How to be a healthcare leader during a crisis

During a crisis, healthcare leaders must find ways to carve out time to think through complex issues and model that behavior for their colleagues.

Health care leaders must have honed skills and abilities to guide their organizations through a crisis, says a Mayo Clinic expert.

Richard Winters, MD, MBA, is director of leadership development at Mayo Clinic Care Network and a practicing emergency physician. He is an executive coach and author of a new book, You are the leader. Now what? Leadership Lessons from Mayo Clinic.

HealthLeaders spoke with Winters recently in a conversation that included how healthcare leaders need to work with colleagues during a crisis, delegate decision-making during a crisis, and be realistic during a crisis. The following transcript of the conversation has been edited for brevity and clarity.

HealthLeaders: How can a leader free up colleagues’ time for deliberate focus, so they can adapt to a crisis and sort through what is most important to address?

Richard Winters: First, it means understanding that it takes time to process and think through complex problems. When you meet with groups of colleagues, you start with whether people are just making decisions or whether they are thinking about the decisions they are making. Even when we structure meetings and make decisions as a group, are we allocating time for people to process what is happening, understand different perspectives, and then make decisions? Generally, that tends not to be the case. Usually, in a crisis, some stubborn people speak up and a decision is made, and those who didn’t speak up can’t reflect or don’t feel safe to develop their thinking.

Leaders must be a role model by taking the time to consider complex and thorny issues.

Leaders can also block time. They need to understand that they are there to act but also to gain perspective. I use the metaphor of the balcony and the dance floor. Leaders need to get off the dance floor and onto the balcony, then get perspectives on what they might do about a situation before reacting, so they can act with deliberate intent. That means that as leaders schedule meetings and put things on their agenda, they leave some room to take some time to think deeply. That can be modeled by senior leaders so that others can feel free to move deliberately.

HL: How can you use your leadership team to clarify perspectives and align thinking and actions?

Winters: What’s great about Mayo Clinic is the leadership of the triad. It has a medical leader, a nurse leader, and an administrative leader who work together to manage the departments and divisions. With triad leadership, each individual has a perspective that others may not have. The nurse has a different perspective than the administrator and the doctor. If you only have one doctor looking at a difficult problem, you move forward with your own perspective, which includes your blind spots.

With triad leadership, you have multiple perspectives that help address blind spots. You can see different ways forward and different possibilities. You can benefit from multiple perspectives.

HL: What about aligning thought and actions?

Winters: Aligning thought and actions means understanding the thinking involved. You are not aligning people with your thinking and blind spots. You are aligning thinking by understanding the perspectives that are within the environment in which you are making decisions. To align thinking, we must first understand the perspectives of others and bring them together. Within those perspectives, you will find disagreements, but those thoughts represent a range of understanding. By understanding disagreements and agreements and what people see as opportunities and threats, you can then begin to think about options.

First, you develop a shared reality and shared perspectives, then you develop options for what you might do given the shared reality and perspectives. From there, you can move on. So first you’re understanding perspectives and aligning them, then you’re making choices about how you can move forward.

HL: How can a leader delegate decision making to experts in a crisis?

Winters: As the leaders go, when a cardiologist becomes a leader or an ER doctor becomes a leader, we have our experience, but there are things we don’t know. Leadership requires other people who have broader knowledge or understanding to make sense of specific areas. Therefore, it makes sense to delegate decisions to people who have the necessary areas of expertise.

For example, when the coronavirus pandemic started, we knew nothing about the virus. We didn’t know what was going to happen. We were unaware of the morbidity and mortality associated with the virus. But CEOs needed to make decisions and didn’t have the benefit of putting together task forces and having committees for several months. They had to make tough decisions. So some decisions were delegated to infectious disease specialists, who certainly knew more about the transmission of the virus.

HL: Why is it important for a leader to be open, humble and realistic during a crisis?

Winters: During a crisis, there are many unknowns. You are in a world of unknowns. If a leader is operating without an openness to the unknown, he is at a disadvantage.

During a crisis, there can be a sense that we make decisions and if a decision works, then it was a good decision. If it doesn’t work, then it was a bad decision. However, that is not the correct way to make decisions in times of crisis. The best way to make decisions in times of crisis is to recognize that the leader has some experience, the leader sees the situation, the leader feels what is happening, then the leader simulates in his mind what might happen if different options are pursued. The leader makes decisions to delve into the crisis and see how the situation responds. It is not about failing in a decision. The leader makes discovery decisions.

Therefore, it is essential to be open and humble about what could happen. You need to be open to how you respond to the situation and new data that comes up. You need to be open about what information the leadership team can gather to make better decisions as we move forward and continue to understand the situation. A leader needs to be humble because he can make a decision that does not have the desired effect.

HL: Why is it important to be realistic?

Winters: There are limitations that we all face. There are limitations. We don’t have infinite budgets. We have groups of people who have different perspectives. There is politics. There are regulations. Within these kinds of limitations, we must be understanding and realistic about it. We have to face them head-on. We need to make decisions based on realistic constraints about where we are effective and where we can affect change.