CEOs reveal how pandemic changed their leadership

During the COVID-19 pandemic, hospital and health system CEOs have faced unprecedented challenges related to the deadly and unpredictable coronavirus. They are tasked with ensuring their organizations have basic supplies and equipment to keep workers and patients safe. They also must navigate how to address the physical, mental and emotional toll the virus is taking on front-line employees. And there is more of a need than ever to communicate information to team members amid ever-changing state and federal guidelines. 

Amid these challenges, certain leadership skills have become more vital than ever, CEOs told Becker's Hospital Review.

Here, three leaders — Jonathan Lewin, MD, CEO of Atlanta-based Emory Healthcare; Steppe Mette, MD, CEO of University of Arkansas for Medical Sciences Medical Center in Little Rock; and Marna Borgstrom, CEO of Yale New Haven (Conn.) Hospital and Yale New Haven Health — share 11 shifts in the way they approach their roles.  

Empowering colleagues. The pandemic has created an opportunity for CEOs to focus more on certain aspects of servant leadership, empowering team members, and creating streamlined decision processes, said Dr. Lewin, who has served five years as CEO of Emory Healthcare, an 11-hospital integrated academic healthcare system.

"COVID-19 has the unintended positive outcome of enabling a rapid acceleration of our organizational learning and adaptability," he said. "We found ourselves years ahead of where we would have been in implementing our strategies otherwise. For me this meant an increase in delegation and empowerment from my usual baseline. I found my role on the team of communicating the 'why' to the leadership team, working with the  broader organizational leadership to help define the 'what', and to empower and unleash the team on the 'how' of our innovations, actions and other responses to COVID."

Representing hope. CEOs have had to balance optimism with the realistic circumstances of the pandemic. Dr. Lewin said he has seen the importance of replacing uncertainty with hope and confidence, which has become increasingly important.

Similarly, Dr. Mette has worked to promote a can-do attitude. He said that's the notion of: "Whatever we put in front of ourselves, we have to do, and we can do." 

"That change of attitude and the promotion by leadership has paid dividends for us. Certainly, what I have valued as leadership effectiveness has been underlined and reinformed," said Dr. Mette, who has served as senior vice chancellor for UAMS Health and CEO of UAMS Medical Center at the University of Arkansas for Medical Sciences since 2019. 

Recognizing workers. Dr. Lewin said the importance of recognizing team member has grown for him over the last year. 

"I've seen authentic recognition of the team as important throughout my career, but given the fatigue, given the effort, given the unwavering dedication to the patients, I found that recognition is even more important," he said. "The rest of the team as well has concentrated on not only recognizing the front-line clinical staff but the back office folks who are working harder than ever."

Boldness with project expectations. Hospital and health system CEOs have had to adapt to various operational changes, including the acceleration of telemedicine. For example, Emory Healthcare did less than 100 telehealth visits in February 2020. Within a matter of weeks, the health system was doing 3,000 a day. And Dr. Lewin said the pandemic showed the same strategies that were part of Emory Healthcare's strategic plan were equally or more powerful in helping the organization adapt to these changes.

He explained: "We did things that would have taken a month in a day. We would have several hours of meetings a day between the larger groups and the smaller leadership team. If we discussed doing something in the morning, then we said in the afternoon, 'Are we done yet? And if not, then can we be done tomorrow morning or the next morning?' The expectations of the team were much bolder, and it was clear across the organization that the limitations in decision-making and execution we had before the pandemic were no longer an option."

Collaborating with peer organizations and state leaders. Early in pandemic, Dr. Lewin said he reached out to the CEOs of peer organizations in metro Atlanta and the surrounding region to offer testing, but it quickly evolved into open, transparent conversation on a wide array of pandemic topics. The clinical and operational leads continue to meet three times a week with most of Emory Healthcare's peer organizations, which have worked together to find personal protective equipment and exchange best practices.

