How COVID-19 Has Changed Clinical Leadership

“Crises by their nature tend to be disorienting and to promote disorganization and institutional dysfunction,” says Tony Barbato, M.D., a WittKieffer physician executive consultant. This may sound familiar to many clinical leaders enduring the current COVID-19 pandemic. Fortunately, Barbato believes, while the shape and scale of crises change, “the principles of successful leadership remain the same.” In the following conversation, Barbato speaks with Kimberly Smith, leader of WittKieffer’s Academic Medicine and Health Sciences Practice, about leadership during the next “normal”.

Smith: These are obviously extremely tough times. The pandemic is taking its toll on clinical leaders that I speak to, with no end in sight. What are you hearing?

Barbato: To describe these days in healthcare as tough is an understatement. It’s not just emergency services and intensive care facilities that are overburdened but the sense — perceived and real — that entire medical centers and health systems are under siege. Complicating leadership’s response to this crisis are a couple of significant considerations. The first is that the pressures will continue to be unrelenting. If leadership burnout was a growing pre-pandemic concern, that concern has grown. The second consideration is uncertainty. How long will it last? What else might go wrong? What should “normal” look like for the next 12 to 18 months, and what will steady-state look like three years from now?

Smith: As difficult as circumstances are, I’ve had many clinical leaders tell me that this is the most meaningful work that they’ve ever done. They are finding purpose every day.  

Barbato: I’ve seen this as well. Successful leaders are using this crisis to reaffirm institutional mission and commitment to the communities they serve. The increased visibility of institutional leadership with the clinical staff and general work force has helped to foster a sense of solidarity and enhanced morale in some institutions that have struggled to find their organizing principle or sense of institutional identity. The intensified financial pressures have helped some institutions rethink plans and priorities and have helped to give clarity to decision-making and priorities.

Smith: How is clinical care changing? Do you see organizations innovating in ways they couldn’t previously?

Barbato: COVID is changing the landscape of clinical care in significant and lasting ways. There are a couple of telling and obvious examples. We have struggled for years to take advantage of telemedicine or telehealth. Progress has forever been impeded by concerns and disagreements over jurisdictional (mostly state) control and reimbursement (both state and federal). COVID removed barriers to progress in this area literally overnight. This technology is here to stay and will continue to expand dramatically.

Most importantly, this pandemic will hopefully cause us to relearn the importance of public health and increase our investment in disease prevention and health promotion, in addition to advancing the sciences that undergird personal, individual medical care. As a nation our failures in public health unmasked by this pandemic have been humbling. Population health has taken on new meaning and importance.

Smith: Related to COVID is the concurrent conversation over race and structural inequities in society. How is this issue influencing clinical leaders and changing their priorities?

Barbato: COVID has exposed some of the structural flaws in the foundation of America’s culture that place certain segments of our population at serious healthcare risk and disadvantage. It has not taught us something new in this regard. It has simply made the point again, in clear and inarguable ways. We have defined the problem but as a country we haven’t begun to remedy it. Hopefully what we are learning about the uneven consequences of COVID related to racial and economic demographics will cause us to refocus our priorities and our resolve to improve healthcare for every person.

Smith: Given these issues, then, what defines leadership success in these times?

Barbato: This is the single-most important question boards of directors should be asking themselves each time they select a new CEO or senior executive. The question is not hypothetical. Crises by their nature tend to be disorienting and to promote disorganization and institutional dysfunction. While there is an endless list of behaviors and actions that successful leaders demonstrate in times of crisis, leaders basically need to make possible the following: to cause their institutions to continue to be a resource to the people and the communities they serve; to continue to support the health and well-being of their medical, nursing and support staff; to prioritize the work that needs to be done; to communicate those priorities with clarity; and to preserve the mission integrity and financial integrity of the institution until planning for a new normal is possible. The shape and scale of crises change; the principles of successful leadership remain the same.

In addition, successful leaders respond positively not only to challenging events and circumstances but also to the opportunity to be of service. This particular crisis will not be short lived, and successful leaders understand that.

Smith: What are the implications for the relationship between schools of medicine and their clinical partners?

Barbato: Even in the short time since the pandemic emerged, the synergism of the medical school — clinical partner relationship has been abundantly clear. Discovery, both at the bench and the bedside, has occurred at a breathtaking pace, and we have witnessed the feedback loop change the clinical care of patients more directly than I can remember at any other time. In addition to the collaboration of clinical and basic scientists, we’re witnessing the power of a new collaboration with public health scientists, epidemiologists, biostatisticians, and others that is accelerating the pace of what we’re learning and the pace of change in the care of patients. We are at the front end of a very steep learning curve, and never have the relationships between medical schools and their clinical partners been more important.

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