|Year : 2021 | Volume
| Issue : 1 | Page : 1-3
Medical leadership during COVID-19 pandemic: A complex, balanced military stewardship
Naveen Chawla1, Sougat Ray1, Kaushik Roy1, Sunil Goyal2
1 DGMS (Navy), Capt (MS)-H, Cdr (MS) - CSL, Army Hospital (R and R), New Delhi, India
2 Institute of Naval Medicine, INHS Asvini, Mumbai, Maharashtra, India
|Date of Submission||07-Jun-2021|
|Date of Decision||19-Jun-2021|
|Date of Acceptance||20-Jun-2021|
|Date of Web Publication||15-Jul-2021|
Surg Capt Sougat Ray
IHQ of MoD (Navy), New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Chawla N, Ray S, Roy K, Goyal S. Medical leadership during COVID-19 pandemic: A complex, balanced military stewardship. J Mar Med Soc 2021;23:1-3
The COVID-19 pandemic has been the most significant global health crises over the past 18 months and has directly and indirectly impacted the life of almost all humans on this planet, in terms of how we live, socialize, travel, and even work. The effect has been particularly dramatic at workplaces as it has revolutionized the way we do business. Almost every aspect of operations in most organizations got affected. This crisis created ambiguity and mandated remodeling of an organization's desired role and necessitated immediate action. As slowly the guidelines based on scientific evidence emerged and got periodically revised,, it was incumbent on the heads of organization to place systems in place and enable adoption of the new normal style of working. However, there was always a shadow of uncertainty and decisions needed to be taken daily, based on risk-benefit analysis. Leaders were essential to bring in unanimity in coordinating the efforts to “flatten the curve” of the disease. During such perilous times, many such examples of strong and dedicated leadership emerged, who were responsible to navigate their organizations through uncharted water. It was their vision and performance which decided the future course, and such decisive leaders have made a profound impact on success of their organizations. It is imperative to analyze such leadership styles and adopt desirable attributes to enable creating a pandemic resilient organization as leadership helps organizations navigate crises, rebuild communities, and forge ahead in moments of ambiguity.
| Medical Leadership in a Crisis|| |
This pandemic highlighted the role of medical leadership, right from the international forum to the heads of national medical bodies, till the last mile leaders in terms of hospital managers. The uncertain scenario requires adaptability and within complex adaptive systems, the pattern of relationship between individual components determines the overall outcome. Medical leaders from countries across the world have employed different strategies to fight COVID with varying success. The medical service in the Navy is an example of one such system where carefully crafted, meticulous strategies have been implemented successfully which has resulted in minimal morbidity and mortality, apart from continuing with normal naval operations at the high seas.
| Cultivating Empathetic Leadership|| |
The pandemic has the potential to adversely affect the mental health by virtue of the associated uncertainty, helplessness, restriction of normal life, and the negative social media messages. Health-care workers (HCWs) are especially prone to mental crisis and suicidal ideation in the backdrop of work-related burnout. They face daily stress of balancing their own safety with needs of the COVID patients and own family and find it difficult to share their mental health problems, thus delaying professional help. It is paramount for the medical leadership to identify and preemptively address these concerns and pave the way for initiatives such as early vaccination for HCWs and their families and support HCWs to reduce stigma at clinical workplace. Institutionalizing telemedicine facilities in the hospital also help in reducing footfall of patients suffering from nonemergency conditions.,
Economic slowdown, disturbance in the work-life balance, and sudden loss of loved ones have aggravated the mental health concerns among the general population as well. Empathy is a critical leadership skill to understand the experiences of others and being aware of their feelings, thereby allaying the fear of COVID and making a positive difference in people's lives. Providing an enabling environment by creation of robust helplines, providing teleconsultations, and disseminating information to combat infodemic help in allaying fear and building confidence. Real-time update on health status of admitted patients is also critical to alleviate anxiety of families.
| Leadership Attributes in a Pandemic|| |
A leader has to be inclusive and decisive during massive crisis. The World Health Organization paved the way for advocating inclusion such that the vulnerable sections are not left behind. The idea was brought to the forefront during the COVID vaccination by prioritizing the front-line workers, e.g. military personnel, elderly, and comorbid persons. Decisive leadership was seen when lockdowns were necessitated despite the risk of economic loss. Initially, when the world was unprepared, it seemed to be the best possible method, providing time to augment health-care resources.
