I took part in our all-staff briefing this week, where we honoured and recognised colleagues across the organisation. Looking back at the achievements in the delivery of care during the pandemic, I reflected on the various leadership approaches that I have both used and observed over the past 9 months.
The impact of management, leadership and command approaches during the pandemic has been reviewed by Grint (2020), who suggests that we can perhaps understand styles better if we frame the COVID-19 issues as ‘tame’, 'wicked' and ‘critical’ problems.
‘Tame’ problems, he states, can be complex, but largely solvable by management who can ensure there are standard operating procedures (SOPs), notwithstanding the issues with the supply chain of personal protective equipment (PPE) this year. The SOP to wear level one PPE in all ward areas, unless otherwise advised, is an example of a simple action that can be managed locally.
According to Grint (2020), leadership is called upon in the case of ‘wicked’ problems, described as complex and possibly not solvable; but they might be ameliorated with a collective response. Therefore the job of leadership under such circumstances would be to mobilise the community, often to address issues they would rather not contemplate. One personal example of my own leadership actions was the development of a cross-organisation surge plan for critical care, requiring consideration to reduce or cease planned care for some specialties.
‘Critical’ problems are crises that need a commander to coerce her or his followers into line to avoid catastrophe. Grint (2020) says that, in effect, command is required to prevent the wrong decision being made to resolve the problem—that could lead to making the situation worse. Seeking collective ideas when the virus is upon us is to adopt a leadership strategy when a command approach is required.
On 2 December 2020 came the great news that a vaccine had been approved in the UK—and who would have thought that the NHS would be ending the year as the first healthcare system in the world to be vaccinating against SARS-CoV-2 using a vaccine that has completed full clinical trials. The challenge has been that, due to the fragility of the novel drug, initial doses needed to be delivered initially within ‘hospital hubs’ serving a wide geographical area and, in addition, we had 2 working days to stand this up. So, did this challenge require a commander?
Sir David Dalton, one of the most respected NHS Chief Executives, reflected in BMJ Leader, that the pandemic has required the establishment of effective chains of command (Dalton, 2020). However, in the article, he sets out options to focus on a set of behaviours that ensure delivery can be achieved. He states:
‘I hope that the need for strong leadership is not misunderstood, by leaders, as a requirement to assert themselves on those whom they lead. Kind, compassionate leadership is the sweetness that needs to come from strength. It is sometimes too easy for leaders to rely on positional power, and become disconnected from their people, and not see the distance between them increasing—until it is too late.’
Visibility of leadership has always been essential—and no more so than now. The pandemic is challenging leaders to find new ways to ‘do visibility’ without always being physically present. Being situationally aware is vital: leaders must understand the extraordinary pressure and suboptimal circumstances staff are working under. Showing empathy and understanding is crucial when staff need to know more than ever that their leaders care about them. This means resisting the temptation to explain why things have to be the way they are and, instead, finding the time to listen to people's frustrations. Encouraging kindness by role modelling it yourself is the true strength of leadership, and it is vital to recognise that the power you have is only given to you by the consent of the people you lead. In exchange, it is possible to receive the one thing that cannot be commanded: the discretionary effort, the extra contribution that could otherwise be withheld.
Our good leaders are comfortable with ‘power and control’, but our best leaders are those who know how to share this appropriately with their staff. I hope very much that during the unprecedented pressures that our leaders will face, they will always show respect, compassion and kindness towards their staff.
Grint (2020) suggests that all three modes of decision-making—leadership, management and command—are necessary to deliver the actions required of us as senior leaders, and concludes that while command is appropriate for certain times and issues, it also poses long-term threats, especially if the context is ignored. However, Dalton appears to advise that the use of command requires a health warning. He reminisces about watching his mum baking flapjacks and being intrigued by the label on the golden syrup tin: a picture of bees flying out of a lion with the caption: ‘Out of the strong came forth sweetness.’
To use Dalton's words in conclusion: ‘Let us hope that the choice and desire of leaders in, and after, the pandemic is to reach for another flapjack, and not for the jackboot!’