Failure of crisis leadership in a global pandemic: some reflections on COVID-19 and future recommendations.

PURPOSE: Being a novel public health crisis, the COVID-19 pandemic presented world leaders with difficult options and some serious dilemmas that must somehow be negotiated. Whilst these leaders had limited knowledge about the coronavirus and how the pandemic would potentially evolve, they were still expected to make high-staked judgements amidst a range of uncertainties. The purpose of this paper is to explore the response strategies used by various world leaders from the perspective of crisis leadership within the public health domain. DESIGN/METHODOLOGY/APPROACH: Secondary data was collected from research papers, policy reports and credible media outlets to examine the construct of crisis leadership within the context of the global pandemic. FINDINGS: The paper identified three cognitive antecedents to the COVID-19 crisis leadership failures, which helped to explain why certain policy decisions were successful and why others were less so. On this basis, a clear dichotomy was drawn between highly rated leaders and their less successful counterparts in relation to the management and governance of the coronavirus pandemic. ORIGINALITY/VALUE: The uniqueness of this paper lies in its psycho-political approach, which offered insights into the cognitive undertones that underpin the three leadership failures that emerged from the distinct approaches used by world leaders to prepare for, respond to and recover from the COVID-19 pandemic. The practical recommendations proposed in this paper are hoped to aid better decision-making for leaders faced with the task of managing future public health crises.

An antidote to what's ailing healthcare workers: a new (old) way of relational leadership.

PURPOSE: The purpose of the study's mixed-methods evaluation was to examine the ways in which a relational leadership development intervention enhanced participants' abilities to apply relationship-oriented skills on their teams. DESIGN/METHODOLOGY/APPROACH: The authors evaluated five program cohorts from 2018-2021, involving 127 interprofessional participants. The study's convergent mixed-method approach analyzed post-course surveys for descriptive statistics and interpreted six-month post-course interviews using qualitative conventional content analysis. FINDINGS: All intervention features were rated as at least moderately impactful by at least 83% of participants. The sense of community, as well as psychological safety and trust created, were rated as impactful features of the course by at least 94% of participants. At six months post-intervention, participants identified benefits of greater self-awareness, deeper understanding of others and increased confidence in supporting others, building relationships and making positive changes on their teams. ORIGINALITY/VALUE: Relational leadership interventions may support participant skills for building connections, supporting others and optimizing teamwork. The high rate of skill application at six months post-course suggests that relational leadership development can be effective and sustainable in healthcare. As the COVID-19 pandemic and systemic crises continue to impact the psychological well-being of healthcare colleagues, relational leadership holds promise to address employee burnout, turnover and isolation on interprofessional care teams.

Lessons from the frontline: Leadership and governance experiences in the COVID-19 pandemic response across the Pacific region.

Background: Universal access to safe, effective emergency care (EC) during the COVID-19 pandemic has illustrated its centrality to healthcare systems. The 'Leadership and Governance' building block provides policy, accountability and stewardship to health systems, and is essential to determining effectiveness of pandemic response. This study aimed to explore the experience of leadership and governance during the COVID-19 pandemic from frontline clinicians and stakeholders across the Pacific region. Methods: Australian and Pacific researchers collaborated to conduct this large, qualitative research project in three phases between March 2020 and July 2021. Data was gathered from 116 Pacific regional participants through online support forums, in-depth interviews and focus groups. A phenomenological approach shaped inductive and deductive data analysis, within a previously identified Pacific EC systems building block framework. Findings: Politics profoundly influenced pandemic response effectiveness, even at the clinical coalface. Experienced clinicians spoke authoritatively to decision-makers; focusing on safety, quality and service duty. Rapid adaptability, past surge event experience, team-focus and systems-thinking enabled EC leadership. Transparent communication, collaboration, mutual respect and trust created unity between frontline clinicians and 'top-level' administrators. Pacific cultural assets of relationship-building and community cohesion strengthened responses. Interpretation: Effective governance occurs when political, administrative and clinical actors work collaboratively in relationships characterised by trust, transparency, altruism and evidence. Trained, supported EC leadership will enhance frontline service provision, health security preparedness and future Universal Health Coverage goals. Funding: Epidemic Ethics/World Health Organization (WHO), Foreign, Commonwealth and Development Office/Wellcome Grant 214711/Z/18/Z. Co-funding: Australasian College for Emergency Medicine Foundation, International Development Fund Grant.

