Ethical guidance, alongside legal and medical frameworks, are increasingly common components of disaster response plans.
Objectives:
To systematically review the prevalence and content of ethical guidance offered for disaster response, specifically around crisis standards of care (CSCs).
Search methods:
We systematically indexed academic literature from PubMed, Google Scholar, and ISI Web of Science from 2012 to 2016.
Selection criteria:
We searched for peer-reviewed articles that substantively engaged in discussion of ethical guidance for CSCs.
Data collection and analysis:
Researchers screened potential articles for identification and discussion of ethical issues in CSC planning. We categorized and cataloged ethical concepts and principles.
Main results:
Of 580 peer-reviewed articles mentioning ethics and CSCs or disaster planning, 38 (6%) met selection criteria. The systematic review of the CSC ethics literature since 2012 showed that authors were primarily focused on the ethical justifications for CSC (n = 20) as well as a need for ethics guidelines for implementing CSCs; the ethical justifications for triage (n = 19), both as to which criteria to use and the appropriate processes by which to employ triage; and international issues (n = 17). In addition to these areas of focus, the scholarly literature included discussion of a number of other ethical issues, including duty to care (n = 11), concepts of a duty to plan (n = 8), utilitarianism (n = 5), moral distress (n = 4), professional norms (n = 3), reciprocity (n = 2), allocation criteria (n = 4), equity (n = 4), research ethics (n = 2), duty to steward resources (n = 2), social utility and social worth (n = 2), and a number of others (n = 20). Although public health preparedness efforts have paid increasing attention to CSCs in recent years, CSC plans have rarely been implemented within the United States to date, although some components are common (e.g., triage is used in US emergency departments regularly). Conversely, countries outside the United States more commonly implement CSCs within a natural disaster or humanitarian crisis response, and may offer significant insight into ethics and disaster response for US-based practitioners.
Conclusions:
This systematic review identifies the most oft-used and -discussed ethical concepts and principles used in disaster planning around CSCs. Although discussion of more nuanced issues (e.g., health equity) are present, the majority of items substantively engaging in ethical discussion around disaster planning do so regarding triage and why ethics is needed in disaster response generally. Public health implications. A significant evolution in disaster planning has occurred within the past decade; ethical theories and frameworks have been put to work. For ethical guidance to be useful, it must be practical and implementable. Although high-level, abstract frameworks were once prevalent in disaster planning-especially in the early days of pandemic planning-concerns about the ethically difficult concept of CSCs pervade scholarly articles. Ethical norms must be clearly stated and justified and practical guidelines ought to follow from them. Ethical frameworks should guide clinical protocols, but this requires that ethical analysis clarifies what strategies to use to honor ethical commitments and achieve ethical objectives. Such implementation issues must be considered well ahead of a disaster. As governments and health care systems plan for mass casualty events, ethical guidance that is theoretically sound and practically useful can-and should-form an important foundation from which to build practical guidance for responding to disasters with morally appropriate means. (Am J Public Health. Published online ahead of print July 20, 2017: e1-e9. doi:10.2105/AJPH.2017.303882).
The goal of this article is to discover how leadership competencies affect the perceived effectiveness of crisis management. The study, based on a self-reported survey of executive public leaders in Turkey, found that the core leadership competencies have a positive relationship with the effectiveness of crisis management. Among task–oriented, people–oriented, and organization-oriented categories of leadership behaviors, task-oriented leadership behaviors were found with the highest level of impact on the effectiveness of crisis management. The study demonstrated the importance of the core leadership competencies in the effectiveness of crisis leadership. The hypothesis testing with the covariance structure model supported the positive impact of the core leadership competencies on the effectiveness of crisis management. This study contributes to the literature on leadership during crisis situations, and also provides proposals for public managers and practitioners to increase their effectiveness in leading their organizations during crises.
Objective:
To develop an evidence-based guideline for Peer Review of Electronic Search Strategies (PRESS) for systematic reviews (SRs), health technology assessments, and other evidence syntheses.
Study design and setting:
An SR, Web-based survey of experts, and consensus development forum were undertaken to identify checklists that evaluated or validated electronic literature search strategies and to determine which of their elements related to search quality or errors.
