Leadership in uncertain times
“We’re over it.” Many of us, health care workers or not, have overtly or covertly expressed this state of being. The ever-changing protocols, the hybrid telehealth clinics, the endless zoom meetings, the cancelled conferences, the restrictions, the distancing, the lack of human touch, the masked smiles. Our day-to-day work and living have fundamentally changed as managers dictate what we can or can’t do. We thought it was going to be a short sprint. It’s turning out to be a marathon that we did not sign up for. And we’re over it.
A mutated RNA virus measuring a mere 125 nanometres infected a host and went viral. Horror pandemics that made great Hollywood movies suddenly became our story. We’ve lost loved ones. We’ve lost jobs and businesses. We’ve lost our dreams and plans. We’ve lost a sense of control over our personal and professional lives.
My patients tell me that they’re scared. The theatre technician tells me she’s confused. Fear & confusion spread rapidly in a pandemic. What drives the R0 of fear? As I reflect on the times that I feel fearful in my work as a surgeon, I fall on these 3: lack of cognitive understanding (I don’t know what’s happening), lack of emotional support (I feel alone) and lack of physical protection (I feel I’m at risk). These are real human concerns that many of us have felt internally behind the heroic narrative bestowed unwillingly upon us. So, we put on that mask.
Knowing that there is still the long journey of COVID normal ahead, what can we do to resolve some of those hidden fears? Waiting for surveys, research grant, program approval and administrative intervention can take a long time. What can we do tomorrow for our colleagues, our team and our patients? What antidote can we offer for this pandemic of fear and confusion sometimes manifested in anger and frustration?
In Dr Anthony Fauci’s widely viewed Grand Round Lecture to Harvard Medical School (at 1:02:20), he underlined humility as something that he has learned and has underpinned his approach. Humility is not just an esoteric conceptual idea, it is a courageous practical reality. Not knowing everything there is to know about this virus. Being willing to put aside dogma in light of new evidence. Being quick to admit wrong. Being prompt in changing protocols and guidelines. Considering the alternative view. Listening to those outside of the specialty. I have been wrong. I have criticised my managers. I have been rebuked, corrected and critiqued. We all need to embrace this humility espoused by Dr Fauci. We are not looking for perfect leaders in this pandemic. We’re looking for authentic leaders willing to accept errors and embrace change. I think we could easily trust leaders who are genuinely interested in hearing every voice and who make efforts to adapt and adopt change. Humility starts with us whether we have a position of leadership or not.
What do you do when you feel you don’t know what’s going on, you feel unsupported at work or you feel you are at risk? You go to your leader. At this point in the pandemic your wellbeing is strongly tied to your leader/manager/supervisor. If you work under a poorly performing leader (I do not have to define that, you know what that would look like), you would not bring up your concerns. But if you have a leader with their heart on their sleeves, you will speak up. A compassionate, competent and collaborative leader makes you feel safe at work, in the midst of all the pandemic stress. Mayo Clinic has shown this to be a fact. They ran 2 studies that linked staff wellbeing with leadership scores of their manager. In 2013 they surveyed 2,813 doctors and in 2017 they surveyed 39,896 Mayo Clinic employees, excluding doctors, reporting very similar outcomes. The immediate supervisor leadership score was strongly associated with burnout and satisfaction of individual employees after adjusting for sex, age, duration of employment and job category. Each one-point increase in composite leadership score of the supervisor is associated with a 7% decrease in the likelihood of burnout and an 11% increase in the likelihood of job satisfaction. What does this mean for us? This pandemic is a long-haul journey to COVID normal. If you’re in any position of leadership, have a big heart. Your team depends on you being a good leader. Your leadership influences their levels of burnout and job satisfaction. No fancy campaigns or expensive programs, be a good person. Have heart and humility. If you do not have a formal position of leadership, lead from within. We all have influence on our workplaces.
Stephen Hawking gave this piece of advice to his children during a June 2010 interview on ABC News: “One, remember to look up at the stars and not down at your feet. Two, never give up work. Work gives you meaning and purpose and life is empty without it. Three, if you are lucky enough to find love, remember it is there and don’t throw it away.”
Beyond the pandemonium that is this pandemic, beyond the science and epidemiology that is pursuing this virus, beyond the fear and confusion, are 7.6 billion human hearts that beats with hope. We have seen the cracks in our health system. We have seen the true colours of leadership. We have seen the dark inequities that exist within our society. The fatalistic, nihilistic, catastrophising view is to say “it is what it is.” The clinician scientists with a hopeful world view would say, “let’s rewrite the story beyond the curve”. Let’s build a new normal. Let’s focus on and fix a few things. You say we can’t change the world. Well, the world has already changed. We now have a pandemic momentum to change a few things. For hope to be realistic, it has to be tangible and measurable in the present. We can start by writing down the top 3 things in our workplaces that we can change. How do we support frontline non-clinicians? How do we improve HCW protection? How do we empower team leaders? How do we better communicate the science? How do we reduce inequities?
So today, how can we and our leaders practically apply Humility, Heart & Hope in our workplaces?