Crisis Leadership During and Following COVID-19

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. Most of us have never experienced such disruptive times, and never has good leadership been more important. But what constitutes 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 diligent planning and running of simulations is paramount in optimal preparation, as is acquisition of personal protective equipment (PPE), which relies on modeling the need and communication 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 reprisal. 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. Don’t let your emotions overwhelm you during 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 equivalent 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 management. 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 constantly 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, 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.