Results:
Systematic review: No new search elements were identified for addition to the existing (2008-2010) PRESS 2015 Evidence-Based Checklist, and there was no evidence refuting any of its elements. Results suggested that structured PRESS could identify search errors and improve the selection of search terms. Web-based survey of experts: Most respondents felt that peer review should be undertaken after the MEDLINE search had been prepared but before it had been translated to other databases. Consensus development forum: Of the seven original PRESS elements, six were retained: translation of the research question; Boolean and proximity operators; subject headings; text word search; spelling, syntax and line numbers; and limits and filters. The seventh (skilled translation of the search strategy to additional databases) was removed, as there was consensus that this should be left to the discretion of searchers. An updated PRESS 2015 Guideline Statement was developed, which includes the following four documents: PRESS 2015 Evidence-Based Checklist, PRESS 2015 Recommendations for Librarian Practice, PRESS 2015 Implementation Strategies, and PRESS 2015 Guideline Assessment Form.
Conclusion:
The PRESS 2015 Guideline Statement should help to guide and improve the peer review of electronic literature search strategies.
Extensive research on leadership behavior during the past half century has yielded many different behavior taxonomies and a lack of clear results about effective behaviors. One purpose of this article is to describe what has been learned about effective leadership behavior in organizations. A hierarchical taxonomy with four meta-categories and 15 specific component behaviors was used to interpret results in the diverse and extensive literature and to identify conditions that influence the effectiveness of these behaviors. Limitations and potential extensions of the hierarchical taxonomy are discussed, and suggestions for improving research on effective leadership behavior are provided.
Purpose
– The aim of this paper is to present evidence of the reliability and validity of the “Local Government 360 (LG360)”, a diagnostic tool for assessing both competent and engaging leadership behaviour among managers and professionals in local government.
Design/methodology/approach
– The paper argues that the assessment of both leadership competencies (the “what”) and engaging leadership behaviours (the “how”) is essential for a valid diagnosis of individuals' strengths and developmental needs.
Findings
– Evidence is presented of the internal consistency (reliability) and the criterion and discriminant validity of the tool, among an opportunity sample comprising 288 local government staff, of whom 143 were female and 77 male; 58 were from a Black and Minority Ethnic background and 220 were White.
Practical implications
– Data on the impact of leadership behaviour on direct reports, provided by the LG360, are powerful in providing evidence to emphasise that the way in which a leader behaves can have a significant effect on staff attitudes and wellbeing at work.
Originality/value
– Although a number of 360-tools are available, only in a small number of cases are their psychometric properties, particularly empirical evidence of their criterion and discriminant validity, reported.
Reviews of public health emergency responses have identified a need for crisis leadership skills in health leaders, but these skills are not routinely taught in public health curricula. To develop criteria for crisis leadership in public health, published sources were reviewed to identify attributes of successful crisis leadership in aviation, public safety, military operations, and mining. These sources were abstracted to identify crisis leadership attributes associated with those disciplines and compare those attributes with crisis leadership challenges in public health. Based on this review, the following attributes are proposed for crisis leadership in public health: competence in public health science; decisiveness with flexibility; ability to maintain situational awareness and provide situational assessment; ability to coordinate diverse participants across very different disciplines; communication skills; and the ability to inspire trust. Of these attributes, only competence in public health science is currently a goal of public health education. Strategies to teach the other proposed attributes of crisis leadership will better prepare public health leaders to meet the challenges of public health crises. (Disaster Med Public Health Preparedness. 2013;0:1-7).
The deeply rooted belief in the importance of public leadership is accompanied by quick and often shallow assessments of leadership performance. Such assessments never arrive more quickly than in the wake of crises and disasters-these episodes make for instant winners (Giuliani) and losers (Bush). These assessments are necessarily shallow, as the public can only judge leaders by what they see. While symbolic performance is important (if only because it can arouse the public), it is not the only performance dimension by which we should assess crisis leadership. In this article, we reflect on the many tasks that strategic leaders are called to perform, and we offer a comprehensive framework for leadership performance in times of crisis.
Purpose
The purpose of this paper is to show that development of competencies needed to be effective managers and leaders requires program design and teaching methods focused on learning. This is the introductory essay to this special issue of JMD .
