Considering the post-pandemic world we live in today, I think we have to reflect on the tsunami of events that we just experienced. Health was at risk, and we lost many people. Mostly elderly people. We realised how important health professionals are, and to show our support we clapped at eight every evening during the time we had to put our lives, travels, and hugs “on hold”.
Nothing that this human generation has lived before mirrors what was experienced during the pandemic in terms of uncertainty.
This is why today, I want to talk about leaders in the health sector. I am not interested in talking about companies, but the people who make up those companies. In each hospital and in each primary healthcare centre, many workers had to take the reins and lead in crazy, uncertain times. I dare say that nothing that this human generation has lived before mirrors what was experienced during the pandemic in terms of uncertainty.
To achieve results, a leader must guide. It is important that she/he has a vision of where to go and the ability to convince others to work towards that end. Uncertainty is always involved in that matter, but what we lived during the Covid pandemic was unprecedented.
Two critical sources of uncertainty for patients
Literature distinguishes between two sources of uncertainty for patients related to healthcare services: 1) uncertainty due to their illness and 2) uncertainty due to the way the healthcare service functions. Both are critical in a pandemic situation. Both dramatically influenced the process of the pandemic. We did not know about the illness and at the same time, we knew how healthcare workers were trying to help, even in precarious conditions. Healthcare systems were pushed to their limits around the world.
I had the opportunity to discuss this topic with an expert, Doctor Miguel Marcos from Salamanca University Hospital, during the lockdown (April 2020). He was one of the leaders of the Covid response at this regional hospital. He shared that his main lessons in terms of leadership during this time were: the need to be as prepared and informed as possible about the characteristics of the disease; the importance of being on the front line with his co-workers; the relevance of showing confidence in the measures to be adopted, trying to give his teams as much certainty as possible.
His team also gathered new data about this disease and used this data in hospital protocols, which reinforced confidence and trust in them. He also publicly shared medical knowledge and recommendations through media and his twitter account, which was later verified due to its relevance and contributed to his consideration as an expert during the pandemic.
Do you know any other kind of service/company that requires so much trust and so much involvement from their customers?
However, leadership in the healthcare sector is not only about having your colleagues and the medical community on board. It is also about having your patients on board. Do you know any other kind of service/company that requires so much trust and so much involvement from their customers? For a treatment to be effective, patient adherence is essential.
Public health is also a matter of behaviour and behavioural change. We saw this on a massive scale during the pandemic. How much trust and involvement of the population was needed in order for healthcare services not to collapse all over the world? The behavioural changes required were also massive – social isolation, wearing masks, etc. -, as were their consequences: a global shift towards teleworking, kids at home 24/7…
‘Pandemic fatigue’ amplified mistrust in healthcare
Trust has been crucial in managing the pandemic. It is an important attitude in the patient-clinician interaction. According to my research, the perception of organisational justice is important because it builds a patient’s trust, and that trust relates to the patient’s adherence. During the pandemic, the levels of trust in the medical institution were fluctuating.
According to a study carried out in Italy, the tendency was a reduction of trust related to pandemic fatigue, defined by the World Health Organisation as “an expected and natural response to a prolonged public health crisis.” Trust in healthcare workers was reduced in 1.5% of participants (in the first measure, April-May 2020, T1) and 2.8% (in the second measure, November-December 2020, T2). The drop of trust in researchers was bigger, it was reduced in 5.8% (T1) and 7.6% (T2). Interestingly, participants who were healthcare workers had a higher likelihood of having a reduction in their trust. It could be related to the low trust in health policies from authorities that many healthcare workers experienced as well.
Information management is vital
I guess we all had many examples of perceived injustice during the implementation of Covid-related measures. This is another important and much undervalued variable in the patient-clinician experience. Informational justice was a delicate issue. It relates to the perception of the information from the healthcare practitioners as clear, sufficient, accurate and honest. We all lacked information at the beginning of the lockdown. Interestingly, Doctor Marcos also highlighted the importance of information management in leadership.
Interpersonal justice or procedural justice were also at stake. Being treated with respect and dignity as human beings (i.e., interpersonal justice) or perceiving that the procedures implemented with patients were the right ones (i.e., procedural justice) were also difficult to assess many times, even by healthcare workers.
During a pandemic, we should try to take care not only of patients, but also of their relatives and healthcare workers.
One thing that we can learn from this experience is that during a pandemic, we should try to take care not only of patients, but also of their relatives and healthcare workers. Healthcare leaders should provide as much certainty as possible (informational justice), but also create spaces for human interactions with dignity and respect (interpersonal justice). Being honest with the information available is the only way of reaching some informational justice in such extreme circumstances.
In summary, here are five recommendations for (healthcare) leaders dealing with uncertainty:
- Stay as informed as possible. Knowledge and critical thinking are essential in uncertain situations.
- Remember that not only the content of the information but the handling of it are important. You are the one in charge of sharing information. You should share it as clearly, sufficiently, accurately and honestly as possible. Remember who your audience is and adapt the message.
- Leave spaces for interactions and dignity. Do not forget that you are dealing (with pathogens, but also) with human beings.
- Remember that uncertain situations involve many stakeholders. Illness is not only a matter of patients, but also the people around them, including their personal social network, and the healthcare workers involved as well.
- The trust of your people (patients, patients’ relatives, and colleagues) will be your most valuable asset.
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