Modeling the turnover intentions of Thai health-care personnel in pandemic times: moderating role of Covid-19 burnout.

PURPOSE: Covid-19 cases are rising at a high rate in Thailand. Thailand's administration has formulated many initiatives to combat the spread of coronavirus. However, during a pandemic, health-care workers have a diverse range of tasks that make it more challenging to continue working in hospitals. Consequently, the authors modeled the turnover intentions of health-care personnel to capture relevant psychological aspects of employees during the pandemic. Specifically, this study aims to focused on the moderating role of Covid-19 burnout (CBO) in the relationship between transformational leadership (TL) and job turnover intentions (JTI) with job satisfaction (JS) and knowledge hiding (KH) as mediators. DESIGN/METHODOLOGY/APPROACH: This research collected data using self-administered questionnaire. A two-stage partial least square-structural equation modeling (PLS-SEM) is carried out as an analysis technique to measure the linear relationship among constructs. The study tests hypotheses (direct and indirect effects) using 310 sample size of health-care personnel. FINDINGS: The findings indicated that CBO intensified the JTI of health-care personnel and strengthened the association of JS and KH with JTI during the Covid-19 pandemic. TL had a negative indirect effect on JTI. In addition, JS had a negative impact on JTI. ORIGINALITY/VALUE: The study highlights the importance of TL and JS as ways to reduce or alleviate JTI in health-care personnel during the Covid-19 pandemic in Thailand. Furthermore, CBO and KH can enhance JTI in health-care personnel.

Crisis leadership: a case for inclusion in accredited Master of Public Health program curricula.

OBJECTIVES: To evaluate the exposure to crisis leadership theory already present in Council on Education for Public Health (CEPH) accredited Master of Public Health (MPH) programs in the United States and provide a compelling case for its future inclusion. STUDY DESIGN: This was a narrative review. METHODS: We compiled a comprehensive list of 179 CEPH schools that offered an MPH program. During January through March 2021, we examined 179 websites for the core courses and elective courses offered in the MPH degree program to determine if any courses covered the topics of leadership, crisis leadership, or crisis management in either the course title or description. RESULTS: Leadership courses were available in only 55.31% of CEPH-accredited schools. Only a single program (0.56%) offers a crisis leadership course. CONCLUSIONS: The current global COVID-19 pandemic and reality of climate-induced disasters have brought crises to the forefront for health systems. Successful leadership for the future requires public health leaders to have training in crisis leadership. The evaluation and revision of public health curricula must focus on leadership competency development to prepare graduates to lead complex multiple crisis events and system shocks simultaneously.

COVID-19 in Africa: rethinking the tools to manage future pandemics.

Corona virus disease 2019 (COVID-19) remains an incurable, progressive pneumonia-like illness characterized by fever, dry cough, fatigue, and headache during its early stages. COVID-19 has ultimately resulted in mortality in at least 2 million people worldwide. Millions of people globally have already been affected by this disease, and the numbers are expected to increase, perhaps until an effective cure or vaccine is identified. Although Africa was initially purported by the World Health Organization (WHO) to be severely hit by the pandemic, Africa recorded the least number of cases during the first wave, with lowest rates of infections, compared to Asia, Europe, and the Americas. This statistic might be attributed to the low testing capacity, existing public health awareness and lessons learnt during Ebola epidemic. Nonetheless, the relatively low rate of infection should be an opportunity for Africa to be better prepared to overcome this and future epidemics. In this paper, the authors provide insights into the dynamics and transmission of the severe acute respiratory syndrome corona virus (SARS-CoV-2) during the first wave of the pandemic; possible explanations into the relatively low rates of infection recorded in Africa; with recommendations for Africa to continue to fight Covid-19; and position itself to effectively manage future pandemics.

Leading through the first wave of COVID: a Canadian action research study.