Design/methodology/approach
Competencies are defined and an overview is provided for the eight papers that will follow with original research on competencies, their link to performance in various occupations, and their development.
Findings
Emotional, social and cognitive intelligence competencies predict effectiveness in professional, management and leadership roles in many sectors of society. In addition, these competencies can be developed in adults.
Research limitations/implications
As an introductory essay, this lays the foundation for the papers in this issue.
Practical implications
Competencies needed to be effective can be developed.
Originality/value
Despite widespread application, there are few published studies of the empirical link between competencies and performance. There are even fewer published studies showing that they can be developed. This special issue will add to both literatures.
The past few decades have witnessed numerous crises that have drawn increasing attention to the study of crisis leadership. However, research in this field remains fragmented and existing reviews often adopt a subjective approach to identify and synthesize the findings of relevant articles. These limitations make it difficult for scholars to appreciate the progress made in the literature, to derive comprehensive and objective insights, and to forge a path ahead. This study synthesizes theoretical insights and empirical findings in the crisis leadership literature using bibliometric techniques. We first review the intellectual structure of the crisis leadership literature by conducting co-citation and bibliographic coupling analyses. We then map the major conceptual themes in the crisis leadership literature via a co-word analysis. To supplement the findings of the bibliometric analyses, we review the key methodological approaches adopted by crisis leadership researchers. Based on the integrative insights, we propose a research agenda highlighting opportunities for theoretical and methodological advancements in crisis leadership research.
The COVID-19 pandemic started globally with the first cases being reported as early as December 1, 2019 in Wuhan, China.1 The first US cases were reported January 20, 2020.2 To date we have 11,892,382 confirmed cases globally and 545,485 deaths.3 Ominously, as of July 2020, the number of cases continues to rise with the United States having the highest cases (3,016,515) and mortality rates in the world. The COVID-19 pandemic has presented unique challenges for emergency managers since most professionals have not experienced or managed a global pandemic. Complicating things further is the nature of SARS CoV-2 itself. As a novel virus we are still learning about the virus which requires adaptive changes to our current response as the pandemic evolves.
The health workforce has been greatly affected by COVID-19. In this commentary, we describe the articles included in this health workforce research supplement and how the issues raised by the authors relate to the COVID-19 pandemic and rapidly changing health care environment.
Background
The COVID-19 pandemic has exposed front-line healthcare workers to unprecedented risks and stressors threatening both physical and mental health. Prior work in the military has found that team identification, or the sense that one was a part of a team, can help reduce stress and prevent burnout during prolonged stress.
Methods
We conducted repeated cross-sectional surveys embedded within emergency department workflow to understand whether team identification was associated with reduced reports of stress and burnout among front-line workers.
Results
During the 10-week study which spanned the first wave of COVID-19, 327 of 431 (76%) front-line healthcare workers responded to at least one round of the survey. Higher team identification was associated with significantly less work stress ( B =−0.60, 95% CI −0.84 to to -0.40, p<0.001) and burnout ( B =−12.87, 95% CI −17.73 to -8.02, p<0.001) in cross-sectional analyses. Further evidence of the protective effect of team identification for work stress ( B =−0.36, 95% CI −0.76 to 0.05, p=0.09) and burnout ( B =−13.25, 95% CI −17.77 to -8.73, p<0.001) was also found in prospective longitudinal evidence.
Conclusion
This work suggests work team identification is a key buffering factor against feelings of stress and burnout. Efforts to promote team identification may offer a promising way for leaders to support front-line healthcare workers’ well-being during the COVID-19 pandemic. These results can inform ongoing COVID-19 operational and quality improvement initiatives.
This article summarises the findings from a review of publications related to healthcare leadership that were published during the first wave of the COVID-19 crisis in 2020. The review discusses a range of strategies for leaders to adopt in challenging situations and identifies three aspects of leadership which are considered essential when leading teams during a crisis: 1) communication, 2) decision making and 3) mental health and wellbeing. This article identifies key principles for each of these three aspects and provides practical tips for how leaders can use the lessons learned from the pandemic in their own contexts.
