Leading through crisis: 8 ways to create an atmosphere of psychological safety

Insight Article - December 14, 2020

Leadership Development

Disaster Planning

Christian Green MA


Healthcare leaders have never faced a challenge like COVID-19. Yet the pandemic has been a proving ground for leaders to show their mettle in overcoming crisis. Regardless of experience and medical expertise, healthcare leaders can’t truly be great until they are able to exhibit leadership traits that address human factors, such as galvanizing diverse teams to maximize engagement or provide exemplary coordinated care.

During their session at the 2020 Medical Practice Excellence Conference, Aimee Greeter, MPH, FACHE, senior vice president, Coker Group, Charlotte, N.C., and Alan Vierling, DNP, MSN, RN, NEA, BC, FABC, president and chief nursing officer, Sparrow Hospital, Lansing, Mich., revealed that there are eight essential leadership traits to ensure effective operations. By exhibiting these traits, particularly during crisis, leaders can champion a culture of psychological safety and engagement.

Hear more on this subject on the MGMA Insights podcast

1. Establish a singular vision

In a crisis, leaders need to rally the troops around a singular evidence-based vision. Doing so helps win the backing of the team, who are more likely to adopt the vision. For Vierling and the leadership team at Sparrow Hospital, during COVID-19, they promoted the vision that “nobody dies, everybody goes home” — that is, none of the more than 8,000 team members, including 5,000 physicians, would lose their lives to COVID-19. Although one caregiver died during the early part of the pandemic, Vierling reported that only about 0.4% of the staff was impacted by the virus, compared to some organizations in which the numbers were around 20%.

“All of your decisions are guided around that, and it allows you to be consistent with your mission and your vision and your values,” Vierling said of the importance of establishing an organizational vision. “It also helps focus all of your decision-making so that you’re quick and you’re clean … and you’re able to move on in rapid fashion.”

2. Decide once, act once

Decisiveness is paramount during times of crisis. Yet, as Vierling emphasized, leaders may not always have all the information they need. “You are making some judgments based on your past experience; based on what limited data you have,” he said. “What you don’t want to do in crisis is waver and you don’t want to waffle.”

Vierling pointed to his time with Harris Health System’s Lyndon B. Johnson Hospital in Houston during Hurricane Harvey, when the administration acted decisively to bring in providers and staff 12 hours before other area hospitals. This enabled them to get ahead of the storm and the wave of storm-related medical needs.

“For a full day it seemed like we were there too early, and other hospitals had delayed because the weather had slowed down and not moved in,” Vierling said. When flooding was worse than expected, the hospital had two full shifts of staff to run 12-hour shifts for six days, all while other hospitals lacked staff and supplies.

In addition, leaders should compartmentalize decision-making, depending on time frame. “What are we going to do in the next two weeks to get through this? What are we going to do in the next three months? How are we going to manage this over the next year?” Vierling said of looking through different lenses to prioritize issues and needs. Although that’s not always easy, if you assign responsibility to different stakeholders, you’ll get an array of opinions that can help you make the right decision, he added.   

3. Provide daily communication

An integral part of promoting psychological safety in an organization is continuous communication between leaders and team members.

In times of crisis, daily communication is even more important, because, as Vierling detailed, team members need to know that they are making a difference. “You have to be transparent,” Vierling stressed. “We start every conversation here with the ‘why.’ We’re always honest — if things look bad, we’re going to tell you it looks bad. If the financial situation is tough, we’re going to tell you the financial is tough.”

During Hurricane Harvey it was a priority for Vierling’s leadership team to update hospital workers frequently and through different channels regarding the storm’s impact. “We put out communication for Hurricane Harvey 20 hours a day,” Vierling said of the urgency. “We put it out roughly at least once every hour to an hour and a half. Sometimes it would come in 15-minute bursts depending on what the notion was — rumor control, rising floodwaters, need to move cars, we’re about to land a helicopter and we don’t have a helicopter pad.”

Once this precedent is set during a crisis, leadership can inspire trust among their team. Case in point: After his time with Harris Health System, Vierling took a position at Sparrow Hospital, where the CEO left nine days after Vierling started. Two weeks after that a Joint Commission survey revealed several immediate threats to life in the hospital, which had to be corrected in 23 days. Upon learning that news, Vierling and the leadership team shared it with the entire organization. Throughout the next six months, the hospital addressed additional Joint Commission surveys before meeting all its standards. During the entire process, the one constant was keeping the team apprised of the hospital’s progress and not withholding any information.

The crisis plan and resulting transparency helped Sparrow Hospital immensely when the pandemic arrived last February. Vierling emphasized that daily communication helped get everyone on board. “We took the daily memo we used during our crisis with the Joint Commission … and we turned that into a COVID daily memo,” Vierling explained. “Then we did a COVID call seven days a week for about two and a half months … on WebEx, and we had more than 1,000 people dial in every day.”

Sparrow Hospital’s staff engagement was reflected in employee responses to the daily memo — averaging 40 to 1 positive to negative. “You really need to do this daily … and your message will change based on your crisis,” Vierling relayed. “A financial crisis is different than a hurricane; it’s very different than a reputational crisis; it’s very different than the sudden departure of a key executive.”

