What can NHS leaders learn from a crisis?

Published: Posted on

By Steve Gulati, Director of Elizabeth Garrett Anderson Programme
School of Social Policy, University of Birmingham

The ongoing bushfire crisis in Australia has thrust the response of leaders into sharp focus, with criticism of the Australian Prime Minister, Scott Morrison. Whilst both the causes of and solutions to the bushfires are not the responsibility of one single individual, how leaders respond to extraordinary events can often attract as high a profile as the event itself.

So, what can NHS leaders learn from this?

The management of unexpected, unusual or unforeseeable events tests the very essence of leadership skills, and the challenge for leaders in public services is exacerbated by the nature of the services and the diversity of stakeholders. The fact that these events almost always have a high profile and attract wide commentary can create a pressure-cooker environment in which leadership action (or inaction) attracts forensic scrutiny, making the challenge for NHS leaders (and those in other public services) intense. How leaders react has implications for service users, the public and, of course, their reputation.

Inquiries such as the Francis Report (2013) and the Kirkup Report (2015) can be instructive in illustrating leadership responses. In broad terms, these can be summarised as follows:

  • Denial – A common response, which can sometimes move into ‘bluster’ or quasi-bullying behaviours: “bring me solutions, not problems”. As events at Mid-Staffordshire Hospital showed in particular (Francis, 2013), denial can be accidental or wilful and is closely associated with groupthink (Turner & Pratkanis, 1998).
  • Analysis Paralysis – Leaders, and their teams, sometimes respond to a crisis by seeking a ‘perfect’ solution that can only be arrived at by accessing increasing amounts of information. Whilst this can often be driven by good intentions, it is arguably a benign version – or extension – of denial. Perfect solutions rarely exist, and are rarely needed – ‘good enough’ is, indeed, sometimes good enough. The opposite of this is the ‘propensity to action’, also a common impulse when faced with a crisis, when doing something – however instinctive or ill-judged – attends to the emotional need to be active.
  • The ‘Heroic’ Leader – “Nobody can fix it but me”, or (more positively), accepting accountability, even when responsibility for the event is obscure or the event itself purely accidental. This can be either positive or negative, egotistical or solution-focused and can result in a binary ‘hero or zero’ outcome.
  • Distributed Leadership – Arguably the most constructive of a crisis-management strategy, but also one that requires courage and an element of strategic preparedness. Utilising the skills, experience and knowledge of a diverse group of people and recognising that hierarchy is not the sole preserve of leadership, this approach can be highly effective and respond at both a short and medium-term level. But it depends on carefully compiled teams and open cultures, and a balance between taking an evidence-based approach allied with the drive to ‘get things done.’

So the leadership response to a crisis can often be as impactful as the event itself. For those in leadership positions, especially in high profile services, it is important to remember that every action has a reaction – and that even in the direst situation, you do have choices.


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