Ms. Borgstrom, who has spent more than 15 years as CEO of Yale New Haven Hospital and Yale New Haven Health, a five-hospital healthcare system, also created different partnerships over the last year, including working with the Connecticut Gov. Ned Lamont and his team to talk through concerns and questions about vaccine distribution and other issues. Additionally, she meets with a group of CEOs regularly. 

"There are some people I always learn from. We have great people leading in this field. They're very helpful in stimulating my thinking when discussing issues we all share," said Ms. Borgstrom. 

Being present and visible to workers. CEOs have worked to communicate on an even greater level with workers at their organizations. This includes being present as well as being visible to them, said Dr. Mette.

"We have people working above and beyond their normal expectations during the pandemic, day in and day out, many working over 100 hours a week," he said. "It is important for leadership to be present, to be shown, to be visible, and to be in touch with their front-line staff. The importance of that has been brought out."

Ms. Borgstrom agreed. For example, Yale New Haven Health began scheduling weekly virtual town halls, where workers can receive information and ask questions in a live format. As a result, she's received positive feedback through emails and in person.

"Enhancing communication, being visible, telling people what you know and don't know has helped to build employee knowledge and confidence.," Ms. Borgstrom said. "I've heard that repeatedly from our employees and medical staff, and they've developed a level of comfort because they participate in the town halls regularly and understand the information evolves and they hear it as it evolves. The cadence creates a sense of comfort and predictability."

Being open to new ideas. The pandemic has also underscored, for Dr. Mette, as a leader, not to put too much weight on the status quo, he said. In other words, being open to new ideas when previous organizational strategy is challenged.

"Listening to front-line staff, asking for their ideas on how to do things better, challenging those ideas and not being afraid to have an organizational strategy to incorporate those ideas in the new workflow is important.  We've done that a lot over last 10 months with phenomenal success, not only in improving some of our operational efficiencies but also gaining the engagement of the front-line staff during the time when they're beleaguered and tired," Dr. Mette said. 

Engaging with the public. Throughout the pandemic, CEOs have been tasked even more with engaging community members and providing information. Like many hospitals and health systems nationwide, UAMS Medical Center limited visitation hours during the pandemic as a safety measure and to help prevent transmission of the virus. Dr. Mette said in hindsight the organization could have done a better job of engaging with the public on why that strategy was chosen. 

"We definitely communicated, but as the responses and the pushback from the public [happened], I realized we didn't do as good of a job as we needed to make sure they understand the rationale for doing so," he said. "In the best of all worlds, my view of a nonprofit is the owners are the communities we serve, and making sure there's embracing of stakeholders, but also true engagement and making sure their voices are represented and accommodated."

Taking on humility. The pandemic has underscored the need for hospital and health system leaders to be humble, especially as information and circumstances continue to evolve, said Ms. Borgstrom. 

She explained: "We've taken humility to a new level because you have limited information and, you can't possibly have all the answers."

Ms. Borgstrom said leaders must be more comfortable with ambiguity because they don't have control over many aspects of this public health crisis.

Being honest. During the pandemic, many hospitals and health systems have lost money amid the interruption of the traditional patient care business model and increased expenses related to COVID-19. Therefore, the pandemic has underscored the importance of honesty from hospital and health system leaders, including clarity with board members about the organization's financial situation now and going forward, Ms. Borgstrom said.

"Being honest about what you think is going to happen [is important]. It’s human to want to try to make things look like they're going to work out fine. We didn't know how this was going to come together, but we knew it was going to be tough. We just didn't know how tough," she said.  

Keeping humor. Ms. Borgstrom said CEOs must also have a sense of humor and take hold of those lighter moments to maintain perspective and optimism.


More articles on leadership and management:
North Carolina health system CEO apologizes for COVID-19 vaccine sign-up problems
What Dr. Rochelle Walensky said on her first day as CDC director
3 healthcare executive actions expected from Biden this week 

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