PURPOSE: This first phase of a three-phase action research project aims to define leadership practices that should be used during and after the pandemic to re-imagine and rebuild the health and social care system. Specifically, the objectives were to determine what effective leadership practices Canadian health leaders have used through the first wave of the COVID-19 pandemic, to explore how these differ from pre-crisis practices; and to identify what leadership practices might be leveraged to create the desired health and care systems of the future. DESIGN/METHODOLOGY/APPROACH: The authors used an action research methodology. In the first phase, reported here, the authors conducted one-on-one, virtual interviews with 18 health leaders from across Canada and across leadership roles. Data were analyzed using grounded theory methodology. FINDINGS: Five key practices emerged from the data, within the core dimension of disrupting entrenched structures and leadership practices. These were, namely, responding to more complex emotions in self and others. Future practice identified to create more psychologically supportive workplaces. Agile and adaptive leadership. Future practice should allow leaders to move systemic change forward more quickly. Integrating diverse perspectives, within and across organizations, leveling hierarchies through bringing together a variety of perspectives in the decision-making process and engaging people more broadly in the co-creation of strategies. Applying existing leadership capabilities and experience. Future practice should develop and expand mentorship to support early career leadership. Communication was increased to build credibility and trust in response to changing and often contradictory emerging evidence and messaging. Future practice should increase communication. RESEARCH LIMITATIONS/IMPLICATIONS: The project was limited to health leaders in Canada and did not represent all provinces/territories. Participants were recruited through the leadership networks, while diverse, were not demographically representative. All interviews were conducted in English; in the second phase of the study, the authors will recruit a larger and more diverse sample and conduct interviews in both English and French. As the interviews took place during the early stages of the pandemic, it may be that health leaders' views of what may be required to re-define future health systems may change as the crisis shifts over time. PRACTICAL IMPLICATIONS: The sponsoring organization of this research - the Canadian Health Leadership Network and each of its individual member partners - will mobilize knowledge from this research, and subsequent phases, to inform processes for leadership development and, succession planning across, the Canadian health system, particularly those attributes unique to a context of crisis management but also necessary in post-crisis recovery. SOCIAL IMPLICATIONS: This research has shown that there is an immediate need to develop innovative and influential leadership action - commensurate with its findings - to supporting the evolution of the Canadian health system, the emotional well-being of the health-care workforce, the mental health of the population and challenges inherent in structural inequities across health and health care that discriminate against certain populations. ORIGINALITY/VALUE: An interdisciplinary group of health researchers and decision-makers from across Canada who came together rapidly to examine leadership practices during COVID-19's first wave using action research study design.

Public health competences through the lens of the COVID-19 pandemic: what matters for health workforce preparedness for global health emergencies.

The COVID-19 pandemic is raising new questions on public health competences and leadership and on health workforce preparedness for global public health emergencies. The present commentary aims to highlight demand and opportunities for innovation through the disruptions caused by the COVID-19 crisis. We review the public health competency framework recently launched by WHO and ASPHER through the lens of COVID-19. The framework provides guidance for aligning public health and global health competences across sectors and professional groups. Five critical competency areas can be identified in relation to public health emergencies: (1) flexibility, adaptation, motivation, communication, (2) research, analytical sensitivity, ethics, diversity, (3) epidemiology, (4) preparedness and (5) employability. However, this may not be enough. New models of public health leadership and changes in the health workforce are needed, which transform the silos of professions and policy. Such transformations would include learning, working, leading and governing differently and must stretch far beyond the public health workforce. To achieve transformative capacity, critical public health competences must be considered for all healthcare workers on all levels of policymaking, thus becoming the 'heart' of health workforce resilience and pandemic preparedness.

Canadian health emergency management professionals' perspectives on the prevalence and effectiveness of disaster preparedness activities in response to COVID-19.

Emergency management (EM) professionals play an integral role in preparing healthcare organizations for disasters but evidence of their pervasiveness in Canadian healthcare is limited. Through an exploratory Canada-wide survey of EM in healthcare organizations, we aim to develop understanding of the prevalence and effectiveness of the disaster preparedness activities enacted in preparation for COVID-19. The online survey generated 161 responses; 150 (93%) had EM responsibility. EM reported that reviewing infectious disease (pandemic) plans and protocols was the most widespread activity (82%), while simulation-based exercises was the least (26%). Organizational incident management response to COVID-19 was led by a sole 'incident commander' 61% of the time, while 39% of 'incident commands' were led by multiple individuals. Of all those assigned to lead IM, only 68% received training in that role. Overall, the prevalence of disaster preparedness activities in healthcare organizations was positively associated with leaders who received training in incident response and having a dedicated EM resource. Meanwhile, the overall effectiveness of activities was positively correlated with having a sole 'incident commander' and was found to improve as the overall prevalence of activities rose. The study provides strong evidence for regional, organizational, and EM resource variation in the delivery of disaster preparedness activities and training for leaders in Canadian healthcare. Hence, we recommend the creation of a national health emergency preparedness system which includes legislated standards and a national training centre to ensure Canadian healthcare is bolstered against future disasters including pandemics.