For many of us in emergency medicine, rising to the challenge of the COVID-19 crisis will be the single most exciting and challenging episode of our careers. Lessons have been learnt on how to make quick and effective changes without being hindered by the normal restraints of bureaucracy. Changes that would normally have taken months to years to implement have been successfully introduced over a period of several weeks. Although we have managed these changes largely by command and control, compassionate leadership has identified leaders within our team and paved the way for the future. This article covers the preparation and changes made in response to COVID-19 in a London teaching hospital.
Background
Effective crisis leadership is dependent on the key tasks of sense-making, decision-making, meaning-making, learning and crisis termination. While instant messaging and social media provided abundant and powerful sources of information during the COVID-19 pandemic, the infodemic—an overabundance of information, some of which is inaccurate—has also complicated the tasks of crisis leadership.
Methods
A qualitative study was undertaken, using semistructured interviews with physician leaders in the hospital dealing with majority of Singapore’s COVID-19 cases. Participants were asked about how they used digital communication tools in their leadership roles before and during the outbreak, and their reflections on the use of these tools. Interviews were audio-recorded, transcribed, coded and subjected to inductive thematic analysis.
Results
Twenty-four physician leaders described the adaptations to crisis leadership tasks using digital communication tools. While these tools were useful for rapid collective sense-making, meaning-making was the most challenging because information was posted by others who were faster, competed with their ability to create nuanced versions of a coherent narrative for stakeholders. Leaders also shared the need to balance their relationship with their smartphone and use digital tools to communicate purpose and meaning to and with their staff when face-to-face meetings are not possible.
Conclusions
The COVID-19 infodemic has disrupted the key tasks of crisis leadership. For each task leaders on the front line can adopt measures to harness the power of and minimise the risk of damage by instant messaging. Infodemic management must be explicitly included in crisis management training for leaders.
Our nation’s nursing home industry has been in need of overhaul for decades – a situation made all the more evident by COVID-19. AMDA – The Society of Post-Acute and Long-Term Care Medicine is dedicated to quality in post-acute and long-term care (PALTC) process and outcomes. This special article presents five keys to solving the COVID-19 crisis in PALTC, related to policy, collaboration, individualization, leadership, and reorganization. Taking action during this crisis may prevent sinking back into the complacency and habits of our pre-COVID-19 lives.
Human behaviour is central to transmission of SARS-Cov-2, the virus that causes COVID-19, and changing behaviour is crucial to preventing transmission in the absence of pharmaceutical interventions. Isolation and social distancing measures, including edicts to stay at home, have been brought into place across the globe to reduce transmission of the virus, but at a huge cost to individuals and society. In addition to these measures, we urgently need effective interventions to increase adherence to behaviours that individuals in communities can enact to protect themselves and others: use of tissues to catch expelled droplets from coughs or sneezes, use of face masks as appropriate, hand-washing on all occasions when required, disinfecting objects and surfaces, physical distancing, and not touching one’s eyes, nose or mouth. There is an urgent need for direct evidence to inform development of such interventions, but it is possible to make a start by applying behavioural science methods and models. Behaviour change is crucial to preventing SARS-CoV-2 transmission in the absence of pharmaceutical interventions. West et al. argue that we urgently need effective interventions to increase adherence to personal protective behaviours.
Background
As the COVID-19 pandemic continues to spread, swift actions and preparation are critical for ensuring the best outcomes for patients and providers. We aim to describe our hospital and Department of Surgery’s experience in preparing for the COVID-19 pandemic and caring for surgical patients during this unprecedented time.
Study Design
This is a descriptive study outlining the strategy of a single academic health system for addressing 4 critical issues facing surgical departments during the COVID-19 pandemic: (1) developing a cohesive leadership team and system for frequent communication throughout the department; (2) ensuring adequate hospital capacity to care for an anticipated influx of COVID-19 patients; (3) safeguarding supplies of blood products and personal protective equipment to protect patients and providers; and (4) preparing for an unstable workforce due to illness and competing personal priorities such as childcare.
Results
Through collaborative efforts within the Department of Surgery and Hospital, we provided concise and regular communication, reduced operating room volume by 80%, secured a 4-week supply of personal protective equipment, and created reduced staffing protocols with back-up staffing plans.
Conclusions
By developing an enabling infrastructure, a department can nimbly respond to crises like COVID-19 by promoting trust among colleagues and emphasizing an unwavering commitment to excellent patient care. Sharing principles and practical applications of these changes is important to optimize responses across the country and world.