4. Remain highly visible

An important part of being a transparent leader during crisis is communicating your plans as soon as possible. Whether it’s responding to a top-performing physician leaving the practice or addressing social issues, Vierling insists that it’s vital to meet with employees, foster ongoing dialogue and discussion with staff, and keep them in the loop regarding next steps.

A good first impression should be set upon joining an organization, Vierling maintains, by getting to know everyone and establishing relationships with them so that you convey an authentic voice. “Relationships matter, so that in crisis, you’ve got that developed and you can come out and you can be empathetic,” Vierling said. “You can’t do it from your office, even in times of COVID. Put on your N95 mask if that’s what’s required, but get out there and see your folks … and let them know that you’re in there with them, and that you’re leading from the front, not directing from the rear.”

5. Carefully select your team

Selecting the right team members is crucial during crisis. Some people are conditioned to up their game when faced with difficult situations, while others languish under pressure. According to Vierling, during tough times, leaders need to be able to trust their team to make sound decisions within the framework of the larger decision and allow them to do their jobs. “In a crisis, you need to hear different viewpoints; you need to hear different perspectives; and you need that feedback that’s really critical to help you stick with your core vision,” Vierling asserted.

In this respect, leaders don’t want to worry about micro-managing team members during a crisis. They want individuals who are calm, even-keeled and able to perform when the stakes are high. “I can’t tell you how many nurses I had who were former Marines and Army Rangers,” Vierling said of his staff during Hurricane Harvey. He wanted “people with different life experiences … because they could improvise and they could solve problems in a hurry, sometimes in creative ways we would have never thought of,” Vierling added.

By identifying the key characteristics and skills needed of their team members, leaders can save time in the long run. “Above all, they’ve got to learn to be great team members,” Vierling said of what he looks for in an employee. “If you’ve got people who want to be one-offs, and they like the glory, and they just want to make it all about them, now’s not the time.”

6. Become involved with your community

In difficult times, the community needs an anchor to help support them. “During Hurricane Harvey, we were the place everybody came to because we were the hospital,” Vierling said of what Lyndon B. Johnson Hospital meant to Houston. “Once the roads were open, we reached out to the churches and to the schools. And we reached out to the community groups that we needed to help because they were suffering so much.”

This is particularly true during a public health crisis such as COVID-19. As Vierling pointed out, healthcare organizations are medical authorities and have a responsibility to be a trusted source by quickly providing information. “You can rely on government agencies if you choose,” Vierling stated. “But in your community, you’re the experts, and people expect you to be there.”

By being a pillar, a healthcare organization can solidify its reputation as a go-to, one that has the community’s best interest at heart. “The benefits of this are long lasting,” Vierling underscored. “It’s important about how you make people feel in the community, and if they feel like they can trust you, they will do that.”

7. Proactively protect staff

If leaders have a high-performing team, they’ll want to support and protect them as best they can. During COVID-19, one of Vierling’s priorities was making sure his staff had enough personal protective equipment to continue their heroic work safely.

“You have to be thinking about your staff in that context,” Vierling said. “And you have to think about the impact the disaster is having on them, and then work through issues to protect them going forward. Because if you lose them, and they’re not available, the entire world hurts.”

Protecting providers and staff also means keeping them working rather than furloughing them or laying them off. Greeter cited an example of how the hospitality industry, affected by the 2003 SARS outbreak, had to find ways to save money, which often meant cutting staff.

However, Mark Conklin, the former general manager of JW Marriott Hotel Hong Kong, took a different approach. “His conversation was about making sure that you do things that matter to the staff,” said Greeter of Conklin’s desire to retain his team. “Not only did executives there give up their own compensation, but they got creative and looked for ways that they could find projects that were still valuable to the hotel, but that would provide remuneration to employees.” Conklin and the leadership team focused on capital expenditure projects that could be carried out by staff, such as ripping out old carpet and replacing it with new carpet, to help keep them employed. 

8. Serve as steward of finances

Crises often carry significant financial strain, so it’s extremely important to take actions to ensure the organization can survive. Although profit margin may not drive every decision, Vierling says that tightening the belt is a necessity. “What we’re very cognizant of is we want to spend our money well,” Vierling observed. “And we want to lay out some scenarios. The longer term of a disaster, such as COVID-19, we’ve had better planning … it’s been easier.” 

No matter what type of crisis your organization faces, Vierling noted that financial planning is essential. “What we’ve learned is you always put money away, because you are going to have a rainy day, literally in Hurricane Harvey, figuratively in COVID-19. … You have to plan for it ahead of time.”
 
With each leadership trait, leaders need to set the tone when leading through crisis. In other words, as Greeter imparted: “Do you want to be a thermometer that takes the temperature of the organization, or do you want to be the thermostat that sets the temperature?”
At the end of the day, leaders need to draw from their experience. “The way that you capitalize on a crisis is to make sure that you learn from it,” Greeter said. “You don’t necessarily have to make massive changes, but you do need to reflect upon what happened and how you use that to impact the organization for the better.”
 

About the Author

Christian Green
Christian Green MA
MGMA Writer/Editor MGMA

cgreen@mgma.com

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