Weighted strategies, based on scientific evidence, such as quarantine, test, isolate, and treat were advocated by the health authorities which were implemented in a tailored fashion. Clear, simple, and open communication resulted in acceptance of these frequently changing guidelines. This yielded results in maximizing the operational capability of the organization. Leaders were also entrusted with taking decision for greater good, i.e. for public health as compared to curbing of individual freedom. They also had to lead by example, and successful leaders were seen wearing the mask and maintaining social distance.
New technology and innovations such as COVID-positive person tracking and using them as interface cohorts to break the chain of transmission, vaccination registration, and real-time bed monitoring applications were adopted with greater operational success. The leaders with the ability to anticipate and plan have meticulously built infrastructure and accumulated resources to tide over the crisis during the future surges.
| Leadership Tool-System Thinking Approach|| |
System thinking is an in-depth tool which helps to understand how the components of the health-care system interact with each other and devise the right approach for the development of highly effective problem-solving interventions. COVID-19 pandemic is a by-product of such interconnected and interdependent components in the health-care system. The components vary from approaches toward controlling the spread of the disease in the community, testing protocols, patient management protocols, and supply chain management.
| Ethical Dilemmas|| |
COVID-19 has raised several ethical dilemmas for the medical leaders. Lack of protective gears such as personal protective equipment posed threat to the HCWs; and deficiency in oxygen, dedicated beds, and ventilators in hospitals were risks to the lives of the patients. With a lack of published research data, treatment protocols continue to vary among countries and institutions leading to increased confusion. There is an ethical dilemma in grant of use or to withheld experimental/off-label medication/treatment protocols in a scenario where no definitive cure exists. Resource allocation and treatment rationing by the medical leaders have been paramount in solving these dilemmas. The decisions of the medical leaders thus should be based on the best available evidence, agreed where practicable, communicated transparently and subject to modification and review as the situation develops.
| COVID-19 Pandemic – A War?|| |
World leaders have likened the COVID-19 health crisis to fighting a war. In crisis situations, a decisive leadership is crucial for time-critical decision-making. Leadership tasks included making decisions to offer incentives and disincentives to ensure that the actions are coordinated and geared toward achieving and maintaining operational commitment and be mission ready. Historically, the 1918 influenza pandemic in the middle of World War I had placed the military leadership in the position of having difficult choices when the disease was killing soldiers, undermining operational readiness and the Army's ability to fight and threatened deployment. The leadership chose to prioritize mobilization then, accepting human toll as a grim necessity. Although the security scenario presently is more benign than a century ago, the military leadership had to actively sync with the medical leadership and balance difficult pandemic choices with mission ready posturing of the troops.
| Conclusion|| |
As the world waits for a definitive treatment and widespread availability of vaccine, effective risk reduction strategies are required during high and low viral transmission for compliance by the community. The pandemic has swamped the health-care systems, threatened the economy and continues to challenge the leadership. The ability of health care to respond swiftly during the upswing phase to reduce morbidity and mortality is the primary objective of an effective leadership. Pandemic responses and the related social and economic upheaval are huge change-management exercises, and there will inevitably be resistance to change. Leading the pandemic care team is an important role in this situation and needs to be practiced.
| References|| |
Standiford TC, Davuluri K, Trupiano N, Portney D, Gruppen L, Vinson AH, et al.
Physician leadership during the COVID-19 pandemic: An emphasis on the team, well-being and leadership reasoning. BMJ Leader 2021;5:20-5.
Warraich S, Olabi B, Azhar B, Tanzeem SF, Fischer M. Medical leadership in the NHS during the COVID-19 pandemic. Br J Hosp Med (Lond) 2020;81:1-3.
Hassan I, Obaid F, Ahmed R, Abdelrahman L, Adam S, Adam O, et al
. A systems thinking approach for responding to the COVID-19 pandemic. East Mediterr Health J 2020;26:872-6.
Gupta S, Sahoo S. Pandemic and mental health of the front-line healthcare workers: A review and implications in the Indian context amidst COVID-19. General Psychiatry 2020;33:e100284.
Rawson T, Brewer T, Veltcheva D, Huntingford C, Bonsall MB. How and when to end the COVID-19 lockdown: An optimization approach. Front Public Health 2020;8:262.
Mheidly N, Fares J. Leveraging media and health communication strategies to overcome the COVID-19 infodemic. J Public Health Policy 2020;41:410-20.
Available from: Lessons from the military for COVID-time leadership | McKinsey. [Last accessed on 2021 Jun 02].