Thinking Around Corners: Crisis Leadership, June 2020

The SARS-CoV-2 virus pandemic is a tectonic force exposing the fault lines underlying current medical practice, care delivery models, and physician career expectations. The professional uncertainty, financial disruption, and personal risk encountered by physicians creates a crisis of confidence that can lead to burnout and career disruption. It seems that this is the classic VUCA situation that I reviewed in my most recent blog post, “The Black Swan”. I just received a special edition of the Harvard Business Review devoted to “Crisis Leadership”. Current events highlighting systemic racism in our society provoked demonstrations that evolved from peaceful gatherings to violent riots; leading some citizens and business owners to believe that they were abandoned by ineffective leaders unable to secure the safety of their homes and businesses. The events seemed to put a fine point on the impact of timely, high-risk leadership decisions made (or not) in volatile situations. Perhaps there are some lessons here for physician leaders who are trying to prevent a “crisis” situation from spiraling out of control. Obviously, this complex subject cannot be fully vetted in a single blog post. I do think there are a few points to be made that might be helpful to physician leaders who need to make very difficult decisions without the luxury of a lot of time for detailed examination. Emergency situations may require leaders comfortable with a “command and control” leadership mindset. That leadership style is sometimes reasonable early in the timeline of an evolving crisis…mostly to buy time for a more adaptive approach later. Fortunately, there are very few “crises” in medical management that are so urgent as to require such an assertive leadership style. I will share a few catch phrases I have learned over time that highlight some key leadership concepts that could help you manage a crisis situation.

  1. “Live to fight another day”. Essentially this is the base level in Mazlow’s Hierarchy of Needs. Unless you can “survive” by meeting your own physiological requirements, you won’t be able to lead anyone. Not only will your performance suffer if you don’t restore yourself with proper rest and nutrition; your stamina will wane, and your performance will suffer. Taking care of yourself in a time of crisis will signal your commitment to success and inspire those who follow you as well. As your team sees you as someone with grit, stamina, and energy to take on and solve problems in a rapidly evolving situation; they will trust that you will see the crisis through and not abandon them at a time of great need.
  2. “The enemy of good is better”. A crisis demands critical decisions made in real time with the best information available. A good decision made with incomplete information at a time when there can be positive impact on the outcome is far better than waiting for all of the information needed to make a “more perfect” decision long past the time to make a difference in the result. As time passes, an inclination to make timely incremental decisions based on increasingly clear information can help you keep a crisis from becoming a catastrophe.
  3. “Play the ball in front of you”. In a rapidly evolving situation, you may be able to fall back on your experience, training, scenario planning…perhaps even action plans previously developed anticipating similar situations. Unfortunately, static plans may not be relevant to your current situation…General Dwight Eisenhower noted, “in preparing for battle I have always found that plans are useless, but planning is indispensable”. A more contemporary quote, both entertaining and true, comes from Mike Tyson, “Everyone has a plan ‘till they get punched in the mouth”. Given the volatility and ambiguity of the environment, the ability to focus on what needs to happen now, will allow you to continue to move forward. You will never know today what you are going to know tomorrow. In my career, I have been able to see the beginning and end of crisis situations only in retrospect. A combination of stamina, perseverance, optimism, and an inclination to adaptive action seems to have been a formula that works for navigating turbulent times.
  4. “Fall back, regroup, tend the wounded, bury the dead, close ranks, move out”. Each of us remembers quotable moments from our time with our parents. My Dad spent time in the military during both WW II and the Korean War and that formative experience changed the trajectory of his professional career as an attorney. His quote above defined his “action plan” for survival during stressful and difficult times; and, included a remedy for adapting to the new normal by cutting your losses, aligning your team and pressing on. He also used to say that when you are preparing to face the day, you get up in the morning and put on your armor…on a “good day” you come home carrying your shield, and on a “bad day” you are carried home on your shield. Either way, you must get up the next morning and do it again…hope springs eternal. I think there is something to this, as he came from very humble beginnings in a small northern Minnesota mining town and he worked his way to the top of his profession. He survived a number of personal, professional, and health challenges. Any one of these events could have taken him out. He is a testament to the adage “you need to survive to thrive”.

Freidrich Nietzsche said “that which does not kill us makes us stronger”. I am not sure you can ever “manage” a crisis, but you can get better at “navigating” one in such a way as to allow you to emerge with a new appreciation for your situation. Adapting to a “new” normal creates an opportunity for you to move forward. In the course of my career I encountered personal and professional crisis situations that required a real effort (and some luck) to survive…In some of those cases, I left a lot of my own blood on the floor. No one gets through life without some adversity, but there is a certain satisfaction in knowing that you are capable of surviving the next crisis. Most importantly, in the context of this discussion on physician leadership…those that you lead will believe that with you, they also can, and will survive as well.