As funding for public health promotion is increasingly limited in the U.S., public relations research informing management of crises that threaten public health is especially critical. Crisis planning models such as Reynolds and Seeger's (2005, 2014) crisis and emergency risk communication model offer comprehensive directives for crisis managers and present opportunities to extend the utility of best practice recommendations. A survey of public information officers (PIOs) (n=208) at local public health departments across the U.S. examines the quality of their relationships with partners in public health crisis management, including first responders, media, law enforcement, and hospitals, and reveals that relationships with key publics in crisis management are lacking. Further, PIOs at state governed health departments may face critical delays in releasing crisis messages, as their messages are required to clear more levels of approval than locally (city/county) governed departments. Implications and future research for these key variables extending public relations crisis communication research with a focus on inter-organizational relationships are discussed.
This research focuses on the 2014 Ebola crisis response by emergency managers in the Dallas-Fort Worth (DFW) Metropolitan region in the State of Texas, U.S.A. It examines the patterns of crisis communication and the use of Standard Operating Procedures (SOPs) during the first month of the crisis. Primary data collected from 24 face-to-face interviews and 12 online surveys are analyzed. The research identifies elements contributing to organizational failures, which by their very nature gain public and media attention, and also explicates the less mentioned successful decisions made by response agencies in the DFW region. It is important to investigate both failures and successes to help inform organizational learning for better preparedness to future health crises. Findings suggest that, although there was a breakdown in communication between small city governments/ municipalities and higher levels of government at the State and Federal levels, prior training and collaborative relationships helped in improvised decision-making. Takeaways for practitioners include reiterating the importance of establishing SOPs, merits of flexibility, and improvisational decisions for shared learning.
Grounded theory methodology and procedure have become one of the most influential modes of carrying out qualitative research when generating theory is a principle aim of the researcher. This volume presents a series of readings that emphasize different aspects of grounded theory methodology and methods. The selections are written by former students of the late Anselm Strauss and have been chosen for their accessibility and range.
This article reports on the design, evaluation framework, and results from the Meta-Leadership Summit for Preparedness Initiative. The Meta-Leadership Summit for Preparedness was a 5-year initiative based on the premise that national preparedness and emergency response is not solely the responsibility of government. From 2006 to 2011, 36 Meta-Leadership Summits were delivered in communities across the country. Summits were customized, 10-hour leadership development, networking, and community action planning events. They included participation from targeted federal, state, local, nonprofit/philanthropic, and private sector leaders who are directly involved in decision making during a major community or state-wide emergency. A total of 4,971 government, nonprofit, and business leaders attended Meta-Leadership Summits; distribution of attendees by sector was balanced. Ninety-three percent of respondents reported the summit was a valuable use of time, 91% reported the overall quality as "good" or "outstanding," and 91% would recommend the summit to their colleagues. In addition, approximately 6 months after attending a summit, 80% of respondents reported that they had used meta-leadership concepts or principles. Of these, 93% reported that using meta-leadership concepts or principles had made a positive difference for them and their organizations. The Meta-Leadership Summit for Preparedness Initiative was a value-added opportunity for communities, providing the venue for learning the concepts and practice of meta-leadership, multisector collaboration, and resource sharing with the intent of substantively improving preparedness, response, and recovery efforts.
This paper focuses on scoping studies, an approach to reviewing the literature which to date has received little attention in the research methods literature. We distinguish between different types of scoping studies and indicate where these stand in relation to full systematic reviews. We outline a framework for conducting a scoping study based on our recent experiences of reviewing the literature on services for carers for people with mental health problems. Where appropriate, our approach to scoping the field is contrasted with the procedures followed in systematic reviews. We emphasize how including a consultation exercise in this sort of study may enhance the results, making them more useful to policy makers, practitioners and service users. Finally, we consider the advantages and limitations of the approach and suggest that a wider debate is called for about the role of the scoping study in relation to other types of literature reviews.
Presents a sourcebook of all published research findings on leadership-abstracts, surveys, and analysis of more than 3,000 books and articles. Topics include leadership theory, leadership personality and behavior, leadership stability and change, emergence of the leadership role, leadership and social power, leader-follower interactions, and leadership and group performance. (150 p ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)